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 Pre-Authorizations
- Rights Regarding Insurance Pre-Authorization & Grievance Procedures
- EOBs and Statements
- Billing Problems and MEDICARE Compliance, Payment Plans and Refunds
- Care Credit
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.
|BCBS Utah Regence Value Care & PPO||RMHP|
|Beech Street||Railroad Medicare/Palmeto GBA|
|Champus||TriCare over 65|
|ChampVA||TriWest under 65|
|CNIC||United Health Integrated/GEHA|
|Cofinity||United Medical Resources|
|Colorado Access CHP+||VA Network with written referral only|
|Colorado Medicaid Accountable Care Collaborative|
|Colorado Medicaid||* Workers Comp|
|Coventry||* Motor Vehicle Claims|
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.
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.
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.
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.
EOBs 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.
Billing and Medicare Compliance, payment plans and refunds
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 a 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.