About Your Health Insurance Coverage

About Your Health Insurance Coverage

When you join RMHP, you're trusting us to help guide you on your healthcare journey - and we take pride in that. RMHP offers extra services and personalized assistance that can help you take steps in your journey to better health, no matter what plan you have. We hold accreditation status from the National Committee for Quality Assurance, so you know you're in good hands. Below, you’ll find information that will help you understand your health coverage.


 

mountain green      Becoming an RMHP Member

When you enroll with RMHP, you’ll receive a Member ID card. There’s no activation required for this card; simply take it with you when you need medical or pharmacy services, and your provider’s office will take care of the rest.

When you join, we encourage you to select a Primary Care Provider, or PCP (some plans require you to make a PCP selection). If you need to find an in-network provider, simply use our convenient Online Provider Directory. When you’re ready to make a selection – or a change - you can do so online by completing an easy-to-use form.

Provider Search
Select/Change PCP

We also offer a variety of online tools and resources for you to make the most of your plan with RMHP. With MyRMHP, our secure Member portal, you can:

  • Estimate medical costs of services with our online Cost Estimator tool (not available for Medicare Members)
  • Save a tree and enroll in paperless documents
  • Rate your latest doctor visit
  • Get healthier the easy way with CafeWell by RMHP, our comprehensive online wellness platform (available to Individual & Family and select Employer Groups only)

Log in to MyRMHP

 

building purple      Claims, Billing, and Benefits

Health insurance plans can be complex, and we know you might have questions. We provide tools and resources that can help you find the answers you need. Looking to pay your premium? Our Online Premium Payment makes it easy to make secure, monthly payments online. MyRMHP, our secure Member portal, allows you to estimate your treatment costs and view information about your claims. You can also refer to your Coverage Schedule in the Schedule of Benefits, found in your Health Plan Guide. If you still have questions, our dedicated Customer Service team is here to help you navigate your plan.

Make a premium payment
Log in to MyRMHP

 

computer dark purple      Understanding Prior Authorization

Our goal at RMHP is to make the prior authorization process as easy as possible for our Members. Referrals are not required; however, certain healthcare 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 obtains the necessary prior authorization for you. For services provided by a non-participating provider, it is your responsibility to start the prior authorization process. Failure to have services preauthorized when required will result in a significant reduction in benefits as described in your Health Plan Guide.

You or your provider can submit a prior authorization request here 24 hours a day, 365 days a year. If you are on a PPO plan and receive services from a provider who is not part of the RMHP network, you will be responsible for submitting the prior authorization request yourself by faxing it to 800-262-2567 or 970-255-5681. Please call RMHP’s Customer Service for additional help in understanding or getting prior authorization.

You can view a list of services that require prior authorization below or by calling Customer Service at 970-243-7050 / 800-346-4643.

To ensure your prior authorization request is completed in a timely manner, please allow:

Medicaid
10 days

Medicare
14 days

CHP+
15 days

Commercial
15 days



Services requiring prior authorization
Durable Medical Equipment (DME)
Notification of admission to a facility


heart blue      We Care By  Being Here

We understand that each Member's health is different, so RMHP works with you and your doctors to make sure the health care you receive is high quality, cost-effective, and right for your situation. Our Care Management team includes physicians, registered nurses, care coordinator, and specialists in oncology, diabetes, asthma, and prenatal care.

Learn more

band aid pink       We Help You Manage Your Health

Our Disease Management program provides the support you need to manage your diabetes and heart disease. Our nurses are available to answer your questions and offer advice and care tips. We will also help you work with your provider to follow your individual health care treatment plan.

Members are enrolled in the Disease Management Program based on medical and pharmacy claims. In addition to being enrolled through claims, you can also self-refer to the programs by calling 1-888-847-6466. This is a no cost program that will provide you with education and resources. Certain requirements must be met.

It is your choice to be in these programs, and you may choose to be removed from a program at any time. If you do not want you or your child to take part in these programs, please call us at the number listed above.

If your health condition is more complex we may have a Nurse Case Manager call you. This nurse will work with your provider to make sure you have what you need to stay well.

If you're interested in learning about a particular health topic, we invite you to search the Healthwise Knowledgebase through the MyRMHP secure Member portal.


Search health topics

 

Want More Information?

We’ve created a convenient Frequently Asked Questions for you to find that answers you need, but if you still have questions about our services, we're happy to help you.
 
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