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:

PPO INSURANCE

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.

Cigna Healthcare 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)

HMO NETWORKS

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)

Other

BlueCard World Wide PPO: card must have a suitcase on it

Kaiser Permanente MTNCO HMO PLAN

Medicare

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