Out-of-State Coverage for PPO Plan Members

True Flexibility

Our PPO plans allow members the flexibility to choose their level of benefits when seeking care. If you are a PPO plan member, please keep these things in mind:

  • You will receive the highest benefit level—and pay the least amount out of your own pocket—when you receive care from providers who are in the True Health New Mexico provider network. (Use our Online Provider Search Tool and our Quick Search PDFs page to search for in-network providers.)
  • If you choose to see an out-of-network provider, then your out-of-network benefits will apply. True Health New Mexico will pay the out-of-network provider up to the usual, customary, and reasonable (URC) charge for the service. The out-of-network provider may bill the member for the remaining balance because the out-of-network provider is not a True Health New Mexico contracted provider. You will be responsible for the remaining amount up to billed charges if billed by the provider. This is called “balance billing.”
  • Please refer to the Summary of Benefits and Coverage (SBC) for your particular plan to learn what your out-of-network PPO benefits are. You can find your SBC on our Small Group Plan Documents page or our Large Group Plan Documents page, depending on what type of group coverage you have.
  • If you are traveling outside of New Mexico and need non-emergency care, you may access a nationwide network of PHCS providers via MultiPlan. Please refer to our PHCS/MultiPlan provider search guide for tips on finding a provider.