How to Use Your Medicare Health Plan
(Applies to RMHP Medicare Cost plan Members only. Not Applicable to Medigap Medicare Supplement Plan Members)
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Medicare 5-Star Member Satisfaction Rating in 2011.**
**Member Satisfaction rating comes from the 2010 CAHPS survey results as featured in Medicare & You 2011. This is the star rating for Ratings of Health Plan Responsiveness and Care for 2011 Plan Ratings. You can find more information on RMHP plan ratings at www.medicare.gov. Star ratings are assessed each year and may change from one year to the next.
Use the detailed information below to help you get the health care services you need and make the most of your Medicare Cost plan.
For more information about using your Medicare Cost plan, please contact our Customer Service Department at 888-282-1420 toll free, 8:00 a.m. to 8:00 p.m., Mountain Time, 7 days a week.
- TTY 711
- Para asistencia en español llame al 888-282-1420.
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Medicare Supplement Plan (Medigap) Members (Plans A, C, F, G and N)
Medigap Members may receive care from any provider that accepts Medicare. The provider will first bill Medicare, and then the bill will be paid by RMHP. Medigap Members are limited to Medicare-covered benefits according to the standardized plan design you have chosen. Find out more about our Medigap plans by clicking on your region below.
RMHP Medicare Service Area
RMHP serves Medicare Members in most areas of Colorado.
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GETTING CARE
(Applies to RMHP Medicare Cost plan Members only. Not applicable to Medigap Medicare Supplement Plan Members)
Using Your RMHP Member ID card
Each time you need health care, show your ID card at the provider's office.
Choosing a Primary Care Physician
All RMHP Medicare Cost plan Members must select a primary care physician (PCP). Each member may select a different PCP. If you are new to the PCP you have chosen, call the doctor's office to be sure they are accepting new patients. Be sure the PCP you pick serves RMHP Medicare Cost plan Members. For your convenience, you can use our online Provider Directory or call RMHP Customer Service at 888-282-1420 for names of doctors in your area.
You can call 8:00 a.m. to 8:00 p.m., Mountain Time, 7 days week.
• TTY: 711
• Para asistencia en español llame al 888-282-1420.
You can tell Customer Service who you choose as your PCP or use the Select PCP Form to submit your PCP selection online.
Changing Your Primary Care Physician (PCP)
Be sure the new doctor's office is accepting new patients. Call us by phone or use our Change PCP Form to submit your PCP change online. You should tell us about the change before you see your new PCP. Arrange to have your medical records transferred to your new PCP.
You may choose, without RMHP approval, to use a nonparticipating provider to receive Medicare covered benefits.
In this case, RMHP will not be responsible for payment. You will pay the provider any required Medicare copayments, coinsurance, and/or deductibles when you receive health care services. The provider will bill Medicare for the services provided.
You Can Access Online Services 24/7
Registered Members may use access|RMHP to
- Search for, select, or change a PCP.
- View your claims
- View your service authorizations
- Order a new ID card
- Research health conditions
Members who have not yet registered can sign up here.
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Preauthorization
(Applies to RMHP Medicare Cost plan Members only. Not applicable to Medigap Medicare Supplement Plan Members)
Medical Services
RMHP must preauthorize certain services before you receive them, even if you receive them from a participating provider. Participating providers are responsible for obtaining required preauthorizations. Examples of services that may require preauthorization include hospital admissions, surgery, computerized tomography (CT) scans, and some durable medical equipment.
Download the full list of services requiring preauthorization and the full list of durable medical equipment and medical supplies that require preauthorization.
Medicare Part D Prescription Drugs
RMHP covers a wide variety of Medicare Part D prescription drugs to Members who have signed up for prescription drug coverage. To find out which prescription drugs are covered or require preauthorization, please visit our Formularies page.
You Can Access Online Services 24/7
Registered Members may use access|RMHP to
- Search for, select, or change a PCP.
- View your claims
- View your service authorizations
- Order a new ID card
- Research health conditions
Members who have not yet registered can sign up here.
