Insurance

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

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 Medicare
BCBS MultiPlan
BCBS Utah Regence Value Care & PPO RMHP
Beech Street Railroad Medicare/Palmeto GBA
Champus TriCare over 65
ChampVA TriWest under 65
CIGNA United Healthcare
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
Great West/Cigna
First Health
Humana

 * We do accept Workers Compensation Insurances and most Motor Vehicle Claims. Please call our office and ask for our Workers Comp / Motor Vehicle Specialists for more information.

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.