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<?xml-stylesheet type="text/xsl" href="https://connect.bcbsnm.com/cfs-file/__key/system/syndication/rss.xsl" media="screen"?><rss version="2.0" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:slash="http://purl.org/rss/1.0/modules/slash/" xmlns:wfw="http://wellformedweb.org/CommentAPI/"><channel><title>Benefits &amp; Coverage</title><link>https://connect.bcbsnm.com/my-coverage-explained/</link><description /><dc:language>en-US</dc:language><generator>Telligent Community 12</generator><item><title>Blog Post: You and Your Doctor: Working Together to Keep You Healthy</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/work-together-with-doctor</link><pubDate>Fri, 10 Apr 2026 19:26:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:d4cedf1a-735e-4727-9002-22cf28c16529</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>When you need medical care, do you have a doctor you can call? If not, find a doctor you can call your own. Don’t wait until you’re sick to become a patient. If you have an HMO*, you’ll need to find a primary care provider, or PCP, to be your “personal” doctor. A PCP most often focuses on general internal medicine, family medicine or obstetrics/gynecology (OB/GYN). Older adults can choose a geriatric doctor. Children can have a pediatrician. The Power of Teaming Up with Your Doctor Here are five ways having a PCP can benefit your health and well-being. Someone to quarterback your care : Having your own personal doctor means you’ll have someone in your corner making sure you get the care you need. They’ll know your health history, any health conditions you have and what medicines you take. More focus on staying healthy: Your doctor will provide your routine medical care such as annual exams and treatment for colds and the flu. They will also make sure you get vaccinations and screenings and talk with you about how your lifestyle might impact your health. That way you can focus on staying healthy, instead of seeking help only when you are already sick or hurt. A trusted guide to your follow-up care: Your doctor can guide you to the best place to go when you need more care. If you need to be seen by a specialist, they can coordinate the care, especially if you need to be seen by more than one. This keeps your care on track and can help you avoid unneeded visits. Detect and treat illness earlier: Early diagnosis and treatment can keep many common health problems from getting worse. Having your doctor manage your care means problems can be caught early before they become serious or lead to other major illnesses. For example, catching high blood pressure early and getting it under control could prevent you from having a stroke later. Manage your conditions and care better: If you have a chronic health issue such as asthma, diabetes or a heart problem, your doctor can make sure you have access to specialized care to help keep your condition from getting worse. Personal Care. Simplified. To make the most of your relationship with your PCP and get the most out of your health plan, follow this advice: Schedule that first visit now: If you’re choosing a new doctor as your PCP, schedule your first visit as soon as possible. The sooner you create a relationship with your doctor, the sooner you’ll have someone in your corner overseeing your care. And going to your new patient appointment right away will help avoid delays in getting an appointment when you’re sick or need a referral. To each, their own PCP: Each person on your plan can pick their own PCP. Your PCP’s name and contact information will be listed on your member ID card. If you decide later your PCP isn’t right for you, you can choose a different one. See your PCP first: It’s best to call or go to your PCP first when you need care unless it’s an emergency. Your PCP will be able to make informed choices and direct you where you need to go for further treatment. That may mean going in to see your PCP or a specialist, going to an urgent care center, or heading to an emergency room. If you need to be seen by a specialist such as a cardiologist, make sure to start with your PCP. It’s important to get your care from providers in your network. This will help ensure you have fewer out-of-pocket expenses. Depending on your type of plan, if you get care from a provider who is not in your plan’s network, you may have to pay the full cost of your care. To make sure a provider or facility is in your plan’s network, log in to your account and go to Find Care . You can search for the provider and location that is right for you. Depending on your plan, you may also be able to estimate the out-of-pocket costs for your tests or treatments. *HMO is the commonly recognized term that refers to a Health Maintenance Organization.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Doctor%2bPatient%2bRelationship">Doctor Patient Relationship</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Primary%2bCare%2bProvider">Primary Care Provider</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Find%2ba%2bDoctor">Find a Doctor</category></item><item><title>Blog Post: Breast Pumps Can Help Make Breastfeeding Easier</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/breast-pumps</link><pubDate>Thu, 09 Apr 2026 18:21:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:b0c14c04-3e54-4ccc-956b-526c47132888</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>Nourishing your newborn baby is an important part of your role as a parent. Breastfeeding is a popular option for many parents — and for good reasons. Breast milk provides ideal nutrition that supports a baby’s growth and development. The Center for Disease Control and Prevention (CDC) reports it lowers an infant’s risk for ear infections, asthma, Type 1 diabetes, obesity and sudden infant death syndrome (SIDS). Anytime, Anywhere Convenience Along with important health benefits, breastfeeding does away with the need to mix formula or prepare bottles. It makes on-the-go feeding easy. Also, when traveling it can give comfort to babies when their normal routine has been disrupted. Breast pumps play a vital role in this flexibility. Pumping and storing breast milk allows both parents and others to share in feeding duties and increases your supply of breast milk. When you need to be away from your baby, there is a supply of milk ready to go. Blue Cross and Blue Shield of New Mexico covers a variety of breast pumps for members whose health care plan includes this benefit. If you have a Flexible Spending Account, you can use your FSA dollars toward any out-of-pocket costs for a breast pump. Which Breast Pump Is Right for You? Every pump is designed with a shield that covers the breast and a container that collects milk. There are some basic variations, though. Before choosing, you’ll want to do a little research to learn about your options. Manual breast pumps don’t require batteries or electricity. Instead, the pump is worked by hand so it can be used anywhere. A manual pump is best for parents who don’t need to pump a lot of milk at one time. Electric pumps have a motor that uses electricity or batteries. They come in single- and double-pump models. Single-pump models collect milk from one breast at a time. Double-pump models can collect milk from both breasts at the same time. Many parents who attend school or work away from home choose double pumps because they work faster and are more convenient. Hospital (or Medical)-grade breast pumps have a more powerful motor for better suction. They are typically used in a hospital setting. The purchase cost of these pumps isn’t usually covered by a health plan. However, they can be rented by the month for home use. Hospital-grade breast pumps are usually only recommended for: Moms who have trouble establishing their milk supply Parents with premature babies, babies with health issues that may impact feeding, or those infants in the NICU Parents of multiple babies Things to Keep in Mind You may not know how often you’ll need to pump until your baby arrives. Your third trimester is a good time to consider ordering your breast pump to ensure you have it before the delivery of your baby. If you’re not sure what kind of pump is best for you, talk with a trained breastfeeding counselor. The U.S. Department of Health and Human Services’ Office on Women’s Health also offers helpful information about breastfeeding , including Your Guide to Breastfeeding , which you can download to refer to when you have questions. We’re Here to Support Parents BCBSNM benefits help support families as they prepare for their new baby . We offer breastfeeding support, counseling and supplies through our maternity benefits. You’ll find a lot is covered by your health insurance plan when you use an in-network provider — even manual and electric breast pumps . Let Us Help You Find a Breast Pump To get started on getting a breast pump, call the number on your member ID card or send a secure message through your member account online . Our Customer Advocates can tell you: If your plan covers a breast pump. If it does, ask if both electric and hospital-grade models are covered. Some plans cover both an electric pump and the rental of a hospital-grade pump up to a certain dollar amount. Other plans may only cover one type of pump. Be sure to ask if there will be an out-of-pocket cost and what that cost may be. Full coverage may only apply to certain models of breast pumps. If your health plan requires a prescription for a breast pump. Which in-network providers or durable medical equipment (DME) suppliers in your network and state offer breast pumps and how to contact