Coverage Information

Claims Payment Policies & Other Information: Retroactive denials

Some claims may be retroactively denied, even after the member has obtained services from the provider. A retroactive denial is the reversal of a previously paid claim, through which the member then becomes responsible for payment.

There are ways to prevent this from occurring. You can:

  • Notify HealthCare.gov promptly of changes that could impact your eligibility or your premium amount owed.

  • Submit requested documentation to HealthCare.gov and/or (issuer name) promptly or within time constraints.

  • Pay your monthly premiums on time

Refunds

Members may obtain a refund of premium overpayment by notifying HealthCare.gov of changes that could impact eligibility or your premium amount owed and then contacting  Customer Service at 855-447-2900. Please note that in some situations, changes to eligibility must be received from HealthCare.gov before the CO-OP can refund an overpayment.

Informative Documents

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Mountain Health CO-OP does not discriminate based on race, color, national origin, disability, age, sex, gender, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

 

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