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.
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.