them. Depending on your health plan, your benefits may include Women and Family Health. The program offers access to a nurse case manager who can help you find breast pumps and connect you with other breast-feeding resources. Sources: Breastfeeding Benefits Both Baby and Mom , Centers for Disease Control and Prevention, 2025; How to Use a Breast Pump , WebMD, 2025; What to Know When Buying or Using a Breast Pump , U.S. Food and Drug Administration, 2023; Breastfeeding , American Academy of Pediatrics, 2024</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Women_1920_s%2bHealth">Women’s Health</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Infant%2bCare">Infant Care</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Pregnancy">Pregnancy</category></item><item><title>Blog Post: Unlock Savings on Health Care</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/how-to-save-money</link><pubDate>Thu, 02 Apr 2026 19:19:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:a8f42177-7ae7-4a26-8490-950a490f6cd0</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>No one likes to pay for health care. But we need health care to help us stay healthy, manage health conditions and get care when we need it most. Health insurance protects us from the financial burden of unexpected medical costs. There are a few ways to help lower your out-of-pocket costs. Read on to learn how you can save on doctor visits, prescription medications, fitness equipment and more. Stay Healthy with Preventive Care The best way to save money on health care costs is to stay on top of your health with preventive care. We can’t always avoid illness, but we can do our part to protect our health with annual exams, health screenings and staying up to date on immunizations. It all begins with scheduling an annual visit with your primary care provider . At the visit, you will talk with your doctor about your health history and any changes you may be noticing. You can also find out what screenings are right for you and if you’re due for any vaccines. Visit an In-Network Provider to Save Money Your health plan gives you access to many kinds of health care providers like doctors, therapists, clinics, pharmacies and hospitals. Before you go for care, make sure a provider is in your health plan network. Those who are contracted to provide care for you and other family members in your health plan are called network providers . They may also be called in-network providers or participating providers . Providers who do not have a contract with your health plan are out of your network . To find providers in your network, log in to your account online or through the BCBSNM App and go to Find Care . Then follow these tips to help keep your costs down. Save on Prescription Medicine There are a few easy ways to save on your prescription medicines: By filling your Rx at an in-network pharmacy for your health insurance plan, by checking your plan’s drug list, and by discussing your options with your provider or pharmacists. Preferred Pharmacy Savings If a preferred pharmacy network is part of your benefits, you’ll save the most money when you fill your prescriptions at one. When you use a preferred pharmacy, you pay the lowest out-of-pocket cost on covered prescription drugs. Some medicines have copays as low as $0 at preferred pharmacies. If you need a 90-day supply, you can git it at preferred pharmacies or by home delivery. Learn how to find an in-network pharmacy. Prescription Drug List A drug list is a list of drugs that are covered under your prescription drug benefit. How much you pay out of pocket is determined by whether your drug is on the list and at what coverage level, or tier. A generic drug is often at the lower tier. See if your drug is covered . Some prescription drug plans may require you to pay more if you fill a prescription for a brand name drug when a generic equivalent is available. Members are encouraged to use drugs that are safe, work well and are cost effective. Learn more about pharmacy and prescription plan coverage here. Ask your provider or pharmacist if there are any lower-cost alternatives for your prescription. A generic or lower-tier brand drug may be right for you. Treatment decisions are always between you and your provider. Get Member Perks Blue365 &amp;#174;* Any member of a participating Blue Cross and Blue Shield plan is eligible for Blue365, a free health and wellness discount program offered to members. You and your covered family members can save with top retailers on products and services that may not be covered by insurance. There are no claims to file and no referrals or prior authorizations needed. Discounts fall into six categories: Apparel and footwear, fitness, hearing and vision, home and family, nutrition, and personal care. Learn how to create an account and save with Blue365. *Blue365 is a discount program only for Blue Cross and Blue Shield of New Mexico members. This is NOT insurance. Some of the services offered through this program may be covered under your health plan. You should check your benefit booklet or call the Customer Service number on your member ID card for specific benefit facts. Use of Blue365 does not change monthly payments, nor do costs of the services or products count toward any maximums and/or plan deductibles. Discounts are only given through vendors that take part in this program. BCBSNM does not guarantee or make any claims or recommendations about the program’s services or products. You should consult your doctor before using these services and products. BCBSNM reserves the right to stop or change this program at any time without notice.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Prescriptions">Prescriptions</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Member%2bRewards">Member Rewards</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Save%2bMoney">Save Money</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Provider%2bFinder">Provider Finder</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Health%2bCare%2bCosts">Health Care Costs</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Blue365">Blue365</category></item><item><title>Blog Post: Need an Explanation of Your Explanation of Benefits?</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/an-explanation-of-your-explanation-of-benefits</link><pubDate>Thu, 02 Apr 2026 12:37:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:da4c836e-b25f-4abb-8789-c23a34ad317a</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>You’ve been to the doctor and paid your copay. How are you going to know when your claim is filed and finalized? Simple — you&amp;#39;ll get your Explanation of Benefits (EOB). Your EOB will break down the services you received, the cost of the services and what you might have to pay. Your EOB is not a bill. What Is an EOB? An EOB is a notice you get when a health care benefits claim is processed by your health plan. The EOB shows the expenses submitted by the provider and how the claim was processed. If you get paper EOBs, an EOB will be mailed to you after a claim has been finalized. If you are signed up for paperless statements , you&amp;#39;ll get an email when your EOB is ready to view in your online account . Below is a sample EOB that explains all of the sections. Keep in mind that every plan is different. The charges on your EOB are according to your plan&amp;#39;s coverage and the services you received. Basics of Your EOB Page One A. Your member ID and group numbers B. How to access your claims online C. Helpful contacts and glossary Basics of Your EOB Page Two Top: D. Patient information E. Provider information F. Policy information Details: G. Amount billed by the provider H . Discounts and reductions in compliance with your plan I. Amount covered is the amount billed (G) minus the discounts and reductions (H) J. Health plan responsibility is the portion your health plan pays to the provider K. Deductible amount L. Copay amount M . Coinsurance amount N. Amount not covered O. The amount you’re responsible for. This column provides details about the amount you may owe shown in the claim summary (O 2 ) O 2 . Claim summary J 2 . Total covered benefits approved is the amount that was paid to the provider P. Numbered notes provide additional details Q. Health care plan maximums Always Check Your EOBs Your EOB is an important record of claims for services paid from your benefits. You need to carefully check your EOB . You want to be sure that the services you received match the services you were billed for. If something looks wrong, call us at the number on your member ID card. Or call your provider&amp;#39;s office to ask about it. Keep your EOBs in case questions come up later about your claim or your bill. If you’ve registered for BAM, we store your EOBs there for 18 months. You can get more information in your online account . And check out these Health Care Coverage 1-on-1 videos to learn more about EOBs and other coverage information and insurance terms.