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A claim is simply a bill your doctor and other health care providers send to a health insurance company (such as Blue Cross and Blue Shield of New Mexico) for payment after they have treated you. In most cases, your provider’s office will submit the claim for you so you don’t have to worry about it. But there are some instances when you may have to file the claim yourself, such as when you get care from an out-of-network provider. Which brings us to the next question: How do you file a health insurance claim?
If you have to file a claim, here’s what you need to do:
There are a couple ways you can check the status of your claim:
Please note that the claim will not show up in Blue Access for Members until it is processed. There are three types of claims statuses that you will see:
Once your claim has been processed by us, you will receive an EOB, either by mail or email. This document will break down:
If your claim has been denied, you can file an appeal to have it looked at again. The appeals information is located with your EOB. Still have questions? Ask us in the comments!
Originally published 2/10/2015; Revised 2022
Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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