- Monitor out-of-pocket expenses & deductibles
- Send secure messages
- See eligibility for your services, and more
- View claims
- View medications and pharmacy details
- View your coverage details
Claims
A claim is a request to an insurance company for payment of health care services. Usually, providers file claims with us on your behalf. If you received services from an out-of-network provider, and if that provider does not submit a claim to us, you can file the claim directly within 365 days.
For support, call 800-299-6080.
To review all your claims, log into your Member Portal.
If you have received an Explanation of Benefits (EOB) in the mail or via your portal that includes a description of services as “miscellaneous”, you may request a more detailed EOB. Your EOB is the document that outlines your payment responsibilities and the coverage provided by your insurance plan.
To request a new detailed copy of your EOB or if you have any other questions, please send us a secure message through the Co-Op Member Portal or call us at 800-299-6080. Your request will be to reprocess your claim for more details. Our team is here to assist you in understanding your benefits and addressing any concerns.
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.
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.
Prior Authorization
Mountain Health Co-Op must approve some services before you obtain them. This is called prior authorization or preservice review.
For example, any kind of inpatient hospital care (except maternity care) requires prior authorization. If you need a service that we must first approve, your in-network doctor will call us for the authorization.
If you don’t get prior authorization, you may have to pay up to the full amount of the charges. The number to call for prior authorization is included on the ID card you receive after you enroll. Please refer to the specific coverage information you receive after you enroll.
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.
Your Health Data
Sometimes you may want someone else—like a family member, caregiver, or another professional—to have access to your health information. To do this, you must give us your permission by filling out the consent form below.
Coordinating Benefits
If you have coverage through more than one health plan, use this form to determine the order in which each plan will receive, process, and pay your claims.
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.
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
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.
Employer Plans
Please contact your HR department to report changes.
Some life changes that may require an update:
• Address
• Birth
• Death
• Marriage
• Income +/ -
• Employment status
Individual & Family Plans
Changes must be managed through the platform you purchased your plan.
Mountain Health Co-Op
800-299-6080
If you purchased your plan directly from us – instead of on the Marketplace – fill out and send us this 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: 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.
Company Fax disclaimer: The 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 the fax and any attachment(s). Thank you.
Your Member ID Card
Access your ID card via the Member Portal or request new paper copies.
Paying your bill.
Pay by Mail
Please make checks payable to Mountain Health Co-Op
Individual Members – Mail Payments to:
LB 201593
Mountain Health Cooperative
PO Box 201593
Dallas, TX 75320-1593
Employer Groups – Mail Payments to:
LB 410035
Mountain Health Cooperative
PO Box 35145
Seattle, WA 98124-5145
Express Courier Delivery (Groups or Individual) – Mail to:
Lockbox Services 201593
Montana Health Cooperative
2975 Regent Blvd., Suite 100
Irving, TX 75063
Online Bill Pay
The easiest way to pay your bill.
Please note:
Payment and billing options on the Member Portal are offline as we make system improvements.
Our guest portal is available to make online payments.
Or pay by phone: 800-299-6080.
Tax Information
Each year, Mountain Health Co-Op mails a 1095-B form for tax purposes to members enrolled in off-exchange individual, small group, and catastrophic plans. If you purchased your plan on the exchange, you’ll receive a 1095-A from HealthCare.gov or YourHealthIdaho.org.
For tax year 2026, you can choose to receive your 1095-B electronically—just click below to let us know.
To request a copy of your 2025 1095-B form, please call Member Service at 800-299-6080 or send a secure message through your member 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 800-299-6080.
Please note that in some situations, changes to eligibility must be received from HealthCare.gov before the Co-Op can refund an overpayment.
If you purchased coverage directly and are overbilled for your premium, you may request a refund through the recoupment of overpayment process.
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.
*Ground ambulance is excluded from surprise billing.
You must pay your premium by the scheduled due date to keep your coverage. If you miss a payment, most individual health care plans provide a grace period—a temporary window of time when your coverage stays active even though payment is late.
During this grace period, any medical bills sent to your plan (called claims) will be put on hold, or pended, until your payment is received. If the premium is not paid by the end of the grace period, your coverage may be canceled and those claims will not be paid.
Learn more about grace period and claim status.
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 800-299-6080.
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
