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UNM Health


UNM Health | Plans

UNM Health Network (Tier 1)

You pay lower co-pays and coinsurance amounts when you access the UNM Health Network.

  • UNM Health System providers and facilities including UNM Hospital and Sandoval Regional Medical Center and associated clinics, and UNM Medical Group clinics
  • ABQ Health Partners
  • First Choice Community Health Providers and Facilities
  • Presbyterian Medical Services (PMS)
  • After Hours Pediatrics
  • Langford Physical Therapy

Extended Network (Tier 2)

Our extended network is provided by BCBSNM. Access to the Extended Network within New Mexico:

  • Requires a Benefit Determination from UNM Health for non-urgent/non-emergent care prior to receiving care.
  • Failure to obtain Benefit Determination before accessing Extended Network providers and facilities will result in services being covered at the Out-of-Network level of benefit.
  • Please call UNM Health Customer Care at 505 925-2432 or toll free at (844) 866-2224 to request a Benefit Determination.

Out-of-Network (Tier 3)

Services are considered out-of-network if providers and facilities are not contracted with UNM Health and a Benefit Determination for the Extended-Tier 2 network is not obtained.

Only usual and customary charges are covered, and some preventive services are not covered for Out-of-Network providers.

Please refer to your Schedule of Benefits or contact UNM Health Customer Care.

Out-of-State

Emergency room and urgent care visits for all members, and regular appointments for dependents who live out of state, are covered at the Tier 2 benefit level when you use UNM Health's BCBS extended network.

Notify UNM Health Customer Care of dependents living out of state.

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