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/How%2bHealth%2bInsurance%2bWorks">How Health Insurance Works</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Understanding%2bInsurance">Understanding Insurance</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Blue%2bAccess%2bfor%2bMembers">Blue Access for Members</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Member%2bClaims">Member Claims</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Insurance%2bBasics">Insurance Basics</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Explanation%2bof%2bBenefits">Explanation of Benefits</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Health%2bCare%2bCosts">Health Care Costs</category></item><item><title>Blog Post: 8 Things You Should Know About Deductibles</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/8-things-deductibles</link><pubDate>Thu, 02 Apr 2026 09:32:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:311df580-6960-44e6-b4c1-946ede181e85</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>Health plans can seem complicated. It helps to know what questions to ask and where to find the information you need. Take deductibles, for example. They’re important to your pocketbook, but do you know how they work? To get you started, here are answers to some common questions we get from our members. Q: What is a deductible? A: A deductible is the amount you pay for certain health care services each year before your health plan starts to pay. For example, if you have a $1,500 deductible, you pay the first $1,500 of the covered services you need. Depending on your plan, you may also need to meet this in-network deductible before you pay for covered prescription drugs. This means you will pay the prescription’s full cost upfront until the deductible is met. Then you will pay your copay or coinsurance amount until you meet your yearly out-of-pocket maximum. But some plans do not have a deductible. And some types of medicines may be available at a lower cost (or at no cost), even if the deductible has not been met first. Q: What happens after I meet the deductible? A: Once you’ve met your deductible, you usually pay only a copay and/or coinsurance for covered services. Coinsurance is when your plan pays a large percentage of the cost of care and you pay the rest. For example, if your coinsurance is 80/20, you’ll only pay 20 percent of the allowed amount when utilizing an in-network provider. Your health plan pays the remaining 80 percent of the allowed amount. Q: You said a deductible is the amount you pay each year. Does the deductible reset each year? A: Yes. Since your deductible resets each plan year, it’s a good idea to keep an eye on the figures. If you’ve met your deductible for the year or are close to meeting it, you may want to squeeze in some other tests or procedures before your plan year ends to lower your out-of-pocket costs. Q: Is a health insurance deductible different from other types of deductibles? A: Unlike auto, renters or homeowner insurance where you don’t get services until you pay your deductible, many health plans cover the cost of some benefits before you meet the deductible. For example, your plan may cover the cost of annual physicals and many preventive health screenings before the deductible is met. Q: My plan information says I have a family deductible, too. What does that mean? A: If your plan covers your family, there will probably be a deductible for each person and a separate family deductible. As soon as the family deductible is met, your plan starts paying at the coinsurance amount for everyone’s care. That’s the case even if some family members haven’t met their individual deductible. Here’s a good example of how this works: Your family gets in a car accident. You all need to get checked at the hospital for injuries. If each person had to meet an individual deductible, you would pay all the deductible amounts before your coinsurance started paying. With a family deductible, once you met that one family deductible amount, no other individual deductibles are needed. After the family deductible is met, you’ll only pay your copay and/or coinsurance amount for services for each family member. Some plans, like a high-deductible health plan with a health spending account (HSA), may only have a family deductible. Check your benefit details if you aren’t sure. Q: Do all health care services apply to my deductible until it’s met? A: Not always. Some plans fully cover preventive services, which means you don’t pay anything at the time you get them. Because you don’t have an out-of-pocket charge, those services won’t count toward meeting your deductible. If you receive care that isn’t covered by your health plan, it often won’t count toward your deductible. This might include such things as cosmetic procedures or seeing a provider who isn’t in your health plan’s network. Q: What are the pros and cons of a high or low deductible? A: In most cases, the higher a plan’s deductible, the lower the monthly premium. If you’re willing to pay more when you need care, you can choose a higher deductible to reduce the amount you pay each month. The lower a plan’s deductible, the higher the premium. You’ll pay more each month, but your plan will start sharing the costs sooner because you’ll reach your deductible faster. Some people who don’t often need medical care would rather have a smaller premium and pay more up front for care as they go. But it can mean taking a chance that you might end up paying a big medical bill if you have an unexpected illness or injury. Other people like knowing that when they need their insurance, they won’t have to come up with a large sum of money before their plan starts helping with the cost. They’d rather have a higher premium, but a lower deductible. It makes costs more predictable. Q: If I pay so much out of pocket before my insurance kicks in, why should I have coverage? A: Health coverage can lower your costs even when you must pay out of pocket to meet your deductible. Insurance companies negotiate their rates with providers, and you’ll pay that discounted rate when you use those in-network providers. Without that discount, people often pay twice as much — or more — for care. For details about your deductible, log in to your online account. To see your deductible amount, go to Coverage and Benefits in the Coverage section. You can see how much of your deductible you’ve met to date in the Spending section. To find more information about insurance terms, check out our online glossary . Your Health Plan Offers Many Benefits at No Extra Cost Your health plan covers many preventive services, including vaccines for children and adults and yearly wellness exams, at no cost when you get services from a provider in your health plan’s network.* And screenings like mammograms, Pap tests and others are also covered at no cost. Learn more about the preventive services covered under your plan. *Preventive services at no cost applies only to members enrolled in non-grandfathered health plans. You may have to pay all or part of the cost of preventive care if your health plan is grandfathered. To find out if your plan is grandfathered or non-grandfathered, call the customer service number on your member ID card. Source: Are You Up to Date on Your Preventive Care? , Centers for Disease Control and Prevention, 2025</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Deductible">Deductible</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Insurance%2bBasics">Insurance Basics</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Health%2bCare%2bCosts">Health Care Costs</category></item><item><title>Blog Post: What Is a Health Insurance Claim?</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/what-is-a-health-insurance-claim</link><pubDate>Mon, 23 Mar 2026 10:47:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:1b44bea3-c950-4e50-8656-864b797f6507</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>We’ve all done it. Shown or uploaded our member ID card when filling out insurance forms in the doctor’s office or through an online portal. Your doctor’s office needs these details so they can file a claim. A claim is a bill your doctor and other health care providers send to a health insurance company for payment after they have treated you. In most cases, your provider’s office will submit the claim so you don’t have to worry about it. Still, there are times when you may have to submit a claim yourself. For example, if you choose to get care from a provider not in your plan&amp;#39;s network. How to Submit a Claim If you need to submit a claim: Go to our Form Finder tool. You’ll find the forms you need to manage your health insurance plan in one convenient place. Scroll the page to find the claim form you need. You can choose from: Dental Medical (Domestic) Medical (International) Prescription Drug (Prime Therapeutics) Click the Download icon to the right. Fill out the form fully. You’ll need this information to complete the form: Date of service/treatment Type of service Dollar amount charged by the health care provider Member ID number (from your ID card) Print the completed form and mail it — along with the original bill from the provider — to the address at the top of the claim form. Some Tips Make copies. The bill you send in with your claim will not be returned to you, so you’ll want to have a copy. Don’t wait too long. Be sure to file your claim soon after you receive care. This is even more important when you go to the doctor late in the year and need to make sure the claim is applied to the right plan year. Check the Status of Claims You can find the status of your claim by: Visiting the “Claims” section in your account online Calling the customer service number on your ID card Your Member Account Online Please note the claim will not show up in your account online until it is processed. There are five types of claims statuses that you may see: Fully Paid: The health care services you received were fully paid by your BCBS Plan. You do not need to pay any part of the bill. Partially Paid: The health care services you received were partially paid by your BCBS Plan. You may still need to pay part of the bill. Check Details of Services for details of what you may owe. Discounts