PATIENTS WALK IN W/NO CARD

PUT IN AS SELF PAY 100% and have them sign "No Insurance Letter"

No proof of insurance and not certain they do OR will get us a card. However, patient walks in stating that they don’t have their card with them, you can add self pay, and a statement will be sent TO THEM. The letter states that they have to provide a copy of the card or they will be charged.

Insurance - IN NETWORK

11/20/2024

ARE IN NETWORK WITH:

COMMERCIAL and WORKMAN’s COMP PATIENTS

Aetna- PPO, Managed Choice, Elect Choice (EPO) and HMO-

BCBS Indemnity Plans

Blue Cross Blue Shield PPO – ALWAYS OK- PPO in suitcase

Blue Cross Blue Shield HMO- ONLY IN COLORADO- some HMO’s can require a PCP referral

Blue Priority PPO- ALWAYS OK- PPO in a suitcase on the bottom of the card

Blue Priority HMO- MUST HAVE REFERRAL- Empty suitcase or blank on the bottom of the card

BCBS Blue Card (out of state) Not in network for some EPO plans-Has PPO in the suitcase

BCBS Federal-These cards always start with the alpha letter R. This plan is always a PPO plan.

BCBS Mountain Enhanced HMO always have Mountain Enhanced on the card

BCBS Mountain Enhanced STD always have Mountain Enhanced Standard on the card

BCBS Pathway HMO/PPO Only in-network for Colorado Members- always have Pathway on the card

Pathway Standard HMO/PPO/EPO Only in-network for Colorado Members- always have Pathway Standard on the card

BCBS Pathway Essentials HMO/PPO- Grand, Lake, Clear Creek and Park counties ONLY

BCBS Pathway Essentials Standard- Grand, Lake, Clear Creek and Park counties ONLY

Champ VA- Spouse or Children of Veteran who is disabled or deceased

CHP+ Colo Access

CHP+ United Healthcare Community plan/Rocky Mountain Health Plans

Cigna PPO, Open Access Plus, Local Plus and Local Plus IN Not in network Cigna Connect and Sure Fit

EBMS

Corvel

First Health Network- This is not Medicaid look below (NO for First Health Network Limited Benefit Plan)

Freedom Life- Through UMR

Health Partners

Kaiser Choice PPO

Lucent Health Cypress -Through AETNA

Meritain- Through AETNA

Multiplan/PHCS (not all plan types, check website)

PNOA- Provider Network of America

Rocky Mountain Sky- Only seen in Eagle and Summit MUST HAVE A REFERRAL

Tricare Select (EAST and WEST)- Dependents of active service personnel

Tricare Prime- Needs a referral- Dependents of active service personnel

Tricare for Life – Retired or spouse (secondary insurance)

TriWest Healthcare Alliance- Needs a referral- ONLY FOR VETERAN

UCHealth

UMR

United HealthCare - Need referrals for Navigate, Compass, Core and Charter

Workers Compensation- in state only (list is not all inclusive)

Pinnacol Sedgwick

Corvel Liberty Mutual

CTSI ACE/ESIS

CCMSI Broadspire

Berkshire Hathaway Chubb

CMI Walmart Hanover

Gallagher Bassett Zurich

MEDICARE PATIENTS – May not be in contract for ANY HMO OR EPO

AARP Medicare Advantage HMO- MUST HAVE A REFERRAL- on the back of the card will have payer ID 87726West or Life1

Medicare- Must have a mix of alpha characters and numbers or GET A NEW CARD

Railroad Medicare- Must have alpha character or GET A NEW CARD

Humana Medicare Advantage

Cigna Medicare Advantage

United HealthCare Medicare Advantage- on the back of the card will have payer ID 87726

United Healthcare/ Rocky Mountain Health Plans

United DUAL-

Kaiser Medicare- Senior Advantage Choice PPO

Effective 10.01.2024, Dr. Ernest Braxton is not contracted with Medicare and VSON cannot bill Medicare on your behalf for services with Dr. Braxton

MEDICAID

Health First Colorado- Colorado Medicaid

United Health Community Plan/Rocky Mountain Health Plans

Medicare plans we are not in network with but will still bill for

BCBS Medicare PPO

Aetna Medicare Advantage PPO

Priority Health Medicare Advantage

Health Net Medicare Advantage

Health Partners Medicare

Network Health

UCARE

Effective 10.01.2024, Dr. Ernest Braxton is not contracted with Medicare and VSON cannot bill Medicare on your behalf for services with Dr. Braxton

* Please Note * Insurance plan contracts change frequently and it is possible that this list may not be 100% accurate. It is always best to confirm our participation directly with your insurance carrier or by contacting our Billing Department at 866-358-0202.

Rocky Mountain Valley formally known as Sky-Valley Plans

Here are a few items that we need to make sure we continue to do when making appointments for Sky/Valley Plans:

Please list primary care doc in patient’s chart.
If they are not in our system

Send email to Vigil/Jacque to add PCP to our system
Please include address, phone, fax, NPI number of PCP in email.

Below is a good example of what is needed.

to patient Nathan Forrester dob 9/28/50

Fax: 334-588-0492.

Send email or teams to Kathy McAlister/ Toya Patterson, they will build the referral.

PATIENTS WALK IN W/NO CARD

PUT IN AS SELF PAY 100% and have them sign "No Insurance Letter"

No proof of insurance and not certain they do OR will get us a card. However, patient walks in stating that they don’t have their card with them, you can add self pay, and a statement will be sent TO THEM. The letter states that they have to provide a copy of the card or they will be charged.

Insurance - IN NETWORK

ARE IN NETWORK WITH:

*** Please Note *** Insurance plan contracts change frequently and it is possible that this list may not be 100% accurate. It is always best to confirm our participation directly with your insurance carrier or by contacting our Billing Department at 866-358-0202.

Rocky Mountain Valley formally known as Sky-Valley Plans

Here are a few items that we need to make sure we continue to do when making appointments for Sky/Valley Plans:

Please list primary care doc in patient’s chart.

If they are not in our system

Send email to Vigil/Jacque to add PCP to our system

Please include address, phone, fax, NPI number of PCP in email.

Below is a good example of what is needed.

to patient Nathan Forrester dob 9/28/50

Fax: 334-588-0492.

Send email or teams to Kathy McAlister/ Toya Patterson, they will build the referral.

* Please Note * Insurance plan contracts change frequently and it is possible that this list may not be 100% accurate. It is always best to confirm our participation directly with your insurance carrier or by contacting our Billing Department at 866-358-0202.