Members

Welcome CO-OP Members

Access your plan

All your medical details in one place online.

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. 

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.

*Applies only to individual members who purchased their plan through healthcare.gov.

Reporting Changes

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. 



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: 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: 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 and request new paper copies.

Or download through our partner University of Utah Health Plans.

Search for University of Utah Health Plans or UUHP in your app store.  

How to Login on the App

The login is your Member ID number.
The pin is the last four digits of your Member ID number.

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

Employer Groups
Pay by logging into the Employer Portal.

Online Bill Pay
The easiest way to pay your bill is through your Marketplace account.

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.

Surprise Billing

If you used an in-network provider, but still recieved a massive bill you may have been subjected to Surprise or Balance 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

Medicare Supplement Insurance

Coverage doesn't have to end where Medicare leaves off.

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.