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New Mexico Turquoise Care - Frequently Asked Questions

Your member ID card holds a lot of important information. It gives you access to your covered benefits. 

Take your member ID card to your appointments:

  • Show it when you fill a prescription
  • Have it ready when you call Member Services; this helps us serve you better
  • Do not let someone else use your card(s). It is against the law.

You should have received your member ID card in the mail within 20 days of joining UnitedHealthcare Community Plan.

UnitedHealthcare Community Plan Turquoise Care gives you health care that is medically necessary. The amount, duration, and scope of benefits you can get are based on your needs and approved services, as determined by the State of New Mexico. Some benefits and services require preauthorization. Preauthorization determines whether the services or benefits are necessary.

If you have a chronic health condition, like asthma or diabetes, you may benefit from our Care Coordinator program. We can help with a number of things, like scheduling doctor appointments and keeping your providers informed about the care you get. To learn more, call 1-877-236-0826, TTY 711.

You’ll get a Health Assessment over the phone. If we see that you could use extra assistance, you will be assigned a Care Coordinator. They will contact you by phone. If they are unable to reach you, you will receive a letter from your care coordinator. 

Contact your Care Coordinator at 1-877-236-0826. Once you are assigned a Care Coordinator, you can contact him or her directly as often as you need to.

As a UnitedHealthcare member, non-emergency transportation and/or mileage reimbursement are available to and from physical health, behavioral health, and pharmacy. To request transportation or mileage reimbursement forms, please call 1-877-236-0826, TTY 711.

You must call at least 3 business days before your appointment. Three business days does not include weekends, holidays, or the day of the call. You can call for a ride up to two weeks before your appointment. You must have your medical or behavioral health appointment date, time and address available. 

  • Open Monday through Friday 8:00 a.m. to 5:00 p.m. Mountain Time 
  • Closed Saturdays and Sundays
  • Closed on national holidays 
  • Calls for trips for urgent/same-day appointments/facility discharges and Ride Assist are handled 24/7, 365 days at 1-877-236-0826 Reservation: 1-877-236-0826 
  • Ride Assist (Where’s My Ride?): 1-877-236-0826 
  • Hearing impaired (TTY): 1-877-236-0826 

Yes, but you must speak with a representative from UnitedHealthcare Community Plan before your appointment. They will send you a voucher form with instructions. To obtain reimbursement: 

  • The provider you are seeing must fill out the form or attach a doctor note 
  • You are responsible for sending the paperwork back to UnitedHealthcare Community Plan for payment 
  • If you have receipts for reimbursement, make copies and include them with your paperwork back to UnitedHealthcare Community Plan 

You may need to see a provider in another city or state because there is not one in your city or town. Work with your Care Coordinator to arrange the transportation and/or lodging through UnitedHealthcare Community Plan. The services must be medically necessary and prior approval must be obtained before seeing a provider out of the UnitedHealthcare Community Plan Turquoise Care network.

The appointment must be at least 4 hours away from your primary residence and it must be medically necessary. Please work with your Care Coordinator to arrange lodging and make sure UnitedHealthcare Community Plan is given advance notice. UnitedHealthcare Community Plan will send you a voucher form with instructions for reimbursement of meal expenses.

Not all appointments qualify for this service 

You can reach our Member Services at 1-877-236-0826, TTY 711, 8:00 a.m.–5:00 p.m. MT., Monday–Friday.

If you speak a language other than English, we can provide translated printed materials. Or we can provide an interpreter who can help you understand these materials. You’ll find more information about Interpretive Services and Language Assistance in the section called Other Plan Details. Or call Member Services at 1-877-236-0826, 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 
  • Contact information for members: 
  • The telephone number to reach the Ombudsman’s office is 1-877-236-0826, TTY 711.

If you have both Medicare and Medicaid, you have more than one insurance coverage:

  • Medicare is considered your primary insurance
  • Turquoise Care (Medicaid) is your secondary insurance

Your Turquoise Care benefits will not change your primary insurance benefits. Your Care Coordinator will assist you in working with your primary insurance to help set up your health care.