Applied: Your BCBS plan has negotiated cost savings for you with your provider. You may still need to pay part of the bill. Check Details of Services for details of what you may owe. Not Paid: The health care services you received were not paid by your BCBS Plan. You may still need to pay all or part of the bill. Check Details of Services for details of what you may owe. No Action Needed: Though the health care services you received were not paid by your BCBS Plan, you do not need to pay any part of the bill. No further action is needed. Claims may go through future reviews, and their statuses may change. Explanation of Benefits (EOB) Statement Once we process your claim, you will receive an EOB , either by email notification directing you to your account online or mail. This document will break down: Amount billed - The amount billed by your provider for service(s) rendered. Discounts and reductions – Cost savings offered by your plan. Amount covered – The amount billed minus any discounts and reductions. Health plan responsibility – The amount your health plan pays to the provider. Deductible – Before your health plan starts to pay for medical care and prescription costs, you pay 100% of these costs until you reach a set dollar amount known as your deductible. Once you pay your deductible in full, you then cover only your copay and coinsurance costs. Copay amount – A set amount you pay every time you see a doctor or get a prescription filled. Your copay is listed on your member ID card. Coinsurance – Your share of costs you pay for care after you’ve met your deductible. It may be a percentage of the cost, or a set amount. Amount not covered – Costs not covered by your health plan. Your total costs – The amount you may still owe your provider. If your claim was not paid, you can file an appeal. The appeals information is included with your EOB.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Understanding%2bInsurance">Understanding Insurance</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Medical%2bClaims">Medical Claims</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Blue%2bAccess%2bfor%2bMembers">Blue Access for Members</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Insurance%2bBasics">Insurance Basics</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Explanation%2bof%2bBenefits">Explanation of Benefits</category></item><item><title>Blog Post: Manage Your Stress with Our Self-Management Programs</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/self-management-programs-managing-your-stress</link><pubDate>Thu, 19 Mar 2026 15:04:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:72f126d3-9d8e-4c2f-a070-1069d60f4d85</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>Stress can happen to anyone. It comes in many different forms and from different areas of your life. Too much work? Not enough “me-time?” Problems with a loved one or friend. Sometimes, stress can be overwhelming. When it is, your body often pays the toll. Anxiety, low energy, body aches, chest pains, headaches and trouble sleeping are some of the side effects. Luckily, help is here. The Well onTarget &amp;#174; portal offers programs, tips, strategies and resources to help you fend off stress. Our digital self-management programs include: Interactive courses with content and learning activities that focus on making behavioral changes to support healthier habits. Educational courses that help you recognize symptoms, understand treatment options and learn relaxation techniques to better control stress triggers. Designed for people who struggle with high levels of stress, all of the content is based on recommendations from accredited programs and guidelines. Best of all, these programs make it easy to learn. You’ll be able to study at your own pace when it’s convenient for you. Ready to calm the chaos? Register for these digital self-management programs today. To sign up, go to the Well onTarget Member Portal at wellontarget.com . Or, use the mobile app, AlwaysOn &amp;#174; . Source: Stress , Cleveland Clinic, 2024</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Stress">Stress</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Using%2bHealth%2bInsurance">Using Health Insurance</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Well%2bonTarget">Well onTarget</category></item><item><title>Blog Post: Beware of Health Insurance Phone Scams</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/beware-of-health-insurance-sales-phone-scam</link><pubDate>Thu, 19 Mar 2026 06:17:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:473ce6a7-d3bd-4fb2-95f0-4952ab284884</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>Some Blue Cross and Blue Shield of New Mexico members have been targeted by phone scammers. There are two types of scam calls that members should be aware of. The first type of scam call is known as &amp;quot;spoofing.&amp;quot; Spoofing happens when someone fakes the identity of another device or user to steal data from the victim. For example, members receive calls that show &amp;quot;Blue Cross and Blue Shield&amp;quot; on their caller ID even though BCBSNM is not making the calls. These scam callers ask for protected health information (PHI). They also claim they can lower member premiums or offer more coverage. The second type of scam call is made by people who falsely say they represent Blue Cross or Blue Cross and Blue Shield. They claim they&amp;#39;re selling health insurance. We don’t know yet who is making these calls, but it&amp;#39;s important for you to know BCBSNM does not make any automated prerecorded sales calls. With both of these phone scams: The calls are not from us. Callers ask for personal or financial information. Hang up right away if you get one of these calls. Don’t give out your personal or financial information. Don’t press any number if prompted to do so. Remember, unless you have a qualifying life event , you can&amp;#39;t apply for health insurance until the next Open Enrollment period starting in November. Read more about health care fraud and ways to protect your personal and financial information. If you have any questions about calls that may come from us, please call the number on your member ID card.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Understanding%2bInsurance">Understanding Insurance</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Phone%2bscams">Phone scams</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Fraud">Fraud</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Health%2bInsurance%2bScams">Health Insurance Scams</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Insurance%2bBasics">Insurance Basics</category></item><item><title>Blog Post: How to Use Your Digital Member ID Card</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/digital-member-id-card</link><pubDate>Tue, 03 Mar 2026 11:52:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:f9cbe062-2245-4b7b-be11-3a50fafba3e1</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>Your phone does a lot more than text and make calls these days. It’s a safe place to keep important parts of your life. You can store photos of people you love and use it to pay for things. You can also use it to see your health insurance benefits. With a digital member ID card, your coverage and benefits information is easy to find when you need it. Your digital member ID card is always up to date and lets you securely verify your Blue Cross and Blue Shield of New Mexico coverage with your doctor. You can find it in our BCBSNM App , or by logging into your member account online . Viewing your member ID card is then just one click away. Here&amp;#39;s How It Works Using your digital member ID card at your doctor’s office is quick and easy: Step 1. Log into the BCBSNM App. Step 2. On the dashboard, tap View ID Card. Step 3. That’s it! You’re now looking at your digital member ID card. Step 4. Tap on the share icon in the top right corner of your screen and select Share ID Card . This will open a window where you can choose to email or message images of the card directly to your doctor’s office. If you have an iOS mobile device, another useful option lets you download your digital member ID card to your mobile device’s wallet.* With this option, you can always access it, even if you don’t have good reception or an internet connection. To share from the mobile wallet, tap the share icon.