Quality Assurance Policies & Procedures
Colorado Choice Health Plans is committed to our Members and the Communities within which we serve. We are dedicated to improving the quality of life through the delivery of healthcare coverage and programs to our Members. Living and working in rural communities, we understand the challenges of ensuring access to healthcare.
Colorado Choice Health Plans strives to ensure that its members receive the utmost Quality Management and Utilization Management. Colorado Choice ensures that the programs are organized, productive, and comply with established goals and objectives. Colorado Choice’s goals with regard to our care management program include keeping care local where appropriate as well as ensuring care returns to our local providers at appropriate times, making it easier on our members and their families. We aim to make healthcare more available and affordable while at the same time providing exceptional service. In order to achieve this we build strong partners in our communities and in supporting the needs of our Members.
Quality Management ensures that the organization monitors the level of care provided by the plan and its health care providers, identifies problems, chooses and examines solutions to those problems, regularly monitors the solutions implemented, and refines solutions as needed for continued improvement. Colorado Choice believes that our Members have the right to quality healthcare services as close to home as possible.
Utilization Management is our systematic program for monitoring, evaluating, and improving the appropriateness and accessibility of health care services provided by the plan to all its members.
Additional information about our Quality Improvement Program is available upon request. Please contact member services to request this information at 719-589-3696 or 1-800-475-8466, TTY users should call 1-800-659-2656.
Colorado Choice Health Plans is a health plan with a Medicare Contract. Enrollment in Colorado Choice’s Medicare cost plan depends on contract renewal.
This information is not a complete description of benefits. Contact the plan for more information.
Limitations, copayments, and restrictions may apply.
You are eligible to enroll if you are entitled to Medicare Part A and/or enrolled in Medicare Part B and you live in the Colorado Choice Health Plans service area. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. Eligible beneficiaries can enroll in Colorado Choice at any time.
You can use any doctor who is part of Colorado Choice’s network. You may also go to doctors outside of our network. We may not pay for services you receive outside of our network, but Medicare will pay for its share of charges it approves. You will be responsible for paying the Medicare deductible and coinsurance for those services, unless they were authorized in advance by Colorado Choice.
Please reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment and any applicable conditions associated with using the plan benefits.
Information is available in alternative formats or languages. Please call 1-800-475-8466 (TTY users should call 1-800-659-2656) for details. Se puede presentar la información acerca del plan en un formato o idioma distinto. Para solicitar un documento en español, favor de llamar a Atención al Cliente, al número telefónico indicado debajo.
For more information, contact Customer Service at 719-589-3696 if calling from within the San Luis Valley or at 1-800-475-8466 if calling from outside the San Luis Valley. (TTY users should call 1-800-659-2656). Hours are 8:00 am to 8:00 pm, 7 days a week , Oct 1 – Feb 14, and 8:00 am to 8:00 pm., Monday through Friday, Feb 15 – Sep 30. (Para asistencia en Español, llame al 719-589-3696 o al 1-800-475-8466).
Information is current as of 6/30/2016. Please contact our Customer Services department to verify that you have the most up to date information.
H0657_2016 Website Plan Information