Complaints, Coverage Determinations and Appeals
To see a summary of the RMHP grievance, coverage determination (including Medicare Part D exceptions), and appeals processes, click here.
For information on how to file or check on the status of an appeal, call Rocky Mountain Health Plans Customer Service at 888-282-1420 8:00 a.m. to 8:00 p.m., Mountain Time, 7 days week.
• TTY 711
• Para asistencia en español llame al 888-282-1420
If you wish to authorize another individual to make requests, obtain information or present information to us on your behalf, you must complete the Appointment of Representation Form and send it to RMHP, PO Box 10600, Grand Junction, CO 81502.
If you would like to submit a complaint to Medicare regarding your health plan, click here. By clicking on this link, you will be leaving the RMHP website.
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Payment For Services
(Applies to RMHP Medicare Cost plan Members only. Not applicable to Medigap Medicare Supplement Plan Members)
The primary geographic location of the provider determines whether you will need to pay your deductible, copay, or coinsurance to your provider at the time of service, or whether you will make your payment directly to RMHP.
Providers include hospitals, physicians, and ancillary services. The copay collection map below shows which counties require deductible, copay, or coinsurance collection at the time of service (Provider collects) or if you will be billed by RMHP (RMHP collects). You will always pay a Pharmacy at the time of service for Medicare Part D prescription drug costs.
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Paying for Services from Participating Providers on the Western Slope
(white counties)
Usually, Members do not pay the provider at the time of service on the Western Slope. However, some statewide providers for services such as oxygen and DME will collect the cost share payment from you. RMHP will send you a Member Billing Statement for any deductible, copay, or coinsurance amounts you owe to RMHP.
Paying for Services from Participating Providers on the Front Range
(blue counties)
Members pay the provider at the time of service on the Front Range. RMHP will send you an Explanation of Benefits that shows the amount the provider charged, the portion of the bill RMHP paid, and any remaining amounts you owe to the Provider.
Services from nonparticipating providers are typically not covered by RMHP and will require a preauthorization, unless it is an emergency service.
In this limited instance, Members pay the provider at the time of service. You may have to pay the provider in full and submit a reimbursement form to RMHP. For a copy of the RMHP Direct Reimbursement Form, see Commonly Requested Forms in Member Services.
You Can Access Online Services 24/7
Registered Members may use access|RMHP to
- Search for, select, or change a PCP.
- View your claims
- View your service authorizations
- Order a new ID card
- Research health conditions
Members who have not yet registered can sign up here.
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Mental Health Services
(Applies to RMHP Medicare Cost plan Members only. Not applicable to Medigap Medicare Supplement Plan members.)
Mental health services are a benefit on all RMHP Medicare Cost plans.
If you reside in one of the following Colorado counties, you are required to use certain providers for mental health care to be covered by RMHP. These providers are listed in the Provider directory with a network listing of Life Strategies:
Adams, Alamosa, Arapahoe, Bent, Boulder, Broomfield, Chaffee, Cheyenne, Clear Creek, Conejos, Costilla, Crowley, Custer, Denver, Douglas, Elbert, El Paso, Fremont, Gilpin, Hinsdale, Huerfano, Jefferson, Kiowa, Kit Carson, Larimer, Las Animas, Lincoln, Logan, Mineral, Morgan, Otero, Park, Phillips, Prowers, Pueblo, Rio Grande, Saguache, Sedgwick, Teller, Washington, Weld and Yuma counties.
Medicare National Coverage Decisions
From time to time, Medicare makes decisions regarding the coverage of items and services. Medicare may newly cover an item or service or change the way an item or service is covered. We want to make sure our Members have access to this up to date information regarding these national coverage determinations (NCDs). See the information below regarding recent changes to the way Medicare covers items or sevices.
Currently there are no recent updates to Medicare National Coverage Decisions.
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RMHP's contract is renewed annually. The availability of coverage beyond the end of the current contract year is not guaranteed. RMHP has contracted with Medicare to provide benefits since 1977.
This page was last updated 10/01/11. Please call to confirm you have the most up to date information about our Medicare Plans. Full list of Medicare Disclaimers.
H0602_1037023 MC150WEB Pending Approval