* When you download the BCBSNM App or add your digital member ID card to your device’s mobile wallet*, there’s no need to wait for a physical card to come in the mail. Access is always at your fingertips. Prefer to log into your account at home? Here’s how you can access your digital member ID card online. Step 1. Log into your account online . Step 2. On the dashboard, click Member ID Cards . Step 3. You’re now looking at your digital member ID card. Step 4. Click Download to email a file to your doctor’s office or Print to print out a copy at home. Manage Your ID Card Preferences You can choose to stop getting a printed member ID card in the mail. Using the BCBSNM App: View your digital member ID card in the app. At the top of the screen, turn on the switch for Opt-in to Digital ID Card Only . Online: View your digital member ID card and click the Opt-in to Digital Only button under the card. You can also go to My Account , then Profile and Preferences . Select ID Card Preferences , turn on Digital-Only ID Card , and click Save . Have Questions? You or your doctor’s office may have questions about how to use a digital member ID card. You can send us a secure message by logging into your member account or calling us at the customer service number listed on your member ID card. *Feature only available for iOS</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Blue%2bAccess%2bfor%2bMembers">Blue Access for Members</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Health%2bInsurance%2bTools">Health Insurance Tools</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/ID%2bcard">ID card</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/BCBS%2bApp">BCBS App</category></item><item><title>Blog Post: The Help You Need to Navigate Your Health Plan</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/help-center</link><pubDate>Fri, 27 Feb 2026 19:09:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:9cd938e6-ee3a-40ed-af67-67e401760074</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>Insurance can be confusing. We’re here to help. Our Help Center can help you find the answers you need to use your benefits and get answers to key questions. Get Help in One Handy Place Bookmark the Help Center and visit often for quick, easy support. Members’ most common questions are front and center. Quickly learn how to: Access your account online. Get a copy of your member ID card. Pay your premium bill. Find a provider in your plan’s network. Find a form to file a claim. Find out what an insurance term means. The Help Center offers many resources broken into sections. This makes it easy to find the information you need. Learn more about a topic, watch videos and read FAQs. You can learn about things like finding care, prescriptions, claims and coverage, and much more. Check out these Help Center sections: Account Management: How to manage your plan, adjust your settings, add a dependent and more. Finding Care: Learning where to go for the care you need can save you time and money. Know your options. Forms and Documents: Get quick access to commonly requested forms for pharmacy, enrollment, claims and more. Shopping for Health Insurance: Find answers to questions about how to shop for a plan, what tools we offer to help you choose and next steps. Privacy and Security: Learn about what we do to protect your information and things you can do to protect yourself from health care fraud. Save time, get answers and make the most of your benefits by visiting the Help Center.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Network%2bProviders">Network Providers</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Understanding%2bInsurance">Understanding Insurance</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Insurance%2bBasics">Insurance Basics</category></item><item><title>Blog Post: Learn About Prescription Costs</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/drug-costs</link><pubDate>Fri, 27 Feb 2026 08:43:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:ab66664a-44be-4344-b88b-2134c5942ef0</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>There are many things to know when it comes to getting the medicine you need. How much will it cost? Is there one that will work just as well but cost less? Does it matter where I go to get my prescription filled? And these are just a few. We have some tips to help. People don’t always understand what goes into how much you pay for a drug. You may think whatever your pharmacy says you owe for what your doctor prescribes is what you’re stuck with paying. You may have more choices about what you pay than you think. Here are some ways you can manage some of your drug costs. Ask for a Generic Generic drugs are just as effective as brand name drugs. Talk to your doctor or pharmacist about your options. There may be a generic or lower-cost choice available for a drug your doctor wants you to take. Generics are often cheaper than a brand name drug. In fact, generics can be as much as 85 percent less than brand name drugs. The U.S. Food and Drug Administration explains why generic drugs may be the best choice . Compare Prices Just like grocery stores and gas stations, pharmacies can charge different prices. A drug that costs $12 at one pharmacy may be just $4 at another. We also have certain pharmacies that work with us to help keep costs as low as possible for our members. You can find network pharmacies by logging in to your account . After you log in, go to Pharmacy and click on Retail Pharmacy Finder . In your online account , you can compare drug prices at the pharmacies in your network. Check Your Drug List The plan you have uses its own drug list. That means not every drug on the market is covered. And doctors don’t always check your drug list before they prescribe a drug. If a drug seems expensive when you go to have it filled, it could be that it isn’t on your drug list or may be in a higher payment tier. You can see what is on your drug list by logging in to your account if you have Prime as your pharmacy administrator. If it isn’t on the list, call your doctor’s office and ask them to prescribe a drug from your list. You have the right to ask for a coverage exception (if your benefits allow). You or your doctor can submit the required documentation. Learn more about these special requirements at the pharmacy section of our website . Get Drugs Delivered to Your Doorstep Trips to the pharmacy are a necessary part of life, especially for people living with illnesses like high blood pressure or diabetes. But between getting to and from work, making dinner, helping kids with homework or hitting the gym, it can be hard to fit those trips into your routine. You may be able to make fewer trips and still get the medicine you need. Depending on your benefit plan, you could get up to a 90-day supply of drugs delivered directly to your home. If you switch to home delivery, you can: Order from home Avoid a trip to the pharmacy Get free shipping within the U.S. Have 24/7 support from a member of the pharmacy team Prime Therapeutics LLC is a separate company contracted by Blue Cross and Blue Shield of New Mexico to provide pharmacy solutions. BCBSNM, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics. MyPrime.com is a pharmacy benefit website offered by Prime Therapeutics LLC. Source: Generic Drug Facts , U.S. Food and Drug Administration, 2021</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Prescriptions">Prescriptions</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Generic">Generic</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Drug%2bList">Drug List</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Save%2bMoney">Save Money</category></item><item><title>Blog Post: What Is a Premium Tax Credit for Health Insurance?</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/what-is-the-premium-tax-credit-for-health-insurance</link><pubDate>Wed, 25 Feb 2026 13:29:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:dcb90db2-ad3e-4d43-97ec-97e6ea1fc096</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>A premium tax credit is a form of financial assistance. It helps with the cost of buying health insurance. Before you enroll in a new plan, check to see if you qualify for a tax credit. Who Is Eligible? Premium tax credits are for individuals and families who: Have a household income that meets the federal guidelines Purchased a Health Insurance Marketplace plan (either on your state’s respective Marketplace or an eligible plan via your insurer’s website) Are U.S. citizens or lawfully present in the U.S. You are not eligible if you can get affordable coverage through your job 1 , or if you qualify for one of the following: Medicare Medicaid Children’s Health Insurance Program (CHIP) TRICARE Learn how to estimate your income for the Marketplace. How Does the Tax Credit Work? Your income, family size and the type (and cost) of plan you buy is used to see if you qualify for a premium tax credit. You’ll give this information on your Marketplace application. If you do qualify, you can decide if you want to have all, some or none of your estimated credit applied to your plan’s monthly premiums. If you choose not to use the credit toward monthly premiums, you can claim the credit when you file your tax return for the year. This will either lower the amount of taxes you owe or increase your refund. Can the Tax Credit Amount Change? If there is a change in your family size, income or employment during the year, the amount of your premium tax credit can change. Be sure to update this information in your Marketplace account. Here are a few events that can affect the amount of your premium tax credit: Your household income changes You get married, divorced, or have a child You gain health care coverage through your job You move to an area with different plans or plan costs What Do I Report on My Taxes? The Marketplace will send you a 1095-A form showing your premium amount. You’ll report this on your tax return. Premium tax credits can be confusing, and the guidelines can change. If you still have questions, a tax advisor can help. You can also find more information at healthcare.gov/taxes or at irs.gov. How Do I Find Out if I Qualify for a Tax Credit? Use the HealthCare.gov Health Coverage Tax Tool to help calculate your premium tax credits today. 1 Your employer must offer health insurance coverage that’s considered “affordable” and meets minimum value standards; in 2026, your plan can cost no more than 9.96% of your household income and at least 60% of allowed costs must be covered to meet these requirements. If your plan is deemed unaffordable or doesn’t meet minimum value standards, you may qualify for premium tax credits.