If you have both Medicare and Turquoise Care, Medicare Part D will cover your medication (you will still have to pay Medicare Part D copays), unless you live in a nursing facility. If you have Medicare, you can use your current doctor. You can get Medicare specialty services without approval from Turquoise Care.

We will work with your doctor for the services you get through Turquoise Care. We can help you pick a doctor if you do not have one. This doctor can set up your Turquoise Care and Medicare services. If you are in a Medicare Advantage Plan, your primary care provider (PCP) is your Medicare Advantage doctor.

You do not have to pick another primary care provider for Turquoise Care. Medicare or your Medicare Advantage Plan will pay for your services before Turquoise Care. Turquoise Care may cover some services that are not covered by Medicare.

If you have questions, call Member Services at 1-877-236-0826. For hearing impaired, dial 711 for TTY service.

Your plan covers a long list of medicines, or prescription drugs. Medicines that are covered are on the plan’s Preferred Drug List. Your doctor uses this list to make sure the medicines you need are covered by your plan. 

New Mexico Preferred Drug List

If your medicines are included on the Preferred Drug List, you’re all set. Be sure to show your pharmacist your new member ID card every time you get your prescriptions filled.

If your prescriptions are not on the Preferred Drug List, schedule an appointment with your doctor within the next 30 days. They may be able to help you switch to a drug that is on the Preferred Drug List. Your doctor can also ask for an exception if they think you need a medicine that is not on the list.

Yes, you have thirty (30) days from the date of the letter that you received to change your pharmacy. In special cases, you may be able to request a pharmacy change after thirty (30) days. You will still only be able to use one pharmacy. To change your pharmacy, call Member Services at the number below.

Search online at myuhc.com/communityplan/nm. 

Look through the Provider Directory. 

Call Member Services at 1-877-236-0826 and talk to a Member Advocate or your Care Coordinator. 

UnitedHealthcare Community Plan of New Mexico Turquoise Care Medicaid Dental manages your dental benefits. You may call Member Services at 1-877-236-0826 to find a dentist in the UnitedHealthcare Community Plan New Mexico network.

March Vision manages your vision benefit. You may call Member Services at 1-877-236-0826 or visit their website at www.marchvisioncare.com to find a vision provider.

The Community Benefit (CB) is Turquoise Care’s name for the home and community-based services (HCBS) benefit package. 

The Personal Care Services benefit is also part of CB. 

Community Benefits are services that allow eligible members to receive care in their home or community as an alternative to being placed in a long-term care facility. 

Community Benefits are intended to supplement natural supports and support community living.

Call your primary care provider. The name and phone number is on your ID card. If you need help, call Member Services.

Most services are covered by Turquoise Care. Copays apply in some instances. The only time you pay is when a service is not covered by Turquoise Care or when you get non-emergency service without meeting rules on prior authorization. In these cases, the provider must talk to you first about payment. Even if you fail to pay, you can keep your Medicaid eligibility. 

If a member has been incorrectly overcharged copayments, the member has a right to be repaid by the provider. The HSD Income Support Division (ISD) determines eligibility for most categories of Medicaid. If the member household disagrees with the household income calculation, then the household may request a HSD fair hearing. 

Members have a right to request from UnitedHealthcare Community Plan at any time, an accounting of his or her household’s accrued copayment total(s). If the member disagrees with the MCO’s accounting of accrued copayments, the member may file an appeal directly with UnitedHealthcare Community Plan Member Services. 

If you get a bill from a provider: 

  • Ask why they are billing you 
  • Give them your Turquoise Care information 
  • You do not have to pay bills that UnitedHealthcare Community Plan should pay.

If you get a bill: 

  • Call Member Services at 1-877-236-0826. 
  • Be sure you have your bill when you call. 

