Insurance Plans Accepted by Children’s Hospital Colorado

The accepted insurance plans list below is not all-inclusive, is updated periodically and may be subject to change.  

Because changes may not be immediately reflected, please contact your plan to understand your benefits and coverage and to make sure that both Children’s Colorado and University of Colorado Medicine participate in your health plan’s network.

• Aetna
• Anthem Blue Cross Blue Shield/Elevance - Denver Metro Region
  (EXCEPT Pathway, Pathway PPO, Pathway Essentials, Pathway Essentials PPO, Pathway Standard, Pathway PPO Standard, Pathway Essentials Standard, Pathway Essentials PPO Standard)
• Anthem Blue Cross Blue Shield/Elevance - Colorado Springs Region
  (EXCEPT Pathway Essentials, Pathway Essentials PPO, Pathway Essentials Standard, Pathway Essentials PPO Standard)
• Blue Cross Blue Shield
• Carelon Behavioral Health
• Centivo
• Cigna (EXCEPT Cigna Connect/Colorado Option & SureFit)
• Colorado Access
• Colorado Community Health Alliance
• ComPsych
• Craig/Swedish/Spaulding Health Benefit Trust
• Denver Health & Hospital Authority – Elevate Medicaid Choice
• Denver Health Medical Plan
• Employers Health Network/Whole Foods only
• Evernorth Behavioral Health, Inc.
• First Choice Health – Big Sky Region
• First Choice of the Midwest
• First Health Network
• Integrated Health Plans
• Kaiser Permanente
• MotivHealth/Denver Public Schools only
• Midlands Choice
• Mines & Associates
• MultiPlan
• Optum Behavioral Health
• Presbyterian Health Plan
• Rocky Mountain Health Plans
• Select Health
• South Dakota Department of Health – Kids with Chronic Conditions
• Stratose / Zelis Healthcare
• TRICARE / TRIWest 
• Simplified Benefits Administrators (fka UCHealth Plan Administrators)
• UnitedHealthcare
• USA Managed Care Organization

It’s that time of year when you may be choosing your health insurance coverage for 2025. We encourage you to choose a plan that will let you keep seeking care at Children’s Colorado. Some plans on the insurance marketplace do not allow you to get care from Children’s Colorado without paying very high out of pocket costs.

Which health insurance exchange plans include Children’s Hospital Colorado for 2025?

• Anthem BlueCross BlueShield/Elevance – HMO Mountain Enhanced/HMO Mountain Enhanced Standard
• Anthem BlueCross BlueShield/Elevance – HMO Pathway/Pathway Standard/Pathway PPO Standard (Colorado Springs locations only)
• Denver Health Medical Plan, Inc. – Elevate/Elevate Colorado Option
• Kaiser Permanente – KP Select
• Kaiser Permanente – KP CO HMO
• Kaiser Permanente – KP Colorado Option
• Rocky Mountain Health Plans – Monument Health HMO, Monument One, Rocky Mountain Valley, Rocky Mountain Sky
• Rocky Mountain Health Plans (partnering with United Healthcare) – RMHP Colorado Doctor’s Plan/RHMP Colorado Doctor's Plan Colorado Option
• Select Health – Select Health Value/Select Health Value Colorado Option

In 2025, Children’s Colorado IS included in the health insurance exchange plans listed above, unless noted. Choosing any of these plans will allow you to keep getting care from Children’s Colorado locations. These health insurance plans, which are available on Connect for Health Colorado, differ by county. Check Connect for Health Colorado to see what plans are available in your county.

Which health insurance exchange plans DO NOT include Children’s Hospital Colorado for 2025?

