Colorado Health Insurance Cooperative

Our records indicate [redacted] was enrolled with her husband, [redacted] , on the Bison HSA EPO plan effective 8/1/ This plan has an aggregate family deductible of $4100.00.The office visit for 9/10/was received on 9/17/and was processed the same date The provider did not bill the charges as preventive services The charges were billed as the treatment of a medical condition For this reason charges are not covered at the preventive benefit level.The total allowable charges were $which was applied to the member's in network deductible The difference of $is the EPO discount and may not be billed to the member The member is financially responsible for paying the $to the provider The claim has been processed correctly and no additional benefits are payable.The Certificate of Coverage, states in pertinent part: "The Annual Deductible must be met before covered charges for these services will be reimbursed."We realize that this is not the answer you were seeking but trust you understand that we are bound by the provisions of the policy If you have any further questions, please feel free to contact member services at 866-915-6619.Sincerely, Jolene CoffmanDirector of Compliance Operations

Although this member sought emergency medical treatment at a contracted hospital facility, the Emergency Room physician, Dr [redacted] , was not contracted Dr [redacted] 's claim was reduced to the reasonable and customary rate and was processed at the In Network Benefit Level applying $to the member's in network deductible.That being said, the charges should not have been reduced to the reasonable and customary rate but should have been allowed at 100% of billed charges The claim has been reprocessed but because the member's in network deductible had not been met, the full billed amount of $has been applied to the members in network deductible.Under the terms of the policy the member's deductible must be satisfied before charges are payable It is the member's financial responsibility to pay the $owed to this provider.If the member has any further questions she can contact member services at 866-915-Sincerely,Jolene CoffmanDirector of Compliance Operations

Final Consumer Response / [redacted] (2000, 6, 2015/05/04) */ This situation has been resolvedThe bill was changed to show the correct sign up period of May 1st