New Mexico Turquoise Care

If you are a new Turquoise Care program member, getting connected during your first 30 days is very important. Here is a to-do list. When you complete this list, it lets us know your choices when it comes to managing your health:  

1. Complete your Health Risk Assessment (HRA). This is an important first step. It helps us know how you are doing today. Call Member Services at 1-877-236-0826 / TTY 711. 
   
2. Let us know how you want to hear from us. This includes mail, email, and texting options. We can also help you set a large print, braille, or other format choice. If English is not your first language, we will send materials in your language. You can share these preferences by calling Member Services.  
3. Choose a Primary Care Provider (PCP). As soon as you can, it is important to choose a Primary Care Provider (PCP) who is part of the UnitedHealthcare provider network. This is your main doctor who sees you for annual checkups, routine sick or well visits, and immunizations (shots).  Here are the options for choosing your PCP:
   • Log into your member portal at MyUHC.com/CommunityPlan.
   • You can use our provider search tool to view all of the providers in our network. 
   • Call Member Services for help finding a PCP. We can also email or send you a list of providers from which to choose. 

You should also:

• Get to know your health plan. Refer to the Health Plan Highlights (page 13) of the Member Handbook.
• Schedule an appointment with your PCP. 
  
• Connect with your Care Coordinator. Call Member Services to get started. Your Care Coordinator is “your go-to person.” 
• Ask questions! We want to hear from you. Get connected to resources, programs, and services. Call Member Services to find out about all the extras we offer here at UnitedHealthcare. We want to make this a pleasant and easy experience for you.

If you have questions about your health plan, please call us. Our toll-free Member Services number is 1-877-236-0826, TTY 711. We are open Monday through Friday, 8 am to 8 pm EST. You can call us at this number 24/7 to get urgent assistance.

UnitedHealthcare Community Plan provides member materials to you in a language or format that makes it easier for you to understand. Our provider network includes many doctors who are multilingual. Our provider directory shows which languages doctors speak. Additionally, many of our Member Services Advocates speak multiple languages, so when you call they will be able to help you or connect you with our interpreter service which covers more than 170 languages.

If you have trouble hearing over the phone you can use a text telephone. This free service allows persons with hearing or speech disabilities to place and receive telephone calls. Call 711, give them the Member Services number, 1-877-236-0826, and they will connect you to us.

You can also get information in large print, Braille or audio tapes. We can also assist with interpreter services, including American Sign Language. To ask for help, please call us Monday through Friday, 8 am to 5 pm MT.

Our toll-free Member Services number is 1-877-236-0826, TTY: 711.

The Just Plain Clear® Glossary contains thousands of health care terms defined in plain, clear language to help you make informed decisions. Visit justplainclear.com to use this free and helpful tool. This resource is currently available in English, Spanish as well as other languages. 

Search for a behavior health/mental health specialist

Medical questions can come up at any time. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week at 1-833-890-3050.

Our nurses will:

• Listen to your symptoms
• Help with self-care
• Advise if you can get care at your next doctor visit or need an urgent care center
• Help you know when it is time to go to the emergency room

As a value-added benefit, members can also speak to a doctor for additional support when medically necessary. This support is available in addition to the regular NurseLine services and gives members access to local medical expertise when needed.

Your secure member website. See your covered benefits, search for providers, view your member handbook and much more. Visit MyUHC.com/CommunityPlan to get started.

It’s designed for people on the go and includes many of the same features as the member website. Find it at the App Store or Google Play.

Our Healthy First Steps® program makes sure that both mom and baby get good medical attention. 

We will help: 

• Get good advice on nutrition, fitness and safety. 
• Choose a doctor or nurse midwife. 
• Schedule visits and exams.
• Arrange rides to doctor’s visits. 
• Connect with community resources such as Women, Infants and Children (WIC) services. 
• Get care after your baby is born.
• Choose a pediatrician (child’s doctor).
• Get family planning information. 

Quit Using Tobacco or Vaping Products

Quitting is hard, but we can help. Did you know that 20 minutes after you quit, your heart rate drops to a normal level? And within 24 hours after quitting the carbon monoxide level in your blood drops to normal.

Talk to your doctor about quitting. Or call 1-800-QUIT-NOW (1-800-784-8669) to get free coaching, counseling and supplies to help you quit.

