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Frequently Asked Questions

I’m traveling out of state with my True Health New Mexico HMO coverage. How can I access care?

All of our plans cover urgent and emergent care, inside and outside of New Mexico. If you or a covered family member get sick or have an emergency while in another state, go to the nearest urgent care center or emergency room.

  • Non-Emergency care: HMO plans do not have coverage for non-emergency care outside of New Mexico. Call Customer Service Monday – Friday; 8:00 am to 5:00 pm at 1-844-508-4677, or refer to your health plan documents, if you have questions about services outside the True Health New Mexico network.
I’m traveling out of state with my True Health New Mexico PPO coverage. How can I access non-emergency care?

If you have a PPO plan, are traveling out of New Mexico, and need non-emergency care, you can access a nationwide network of providers via MultiPlan. Please refer to our PHCS/MultiPlan Provider Search Guide for tips on finding a provider. *MultiPlan/PHCS is not available in the True Health New Mexico service area, which includes all of New Mexico and some parts of Texas (Amarillo, El Paso, Lubbock, and Muleshoe).

  • Emergency care: All of our plans cover urgent and emergent care, inside and outside of New Mexico. If you or a covered family member get sick or have an emergency while in another state, go to the nearest urgent care center or emergency room.
I’m a new member and currently receiving care from my doctor. What do I do?
  1. You need to notify all your doctors of your change in health insurance, as soon as possible.
  2. If you or a covered family member have any upcoming procedures scheduled or if anyone is currently being treated with their current doctor, please refer to the If You Need to Continue Existing Care and If You Are Taking Prescription Medications pages for instructions regarding these situations.
How do I find a True Health New Mexico in-network provider?

Our network of providers is over 10,000 and growing, and includes providers in El Paso and west Texas. We encourage all members to connect with a primary care provider (PCP), and we currently contract with an extensive number of PCPs in New Mexico.

  1. Search our online provider directory to find out more about our hospitals and practitioners who will partner in your care.
  2. Visit our Quick-Search PDFs page to find an in-network laboratory, urgent care or walk-in clinic, freestanding radiology provider, mammography provider, specialty laboratory, and vision service provider.
  3. Find an in-network pharmacy by using the CVS Pharmacy Locator.
What preventive healthcare services are covered with no cost-sharing?

Preventive care is healthcare services, such as screening tests, annual exams, counseling services, and preventive medicines that a doctor or other healthcare professionals provide to prevent illness before they cause symptoms or problems in the patient.

True Health New Mexico covers a wide range of preventive health services for men, women, and children. Most of these services are covered without cost-sharing when they are provided by an in-network provider.

I need a prescription filled. How do I know if it’s covered and how much it will cost?

To find out if your drug is covered through True Health New Mexico, you can:

  • Call Customer Service Monday through Friday; 8:00 a.m. to 5:00 p.m. at 1-844-508-4677; or
  • View the formulary for your coverage type on our Pharmacy page.

Note: Be sure to read the Understanding Coverage and Cost‐Sharing section of your plan’s formulary to learn what your cost-sharing amount will be when you fill your prescription.

*APS members, your pharmacy coverage is administered through Express Scripts: 1- 866-563-9297

How does True Health New Mexico evaluate medical necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities?

We follow strict utilization management (UM, sometimes called utilization review) procedures. To learn about UM, please visit our Case Management page.

Does True Health share information about their insured members with others?

We take our members’ protected health information (PHI) very seriously. We may share their PHI without their written authorization when necessary while providing their health benefits. You can learn when and how we share PHI on our Protecting Your Privacy page. We do not share our members’ PHI with their employers or health plan sponsors without their authorization.