How to Use RMHP Medicare Cost Plans

Want to learn how to use Medicare plans? 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 (TTY dial 711).  Hours are 8am - 8pm, & days/week, Oct. 1-Feb.14, and 8am – 8pm, M-F, Feb 15-Sept 30.

GETTING CARE

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 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.

Preauthorization

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.  (Effective 7/1/2014)

Preauthorization Request Form
DME Authorization Form

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.

Complaints, Coverage Determinations and Appeal

To see a summary of the RMHP grievance, coverage determination (including Medicare Part D exceptions), and appeals processes, click here


Part D Coverage Determinations and Appeals

 

See Chapter 2 in the Evidence of Coverage for instructions on how to request a Part D coverage decision or appeal by phone, fax, or mail. Click here to see how or if your drug is covered.

Click here to see the Medicare Prescription Coverage Determination Request Form.

Click here to see the Redetermination Request (Appeal) Form to request an appeal of a Medicare prescription drug denial.

If you wish to request a coverage decision about your Medicare Part D prescription drug benefit through our website, click here.

If you wish to file an appeal through our website, click here. PLEASE NOTE: You must make your appeal request within 60 calendar days from the date on the written notice we sent to tell you our answer to your request for a coverage decision.

For more information on making an appeal or asking for coverage decisions about your Part D prescription drugs, see Chapter 9 in the Evidence of Coverage for your plan.

For information on how to file or check on the status or process of an appeal, or to obtain an aggregate number of grievances, appeals, and exceptions filed with Rocky Mountain Health Plans, call customer service department at 888-282-1420 (TTY dial 711).  Hours are 8am - 8pm, & days/week, Oct. 1-Feb.14, and 8am – 8pm, M-F, Feb 15-Sept 30.

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.

Payment For Services

Paying for Services from Participating Providers

Members pay the provider at the time of service. Providers include hospitals, physicians, ancillary services and pharmacies.

Paying for Services from Non-Participating Providers

Services from non-participating providers are typically not covered by RMHP, except for emergency services or services that have been preauthorized. For emergency services, Members pay the provider at the time of services and submit a reimbursement form to RMHP. For a copy of the RMHP Direct Reimbursement Form , see Commonly Requested Forms in Member Services.

 

Mental Health Services

Mental health services are a benefit on all RMHP Medicare Cost plans.

Members must use the RMHP participating mental health providers.  For a provider in your area, see our on-line Provider Directory.


Medicare National Coverage Determinations

From time to time, Medicare makes decisions regarding the coverage of items and services. These decisions are called Medicare National Coverage Determinations (NCD).  Medicare may begin covering an item or service or change the way an item or service is covered. We want to make sure our Members have the most up-to-date information regarding NCDs.

Click on the link to see information regarding specific NCDs


RMHP's contract with Medicare 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: 3/1/15.  Please call to confirm you have the most up to date information about our Medicare Cost plans. Medicare Disclaimers

RMHP is a Medicare-approved Cost plan. Enrollment in RMHP depends on contract renewal. H0602_MS_MC300WEB_RMHP6 Pending

Star Rating

For the 2015 plan year, Rocky Mountain Health Plans received a Medicare 3.5-Star Overall Plan Rating.**

**You can view RMHP’s overall Medicare Plan Rating here. Plan performance summary star ratings are assessed each year and may change from one year to the next. You can find more information on RMHP plan ratings at www.medicare.gov. By clicking on this link, you will be leaving the RMHP website.

 

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.