Health insurance or Medicaid said no in New Mexico? Deadlines and free help

In New Mexico, your health plan is regulated by New Mexico Office of Superintendent of Insurance (OSI), Managed Health Care Bureau, if it is a state-regulated plan.

New Mexico runs its own independent review of denials: External review by an Independent Review Organization (IRO) appointed by the Superintendent of Insurance. You generally have 4 months to ask for it.

External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.

Pick your plan type

Which kind of coverage was denied? The plan type decides which rules and deadlines apply.

Insurance I bought or got through work

Your state insurance rules may apply. First appeal to your plan, then ask for an outside review.

My employer pays claims itself (self-funded)

Federal rules apply, and most state insurance laws do not. Free help comes from the U.S. Department of Labor.

New Mexico Medicaid

You ask the state for a fair hearing. In a Medicaid health plan, you usually appeal to the plan first.

Marketplace (BeWell (New Mexico Health Insurance Exchange)) decision

A decision about whether you can buy a plan or get financial help is appealed to the Marketplace.

How long do I have?Urgent care: faster decisionWrite my appealFree help

Checked against official sources: October 30, 2026.

Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.

How long do I have in New Mexico?

Appeal to your plan
At least 180 days from receipt of the denial (federal rule)
Outside review
4 months
Hearing deadline
90 days
Appeal to the plan first
60 days (federal rule)
Then a state hearing
90 days
Appeal deadline – BeWell (New Mexico Health Insurance Exchange)
90 days

All the details →

How long do I have? Deadline calculator

How do I know which plan type I have?

How to tell which agency regulates your plan

If you bought insurance yourself or have insurance from an employer that does business only in New Mexico, contact the Office of Superintendent of Insurance. If your coverage is through a self-insured employer (typically a large company or one with locations in several states), contact the U.S. Department of Labor, EBSA.

Step 1: Appeal to your plan in New Mexico

What it is called: Grievance: internal review of an adverse determination (and, for managed care plans, an optional internal panel review)

Your insurer must finish an internal review within 30 days for care you have not received yet and within 60 days for a claim for care already received (including any panel review you ask for). In an urgent care situation it must decide within 72 hours, and care during a hospital stay or approved treatment continues until it decides. You can see your claim file and get copies of the evidence at least 5 days before the review. If the insurer misses its deadline (and you did not ask for a delay), the service is treated as approved if it reasonably appears to be a covered benefit. After the first-level review, managed care plan members may ask for an internal panel review within 15 days, where you can appear in person; public employees under the Health Care Purchasing Act must use the panel review.

Law: 13.10.17.14-13.10.17.16 NMAC

All the details →

Step 2: Outside review in New Mexico

External review by an Independent Review Organization (IRO) appointed by the Superintendent of Insurance

Deadline to ask: 4 months.

All the details →

Urgent care in New Mexico: faster decisions

Outside review

If your medical situation requires it, you or your provider can ask for an expedited IRO review by phone (Managed Health Care Bureau, 505-827-4601 or 1-855-427-5674). Send a complaint form with a signed medical release and a statement from your treating physician. The IRO decides within 72 hours after it is appointed.

Law: 13.10.17.19-13.10.17.24 NMAC

Standard: 20 days

Medicaid

Any party can ask in writing for an expedited hearing about health, safety or service availability, explaining in detail why; the judge decides whether to grant it.

Law: 8.352.2 NMAC; HCA Fair Hearing Request form (2024)

Marketplace

You can ask for a faster appeal if the standard process would jeopardize your life, health or ability to attain, maintain or regain maximum function; explain why in your request.

Complaints about your plan in New Mexico

For non-medical problems (an 'administrative grievance', such as claims payment or termination of coverage), use the insurer's internal review and reconsideration first, then ask the Superintendent for external review within 20 days of receiving the reconsideration decision, using the same OSI mail, email, fax or online options. Denials involving rescission or no medical judgment can go to a Superintendent's hearing; request it within 4 months of the insurer's internal decision.

Law: 13.10.17.24, 13.10.17.27-13.10.17.33 NMAC

www.osi.state.nm.us

Medicaid (New Mexico Medicaid (Turquoise Care managed care)) denials in New Mexico

Who holds the hearing: HCA Office of Fair Hearings.

Hearing deadline: 90 days

All the details →

Marketplace decisions in New Mexico

Marketplace

BeWell (New Mexico Health Insurance Exchange) · 1-833-862-3935

Appeal deadline

90 days

The date of your eligibility notice

How to appeal

For a 2026 plan, log in to the BeWell portal, choose My Support Requests, then Submit New Support Request and pick 'Appeals'. You can also call 833-862-3935 (TTY 711), or mail or fax a signed written appeal (account number, name, date of birth, phone, plan year, people appealing, date of the notice, what you think is wrong and why, whether it is urgent, and copies of documents) to New Mexico Health Insurance Exchange, Appeals Department, PO Box 25247, Albuquerque, NM 87125, fax 1-505-216-7776, or deliver it to 7601 Jefferson St. NE, Suite 120, Albuquerque, NM 87109. BeWell first tries to resolve it informally.

