As a Blue Cross and Blue Shield of New Mexico (BCBSNM) plan member, you have certain rights related to your privacy. To make a request regarding these rights, use a privacy form. You can:
- Print out a form. Complete and sign the form, then mail it to the address shown on the form.
- Request to have a certain form sent to you. Call Member Services at 1-866-689-1523 (TTY: 711).
Standard Authorization Form
Use this form to ask BCBSNM to share your protected health information (PHI) with a certain person or entity.
Request PHI Records
Use this form to ask BCBSNM for a copy of your PHI records.
Request to Amend PHI
Use this form to ask BCBSNM to update your PHI.
Request for Accounting of PHI Disclosures
Use this form to get a record of how BCBSNM shared your PHI.
Response to Denied Amendment
If you had a request to update your PHI denied by BCBSNM, use this form. You can ask that the original request and the denial be attached to future disclosures of your PHI.
Confidential Communications Request
Do you feel your life could be in danger if you get mail at your current address? Use this form to ask BCBSNM to restrict your PHI and communicate with you at an alternate location.
Restriction Request
Use this form to ask BCBSNM to restrict your PHI from being used or shared with another person or non-covered entity under HIPAA.
Privacy and Security Complaint
Use this form to file a privacy or security complaint with BCBSNM.
Privacy Questions or Concerns
Do you have any questions or concerns about your privacy rights?
- Call: Member Services 1-866-689-1523 (TTY: 711)
- Write to:
Privacy Office
Blue Cross and Blue Shield of New Mexico
300 East Randolph Street
Chicago, Illinois 60601-5099
1.0-2024