Coverage Information

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

Refunds

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  Customer Service at 855-447-2900. Please note that in some situations, changes to eligibility must be received from HealthCare.gov before MHC can refund an overpayment.

Informative Documents

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Montana Health CO-OP does not discriminate on the basis of race, color, national origin, disability, age, sex, gender, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

 

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