• Anthem BlueCross BlueShield/Elevance – Pathway (Denver Metro locations only)
• Anthem BlueCross BlueShield/Elevance – Pathway Standard (Denver Metro locations only)
• Anthem BlueCross BlueShield/Elevance – Pathway Essentials (All locations)
• Anthem BlueCross BlueShield/Elevance – Pathway Essentials Standard (All locations)
• Anthem BlueCross BlueShield / Elevance – Pathway Essentials PPO (All locations)
• Anthem BlueCross BlueShield / Elevance – Pathway Essentials PPO Standard (All locations)
• Anthem BlueCross BlueShield/Elevance – Pathway PPO (Denver Metro locations only)
• Anthem BlueCross BlueShield/Elevance – Pathway PPO Standard (Denver Metro locations only)
• Cigna Health Plan of Colorado – Connect/Connect Colorado Option (Except for behavioral health services)

In 2025, Children’s Colorado is NOT included in the health insurance exchange plans listed above.  Choosing one of these plans will mean paying much higher out of pocket costs if you get care from Children’s Colorado locations.

Questions

If you have questions, please call our Financial Counseling office at 720-777-7001.

Additional Resources

• cohealthinfo.com
• Connect for Health Colorado or 1-855-752-6749

Aetna Institutes of Excellence – Heart, liver, kidney and bone marrow transplants

Anthem Centers of Medical Excellence for Transplants – Kidney transplants

Blue Distinction Centers for Transplant – Heart, liver and bone marrow transplants

CIGNA LifeSOURCE Transplant Network – Heart, liver, kidney and bone marrow transplants

Humana National Transplant Network – Heart, liver, kidney and bone marrow transplants

INTERLINK Transplant Network – Heart, liver, kidney and bone marrow transplants

Kaiser Permanente National Transplant Services – Heart, liver, kidney and bone marrow transplants

LifeTrac Network – Heart, liver, kidney and bone marrow transplants

OptumHealth Transplant Centers of Excellence Network – Heart, liver, kidney and bone marrow transplants

Some health insurance plans require you to get a referral from your primary care doctor or authorization from your plan before you see a specialist. Watch the video below to learn how the process works.

Yes. We will file your claim using the insurance information you provide during visit registration. 

It is important that you provide us with all the necessary information to ensure that we are billing the correct health insurance plan in a timely manner.

We will send your claim to all of the health insurance plans that you provide at each visit. The insurance plan(s) that we have on file for each visit will be listed on your billing statement.

Copays

A copay is a monetary charge that your health insurance plan may require you to pay in order to receive a specific medical service or supply. Copays vary by policy and can change depending on the type of visit.

For example: Let's say Gary goes to a Children’s Colorado specialist with a case of mono. His specialist reviews his insurance and sees that he has a $25 co-pay based on his insurance benefits. His copay is collected, and his insurance company will reimburse the specialist for the difference between the copay and the cost of treatment.

Here's another example: Say your plan’s deductible is $2,500, your plan covers 70% of services and your out-of-pocket max is $7,350. Setting aside copays, here’s what your year looks like:

Deductibles

Your deductible is the amount of your medical costs that you have to pay before your health insurance will pay benefits consistent with the benefit plan.

Example: Gary has a health plan with a $1,500 deductible. If Gary only has minor health expenses during the year that cost less than $1,500 total, he's going to pay the full amount to treat them. However, if Gary has a serious illness that requires a lot of medical care, he'll pay his $1,500 deductible and then his health insurance will pay benefits consistent with the benefit plan.

Coinsurance

Coinsurance is the way you and your health insurance company share the costs of your care. For example, if Gary is injured and he’s met his deductible for the year, his health plan will pay 80% of the cost of his bills, leaving him responsible for the remaining 20%.

So, in summary:

• You pay copays when you see the doctor.
• Deductibles are the portion you must pay before your insurance pays.
• Coinsurance is how you and your insurance company split up the cost of your care.

Coverage can change every year depending on your health insurance plan. This determines whether or not a patient’s bill is covered by insurance. Hospital coverage often has patient responsibilities including deductible, copayment or coinsurance. Since each plan can be different, we encourage families to carefully review their benefits with their insurance company.

If you disagree with the insurance company’s payment amount, contact the insurance company directly and ask them to review how the claim was processed. If the insurance company determines the bill was paid correctly and you still disagree, please contact your benefit manager with your insurance company. They can provide guidance on how to file an "appeal" with them. Filing an appeal will ensure that your claim will be reviewed for reconsideration.