Billing and Insurance
General Insurance Guidelines
Each insurance policy is different, depending upon:
- Your insurance company
- The amount of coverage that is part of your healthcare benefits package
- Your specific policy
Patients may be required to obtain authorization from their insurance company before they can receive treatment. It is a patient’s responsibility to obtain all necessary authorizations from their insurance company. To find out the details of your policy, contact the Customer Service or Member Services Department at your insurance company (the phone numbers are on your insurance card or in your benefits book).
Contracted insurances accepted by Colorado Mountain Medical:
Aetna PPO: PPO Plans, Choice POSII, Elect Choice, Open Access Elect Choice, Aetna Select, Open Access Aetna Select, Open Choice, Managed Choice, Open Access Managed Choice, Traditional Choice (PPO), Dependent Out of Area Plan-TC, Dependent Out of Area Plan-PPO, HealthFund Managed Choice, HealthFund Choice POSII, HealthFund Open Access Elect Choice, HealthFund Open Choice, HealthFund Open Access Aetna Select, HealthFund PPO HSA, Health Fund MC HSA, Cofinity, Aetna Signature Plans.
Anthem BCBS PPO: Anthem PPO, Blue Priority PPO, Colorado Pathway, FEP, Blue Card/Out-of-State: must have a PPO in a suitcase logo on ID card; or can utilize the indemnity network of there is an empty suitcase logo.
BCBS PPO: Anthem PPO, Blue Priority PPO, Colorado Pathway, FEP, Blue Card/Out-of-State: must have a PPO in a suitcase logo on ID card; or can utilize the indemnity network of there is an empty suitcase logo.
BCBS HMO: Colorado HMO, (HMOC) Colorado Pathway HMO: Pathway X,Pathway, Pathway Network, and Mountain Enhanced HMO.
Cigna PPO: GWH-CIGNA, GWH-CIGNA Open Access Plus, SOS International, Choice Fund OA Plus, Open Access Plus, Local Plus, Local Plus IN Vantage, Local Plus Choice Fund, Local Plus IN Choice Fund, PPO.
Cofinity: all PPO plans
Colorado Access CHP Plus
Humana: Choice Care PPO
Rocky Mountain Health Plans PPO
Rocky Mountain CHP+
United Healthcare PPO
Unicare (administered by BCBS)
Anthem BCBS of Colorado: Colorado HMO, (HMOC) Colorado Pathway HMO: Pathway X, Pathway, Pathway Network, and Mountain Enhanced HMO.
Colorado Access CHP Plus HMO
Rocky Mountain Health Plans HMO
United Healthcare HMO Colorado
United Healthcare HMO– Out of state – point of service plan only)
United Healthcare Nexus ACO (referral required)
BlueCard World Wide PPO: card must have a suitcase on it
Kaiser Permanente MTNCO HMO PLAN
Medicaid Standard: up to age 18. Limited after age 19
Triwest/Tricare Prime (non-network participating provider REFERRAL NEEDED) patient responsible for referral.
Triwest/Tricare Standard/Remote/Reserve Select (non-network participating provider)
*Patients are responsible for charges that are denied for out of network services