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Frequently Asked Questions about Managed Care

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No, but the health plan must arrange for a referral to a qualified provider and ensure that you will not have to pay more than if you had been treated by an in-network provider.

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Insurance law requires a 60-day notice when a provider terminates or is terminated from a network and a good faith effort on the part of the carrier to provide adequate notice to covered persons. Without the required notice, health plans must make arrangements for continued care with the doctor for up to 60 days.

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No. All covered benefits provided at an in-network facility should be provided at the in-network benefit level.

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Yes. There is no law prohibiting a provider or managed care plan from terminating their contract with one another at any time with at least 60 days notice. Colorado law does, however, requires that proper notice be given. If not, the provider must continue providing coverage for up to 60 days after termination of the contract.

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If you are in an exclusive provider arrangement contact your managed care plan to arrange for a new PCP or specialty provider. If your plan provides out of network benefits for your particular care you can elect to continue with the previous provider at the out-network benefit level.

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No. Colorado law requires all contracts between providers and managed care plans to contain provisions wherein the provider is prohibited from billing the enrollee when payment for which the plan is responsible is not made. This does not include an enrollee's payment of co-payments, coinsurance or deductibles.

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No. Nothing in Colorado law requires a managed care plan to contract with "any willing provider". This is a contract negotiation issue between the provider and the managed care plan.

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1560 Broadway, Suite 850, Denver, CO 80202 Email
(303) 894-7490 - Phone (800) 930-3745 - Toll Free (303) 894-7455 - Fax