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.
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.
Nationwide network
You have access to a nationwide network of participating providers through Health Directions, our partnership with Private Healthcare Systems (PHCS).
As you know, your out-of-pocket costs are less when you use participating providers than when you use nonparticipating providers. When you or our covered family members use PHCS Health Directions providers for health care services outside of Colorado, the services will be covered as in-network benefits, resulting in a lower cost to you than using nonparticipating providers. You may not use PHCS Health Directions providers within Colorado for in-network benefits.
Your member ID card shows that you have access to this extended provider network. Simply present your ID card to a PHCS Health Directions provider when you receive health care services, and they will do the rest. Visit www.phcs.com for information on available network providers. If you have questions, please call RMHP Customer Service.
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
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.
Click on the link to the left to learn more about Prescription Drug Information.
Did You Know?
- Registered Members may use Access RMHP to check the status of prequthorization requests. Members who have not yet registered can sign up here.
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 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 who have a PCP located on the Western Slope must use RMHP participating mental health providers. For a provider in your area, see our on-line Provider Directory.
Members who have a PCP located on the Front Range must use Life Strategies mental health providers. For a listing of Life Strategies 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 for Services section of this page.