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Understanding%2bInsurance">Understanding Insurance</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Premium%2bTax%2bCredit">Premium Tax Credit</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Health%2bCare%2bCosts">Health Care Costs</category></item><item><title>Blog Post: Everything You Need to Know About Health Savings and Flexible Spending Accounts</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/health-savings-accounts-and-flexible-spending-accounts</link><pubDate>Wed, 11 Feb 2026 12:24:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:6be1e65b-bbff-43c2-9bf5-ba8aa55bc9f2</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>Along with acronyms for preferred provider organizations (PPOs) and health maintenance organizations (HMOs), add two more to your list. Both can help you pay doctor bills and save money. Health savings accounts (HSAs) and flexible spending accounts (FSAs) help pay medical expenses and offer tax-savings benefits. They both can help you make the most of your health care dollars. When you go to the doctor, you may have to cover a copay or pay the full amount of the visit upfront (depending on your health insurance plan). Either way, most people pay this amount out of pocket. If your copay is $30, the cost may not be a big deal. But if your health plan requires you meet a deductible before it starts paying, the upfront, out-of-pocket cost could be pretty steep. It could even be several hundred dollars or more if you see a specialist. Wouldn’t it be nice to have a savings account to cover these out-of-pocket costs? What if the savings account was funded with pre-tax dollars? An account like that could be helpful. HSAs and FSAs do exactly that. They set aside some of your income before you pay taxes. When you use these accounts, you can save hundreds of dollars throughout the year. At the end of the year, you also have a lower reported income. There are some rules to make sure these accounts are used properly. Answers to these questions will help you understand more. How Does an HSA Work? Because it is a health savings account, an HSA can be used only to pay for qualified medical expenses — even those not covered by health insurance. Qualified medical expenses are defined by the Internal Revenue Service. They include many standard medical, dental, vision and prescription drug expenses. You can also use your HSA to pay expenses related to a high deductible health plan (HDHP), including Affordable Care Act on- and off-exchange bronze starting in 2026. You must be enrolled in an HSA-qualified HDHP or bronze plan to contribute to an HSA. Even if you are no longer enrolled in a qualified HDHP, bronze plan, you can still use the funds to pay for qualified medical expenses. With an HSA, you set aside pre-tax money to fund the account. When you visit a doctor or go to a hospital in your network, you can pay the full cost of service from your HSA account until you reach your deductible. Once you meet your deductible, your HDHP or bronze plan kicks in and you can use your HSA to pay lower upfront costs. Always check to see which doctors are in your network. Use the Blue Cross and Blue Shield of New Mexico Provider Finder &amp;#174; before scheduling a visit to keep your costs down. You can still choose to see a doctor out of your network , but will pay a higher price. What Do I Get? When you deposit money into your HSA account, you get tax savings. Some employers even contribute funds to your HSA. If you don’t use all the money in your account by the end of the year, you can roll it over. Your HSA money grows from year-to-year and never expires. Plus, you get to keep all the interest. You can even take your money with you if you retire, change jobs or move to another city. What Isn’t Covered? While your money rolls over year to year, it could run out if you have a major medical expense and don’t have enough money in your HSA to cover it. Also, an HSA isn’t an emergency piggy bank. There are penalties if you use it to cover non-qualified medical expenses. How Does an FSA Work? Similar to an HSA, a flexible spending account is also a savings account. An FSA is funded with pre-tax dollars you can use to pay qualified medical expenses. You can add funds to your FSA throughout the plan year without paying tax on that money. The account can help cover copays, coinsurance , medical tests, vision, dental and prescription drug expenses . You can have an FSA with any group health plan, including a PPO or HMO. If you want to have both an HSA and FSA, the FSA may only be used for limited purposes. What Do I Get? An FSA offers tax savings! Some employers contribute funds to your FSA, and you may be able to roll over money to the next year, depending on IRS rules . What Are the Drawbacks? If you have extra money in your FSA account at the end of the year, you may lose it. Rollover limits can change, and employers decide if they will allow it or cap it at a lower amount. Your employer owns the account, and you can’t take the funds with you if you change jobs or retire. How Are an HSA and FSA Alike? Both are pre-tax savings accounts used to pay for your doctor, hospital visits, prescriptions and other medical expenses. You can contribute to them all year long, and your employer may contribute as well. You don’t have to open an HSA or FSA. They are just two options to help you save money and make the most of your health care dollars. Remember, you save when you use doctors who are in network. Once you meet your out-of-pocket maximum, your health plan pays covered services at 100 percent. Depending on your needs, you can save a lot of money by having one of these savings accounts. Should I Choose an FSA or HSA? Your choice depends on the level of coverage that’s right for you. If you are not managing ongoing medical treatment and want to invest the money you save for future medical expenses, an HDHP or bronze/HSA combination may be right for you. If you are managing a chronic health condition and ongoing medical expenses and you&amp;#39;re enrolled in an employer plan, a group PPO and FSA might be a good choice. Our customer advocates for ACA plans and/or your human resources department can help you decide.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Flexible%2bSpending%2bAccount">Flexible Spending Account</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Understanding%2bInsurance">Understanding Insurance</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/health%2bsavings%2baccount">health savings account</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Health%2bCare%2bCosts">Health Care Costs</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/consumer%2bdriven%2bhealth%2bplans">consumer driven health plans</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/PPO">PPO</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/HMO">HMO</category></item><item><title>Blog Post: What Is an HMO?</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/what-is-an-hmo</link><pubDate>Mon, 09 Feb 2026 21:28:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:a551096c-d50d-4ba7-8bb4-927b5e07437b</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>An HMO — or health maintenance organization — can help keep your costs lower and more predictable compared to other types of plans. With one doctor to coordinate your care, an HMO health plan is easy to use. An HMO health plan offers: Monthly premiums, copays and deductibles that are often lower than other types of plans. Access to certain doctors, hospitals, clinics, pharmacies, labs, and other care and service providers in your HMO network, to help control how much you pay for health care. A primary care provider (PCP) you see for annual physicals, preventive screenings, common illness or injuries, and other routine care. It&amp;#39;s Personal An HMO health plan offers personalized care. Your care is coordinated by one doctor who knows you — your health history, current issues, medicines, lifestyle and how your family health history may affect your health. Get Started When you first sign up for an HMO health plan, you choose, or are assigned, a PCP who&amp;#39;s part of a medical group or independent practice association. Each person on your plan can pick a PCP. A PCP most often focuses on general internal medicine, family medicine or obstetrics/gynecology (OB/GYN). Older adults can choose a geriatric doctor. Children can have a pediatrician. If you&amp;#39;re a member, you can find your PCP or your medical group listed on your member ID card. Your Health Partner As the primary member of your care team, your PCP plays a big role in helping you stay healthy. Here are some tips to help you make the most of your PCP: If you&amp;#39;re a new patient, see your PCP right away. When you make your first appointment, let the doctor&amp;#39;s office know you&amp;#39;re a new patient. Going to your new patient appointment right away will help avoid delays in getting an appointment when you’re sick or need a referral. Stay in network. New Mexico HMO plans do not require referrals for specialist appointments, but your specialist providers must be in your network for your plan to pay covered benefits. Call your PCP when you need care. Your PCP should be your first stop when you need care. If the office is closed, call the doctor&amp;#39;s after-hours number. For common illness and injury, like a cold, flu, minor cuts or burns, they will fit you into their schedule or refer you to another doctor or clinic. In some cases, they may have you go an urgent care clinic or a hospital. For emergencies * . If your illness or injury is life-threatening, call 911 or go to the nearest emergency room. You don&amp;#39;t have to stay in-network or get a referral. Just let your PCP know that you had