If you need a ride, your benefits include transportation. We cover trips to: 

• Medical appointments 
• Food pantries 
• Pharmacy 
• WIC appointments 
• Medicaid eligibility appointments 
• Places of worship 
• Birthing classes 
• Grocery stores 
• Laundromats 
• Gyms 
• Job-related activities (e.g., training, interviews, testing) 
• Support group meetings 
• Social Security Administration 

Following these simple rules will help you get a ride: 

• Call 3+ business days ahead of time for local travel 
• Call 2+ weeks in advance for long-distance travel (out-of-state travel or flights). (This is for medical appointments only, not VABs.) 
• Call 1-877-236-0826, TTY 711 to set up your ride  
• If you cancel your visit, call 1-877-236-0826 to cancel your ride  
• Have your Medicaid ID card available  
• Rides are only for approved reasons  
• Know the address of your health care provider and the date and time of your appointment 
• Be specific about where you need a ride to  
• If your doctor gives you a prescription, you can stop at the pharmacy to get it  
• Let us know if you have special needs like a wheelchair  
• Members under the age of 16 must have a parent or guardian with them. Exceptions may apply. 
• Transportation may be limited to a provider near you 
• UnitedHealthcare will allow up to three family members or caregivers to accompany members to their appointment, with three-day prior pre-approval 

You may also qualify for a bus pass or friends and family mileage reimbursement. Gas mileage reimbursement is available to a friend or family member who drives you to and from physical health, behavioral health, and pharmacy. You cannot be reimbursed for driving yourself or a minor child you are legally responsible for. Transportation may be limited to a provider near you. Trips over 120 miles each way require pre-approval. Give Member Services a call to schedule a ride or ask questions about transportation services.

This service is for rides planned in advance. If you have a life-threatening emergency, call 911. An ambulance will be provided if you need to be sent to the hospital.

We offer benefits and extra services, such as:

Acupuncture

Availability: All members ages 18+

Limits: Up to 5 visits per year, $75 per visit limit, specific codes apply

Requirements: Provider must be in-network

Assurance Wireless

Eligibility: Members 18+

Limits: $50 per member in the purchase of a cell phone.

Prior Authorization: None

Next Steps: Member go to https://www.assurancewireless.com/partner/buhc to complete the application process

Babyscripts

Eligibility: Members who are prenatal, postpartum, and parenting children

Limitations: Program ends at 12 months post-delivery

Prior Authorization: None

Next Steps: Download the Babyscripts myJourney app from Google Play or the Apple App Store

Calm Health

The Calm app helps you check in on your mental health and find support when you need it.

• Availability: All members ages 13+
• Limits: Some premium content and features are not included
• Next Steps: Download the Calm app. Create an account or log in to an existing account. A 6-digit code will be sent to verify your identity. Complete your registration by adding additional details, including your Date of Birth and UnitedHealthcare Member ID.

Car Seats

Eligible Population: Prenatal, postpartum, and parenting children

Limitations: One Car Seat per infant per delivery

Next Steps: Benefit can be requested through Member Services or member's Care Coordinator. VAB Staff will reach out to member within 3 business days.

Dental

Availability: All members

Limits: Dental Prophylaxis (Teeth Cleanings): 4 Cleanings per year (Standard Medicaid covers 1 per year)

Limits: Fluoride Treatment: 1 treatment every 6 months

Limits: Varnishing Treatment: 1 treatment per lifetime

Requirements: Provider must be in-network

Diet & Nutritional Counseling

Availability: All members (No medical diagnosis required)

Limits: Lifetime maximum of 24 visits

Requirements: Provider must be in-network

Electroconvulsive Therapy

Availability: All members. Court order is required for children under 14. UHCCP will follow BHSD LOC guidelines and NM Statute.

Requirements: Requires evaluation and Assessment by psychiatric provider

Requirements: Provider must be in-network

Prior Authorization: Required

Emergency Clothing Fund

Eligibility: Children and adolescents (ages 0-20)

Limitations: $100.00 per member per year

Prior Authorization: No

Next Steps: Benefit can be requested by contacting Member Services or member’s Care Coordinator

Enhanced NurseLine Support

As a value-added benefit, members can also speak to a doctor for additional support when medically necessary. This support is available in addition to the regular NurseLine services and gives members access to local medical expertise when needed.

