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Member Rights and Responsibilities

At Blue Cross and Blue Shield of New Mexico (BCBSNM), we want to make sure our members get the health care they need. We also want to make sure our members’ rights are respected. It is the policy of BCBSNM to make sure that you know you have the below rights and responsibilities.

Member Rights

As a member of Centennial Care, you have the right to:

  • Health care when medically necessary as determined by a medical professional or BCBSNM; 24 hours per day, 7 days per week for urgent or emergency care services, and for other health care services as defined in the Member Handbook
  • Receive health care that is free from discrimination
  • Bet treated with respect and recognition of your dignity and right to privacy
  • Choose a PCP or provider from the BCBSNM network and be able to refuse care from certain providers (a prior authorization may be necessary to see some providers)
  • Receive a copy of, as well as make recommendations about BCBSNM's member rights and responsibilities policy
  • Be provided with information about BCBSNM's member rights and responsibilities, policies, and procedures regarding products, services, providers, appeals procedures, and other information about the company and get information about how to access covered services and the providers in our network
  • Receive a paper copy of the official Privacy Notice from the HSD upon request
  • Be assured that your MCO is in compliance with applicable federal state laws including Civil Rights Act of 1964, Age Discrimination Act of 1975, Rehab Act of 1973, Education Amendments of 1972, Americans with Disabilities Act (ADA), and Section 1557 of the Patient Protection and Affordable Care Act
  • Be given the name and professional background of anyone involved in your treatment and the name of the person primarily responsible for your care
  • Choose a surrogate decision-maker to be involved and assist with care decisions as appropriate; this can be done by you or your legal guardian
  • Have an interpreter present when you do not speak or understand the language that is being spoken
  • Participate with our provider in all decisions about your health care, including gaining an understanding of your physical and/or behavioral condition, being involved in your treatment plan, deciding on acceptable treatments, and knowing your right to refuse health care treatment or medication after possible consequences have been explained in a language you understand. Family members, legal guardians, representatives or decision-makers also have this right, as appropriate
  • Talk with your provider about treatment options, risks, alternatives, and possible results for your health conditions, regardless of cost or benefit coverage and have this information documented in your medical record. If you cannot understand the information, the explanation will be provided to your family, guardian, representative, or surrogate decision-maker
  • Give informed consent for physical and/or behavioral health medical services
  • Decide on advance directives for your physical and/or behavioral health care. These decisions can be made by you or your legal guardian as allowed by law
  • Access your medical records in accordance with applicable federal and state laws, which means that you have the right to receive communications about your private records, request a change or addition if you feel they are incomplete or wrong, and request restricted disclosure of your medical records, and the right to be notified if accidental disclosure occurs. If the member has a legal guardian, the legal guardian has the right to access the member's medical records
  • Request a second opinion from another BCBSNM provider. This can be done by you or your legal guardian
  • File a grievance or appeal about BCBSNM or the care that you received and receive an answer within a reasonable time. Complaints can be filed with BCSNM and/or New Mexico HSD without fear of retaliation. You can also request a Fair Hearing with HSD for items that have been appealed
  • Receive prompt notification of termination or changes in benefits, services, or provider network
  • Be free from harassment from BCBSNM or its network providers in regard to contractual disputes between BCBSNM and providers
  • Select a health plan and exercise switch enrollment rights without threats or harassment
  • Befree from any form of restraint or seclusion used as a means of coercion, discipline, convenience, or retaliation, as specified in federal or New Mexico regulations on the use of restraints and seclusion
  • Exercise rights without concern that care will be negatively affected
  • Receive information on available treatment options and alternatives in an understandable manner

Member and Member Representative Responsibilities

As a member of Centennial Care, you have these responsibilities:

  • Give complete health information to help your provider give you the care you need
  • Follow your treatment plan and instructions for medication, diet, and exercise as agreed upon by you and your provider
  • Do your best to understand your physical, long-term care, and/or behavioral health conditions and take part in developing treatment goals agreed upon by you and your provider
  • Make appointments ahead of time for provider visits
  • Keep your appointment or call your provider to reschedule or cancel at least 24 hours before your appointment
  • Tell your providers if you don't understand explanations about your health care
  • Treat your provider and other health care employees with respect and courtesy
  • Show your ID card to each provider before receiving medical services (or you may be billed for the service)
  • Know the name of your PCP and have your PCP provider or arrange your care
  • Call your PCP or the 24/7 Nurseline before going to an emergency room, except in situations that you believe are life threatening, or that could permanently damage your health, or if you are having thoughts of harm to yourself or others
  • Provide information to New Mexico HSD and BCBSNM of your:
    • Current mailing address
    • Current phone number, including any land line and cell phone, if available
    • Current emergency contact information
    • Current email address, if available
  • Tell New Mexico HSD and BCBSNM about changes to your phone number or address
  • Tell BCBSNM if you have other health insurance, including Medicare
  • Give a copy of your living will and advance directives regarding your physical, long-term care, and/or behavioral health to your PCP to include in your medical records
  • Read and follow the Member Handbook