Are insurers allowed to deny coverage for treatment received outside of a network in Colorado?

In Colorado, insurers can deny coverage for treatment received outside of a network, but this is typically subject to the terms and conditions outlined in the individual policy. When an insurance policy specifies that certain treatments or services are only covered when provided by in-network providers, then a claim for out-of-network treatment may be denied unless the policy indicates otherwise. This allows insurers to manage costs and encourage the use of a specific network of providers.

Policies often include clauses that explain the boundaries of coverage in terms of network participation. Therefore, it is crucial for policyholders to thoroughly review their insurance documents to understand their coverage options and any restrictions concerning out-of-network providers. This approach maintains the integrity of network-based plans while still giving policyholders the ability to seek care, albeit potentially at a higher out-of-pocket expense.