Patient Advocates for Blue Cross Blue Shield of New Mexico - Find one today.
Supporting and empowering Blue Cross Blue Shield of New Mexico patients.
Blue Cross Blue Shield of New Mexico serves nearly 400,000 New Mexicans, but navigating their authorization requirements and appeals process can be overwhelming, especially in a state with many rural communities. Your Solace advocate understands BCBSNM's systems inside and out—from securing prior authorizations to appealing claim denials and coordinating specialist care. They'll handle the time-consuming phone calls, paperwork, and follow-ups so you can focus on your health instead of fighting with insurance.
Best of all, most patients pay nothing out of pocket.
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About
Blue Cross Blue Shield of New Mexico (BCBSNM) is a division of Health Care Service Corporation and serves as one of the major health insurers in the state, offering individual and family plans, employer group plans, Medicare Advantage, and Medicaid coverage through the state's Turquoise Care program. With over 800 employees based in New Mexico, BCBSNM provides access to a large network of providers throughout the state. However, members often face challenges with the insurer's complex prior authorization requirements, especially for specialty medications and procedures. BCBSNM operates a multi-tier appeal process that can be difficult to navigate, and with New Mexico's rural geography, coordinating care between in-network providers and specialists can present additional hurdles for members trying to access timely and appropriate healthcare services.
What problems can a Blue Cross Blue Shield of New Mexico patient advocate help you with?
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Get the clarity you need to make sense of your care and take charge of your health.
We’ll make the calls (and the callbacks) so you can spend more time doing what you love.
Keep your care affordable with lower medical bills and access to local financial help.
Advocates review coverage, handle preauthorizations, and even help with appeals.
Stay on top of the cutting-edge treatment options and leave no stone unturned.
Advocates coordinate your care team so your health never falls through the cracks.
Get the tools and answers you need to make informed decisions about your care.
Advocates help you overcome your healthcare hurdles—no matter how big they might be.
Solace has helped over 14,000 patients and families
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04/01/2024
Eric H.
08/07/2024
Joan H.
05/01/2024
Stephen I.
04/27/2024
Jonathan J.
06/05/2024
Anne J.
07/27/2024
Blue Cross Blue Shield of New Mexico Appeals with a Patient Advocate
BCBSNM's appeal process involves multiple stages that can be overwhelming to navigate alone. For standard appeals, you have 60 calendar days from the date of denial to file, and the process typically takes up to 30 days for medical service authorization decisions. Your Solace advocate knows how to prepare comprehensive appeals that include all necessary documentation, proper coding references, and address BCBSNM's specific coverage criteria. They'll track deadlines, follow up persistently, and guide you through each stage from internal review to external review with the New Mexico Office of Superintendent of Insurance if necessary.
When facing a BCBSNM denial, your advocate will immediately identify whether the issue stems from missing documentation, coding errors, network limitations, or medical necessity determinations. They'll work with your healthcare providers to gather supporting evidence and may arrange peer-to-peer reviews between your doctor and BCBSNM's medical directors. For Medicaid (Turquoise Care) members, they understand the specific grievance and appeal rights available, and for Medicare Advantage members, they know how to navigate the unique requirements for expedited reviews when your health requires a quick response.
New Mexico's vast rural landscape makes navigating BCBSNM's complex policies especially challenging—precisely why a Solace advocate's expertise is invaluable.
The Solace care team model
With Solace, you get both a patient advocate and a supporting physician, which we refer to as your “care team”.
Your advocate will be there to manage the day to day aspects of your care: coordinating with doctors, researching potential solutions and communicating updates to you.
Your supporting physician can unlock resources for you and your advocate that might otherwise be out of reach.
We’ve Got Answers
Still unsure how an advocate can help? Explore these answers to the questions we’re asked the most.
How are Solace advocates qualified to help?
Advocates on Solace are experienced physicians, nurses, pharmacists, and other healthcare professionals from a wide range of backgrounds. 98% of Solace patients report better healthcare outcomes after working with an advocate.
What else can a Solace advocate help me with?
What can a Solace advocate not do?
We know our advocates sound like miracle workers, but they have limits. They can’t prescribe medications or diagnose an illness, for instance. They can’t replace your doctor, but they can break down the barriers standing between you and the quality care you deserve.