What are you looking for? Patients Debt Collection Protection ActReport Insurance Fraud in New MexicoInsurance TypesTitle InsuranceHomeowners InsuranceCondo InsuranceRenters InsuranceAuto InsuranceHealth InsuranceManaged Health Care ReviewGrievance Procedures RulesWhat Consumers need to know about Surprise BillingIndependent Review OrganizationBilling ExamplesHealthcare Provider ArrangementsMultiple Employer Welfare Arrangement (MEWA)Life InsuranceOther Types of Health InsuranceStay Ready for Disasters!Winter StormFloodWildfireWind & Hail Resources Rules Currently in Effect Rules in Effect Pre – January 2016 Summary of Health Insurance Grievance Procedures Grievance Log Template OSI Events Calendar View our calendar of events Summary of Health Insurance Grievance Procedures This is a summary of the process you must follow when you request a review of a decision by your insurer. You will be provided with detailed information and complaint forms by your insurer at each step. In addition, you can review the complete New Mexico regulations that control the process under the Managed Health Care Bureau page found under the Departments tab on the Office of Superintendent of Insurance (OSI) website, located at www.osi.state.nm.us. You may also request a copy from your insurer or from OSI by calling 1-505-827-4601 or toll free at 1-855-427-5674. What types of decisions can be reviewed? You may request a review of two different types of decisions: Adverse determination: You may request a review if your insurer has denied preauthorization (certification) for a proposed procedure, has denied full or partial payment for a procedure you have already received, or is denying or reducing further payment for an ongoing procedure that you are already receiving and that has been previously covered. (The insurer must notify you before terminating or reducing coverage for an ongoing course of treatment, and must continue to cover the treatment during the appeal process.) This type of denial may also include a refusal to cover a service for which benefits might otherwise be provided because the service is determined to be experimental, investigational, or not medically necessary or appropriate. It may also include a denial by the insurer of a participant’s or beneficiary’s eligibility to participate in a plan. These types of denials are collectively called “adverse determinations.” Administrative decision: You may also request a review if you object to how the insurer handles other matters, such as its administrative practices that affect the availability, delivery, or quality of health care services; claims payment, handling, or reimbursement for health care services; or if your coverage has been terminated. New Grievance Log Coming Soon! Annual Grievance Report – Due annually on or before March 1st (NMAC 59-46-9 1978)
June 26, 2026 Bulletins MEDICAL MALPRACTICE PREMIUM REDUCTION AMENDED BULLETIN 2026-010: The New Mexico State Legislature appropriated $5 million to the New Mexico Office of Superintendent of Insurance (OSI) to address medical malpractice insurance costs for individual providers. The appropriation was part of a supplemental appropriation package passed in 2025. This one-time appropriation directs OSI to provide a premium subsidy for private medical malpractice insurance policies. […] Read More
June 12, 2026 Announcements NOTICE OF PRESCRIPTION DRUG PRICE TRANSPARENCY ANNUAL MEETING The Office of the Superintendent of Insurance will hold its annual public meeting to present and discuss the findings and recommendations contained in the 2025 Prescription Drug Price Transparency legislative report. The purpose of this meeting is to inform the public of the report’s contents and to provide an opportunity for public comments and questions. […] Read More