an emergency as soon as you can. They’ll follow your treatment and manage your follow-up care. You Have Choices Finding a provider you feel comfortable with is important. You can change your PCP, medical group or independent practice association to another in-network provider at any time. The only exceptions are when you are hospitalized or in the second or third trimester of pregnancy. To change to a different PCP : Online Log in to your account. Choose the “Change PCP” link. Follow the instructions. By phone Call the customer service number on your member ID card. Having one health care expert coordinate all your health care helps keep your costs and health on track. Year after year, health plans help improve member health and lower their total cost of care because health issues are handled before they get serious. In most cases, your HMO health plan won&amp;#39;t cover your costs if you go to a provider who isn’t in your network. Your health plan contracts with network providers who offer a service at a set price. Because out-of-network providers don&amp;#39;t have a contract with us, we can&amp;#39;t control how much they charge you. To avoid getting big bills, make sure you stay in your network. Be Informed No matter which type of plan you have, review it carefully. Know what&amp;#39;s covered and where you can go for care before you need it. Understanding how your plan works may save you time and money. * Emergency care benefits are available out of network for HMO plans. Medically Necessary covered services not available in network may be referred to an out-of-network provider and be reimbursed at the in-network rate. If you are already enrolled in an HMO plan, you received more information about Medically Necessary covered services in your benefit materials.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Using%2bHealth%2bInsurance">Using Health Insurance</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Blue%2bAccess%2bfor%2bMembers">Blue Access for Members</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Provider%2bFinder">Provider Finder</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/HMO">HMO</category></item><item><title>Blog Post: How to Find In-Network Providers</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/save-time-money</link><pubDate>Mon, 09 Feb 2026 20:42:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:5820bf6d-1044-46d8-a442-05deacf859ad</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>There’s a lot to think about when deciding where to get health care – cost, networks, location and more. Being informed does not have to be tricky. We have resources available to help you make the best decision for you. Your online member account is a good place to start. Who Do You See? Your health plan gives you access to many kinds of health care providers like doctors, therapists, clinics, pharmacies and hospitals. Before you go for care, make sure a provider is in your health plan network. To search for providers in your network, log in to your account online and go to Find Care . Those who have agreed to give care for you and other members in your health plan are called network providers . They may also be called in-network providers or participating providers . Others who do not have a contract in place to give care for you and other plan members are out of your network . It’s important to know the difference. By staying in the network, you can take advantage of discounted rates and avoid surprise charges. Follow These Tips to Keep Your Costs Down Go to the Find Care section in your account to see what doctors, hospitals and urgent care centers are in your health plan’s network. Once you have found a doctor, double check with their office to make sure the doctor is in your network. Give the doctor’s office the information on your member ID card, including the full name of your plan. This will help them find what your plan covers. If your primary care doctor gives you a referral to another doctor, ask for one who is in your plan’s network. It is important that you make sure that the new doctor is also in your network. If you need surgery or other health services, make sure each provider who will care for you is in your plan’s network. Call the number on your Blue Cross and Blue Shield of New Mexico (BCBSNM) member ID card and ask if a certain doctor or other provider is in your network.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Network%2bProviders">Network Providers</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Provider%2bFinder">Provider Finder</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Health%2bCare%2bCosts">Health Care Costs</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Participating%2bProviders">Participating Providers</category></item><item><title>Blog Post: Know Where to Go When Minutes Count, or Anytime</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/because-your-health-counts</link><pubDate>Mon, 09 Feb 2026 14:21:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:c80043e1-4fec-4a02-bd75-585c022e3ff7</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>It’s important to know where to go when you need care. Sometimes the choice is clear. If you’re having signs of a heart attack or stroke, it’s best to go to an emergency room (ER). But what if you have a sore throat? Or an upset stomach after eating sushi? The choice may not be so clear. Knowing where to go for medical care may save you money and time. Keep these options for care in mind. And always make sure all of the providers and facilities you use are in your health plan’s network. Telehealth Visits You may be able to visit with a doctor by phone, online video chat or via mobile app for non-emergency medical and behavioral health concerns. * Many providers offer telehealth visits outside of regular office hours. They can be a good option when you have allergies, a cold or flu, or suffer from depression. Doctor&amp;#39;s Office Talk to the doctor who knows you and your medical history best. Your doctor can help with preventive care and common health issues like fevers, colds, the flu, sore throats and stomachache. Urgent Care Your neighborhood urgent care is a good option when a health issue needs immediate attention but isn’t an emergency. An urgent care center: Offers evening, weekend and holiday hours. Treats cuts that need stitches, migraines and severe headaches, back pain, sprains and strains, animal bites, rashes, and more. The closest urgent care center may not be in your health plan’s network. That’s why it’s good to think about where you would go now, before you need care. To find your closest in-network urgent care center, log in to your account online or through the BCBSNM App and go to Find Care. Be careful to choose an urgent care center and not a standalone ER. If the building has “Emergency” listed on its exterior, it is an ER. If it is not attached to a hospital, it is a standalone ER. That means it may not be covered by your health plan and can cost you a lot more money. Hospital Emergency Room Go to a hospital ER if you have life-threatening symptoms. Any time you have chest pains or heart problems, trouble breathing, heavy bleeding, broken bones, or sudden or severe pain, seek help right away. Help is available 24 hours a day, seven days a week. With a staff of medical experts, an ER is best equipped to care for you in an emergency. Find Care To find a doctor&amp;#39;s office, urgent care center or hospital ER in your plan&amp;#39;s provider network, log in to your account online and go to Find Care. Remember, when you visit in-network providers, you may pay less for care. That’s why it’s good to learn about your choices now. It will help you be prepared the next time you need care. * Telehealth visits may not be available with all plans. Check your benefits booklet for details. Internet/Wi-Fi connection is needed for computer access. Data charges may apply. Check your cellular data or internet service provider’s plan for details. Non-emergency medical service in Idaho, Montana and New Mexico is limited to interactive audio/video (video only), along with the ability to prescribe. Non-emergency medical service in Arkansas is limited to interactive audio/video (video only) for initial consultation, along with the ability to prescribe. Behavioral Health service is limited to interactive audio/video (video only), along with the ability to prescribe in all states. Service availability depends on location at the time of consultation.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/In_2D00_Network">In-Network</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Where%2bYou%2bGo%2bMatters">Where You Go Matters</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Emergency%2bCare">Emergency Care</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Provider%2bFinder">Provider Finder</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Health%2bCare%2bCosts">Health Care Costs</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Find%2ba%2bDoctor">Find a Doctor</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/SmartER%2bCare">SmartER Care</category></item><item><title>Blog Post: What’s In Your Benefit Book?