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Appeals and Grievances

How to Contact Us

Customer Service Phone: 

1-844-508-4677

Appeals and Grievances Fax: 

1-800-747-9132

Email: member-a-and-g@truehealthnewmexico.com

Appeal and Grievance Forms
What is an appeal?

An appeal is a denial, reduction, or termination of, in whole or part, of an authorization request for services or of a claim, or any rescission (cancellation) of coverage.   

What is an expedited appeal?
  • An appeal considered when the life or health of a grievant would be jeopardized, or when the grievant’s ability to regain maximum function would be jeopardized.
  • True Health New Mexico responds to expedited appeals within 72 hours of receipt of the appeal request.
What is a standard appeal?
  • An appeal considered when the life or health of a grievant would not be jeopardized.
  • True Health New Mexico responds to standard pre-service and standard post-service appeals within 30 days from receipt of the appeal request.
How to file an appeal

Members have 180 days from the receipt of a True Health New Mexico denial notice to file an appeal.

Appeals may be submitted in one of four ways:

  • By phone: Calling Customer Service at 1-844-508-4677.
  • By mail: True Health New Mexico, Attention: Appeals and Grievances, P.O. Box 37200, Albuquerque, NM 87176
  • By fax: 1-800-747-9132
  • By email: member-a-and-g@truehealthnewmexico.com

You may appoint someone in writing to act on your behalf to file an appeal and represent you during the appeal review.

External appeals

True Health New Mexico allows two levels of internal appeal review. If a member is not satisfied with our final appeal decision, they may request an external review through the Office of the Superintendent of Insurance within four months after receipt of our final appeal decision.

Please refer to your Evidence of Coverage (Member Handbook) for complete details of the appeal process.

How to request an external review

You may mail, email, or fax your request for an external, independent review to the OSI. You must file your request within 120 calendar days that you receive True Health New Mexico’s written notice of adverse determination.

  • By mail:
    New Mexico Office of Superintendent of Insurance
    Attn: Managed Health Care Bureau – External Review Request
    O. Box 1269, 1120 Paseo de Peralta
    Santa Fe, NM 87504-1269
  • By email: grievance@state.nm.us. Put “External Review Request” in the subject line.
  • By fax: (505) 827-4734. Write “Managed Health Care Bureau – External Review Request” on the cover sheet.​

Questions about your external appeal rights?

Contact the Managed Health Care Bureau of the OSI by calling (505) 827-4734 or writing or emailing the OSI (see above). You also may call True Health New Mexico with questions about your appeal rights or the appeal process at 1-844-508-4677.

What is a grievance?

A grievance is an expression of dissatisfaction regarding True Health New Mexico’s handling of matters such as its administrative practices that affect the availability, delivery, or quality of health care services; claims payment, handling, or reimbursement for health care services; or if a member’s coverage has been terminated. 

How to file a grievance

Members have 180 days from the date of the dissatisfaction or occurrence to file a grievance with True Health New Mexico. We will investigate the member’s grievance and respond to the member in writing within 30 days of receipt of the grievance.

Grievances may be filed in one of four ways:

  • By phone: Calling Customer Service at 1-844-508-4677.
  • By mail: True Health New Mexico, Attention: Appeals and Grievances, P.O. Box 37200, Albuquerque, NM 87176
  • By fax: 1-800-747-9132
  • By email: member-a-and-g@truehealthnewmexico.com

You may appoint someone in writing to act on your behalf to file a grievance and represent you during a grievance review.

External grievances

True Health New Mexico allows two levels of internal grievance review. If a member is not satisfied with our final grievance decision, they may request an external review through the Office of the Superintendent of Insurance within 20 days after receipt of our final written decision.

Please refer to your Evidence of Coverage (Member Handbook) for complete details of the grievance process.