Who should I call if I have any questions about filing a complaint?

You can contact the New Mexico Attorney General’s Office at (866) 627-3249 or (505) 827-6000 or (505) 222-9100. The Office is open from 8:00 a.m. to 5:00 p.m., Monday through Friday. You can contact the Office of Superintendent of Insurance...

What happens after the Attorney General’s Office receives my complaint?

The Attorney General’s Office will investigate and may refer your complaint to the Office of Superintendent of Insurance for resolution if it determines that the Office of Superintendent of Insurance is better able to assist you with your complaint.

How do I file a complaint with the New Mexico Attorney General’s Office?

If you are a New Mexico resident and your insurer denies your claim after the external review process, you can file a complaint with the New Mexico Attorney General’s Office. A copy of the complaint form can be found here. Complaint...

What happens after the Office of Superintendent of Insurance receives my complaint?

The Office will contact your health insurer by mail or phone depending on the complexity of your claim. If it contacts your insurer by mail, the insurer must respond within 10 business days. Once the Office receives the insurer’s response,...

How do I file a complaint with the New Mexico Office of Superintendent of Insurance?

If you are a New Mexico resident, you have coverage through a managed health care insurer, and you believe your insurer did something illegal or unethical, you can file a complaint with the Office. Complaint information. Your complaint should include the...

How long will the external review process take?

The external review process should take no more than 45 days.[19] If you request an expedited external review, the process should take no longer than 72 hours.[20]

How do I request an external review?

You should submit your request for an external review to the New Mexico Office of Superintendent of Insurance (“Office”) within 120 days from when your insurer sent you the most recent decision.[16] Information. You can find a copy of the external...

In what circumstances can I apply for an external review?

During an external review, an independent third party reviews your insurer’s decision.[13] Your insurer will no longer have the final say over whether to approve a treatment or pay a claim. Under New Mexico law, you are entitled to request an...

How long should the internal reviews process take?

Both the first and second level internal review combined should take a maximum of 30 days if you have not yet received the requested service or treatment and a maximum of 60 days if you have received the service or...

If I have a group health plan, how do I request an internal review?

If you have a group health plan and your insurer denies your claim, you have the right to two levels of internal review (sometimes referred to as an internal appeal).[1] This means you can ask your insurer to conduct a full...

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