</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/whats-in-your-benefit-book</link><pubDate>Mon, 09 Feb 2026 14:10:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:42d36d82-0956-4aa9-966c-086fae14ac4d</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>This article is intended for members enrolled in an individual health insurance plan. In some of the emails, letters and other communications you get from us, you may notice the phrase, “See your Benefit Book for details.” That’s because your Benefit Book is specific to you. It contains details about the plan you enrolled in. Inside, you’ll find three levels of detail. At-A-Glance This is a single page rundown of your basic plan information, which may include: Who’s covered The plan you chose The network that belongs to that plan Your member ID number The dates your coverage starts and ends Translation and TTY info Various Regulatory Reminders If you chose an HMO, there will be information about what an HMO is and how it works. Sometimes states require that we provide information about rights and responsibilities or assistance services to HMO members. Get to Know Your Plan This is a quick start guide to what your plan offers and how to use it. We cover basic information like managing your account, finding care and extra features of your plan. We point you in the right direction to learn more or get help. Your Full Contract Your contract provides detailed information about what your plan covers, how to use that coverage and what you may need to pay out of pocket. It spells out what your plan covers, such as: Network: Your plan network and the types of fully covered providers. Types of care available: Visits and services covered, including preventive care, diagnostic care and treatment, and primary or specialty care. Limits: The number of different types of visits, services or refills covered in your plan year. Exclusions: Any type of provider, service or treatment not covered by your plan. Get Your Book Online You can access your Benefit Book any time online. Log in to your member account. From your dashboard, select Coverage, then Coverage and Benefits . Then scroll down to All My Benefits to open your Benefit Book or download it for easy searching. Still getting information mailed to you? You can get your plan information online or by email or text. Just log in to your member account online and let us know how you&amp;#39;d like us to send you information. You can also update your email address and phone number to make sure we know the best way to contact you.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Blue%2bAccess%2bfor%2bMembers">Blue Access for Members</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/BAM">BAM</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Individual%2band%2bFamily%2bCoverage">Individual and Family Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Communication%2bPreferences">Communication Preferences</category></item><item><title>Blog Post: Why Verifying Your Identity Is Worth Your Time</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/verifying-identity</link><pubDate>Thu, 29 Jan 2026 15:58:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:df671e88-3334-4746-8a93-2917748df30f</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>Any time you call us with questions about your account or benefits, our automated system asks you to enter your name and member ID before routing your call. That may be frustrating at the time, especially if you need to call more than once. But taking the time to complete this process up front (unless you have lost your member ID) helps protect your privacy and should save you time in the long run. How Does Taking Time Save Time? When you call in and decline to enter your information, the chances are higher that the first person you speak to may need to transfer you. Calls without member identification take longer than those with identification. Many representatives specialize in questions about certain types of coverage. For example, if you have an Individual and Family plan, but a Medicare-trained representative gets your call, they will need to transfer you. Your hold time starts over. When you do enter your information, you are usually routed to representatives who specialize in addressing questions about the type of coverage you have. When we ask you to identify yourself up front, we are not just saving our representatives a few keystrokes. We hope to save your valuable time, too. What If You Call Me? We don&amp;#39;t call members often. If you do receive a call from us, you will be asked for your name and member identification number, the same as when you call us. But how can you be sure the call is from us? For added security, customer advocates who call you can offer a reference number that you can verify by calling the number on your member ID card. After you verify the call is from us, you can safely provide your information. Why Do We Ask? Asking for your identification information also helps us prevent fraud. Medical identity theft represents nearly half of all identity theft crimes in the United States every year. Fraudulent medical claims run into the hundreds of millions of dollars. They can cost thousands per victim, and resolving the issue can take hundreds of hours. Sources: Identity Theft Statistics By Reveal, Risks, Technology (2026) , Market US Scoop, 2026; What is medical identity theft and how can you avoid it? , The Week, 2023; A Quick Guide to Medical Identity Theft , Allstate Identity Protection, 2023</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Health%2bInsurance%2bScams">Health Insurance Scams</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Scams">Scams</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Safety">Safety</category></item><item><title>Blog Post: Self-Management Programs: Quitting Tobacco and Staying Tobacco Free</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/self-management-programs-quitting-tobacco-and-staying-tobacco-free</link><pubDate>Fri, 16 Jan 2026 09:50:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:7253bcb4-8671-4466-a415-b6cdccca3231</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>When you&amp;#39;re ready to quit tobacco, you boost your chance for success. When that day comes, we’re here to help you stay strong. The Well onTarget &amp;#174; portal provides self-help programs, tips and tools to help you break free from tobacco. The digital program includes: Courses with learning activities focused on behavioral changes that make it easier to quit. Courses to inspire positive lifestyle changes that curb cravings and the need for tobacco. Every course lets you to study at your own pace, so it’s easy to learn. All content is based on advice from accredited quit programs and guidelines. Real-world Know-how Makes All the Difference. Quitting Tobacco tackles many of the factors that aid addiction. The physical, psychological, social and cultural aspects are all covered. Once you kick the habit, Staying Tobacco Free helps with the day-to-day aspects of living tobacco free. You’ll learn how to cope with the complex physical, psychological, social and cultural factors that boost the desire for tobacco. Key benefits include tips to avoid triggers — along with social support. Ready to Quit? Visit wellontarget.com to log in to your account or sign up on the site. Then access both programs in the Well onTarget member portal. Navigate to the Browse All Activities tab in the middle of the page and search under the Self-Management Programs section. You can also access the programs using the AlwaysOn &amp;#174; Wellness mobile app. Download it today from the Apple App Store or get it on Google Play.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Using%2bHealth%2bInsurance">Using Health Insurance</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Stop%2bSmoking">Stop Smoking</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Well%2bonTarget">Well onTarget</category></item><item><title>Blog Post: Find Out If You Have a Copay Before You Go to the Doctor</title><link>https://connect.bcbsnm.com/my-coverage-explained/b/weblog/posts/find-out-copay</link><pubDate>Mon, 05 Jan 2026 20:36:00 GMT</pubDate><guid isPermaLink="false">6e104328-2028-43b6-bb31-8401437dc51f:7db839b1-03c7-44c1-880b-91a8745e2fa3</guid><dc:creator>BCBSNM Connect Team</dc:creator><description>Before visiting your health care provider, check to see if you’ll need to make a copay. You can find out your copay amount by looking at your member ID card or checking your benefit booklet or health plan contract. You can also log in to your online account and check the Coverage section. Keep in mind that copays are due at the time of service. Copays may be different for different kinds of visits or services. For example, your copay for a visit to a specialist may be higher than it would be for a visit to your primary care provider (PCP). Here are three tips to help you manage your copay costs: Always carry your current Blue Cross and Blue Shield of New Mexico member ID card. Or get your digital member ID card on the BCBSNM App or by logging in to your account. Call the precertification, preauthorization or prior authorization number on your member ID card, if required. When you get to the doctor’s office, urgent care center or hospital, simply show your member ID card. Copay costs may be higher if you see a provider who is not in your health plan’s provider network. To make sure that your doctor, hospital or other health care provider is in network, log in to your account online . Then go to Find Care . As always, in case of emergency, go straight to the nearest hospital.</description><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Network%2bProviders">Network Providers</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Benefits%2band%2bCoverage">Benefits and Coverage</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Provider%2bFinder">Provider Finder</category><category domain="https://connect.bcbsnm.com/my-coverage-explained/tags/Copayment">Copayment</category></item></channel></rss>