You must report other health insurance to your local Income Support Division office. If your private insurance is canceled, you have new coverage, or have questions, call Member Services or your Care Coordinator. Having other insurance does not affect whether you qualify for Turquoise Care.

If you suspect fraud or abuse by a caregiver, medical provider, behavioral health provider, another member or anyone else, you can report it safely without providing your name or identity to the State or to UnitedHealthcare. There are email addresses and websites provided below that you can use to report suspected fraud or abuse 24 hours a day 7 days a week. 

You can report to UnitedHealthcare Community Plan. You can do this by calling your Care Coordinator, by telephone or through our website at: UnitedHealthcare Fraud Hotline: 1-844-359-7736. 

Website: uhc.com/fraud

You can first talk to your doctor or provider if you have questions or concerns about your care. They can work with you on fixing the problem. If the problem isn’t fixed, you can call us. 

You may file a grievance over the phone with Member Services at 1-877-236-0826, TTY 711. 

You may file grievances online at member.uhc.com/CommunityPlan. 

You can send your written grievance to: 

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

Fax: 1-801-994-1082

All members can file an appeal through these processes. You may file an appeal over the phone with Member Services at 1-877-236-0826, TTY 711. 

You may file appeals online at member.uhc.com/CommunityPlan. 

You may also file a written appeal by sending it to: 

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

Fax: 1-801-994-1082

Long-term services and supports (LTSS) refers to a broad range of medical, functional and social services that are needed by individuals who have complex health needs due to aging, chronic illness or disability. These services can be provided in a range of settings, including nursing homes, assisted living facilities, convalescent homes, and home and community-based settings. 

Learn more about New Mexico Turquoise Care


Individual & Family ACA Marketplace Plans Disclaimer
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The benefits described may not be offered in all plans or in all states. Some plans may require copayments, deductibles and/or coinsurance for these benefits. This policy has exclusions, limitations, reductions of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, review your plan documents, call or write your insurance agent or the company, whichever is applicable. Plan specifics and benefits vary by coverage area and by plan category. Please review plan details to learn more.

UnitedHealthcare Individual & Family plans medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in AL, KS, LA, MO, NJ, and TN; Optimum Choice, Inc. in MD and VA; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of Mississippi, Inc.; UnitedHealthcare of New Mexico, Inc.; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Ohio, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of South Carolina, Inc.; UnitedHealthcare of Texas, Inc.; UnitedHealthcare of Oregon, Inc. in WA; and UnitedHealthcare of Wisconsin, Inc.  Administrative services provided by United HealthCare Services, Inc. or its affiliates.

This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company, whichever is applicable. By responding to this offer, you agree that a representative may contact you.

1 Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all members. Check your benefit plan to determine if these services are available. Data rates may apply. Certain prescriptions may not be available and other restrictions may apply.

2 Tier 2 prescriptions for $5 or less not available on all medications. 3-month fills apply to select maintenance medications only. Applicable formulary requirements such as prior authorization and quantity limits may apply to your pharmacy benefits. Walgreens discount valid until 12/31/24. Discount valid only for in-store purchases of eligible Walgreens brand health and wellness products by current members eligible for the UnitedHealthcare discount program. Discount cannot be used online. For a full list of Walgreens brand health and wellness products and exclusions, please visit www.walgreens.com/smartsavings.

Last Updated: 04.18.2024 at 12:11 AM CDT

Disclaimer information
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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

Nurse Hotline disclaimer

This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your provider's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time. Nurse Hotline not for use in emergencies, for informational purposes only.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® (Medicare-Medicaid plan)

UnitedHealthcare Connected® (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® general benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the member handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® member handbook. 

UnitedHealthcare Senior Care Options (HMO SNP) plan

UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health Insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program.

Star ratings disclaimer

Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2024.

Important provider information

The choice is yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non-contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 1-888-638-6613 / TTY 711, or use your preferred relay service.

Declaration of disaster or emergency

If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.