External review in New Mexico: deadline, cost and how to ask
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.
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.
Step 2: Outside review in New Mexico
- Program
External review by an Independent Review Organization (IRO) appointed by the Superintendent of Insurance
- Who runs it
- Office of Superintendent of Insurance, Managed Health Care Bureau (assigns an IRO at random): Insured health plans and managed health care plans regulated by OSI, and New Mexico Health Care Purchasing Act plans
- Deadline to ask
4 months
Send a written request to OSI within 4 months of receiving the final internal decision. The Superintendent can extend this for good cause.
- The deadline runs from
The date you receive the written notice of the insurer's final internal review decision
- Do I have to appeal to my plan first?
OSI may require you to finish the insurer's internal review first. You can skip it if the insurer waives it, if the insurer broke the internal review rules, or if you ask for an expedited internal review and an expedited IRO review at the same time.
- How long the review takes
Standard: 20 days
- Cost
IRO review is free to you. The insurer pays the IRO's fees.
- What can be reviewed
Denials after internal review that involve medical judgment: medical necessity, appropriateness, health care setting, level of care, effectiveness, or experimental, investigational or unproven treatment. Denials based on rescission or that do not involve medical judgment go to a hearing before the Superintendent instead.
- Is the decision final?
The IRO decision is binding on the insurer and on you, except for other remedies under state and federal law. You can ask the Superintendent for a hearing within 20 days of the IRO decision. You cannot ask for a second IRO review of the same denial.
- How to ask
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. After the IRO is assigned you have 5 working days to send it more information.
Law: 13.10.17.19-13.10.17.24 NMAC
- Phone
505-827-4601; 1-855-427-5674
Write my appeal: free letters
Sources
The official sources for New Mexico are listed on the New Mexico page.