New Mexico § 13-7-9 - General anesthesia and hospitalization for dental surgery

§ 13-7-9. General anesthesia and hospitalization for dental surgery

A. Group health care coverage, including any form of self-insurance, offered, issued

or renewed under the Health Care Purchasing Act shall provide coverage for hospitalization

and general anesthesia provided in a hospital or ambulatory surgical center for dental

surgery for the following: (1) insureds exhibiting physical, intellectual or medically compromising conditions

for which dental treatment under local anesthesia, with or without additional adjunctive

techniques and modalities, cannot be expected to provide a successful result and for

which dental treatment under general anesthesia can be expected to produce superior

results; (2) insureds for whom local anesthesia is ineffective because of acute infection,

anatomic variation or allergy; (3) insured children or adolescents who are extremely uncooperative, fearful, anxious

or uncommunicative with dental needs of such magnitude that treatment should not be

postponed or deferred and for whom lack of treatment can be expected to result in

dental or oral pain or infection, loss of teeth or other increased oral or dental

morbidity; (4) insureds with extensive oral-facial or dental trauma for which treatment under

local anesthesia would be ineffective or compromised; or (5) other procedures for which hospitalization or general anesthesia in a hospital

or ambulatory surgical center is medically necessary. B. The provisions of this section do not apply to short-term travel, accident-only

or limited or specified disease policies. C. Coverage for dental surgery may be subject to copayments, deductibles and coinsurance

subject to network and prior authorization requirements consistent with those imposed

on other benefits under the same group health care coverage, including any form of

self-insurance.