HMO Plans


HMO Service Area

For 30 years, Rocky Mountain Health Plans has maintained a competitive edge in the Colorado marketplace for HMO plans. Currently, RMHP offers a large number of group and individual plans, as well as Medicare HMO plans.


RMHP serves most Colorado counties.

Service Area Map

Getting Care

Show your RMHP Member ID card

Each time you need health care, show your ID card at the provider's office.

 
Choosing a PCP

All RMHP HMO Members must select a primary care physician (PCP). Each covered Member of your family may select a different PCP. If you are new to the PCP you select, call the doctor's office to be sure they are accepting new patients. Be sure the PCP you pick serves the type of plan you are enrolled in. For your convenience, you can use our on-line Provider Directory or call RMHP Customer Service at 970-243-7050 or 800-346-4643 for names of providers in your area. Click here for the Select PCP Form to submit your PCP selection on-line.


Changing your doctor is easy

Click here for the Change PCP Form to submit your PCP change on-line. Each covered Member of your family may select a different PCP. Be sure the new doctor's office is accepting new patients. Contact us by phone or on-line to tell us who your new PCP will be. You must tell us about the change before you see your new PCP. Arrange to have your medical records transferred to your new PCP.


Using participating providers for care

Participating providers are providers that contract with RMHP and thereby become part of the RMHP provider network. Each time you need health care, show your ID card at the provider's office. To be covered, all health care must be provided by participating providers except in medical emergencies and urgent care situations.

Generally, you pay less for care from your PCP than from other providers. If the service you need is covered by your plan but cannot be provided by a participating provider, you may be referred to a nonparticipating provider. Your PCP will work with us to get your care approved and arranged.

Did You Know?

  • Registered Members may use access|RMHP (access now) to  search for, select, or change a PCP. Members who have not yet registered can sign up here.

Preauthorization

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.

Click here to see the list of services requiring preauthorization. Click here to see the list of durable medical equipment and medical supplies that require preauthorization.

RMHP offers an extensive formulary of prescription drugs to members who have prescription drug coverage. Click here to see the Formulary for all prescription drugs, including those that require preauthorization.

Medical Preauthorization Forms

Click on the links below to download preauthorization request forms:

  Preauthorization Request Form (*Pharmacy preauthorizations must be completed on the appropriate, medication-specific PA Form or they will not be processed)
  Home Health Authorization Form
  DME Authorization Form

Click on the link to the left to learn more about Prescription Drug Information.

Did You Know?

  • Registered Members may use access|RMHP (access now)  to check the status of preauthorization requests. Members who have not yet registered can sign up here.


To ensure your pre-service request is completed in a timely manner, please allow:

Medicaid — 10 days         Medicare — 14 days          CHP+ — 15 days           Commercial —15 days

Payment For Services

All Members are responsible for paying any applicable cost-sharing (copays, coinsurance or deductibles) directly to the Provider at the time of service. RMHP will send you an Explanation of Benefits that shows the service you received, the amount billed, the portion of the bill RMHP paid, and what the Member will pay to the Provider.

Did You Know?

  • Registered Members may use access|RMHP (access now) to check the status of claims.  Members who have not yet registered can sign up here.

Mental Health Services

Mental health services are a benefit of most RMHP plans. See your plan materials for your mental health coverage. Members must use the RMHP participating mental health providers. For a provider in your area, see our on-line Provider Directory.