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Appeals & Grievances – Federal Employees

What Is an Appeal?

An appeal is a written dispute submitted by or on behalf of an enrollee regarding a denial of a pre-service or post-service claim. Appeals may be filed for denials of pre-service (the service has not yet been obtained) and post-service (the service has already been obtained) issues.

What Is an Expedited Appeal?
  • 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?
  • When the life or health of a grievant would not be jeopardized.
  • True Health New Mexico responds to standard pre-service and post service appeals within 30 days from receipt of the appeal request (unless additional information is required).
How to File an Appeal

Members have six months from receipt of a True Health New Mexico denial notice to file an appeal with True Health New Mexico.

Appeals must be submitted in writing and may be submitted in one of three ways:

  • By mail: True Health New Mexico, Attention: Appeals and Complaints, P.O. Box 37200, Albuquerque, NM 87176
  • By fax: 1-800-747-9132
  • By email: Member-A-and-G@truehealthnewmexico.com

If we receive the request past the allowed six-month period, we shall deny the enrollee’s request as past time to appeal and provide the enrollee with contact information for the Office of Personnel Management (OPM).

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

External Appeal

True Health New Mexico allows for one level of internal appeal review. If a member is not satisfied with our final appeal decision, they may request an external review through the OPM. 

Please refer to your official FEHB brochure for complete details of the appeal process.

What Is a Complaint?

A complaint is an oral or written expression of dissatisfaction.

How to File a Complaint

Members have six months from the date of the dissatisfaction or occurrence to file a complaint with True Health New Mexico. We will investigate the member’s complaint and will generally respond to the member in writing within 30 days of receipt of the complaint (unless additional information is required).

Complaints may be filed in one of four ways:

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