What is Monument Health?
Monument Health is a clinically integrated network, which is a team of independent health care providers working with you and with each other to provide better health care at a lower cost.
What does having Monument Health mean for me?
If you are a member of a Monument Health network plan, we encourage you to select high-performing providers and facilities (designated in our network as Tier 1), where you will have accessible, appropriate and more affordable care. You will have guaranteed access to our primary care practices, and efforts will be made to accommodate your urgent needs with same-day or next-day appointments. If you need specialty care, it will be provided right here, close to home. And because our providers work together as a team and confidentially share data, you are less likely to experience repeated or duplicated tests and procedures; this saves you frustration and money.
Why is Monument Health changing the way things are done?
Things in health care are ever-changing, access to care is diminishing and costs are on the rise. Monument Health’s founding partners and its network providers believe a different approach to health care is necessary–specifically a truly integrated approach–which offers better care and lower costs, and eventually a healthier Mesa County. We are committed to this approach now and well into the future.
What are Monument Health providers doing differently to improve my care?
Monument Health providers are doing three things differently to improve your care and lower costs.
- First, these practices and hospitals have demonstrated, by meeting national standards, the commitment and ability to put patients at the center of care and to deliver care more efficiently and more smartly.
- Additionally, these practices and hospitals confidentially share data and follow very specific guidelines to work as a team.
- And last, physicians in our Tier 1 practices and other providers are paid on how well they take care of you, not how many patients they see each day.
What are the reasons for the tiers and what does it mean to be in Tier 1?
All Monument Health plans—including those offered by Rocky Mountain Health Plans (RMHP) or those offered in partnership with CNIC or Cigna—offer you access to the clinically integrated Monument Health Tier 1 network. We believe you will experience the highest level of care with the most manageable costs when you see Monument Health Tier 1 providers.
You and your family may also see Tier 2 providers in Mesa County, throughout Colorado and even nationwide. For RMHP and CNIC health plans, Tier 2 includes providers in the RMHP statewide network and the First Health National Network. For Cigna health plans, Tier 2 includes providers across Colorado and nationwide who are in the Cigna national network.
You may also see Tier 3 providers who are considered “out-of-network” and who are generally associated with the highest costs.
Please remember that all emergency room care is covered at the Tier 1 benefit level without exception. And most urgent care is also covered at the Tier 1 benefit level (please call the number on your member ID card to confirm).
How do I know who is in Tier 1?
You can find Tier 1 providers, practices and hospitals in the provider directory. Alternatively, you may request a provider directory from your benefits professional (e.g., your human resources manager) if you obtained your Monument Health network plan through your employer.
Why do I need a primary care provider?
We strongly encourage each Monument Health member to have a primary care provider–a physician (MD or DO), a nurse-practitioner (NP) or a physician assistant (PA). Having a designated primary care provider–who you know and trust and who knows you–ensures you have a “medical home.” In a medical home, you are at the center of care. Your care is comprehensive, not just about sick care or urgent care and not just about your physical health but, instead, inclusive of mental health and other important aspects of the whole you.
Am I required to change my primary care provider to a Monument Health provider?
No, you are never required to change your primary care provider (or other providers, like specialists, etc.). We do suggest that you consider a Tier 1 provider or facility to optimize your experience and keep costs down.
What happens if I need to go to the emergency room?
First, your safety and well-being is the priority. Please seek care at the nearest or otherwise most appropriate facility if you truly have a life-threatening emergency. If, however, you are in a position to select which emergency room to seek care, we encourage that of St. Mary’s Hospital. At St. Mary’s emergency room, we have the teams, processes and technology set up to optimize your experience while best controlling the cost. Please also remember that Monument Health members have guaranteed access to Docs On-Call and the Redlands After Hours Clinic for your urgent-care needs. And last, we look forward to working with other local hospital partners to improve choice.
Traveling out of Mesa County? Emergency care is always covered as if it’s in network.
How will I save money, especially with insurance rates on the rise?
Health care is a rapidly changing area and costs are indeed on the rise. By seeing Tier 1 providers or going to a Tier 1 facility, your total out-of-pocket costs are much lower. Your office or hospital co-pay is lower (i.e., the amount you pay at the time of service), your co-insurance is less (i.e., the amount you get billed later) and you have a smaller deductible (i.e., the amount you have to pay before your insurance kicks in.)
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