Home-Delivered Meals for Transition of Care

Eligibility: Post-delivery, for members and up to four household members

Eligibility: Post-release meals for justice-involved members

Eligibility: Skilled nursing facility (SNF) transition, focused on LTSS members

Eligibility: Post-discharge from in-patient stay

Prior Authorization: Required

Next Steps: Care Coordinator will complete referral to Meals on Wheels upon request

Important: This VAB is separate from the Food is Medicine (FIM) benefit, which is a standard Medicaid benefit implemented in July 2025

Hypo-Allergenic Pillowcases & Mattress Cover

Eligible Population: Members between the ages of 3-21 with a diagnosis of asthma and/or allergies

Limitations: This benefit can be requested once per calendar year

Prior Authorization: No

Next steps: Benefit can be requested by contacting Member Services or member’s Care Coordinator

OnePass™ Fitness Program

Eligible Population: Members 18+

Requirements: Requires member code (from Member Services)

Prior Authorization: No

Next Steps: Member will call Member Services to get their Member Code. Member can find a participating gym by going to youronepass.com and clicking on Find A Gym Near You. Member should bring Member Code to a participating gym to enroll and start using this benefit immediately.

Pets Are Family

In partnership with Paws In Action, members can choose pet services for up to $80 in value including three 20-minute walks or visits for potty breaks, feeding, or companionship; three 30-minute visits for light walks, playtime, feeding, or medication reminders; and up to three hours of short-term care within 48 hours for urgent needs.

• Availability: Dual Special Needs Plan (D-SNP) members only
• Exclusions/Limitations & Other Requirements including Prior Authorization: $80 per member per year; Some services limited to Bernalillo County and Rio Ranch area
• Requirements: D-SNP (Medicaid and Medicare through UHC, plus D-SNP)
• Timeline: Allow at least 48 hours in advance for services
• Next Steps: Request the service through Member Services or your Care Coordinator

SDOH Flex Fund: Employment & Education (E&E)

Eligible Population: SDOH Employment and education – Members will receive help with education and employment such as job training, skills classes, 1:1 career coaching, resume and interview assistance, help finding employment, and ongoing support from a Goodwill Career Specialist. Goodwill will help participants connect with employers throughout the community and helps them find long-term employment that meets their needs, abilities, and interests. Participants in Goodwill programs may be eligible to receive a no-cost technology device to support their success in the program.

• Eligibility: All members 16+. Members must meet specific eligibility requirements related to employment and education.

Support services may include the following (subject to change):

Next Steps: Benefit can be requested by contacting Member Services or member's Care Coordinator

SDOH Flex Fund: Helping Out Mom and Baby (HOMB)

Eligibility: Members may be eligible to participate in the benefit if they meet certain criteria as determined by UnitedHealthcare.

• Members must be mothers and children must be ages 0-2
• Members must not have other funding sources available to meet their needs
• Support services may include the following (subject to change):
• Portable play pen
• Stroller
• Diapers
• Infant formula
• Other baby supplies as needed

Limitations: $175 per member per year

Next Steps: Benefit can be requested by contacting Member Services or member's Care Coordinator

SDOH Flex Fund: Home Adaptations for a Healthier Home (HAHE)

Eligibility: Members may be eligible to participate in the benefit if they meet certain criteria as determined by UnitedHealthcare.

• Member must be disabled, have a qualified chronic health condition and/or be considered elderly (55+) and at risk as it relates to environmental health and safety
• Members must not have other funding sources available to meet their needs
• Support services may include the following (subject to change):
• Improving air quality with air purifiers
• Portable air conditioning
• Adding non-slip mats and grab bars to prevent falls
• Wheelchair ramps (RAMP NM)

Limitations: $300 per member per year

Next Steps: Benefit can be requested by contacting Member Services or member's Care Coordinator

SDOH Flex Fund: Move-In Assistance for a New Start (MANS)

Eligibility: Members may be eligible to participate in the benefit if they meet certain criteria as determined by United.

• Members must meet the definition for an individual or family experiencing housing instability
• Members must not have other funding sources available to meet their needs
• Support services may include the following (subject to change):
• ID ready assistance
• Application fees
• Utility startup costs
• Pest control

Limitations: $300 per member per year

Next Steps: Benefit can be requested by contacting Member Services or member's Care Coordinator

Substance Use Disorder Helpline

Availability: All members (No medical diagnosis required)

Availability: Helpline is free and available 24/7

Next Steps: To call the SUD Helpline, dial 1-888-702-2202.

