- Monitor out-of-pocket expenses & deductibles
- Send messages
- See eligibility for your services, and more
- Upload receipts for eye and vision exams
- View claims history
- View medications and pharmacy details
- View your coverage details and estimate costs
- Find providers and more...
Claims
Not all providers bill insurance for you, but that doesn’t mean the service isn’t covered. File a claim to recover a provider fee if the service is covered under your plan.
The best way to manage claims is in the Member Portal.
To Expedite your Claim Request
• Make sure the bills identify the patient.
• All bills should show the date of treatment, description of service, and amount of charges.
•Procedure Codes and Diagnosis codes must be included or claim form will be returned.
•All statements should have Member identification number listed.
Your Health Data
Appeals
If your claim is denied and you disagree with this decision you may file an appeal within 180 days from receipt of the claim determination. Learn more about appeals.
Coverage Decisions
All utilization review decisions and care management actions are based on a determination of appropriateness of care and service according to the benefit coverage for the member.
The CO-OP provides no incentive or reward for issuing denials of coverage.
There is no use of incentives to encourage barriers to care and services. Utilization Review decisions are based on nationally recognized criteria, plan benefits and adherence of utilization management policies and procedures.
External Review for Claim Denials
If you appeal a claim and were still denied you can request a review of the circumstances. In most cases, before filing an external review, you must first exhaust your internal grievance and appeal rights.Â
Tip: Expedite your Claim Request
• Make sure the bills identify the patient.
• All bills should show the date of treatment, description of service, and amount of charges.
• Procedure Codes and Diagnosis codes must be included or claim form will be returned.
• All statements should have Member identification number listed.
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.
Ways to prevent this from occurring
Notify HealthCare.gov promptly of changes that could impact your eligibility or your premium amount owed. See reporting changes.
Submit requested documentation to HealthCare.gov and/or (issuer name) promptly or within time constraints.
Pay your monthly premiums on time. See billing.
Reporting Changes & Canceling Policy
Some life changes that may require an update:
• Address
• Birth
• Death
• Marriage
• Income +/ -
• Employment status
Why is this required?
Any life changes must be reported to your policy to ensure claims are processed properly.
If you don’t report life changes, you may be at risk of claim denials.
Employee Plans
Please contact your HR department to report changes.
Individual & Family Plans
Changes must be managed through the platform you purchased your plan.Â
Mountain Health CO-OP
855-447-2900
If you purchased your plan directly from us – instead of on the Marketplace – fill out and send us the form.
Your Health Idaho
855-944-3246
Report online via your account YourHealthIdaho.org
Marketplace / Exchange
800-318-2596
Report online via your account healthcare.gov
Fine print
Member email disclaimer:Â Please keep in mind that communications via email over the internet are not secure. Although it is unlikely, there is a possibility that information you include in an email to Mountain Health CO-OP can be intercepted and read by other parties besides the person to whom it is addressed.Â
Company Fax disclaimer:Â This fax and any attachment(s) is/are for authorized use by the intended recipient(s) only and must not be read, distributed, disclosed, used or copied by or to anyone else. If you are not the intended recipient, please notify the sender immediately and securely and permanently destroy this fax and any attachment(s). Thank you.
Digital ID Card
Access your ID card on any mobile device via the Member Portal or request new paper copies.
Request New Paper ID Card
Reading your Member ID Card
Paying your bill.
Pay by Mail
Please make checks payable to Mountain Health CO-OP
Mail
LB 410035
Mountain Health Cooperative
PO Box 35145
Seattle, WA 98124-5145
Express Mail payments:
Lockbox Services-#410035
18035 Sperry Dr
Tukwila, WA 98188-4750
Online Bill Pay
The easiest way to pay your bill.
Employer Groups
Pay by logging into the Employer Portal.
Refunds
Members on Individual plans purchased through HealthCare.gov 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 Member Services 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.
Surprise Billing
When you get emergency care, or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.Â
*Ground ambulance is excluded from surprise billing.
Maximize coverage by learning how to use your plan best.
Transparency in Coverage
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
*Applies only to individual members who purchased their plan through healthcare.gov.
In and out-of-network rates
Surprise Billing
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
For more information on surprise billing, click the following link: Balance Billing Disclaimer
Refunds
Individual 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 Member Services 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.
Policy Documents
More Helpful Info