Frequently Asked Questions
- How would my employees be covered under an HMO while traveling?
All of our plans cover urgent and emergent care coverage outside of New Mexico. If a member gets sick or has an accident while in another state, he or she should go to the nearest urgent care center or emergency room.
- However, HMO plans do not have coverage for non-emergency care outside of New Mexico. Members should call Customer Service at 1-844-508-4677, or refer to their health plan documents (see the links to the left), if they have questions about healthcare outside of New Mexico.
- Do employees have to do anything if their doctors are already in your network?
Your employees will need to notify their doctors of their change in health insurance. If your employees have any procedures already scheduled or are in current treatment with their current doctors, 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 large is your provider network?
Our network of providers is over 10,000 and growing, and includes providers in El Paso and west Texas. Search our online provider directory to find out more about our hospitals and practitioners who will partner in your care. 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. After you join True Health New Mexico, if your employees need help finding a PCP or a specialist, our care management team can help. Call 1-844-691-9984.
- What preventive healthcare services are covered by your plans 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. To find a list of these covered services, please refer to our Preventive Health Care Guide.
- How do you 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 New Members page and scroll to the bottom.
- Do you share information about your 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 find a list of the instances when we share PHI on our Protecting Your Privacy page. Scroll to the bottom and click on the Notice of Privacy Practices. We do not share our members’ PHI with their employers or health plan sponsors without their authorization.