How to Use Your Medicare Health Plan
(Applies to RMHP Medicare health plan Members only. Not Applicable to Medigap Medicare Supplement Plan Members)
Our Medicare HMO plans were created with our Members in mind. We offer a broad list of preferred drugs, a large list of doctors, specialists and health care facilities, and acclaimed customer service.
Use the detailed information below to help you get the health care services you need and make the most of your Medicare health plan.
- Medicare Service Area – Find out the counties where your Medicare HMO plan is available.
- Getting Care – Find out how to choose and change your primary care physician.
- Preauthorization - Learn what medical services and prescription drugs require preauthorization from RMHP.
- Payment for Services - See which counties require you to pay copays to RMHP or to your provider at the time of service.
- Mental Health Services - Find out if your Medicare HMO plan covers mental health services and how to find a provider.
For more information about using your Medicare health plan, please contact our Customer Service Department at 970-244-7912 or 888-282-1420.
For medical benefit questions, we are open 8:00 a.m. to 5:00 p.m., Mountain Time, Monday through Friday.
- If you are hearing impaired and use TTY equipment, call 800-704-6370.
- Para asistencia en español llame al 800-346-4643.
For Part D prescription drug benefit questions, please call between 8:00 a.m. to 8:00 p.m., Mountain Time, Monday through Friday. From November 15 through March 1, we are also available 8:00 a.m. to 8:00 p.m., Mountain Time, on weekends and most holidays
Medicare Supplement Plan (Medigap) Members:
Medigap Members may receive care from any provider that accepts Medicare. The provider will first bill Medicare, and then the bill will be paid by RMHP. Medigap Members are limited to Medicare-covered benefits according to the standardized plan design you have chosen. Find out more about our Medigap plans by clicking on your region below.
Medicare Service Area
RMHP serves Medicare Members in most areas of Colorado.
*Medigap Plans available statewide in Colorado
*PDP Standalone and Medigap Plans available in all areas.
GETTING CARE
(Applies to RMHP Medicare health plan Members only)
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 health plan 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 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 online Provider Directory or call RMHP Customer Service at 970-244-7912 or 888-282-1420 for names of providers in your area. Use the Select PCP Form to submit your PCP selection online.
Changing Your Primary Care Physician (PCP)
Use our Change PCP Form to submit your PCP change online. 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 online 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.
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.
Did You Know?
Registered Members may use access|RMHP to search for, select, or change a PCP. Members who have not yet registered can sign up here.
Preauthorization
(Applies to RMHP Medicare health plan Members only. Not applicable to Medigap Medicare Supplement Plan Members)
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.
Prescription Drugs
RMHP covers a wide variety of prescription drugs to Members who have prescription drug coverage. To find out which prescription drugs are covered and require preauthorization, please visit our Formularies page.
Did You Know?
Registered Members may use access|RMHP to search for, select, or change a PCP. Members who have not yet registered can sign up here.
Payment For Services
(Applies to RMHP Medicare health plan Members only. Not applicable to Medigap Medicare Supplement Plan Members)
The primary geographic location of the provider determines whether you will need to pay your deductible or copayment to your provider at the time of service, or whether you will pay your copayment directly to RMHP.
Providers include hospitals, physicians, and ancillary services. The copay collection map below shows which counties require deductible and copayment collection at the time of service.
Paying for Services from Participating Providers on the Western Slope
(white counties)
Usually, Members do not pay the provider at the time of service. However, some statewide providers for services such as oxygen and DME will collect the copayment from you. RMHP will send you a Member Billing Statement for any deductible or copayment amounts you owe.
Paying for Services from Participating Providers on the Front Range
(blue counties)
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 RMHP paid, and any remaining amounts you owe.
Services from nonparticipating providers are not covered by RMHP and will require a preauthorization, unless the services are not available from a participating provider or it is an emergency service.
In this limited instance, 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 a copy of the RMHP Direct Reimbursement Form, see Commonly Requested Forms in Member Services.
Did You Know?
Registered Members may use access|RMHP to search for, select, or change a PCP. Members who have not yet registered can sign up here.
Mental Health Services
(Applies to RMHP Medicare health plan Members only)
Mental health services are a benefit of most RMHP plans. See your plan materials to find out if you have mental health coverage.
Members who have a PCP located on the Western Slope must use RMHP participating mental health providers. For a provider in your area, see our online Provider Directory.
Members who have a PCP located on the Front Range must use Life Strategies mental health providers. For a listing of Life Stategies providers, call 1-800-382-6871.
To determine if the Member is in the Western Slope or Front Range, reference the map in the Payment Services section of this page.
Information is current as of 10/1/09. Please call to confirm you have the most up to date information about our Medicare Plans. Click here for a full list of Medicare Disclaimers.
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