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

Because insurance plans are constantly changing, you are responsible for charges that may deny for out-of-network services.

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 as of January 2019:

PPO INSURANCE

Aetna: 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.

BCBS PPO Plans:

Anthem PPO, PAR, Blue Priority PPO Tier 2, FEP, WellChoice PPO Tier 1, Colorado Anthem Medicare PPO, Blue Card World Wide PPO, Blue Card: must have a PPO in a suitcase logo on ID card; or can utilize the indemnity network of there is an empty suitcase logo. Out of network if PCP on card.

BCBS HMO Plans: Colorado HMO, (HMOC) Colorado Pathway HMO: Colorado 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.

Aetna PPO:  see above for eligible plans

Anthem BCBS PPO:  see above for eligible plans

Cigna Healthcare PPO

Cofinity: all PPO plans

Humana: Choice Care PPO

Rocky Mountain Health Plans PPO

Rocky Mountain Health Plans PPO

United Healthcare PPO

Unicare (administered by BCBS)

HMO NETWORKS

Anthem BCBS of Colorado HMO: see above for eligible plans

Colorado Access CHP Plus HMO

Colorado Medicaid (State health plan):  up to age 18, limited > 19

Kasier Permanente: MTNCo plan only (only until 31 December 2019)

Rocky Mountain Health Plans HMO

Rocky Mountain CHP Plus HOM, Prime

United Healthcare HMO: Colorado

United Healthcare Nexus ACO

United Healthcare HMO: Out of state (point of service plan only)

United Healthcare Nexus ACO R (referral required)

Other

Medicare-Novitas

Multi Plan Private Health Care Systems (PHCS) eff 1.1.19

Triwest – Tricare Prime (non-network participating provider): Referral is required. Patient is responsible for obtaining referral.

Tricare – Remote (non-network participating provider): Referral is required. Patient is responsible for obtaining referral.

TriWest – Tricare Standard/Reserve Select (non-network participating provider)