Faster appeal

You can ask for a faster appeal if the standard process would jeopardize your life, health or ability to attain, maintain or regain maximum function; explain why in your request.

Coverage while you appeal

Depending on your appeal, you may be able to keep your current coverage, premium tax credit or cost-sharing reductions while the appeal is processed; BeWell sends a notice explaining it. You may have to pay back extra tax credit at tax time.

If you disagree

If you disagree with the Office of Fair Hearings decision, you can appeal to the U.S. Department of Health and Human Services within 30 calendar days of the decision notice.

Other rights in New Mexico

Missed deadline means approval

If your insurer does not finish your internal review on time (and you did not ask for a postponement), the requested service is treated as approved, as long as it reasonably appears to be a covered benefit.

Law: 13.10.17.14(H) NMAC

Hearing before the Superintendent

After an IRO decision you can ask the Superintendent of Insurance for a hearing within 20 days. The Superintendent completes an expedited hearing within 72 hours and a standard one within 45 days of a complete request; health professionals may sit as co-hearing officers.

Law: 13.10.17.24-13.10.17.25 NMAC

How long do I have? Deadline calculator

Pick your plan type and enter the dates on your notice. We count from the rules in New Mexico and the federal rules.

Worked out in your browser. Nothing you enter here is saved or sent.

If you are not sure when it arrived, use the date printed on the notice. That date is never later than the day it arrived.

Choose what was decided and enter the date on your notice

We add the number of days or months from the law to your date. Nothing is saved.

Write my appeal: free letters

Free help in New Mexico

Good to know in New Mexico

  • In New Mexico the Office of Superintendent of Insurance itself receives external review requests and randomly assigns the IRO, which decides standard cases within 20 days of appointment.

    Law: 13.10.17.21-13.10.17.22 NMAC

  • If an insurer misses the internal review deadline, the requested service is deemed approved when it reasonably appears to be covered.

    Law: 13.10.17.14(H) NMAC

  • New Mexico Medicaid managed care members can ask for an expedited state hearing within 30 days, or a standard hearing within 90 days, of the plan's final appeal decision.

    Law: 8.308.15 NMAC

Changes in 2024–2026

July 1, 2024: the Human Services Department became the New Mexico Health Care Authority (HCA), which now runs Medicaid and fair hearings.

Law: 8.352.2.1 NMAC, amended 7/1/2024; November 19, 2024; OSI amended its grievance rule, 13.10.17 NMAC (internal review, IRO review and hearing provisions)

Questions about appeals in New Mexico

How long do I have to appeal a health insurance denial in New Mexico?

You have 180 days from the date of the adverse determination to ask your insurer for an internal review. You have at least 180 days (about 6 months) from when you receive the denial notice to file an internal appeal.

How do I get an outside (external) review in New Mexico?

External review by an Independent Review Organization (IRO) appointed by the Superintendent of Insurance. Send your request, a copy of the insurer's decision notices and a signed medical-records release to OSI: by mail to Office of Superintendent of Insurance, Attn: Managed Health Care Bureau - External Review Request, P.O. Box 1689, 1120 Paseo de Peralta, Santa Fe, NM 87504-1689; by email to mhcb.grievance@osi.nm.gov (subject: External Review Request); by fax to (505) 827-4253; or with the OSI complaint form. If you send it to your insurer by mistake, the insurer must forward it to OSI within 3 working days.

Is outside review free in New Mexico?

IRO review is free to you. The insurer pays the IRO's fees.

How long do I have to ask for a Medicaid fair hearing in New Mexico?

90 days. The date of the notice of action

Can I keep my Medicaid benefits while I appeal in New Mexico?

If you already get the benefit, ask to continue it within 10 calendar days of the mailing of the notice of action (for managed care, ask your plan within 10 calendar days of its notice, or before the date the notice says the benefit will end). You may have to repay continued benefits if you lose.

How do I appeal a Marketplace decision in New Mexico?

For a 2026 plan, log in to the BeWell portal, choose My Support Requests, then Submit New Support Request and pick 'Appeals'. You can also call 833-862-3935 (TTY 711), or mail or fax a signed written appeal (account number, name, date of birth, phone, plan year, people appealing, date of the notice, what you think is wrong and why, whether it is urgent, and copies of documents) to New Mexico Health Insurance Exchange, Appeals Department, PO Box 25247, Albuquerque, NM 87125, fax 1-505-216-7776, or deliver it to 7601 Jefferson St. NE, Suite 120, Albuquerque, NM 87109.

Not about a denied claim?

Nearby states

Sources

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