Some services require approval from BCBSNM. This approval is called “prior authorization.” If BCBSNM does not approve the services, the costs will not be covered (paid) by BCBSNM. You and your provider can still decide to get the services, but you may have to pay for them.
Approval from BCBSNM is required before:
- You are admitted as an inpatient to a hospital
- You receive any of the services listed as needing approval
- You visit a provider that is not in our provider network
To request approval, you or your provider must call BCBSNM Health Services. Call 1-877-232-5518, Monday through Friday, 8 a.m. to 5 p.m. MT. In-network providers know which services need to be approved and they will ask BCBSNM for you. Out-of-network providers may not.
If you are a Native American member, you do not need approval to visit Indian Health Service, Tribal, and Urban Indian providers (all together referred to as "I/T/U"). For services from a non-ITU provider, approvals are required for Native American members. Call 1-877-232-5518 (TTY: 711) to ask if those services need prior authorization.
See a list of services requiring approval