New Mexico

STEP ONE – Notify Your Health Plan

The first thing you need to do is file a complaint with your health plan. Follow the steps below to file a complaint and appeal with your health plan:

  • Call the member/customer service phone number for your health plan.
  • Tell them you want to file a formal complaint and then explain the problem.
  • You can also file your complaint by letter, email, or online through your health plan’s website (see below).
  • If you disagree with your health plan’s decision, you have the right to file an appeal.

Below are links to the complaint forms and information for New Mexico’s top health plans:

STEP TWO – File a Complaint

You have the right to file a complaint with the New Mexico Office of Superintendent of Insurance (OSI) if you have a problem getting the services you need, including quality and affordable health care. To file a complaint, you must first complete your health plan’s appeal process.

You can find information on how to file a consumer complaint or appeal with the New Mexico OSI here.

You can also call the Office of Superintendent of Insurance’s help line at: (855) 427-5674.

If you have coverage through Medicaid or Medicare, you have the right to file a grievance with the New Mexico Human Services Department’s Medical Assistance Division at: (888) 997-2583.

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My Patient Rights can help guide you in resolving issues so you can get the health care you deserve.


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Know Your Rights

State and federal law protects your rights. When you sign up for a health plan and/or if you have problems accessing care through your health plan, it is important to know your rights.