PPO Plans

PPO Service Area

Rocky Mountain Health Plans maintains a competitive edge in the Colorado marketplace for preferred provider organization (PPO) plans. RMHP offers a growing number of PPO group and individual plans to meet a wide range of health benefits needs.

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 doctor

Many RMHP PPO members must select a primary care physician (PCP). Check your plan materials to see if you must select a PCP. If you are new to the PCP you pick, 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. Most services are covered by both participating and nonparticipating providers. Check your plan materials to see which benefits are covered by nonparticipating providers. If you go to a participating provider, you pay less for covered health care services. You pay more for covered health care services when you receive them from a licensed health care provider who does not participate with RMHP.

National Network Access

RMHP Members have access to our national network through First Health. Learn more about our National Network Access.

RMHP's Colorado Group PPO Health Plans provide access to a national network of providers for enrolled Members.  Learn more about National Network Access.  Coverage is also available through out-of-network providers, with higher out-of-pocket costs.


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

Payment For Services

PPO members have the option of receiving covered services from participating and nonparticipating providers.

Services from participating providers

Members pay the provider at the time of service. RMHP will send you an Explanation of Benefits that shows the amount the provider charged, the portion of the bill that RMHP paid, and any amounts you may owe. When you see a participating provider, you cannot be charged more than your copayment, coinsurance, or deductible for a covered service.

Services from nonparticipating providers

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 reimbursement. If the nonparticipating provider charges more for a covered service than the plan normally pays, you may have to pay the difference. For a copy of the RMHP Direct Reimbursement Form, see Commonly Requested Forms in Member Services.'


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. For a provider in your area, see our on-line Provider Directory.