Traditional & Cultural Services Support

Eligibility: Medicaid-enrolled Native American members in New Mexico

Prior Authorization: No

Limitations: All services are voluntary and offered in alignment with tribal and cultural traditions. No medical billing or diagnosis is required. All services are subject to approval by the vendor.

Limitations: As of March 2025, UnitedHealthcare no longer offers reimbursements or stipends for traditional healing or other traditional services. Members are encouraged to seek traditional wellness services with our provider and partner, First Nations Community Healthsource in Albuquerque. For a complete list of services, please visit https://www.fnch.org/services/.

Next Steps: Member self-refers to First Nations Community HealthSource by calling 505-515-3919 or visiting in person

Transportation

If you need a ride, your benefits include transportation. We cover trips to:

• Medical appointments
• Food bank
• Pharmacy
• WIC appointments
• Medicaid eligibility appointments
• Places of worship
• Birthing classes
• Grocery stores
• Laundromats
• Gyms
• Job-related activities (e.g., training, interviews, testing)
• Support group meetings
• Social Security Administration

Following these simple rules will help you get a ride:

• Call 3+ business days ahead of time for local travel
• Call 2+ weeks in advance for long distance travel (out of state travel or flights). (This is for medical appointments only.)
• Call 1-877-236-0826, TTY 711 to set up your ride
• Transportation may be limited to a provider near you

Limits:

• Limited to 20 one-way or 10 round trips per year
• Rides to/from venues such as liquor stores, casinos, bars, horse tracks, court-ordered appearances, and banks are not permitted
• Travel mileage is limited to a 120-mile radius. (This is for medical appointments only.)
• Longer trips require prior pre-approval. (This is for medical appointments only.)
• Transportation may be limited to a provider near you
• Limited to $1,000 per member per year
• Gas Mileage Reimbursement is for a friend or family member. You cannot be reimbursed for driving yourself or a minor child you are legally responsible for.

Requirements:

• Transportation must be scheduled through Member Services

UHC VIP Member Solutions

Availability: All members

Next Steps: Members can reach out to the Ombudsman directly, or staff can make a referral by reaching out to the Ombudsman on the member's behalf. Ombudsman’s email address is nm_ombudsman@uhc.com.

Vision

Limits for members ages 20 and under:

• Refractive Eye Exam: 1 Exam every 12 months (per Standard Medicaid, not a VAB)
• Frames: 2 Frames every 12 months (Standard Medicaid covers 1 every 12 months)
• Lenses: 2 Pairs of Lenses every 12 months (Standard Medicaid covers 1 every 12 months)
• Contact Lenses: Covered as needed ages 20 and under (per Standard Medicaid, not a VAB)

Limits for members ages 21+:

• Refractive Eye Exam: 1 Exam every 24 months (Standard Medicaid covers 1 every 36 months)
• Frames: 1 Frame every 12 months (Standard Medicaid covers 1 every 36 months)
• Lenses: 1 Pair of Lenses every 12 months (Standard Medicaid covers 1 every 36 months)
• Contact Lenses: 1 Pair of Contact Lenses every 12 months (Standard Medicaid covers 1 every 24 months)

Requirements: Provider must be in-network

Being healthy is not always about your medical needs. Sometimes you need help connecting to resources out in the community. We call these social needs.

These are things like housing, getting food every day, getting to the grocery or feeling safe. We can also help you get access to help with employment or finishing your education. Want to find help on your own? Check out UHCHealthierLives.com. You can also talk to your Care Coordinator or Member Services. They can give you referrals to local organizations.

Getting to the doctor when you are healthy is important. We have guides to help you know what to expect at each well visit. You can also talk to Member Services for support and information.

We also have helpful guides for most health problems and conditions. These materials can be found on https://member.uhc.com/communityplan.

