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Rocky
Mountain Orthopaedic Associates will help in any way we can with
your insurance requirements, physician referrals and payment for
services. Please click on any of the links below for information.
Insurance Plans That We
Participate In
Other Insurance Plans
Co-pays and Deductibles
Medical Discount Card Plans
Referrals and Preauthorizations
EOB's and Statements
Billing Problems and
MEDICARE Compliance
Payment Plans
Refunds
Insurance Plans That We Participate In
All of our
physicians participate with MEDICARE, MEDICAID, and many private
insurance plans (see plan list below - as of October 1, 2002 ).
We will bill these insurance companies on your behalf and make every
effort to resolve any billing problems that arise. Not every physician
in our group participates with every plan listed. Our reception
staff will be happy to provide you with more information when you
call for an appointment.
PLEASE NOTE:
Insurance plan contracts change frequently and it is possible that
this list may not be 100% accurate. We try to update our website
regularly, but it is always best to confirm that we participate
with your insurance when making your appointment.
- AETNA
- Affordable
- America's Health Plan
- Blue Cross/Blue Shield of Colorado
- Beech Street
- CCIA
- CCN
- CHAMPUS/TriCare
- CHP+ (through Rocky Mountain HMO only)
- CIGNA
- Colorado Child Health Plan (through HMO Colorado only)
- First Health
- GEHA
- HMO Colorado
- HUMANA
- Mailhandlers Insurance
- MEDICAID (Colorado and Utah)
- MEDICARE
- Mountain Medical Affiliates
- One Health Plan (Great West)
- Pacificare
- Pinnacol Assurance
- Private HealthCare Systems (PHCS) - Terminated 12/31/1999
- Railroad Medicare
- Rio Grand Hospital Association
- Rocky Mountain HMO
- Rocky Mountain HMO MEDICARE and MEDICAID
- Sloan's Lake Managed Care Plan
- Trauma Care Network (QMC3)
- United HealthCare
- Wausau
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Other Insurance Plans
There are
also many insurance plans that we do not contract with to be plan
providers. This may be because of unacceptable contract provisions,
insufficient "covered lives" in our service area, or it may be an "open
plan" that does not contract for services. As a courtesy to our patients,
we will still bill these insurance carriers on your behalf. However, if
the insurance company does not respond to the bill in a timely manner (60
days from the time the bill is properly submitted), we will contact you
for payment and provide you with the necessary information to seek reimbursement
from the insurance company. Return to top
Co-pays and Deductibles
Many
insurance plans require that we collect co-pays and/or deductibles from
the patient. By law we cannot waive these fees. MEDICARE has enacted
tough penalties for providers who do not make a diligent effort to collect
these payments from the patient.
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Medical
Discount Card Plans
RMOA does not participate with any of the "Medical
Discount Card" plans. Members of any of these plans are personally
responsible for payment at time of service. We will provide you with
copies of your bill to submit to the plan yourself.
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Referrals and
Preauthorizations
Many
private insurance plans require referrals and/or preauthorizations for
some types of services. Because of the multitude and complexity
of plans, our office may not be aware of the requirements of your
particular health plan. We strongly advise that you read your plan
materials or consult with the plan's customer service department
to determine if there are any special requirements. If
you do not get the necessary referrals or preauthorization, the insurance
company will often refuse to pay the bill and you will be responsible
for payment. In some cases it may be necessary to reschedule your
appointment until the required referral or preauthorization is obtained. We
will be glad to assist you in obtaining these items and answering
any questions that we can. Return to top
EOB's and Statements
In most
cases you will receive an EOB (Explanation of Benefits) from your
insurance carrier outlining what was billed and what was paid. The EOB
should also provide an explanation of any amounts that you owe. There are
many different formats and codes used by the various insurance companies.
If you have questions regarding the information contained on your EOB, it
is usually best to call the member services department at the insurance
company. If you have questions about the services shown on the EOB, please
call our billing department.
If you
would like an itemized statement for your records we will be happy to
provide you one on request.
If there
are unpaid balances on your account, you should receive statement from us,
even if we are billing your insurance company. Items pending from the
insurance company will show on your bill, but should indicate that we are
waiting for payment from them. If you have questions about your statement
please contact our billing department.
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Billing Problems
and MEDICARE Compliance
It is the
policy of our organization and each of the physicians to comply with
MEDICARE guidelines and other federal/state regulations regarding the
provision of services and billing.
If you
notice any discrepancy on your bill (such as an item or service that has
been billed that you did not receive) please contact our billing department
as soon as possible. If the problem is not resolved, please contact
our operations manager or CEO. Return to top
Payment Plans
If you are
uninsured or are responsible for a portion of your bill, you will
be expected to make payment at the time of service. If you cannot
pay for your care at the time of your visit, please contact our billing
office prior to your appointment to determine if you qualify for a deferred
payment plan. Our staff will work with you to arrange a reasonable payment
schedule for the services you require. Return to top
Refunds
In the
event that an overpayment or duplicate payment is made, we will make a
refund to the patient or insurance company as soon as possible (normally
within 5 business days).
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Rocky Mountain Orthopaedic Associates Physicians:
Kirk D. Clifford, MD
Mary Beth Deering, MD
Michael P. Dohm, MD
Michael Dolecki, MD
David P. Fisher, MD
Robert L. Frazho, MD
James S. Gebhard, MD
Steven J. Heil, MD
Sandra A. Horvath-Dori, MD
Michael J. Huang, MD
Mark G. Luker, MD
David M. Mayer, MD
Jeffrey M. Nakano, MD
Michael T. Reeder, DO
Michael D. Rooks, MD
James K. Weaver, MD
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