Resources

Check here for the most current versions of the newsletter dedicated to you and your health.

The Member Advisory Board (MAB) plays a key role in helping BCBSNM improve your Medicaid health plan. We want to know your experience with services you receive from us. Learn how to take part in MAB meetings.

Check the complete list of Member Rights and Responsibilities.

Advance health care directives are legal instructions. They include written instructions for health care and a power of attorney for health care.

These directives help if you become injured or too ill to make health care decisions on your own. Even though you may not be injured or ill now, you can decide how you want to handle these situations in the future.

Instructions for Health Care

These legal instructions state what to do if you become terminally ill or permanently unconscious. They say whether or not you want to be put on a life support system. They also say what kind of treatment you do and do not want. Instructions for health care are sometimes called a "Living Will."

Power of Attorney (POA) for Health Care

This power gives a person you choose the right to make health care decisions for you if you are unable to express your own wishes. This person should be someone you trust. Learn more about Advance Directives in your Member Handbook. Download a POA/Advance Health Care Directives form with instructions.

If you have questions, speak with your care coordinator or call BCBSNM at 1-866-689-1523. If you are speech or hearing impaired, call TTY 711. You can also call the State of New Mexico Aging and Disability Resource Center at 1-800-432-2080.

Other Resources

• End-of-Life Options Act – This state law was passed in 2021 to aid those who are terminally ill. It allows them to ask for help to die in peace if they choose. Learn more at the End-of-Life Options New Mexico website.
  
• End-of-Life Care for Those Who Have Cancer – Visit the National Cancer Institute website to find out why it is important to discuss what a loved one wishes before they are unable to do so.
  

At BCBSNM, we take great pride in helping you get the care you need. If you have a complaint about how we handle any service provided to you, you can file an appeal or a grievance. Learn more about appeals and grievances.

Health care fraud, waste and abuse create a negative effect on the health care industry. These cost billions of dollars each year. It impacts all of us in the long run. Health care fraud leads to:

• Higher health care costs
• Limited health care resources
• Lower consumer confidence in our health care system

Avoid Health Care Fraud

Protect your information.

• Contact Blue Cross and Blue Shield of New Mexico if you lose your member ID card or if it’s stolen.
• If your personal information is compromised, report this at IdentityTheft.gov.

Beware of “free” services.

• Beware if you are asked to provide your health insurance information for a “free” service. Your policy may be billed.
• Never share your personal information with callers you have not confirmed.

Reasons to Contact BCBSNM

BCBSNM can check your claims. We may refer concerns to our Special Investigations Department (SID). Here are some reasons why SID may review a claim:

• You did not request or receive a service or supplies.
• There is a concern with repeat billing of a service or supplies.
• You shared your health insurance ID number during a marketing call and now you have concerns. 

We all need to work together to reduce health care fraud. BCBSNM works to fight fraud with help from our:

• Members
• Providers
• Employer groups
• Producers
• Local, state and federal agencies and law enforcement

BCBSNM's SID staff includes people from diverse backgrounds such as:

• Medical providers (doctors and nurses)
• Professional coders
• Insurance industry experts
• Law enforcement

SID also has a Data Intelligence Unit to partner with SID investigators. They work to find and stop fraud, waste and abuse. When needed, SID refers fraud cases for criminal prosecution.

Review tips to prevent health care fraud.

How Do I Report Potential Concerns?

If you suspect fraud, there are ways to report it.

Report Online
Complete a fraud report
If you need to file a report in Spanish or another language, please Report by Phone.

Report by Phone
To report fraud, you can call:

• Medicaid Member Services at 1-866-689-1523
• BCBSNM Fraud Hotline at 1-800-543-0867
  

Calls are always confidential. You can remain anonymous or let us know if you want to be contacted.

Report by U.S. Mail
Blue Cross and Blue Shield of New Mexico
Special Investigations Department
5701 Balloon Fiesta Pkwy. NE
Albuquerque, NM 87113

BCBSNM Medical Policies are based on scientific and medical research. They are often used as a guide to decide what is covered by a health plan. Medical Policies can relate to topics such as:

• Medical procedures
• Treatments
• Drugs
• Devices

BCBSNM puts these policies online. Medical Policies are not medical advice or care. They do not promise any results. BCBSNM does not give medical advice. BCBSNM does not provide health care. Independent health care providers are responsible for:

• Diagnosis
• Treatment
• Medical advice
  

Members may talk about Medical Policies with their health care providers. Members should always talk to their health care providers about any health questions or concerns. Review Medical Policies.