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 following information:
- The name, address, telephone number, and email address of the insured;
- The type of complaint;
- The name of your employer and type of plan;
- The name of the insurance company;
- The reason for the complaint;
- The level your claim has reached in the internal and external review processes;
- The details of your complaint; and
- What you think would be a fair resolution.[21]
Supporting documents. You should submit the following documents as supporting information with your complaint:
- A copy of your benefits booklet;
- A copy of your insurance policy;
- A copy of all correspondence related to your claim;
- A copy of your adverse benefit determination letter; and
- Copies of any supporting documents from your healthcare provider.[22]
How to submit. You can submit your complaint and supporting documents in the following ways:
- Online here;
- By email to [email protected]
- By fax to (505) 827-4734; or
- By mailing a copy to the following address:
Office of Superintendent of Insurance
1120 Paseo de Peralta
Santa Fe, NM 87501[23]