You will find condition-specific and general health topics, including:

Physical Health

• Arthritis
• Asthma
• Cancer
• Children's health
• Chronic pain
• Diabetes
• HIV
• Heart health
• Infertility
• Men’s health
• Traumatic brain injury
• Virtual visits
• Weight management
• Women’s health

Well-being

• Aging
• Brain health
• Coping
• Exercise & fitness
• Healthy eating
• Mindfulness
• Sleep
  

UnitedHealthcare offers many brochures about health conditions. Talk to your Member Services Advocate about any health needs that you have. We can send you helpful information. We can also connect you with a Care Manager who can help you create a plan of care and make sure you get all the services you need.

The member will need to submit the Traditional Healing Reimbursement Form.  For more information or assistance, please contact Member Services at 1-877-236-0826. For hearing impaired: TTY 711.

Your Ombudsman:

• Is a neutral party and a member advocate. The ombudsman will work directly with the member in order to research and address member concerns.
• Is a resource for finding a solution
• Will work with members to help them understand their rights and their responsibilities

What are the limitations of the Ombudsman?

• The ombudsman will not file appeals or grievances on behalf of the members
• The ombudsman does not have the authority to override policies or procedures
• The ombudsman will not make decisions for the members
• Members have the right to refuse ombudsman services. An exception for ombudsman services to continue without member consent is in a life-threatening event to the member or to others. If this occurs, the Ombudsman will report this event.

Contact information for members:

The direct telephone number to the Ombudsman’s office is 1-877-236-0826, TTY 711.

How can a member reach their UnitedHealthcare Ombudsman?

• By email: NM_Ombudsman@uhc.com
• By phone: Member Services at 1-877-236-0826; TTY 711 for hearing impaired

An advance directive is a set of written steps you want to be taken when you can no longer make health care choices for yourself. It tells what health care you want or do not want. You should talk about your wishes with your doctor, family and friends. These steps will not change your health care benefits. 

What are advance health care directives? 

By State of New Mexico and federal law, you have the right to make an advance directive. It is a document that lets you say exactly how you wish to be treated if you are too sick to make health care decisions. An advance directive will help your doctor and family make choices about your health care. You can also name someone to make your health care decisions. That person is called a surrogate or an agent. He or she has the right to refuse or stop treatment for you in some cases. 

The document could be called an advance health directive, mental health advance directive, psychiatric advance directive or PAD, living will, durable health care power of attorney and/or durable mental health care power of attorney. 

It is UnitedHealthcare Community Plan policy to let all adult Turquoise Care members know they can do this. State and federal law says hospitals, nursing homes, and other providers have to tell you about advance directives. They need to explain your legal choices about medical decisions. The law was made to give you more control during times when you may not be able to make health care decisions. 

UnitedHealthcare Community Plan follows the regulations in the Mental Health Care Treatment Decisions Act [24-7B-1 NMSA 1978] and the federal regulation 42 CFR 489 subpart I and 42 CFR 422.128. 

How do I get an advance directive? 

Contact Member Services or your Care Coordinator at 1-877-236-0826. If you are speech or hearing impaired, call TTY 711. 

You can also call the State of New Mexico Aging and Disability Resource Center: 1-800-432-2080.

We want to hear from our members about any questions, complaints, or concerns you may have. If you have a grievance, please call Member Services toll-free, at 1-877-236-0826, TTY 711.

If you are not happy with your care or treatment by Member Services, Care Coordinator or a provider, you may file a grievance. You may file a complaint or grievance against us (the health plan) or a provider at any time.

Members may file a grievance verbally with Member Services from 8 am to 8 pm EST, Monday through Friday, at 1-877-236-0826, TTY 711. All members can file a grievance through this process. 

You can also send a letter. Please include your name, address, member ID, reason for your grievance, and any other information you think is important. That address is:

UnitedHealthcare Grievances and Appeals
P.O. Box 31364
Salt Lake City, UT 84131-0364

You have other rights that include appeals and a State Fair Hearing. For detailed information about complaints and appeals, contact Member Services or view the Appeals and Grievances section of the Member Handbook.

Fraud, waste, and abuse are serious problems. There can be penalties under law. To make a report, call the UHC Fraud Hotline at 1-844-359-7736. You can also call Member Services at 1-877-236-0826. We will not use your name in your report. You will not get in trouble for reporting this. We will look into the matter for you. 

For more information about fraud, waste, or abuse, or to make a report online go here.

We have a Notice of Privacy Practices that tells you how health information about you may be used and shared. We are required by law to let you know that the Notice is available, and how you can get a copy of it. View a copy of our Notice of Privacy Practices.