Member Frequently Asked Questions
RMHP offers a variety of plans, so the answers below may differ depending on the RMHP plan through which you receive your benefits. For additional information, see your plan materials or contact Customer Service.
Customer Service
You can contact RMHP Customer Service Monday through Friday from 8:00 a.m. to 5:00 p.m. at 970-243-7050 or 800-346-4643 or email customer_service@rmhp.org
General Questions
If a Member disagrees with a decision made by RMHP and wants to appeal the decision, the Member must use the Dispute Resolution Procedures described in the Health Plan Guide. These procedures vary depending on your RMHP plan.
My Benefits
After enrolling in an RMHP plan, the subscriber will receive a Health Plan Guide that includes a summary of benefits. If you need a replacement Health Plan Guide, you may contact Customer Service.
There are time limits for making changes to your coverage, such as adding your spouse or other dependents to your plan. See your Health Plan Guide for time limits. You can obtain a change form from your employer or by contacting RMHP Customer Service.
Except for Members enrolled on an Indemnity or PHCS plan, eligible under any continued coverage through COBRA, or dependent children, Members who do not reside in the service area are not eligible to receive any benefits. These requirements vary depending on your RMHP plan.
Referrals are not required; however, certain health care procedures and services must be preauthorized by RMHP before you receive them, or you may not get the maximum level of coverage your plan allows. When you see a participating provider, your doctor gets the necessary preauthorization for you. For services provided by a nonparticipating provider, it is your responsibility to start the preauthorization process. Failure to have services preauthorized when required will result in a significant reduction in benefits, as described in your Health Plan Guide. 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.
To ensure your preauthorization request is completed in a timely manner, please allow:
Medicaid — 10 days Medicare — 14 days CHP+ — 15 days Commercial —15 days
Claims
Coordination of Benefits (COB) is when a person has health care coverage under more than one health plan. Refer to your Health Plan Guide for COB provisions and be sure to notify RMHP if you or a covered family Member has medical coverage with another health plan.
Copayments and Deductibles
The subscriber receives a Coverage Schedule that shows how much you pay for the covered health care services listed in the Schedule of Benefits in the Health Plan Guide. It also shows benefits that are limited to a number of treatments, days, visits, or a specific dollar amount. This information for most commonly used services is accessible in Access RMHP for Members, click here to register.
A Member Billing Statement (MBS) will show the health care services you've received and any deductibles or copayments due to RMHP. You will receive a Member Billing Statement (MBS) only when you have received services for which RMHP has already paid the provider in full and for which you must pay your copayment directly to RMHP.
You will receive an Explanation of Benefits (EOB) each time you receive services from a provider who is responsible for collecting your copayment. You will also receive one if you have medical coverage with another health plan. If you have questions about your copayments, coinsurance, or deductibles, the amounts can be found in the Coverage Schedule section of your Health Plan Guide.
Additional Resources for Members
Colorado Division of Insurance
Colorado Division of Insurance, Board of Examiners
Colorado Health Guide
Colorado Quitnet
Colorado Health Online (CBGH)
Mail Order Pharmacy or Online Pharmacy Refills
Leapfrog Group Hospital Quality and Safety Survey Results
Hospital Compare, US Dept of Health & Human Services
Quality Care Finder, Medicare.gov
Prepare for Natural Disasters
Healthwise Knowledge Base
