You are encouraged to use network providers for all your medical care. Network providers have agreed to accept contracted rates for their services, which results in lower out-of-pocket costs for you. And, you can receive services from any network provider without a referral from your primary care physician.
You can save on your out-of-pocket costs for care by using providers who participate in the plan’s network.
To find network providers, log on to the MyQHealth website, click My Plan, and then click CARE FINDER to use the online provider search tool.
You can also call Quantum Health at 855-497-1237 and a Care Coordinator can help you find a network provider.
Important: If you are enrolled in the EPO or HDHP, you must use network providers. If it’s not an emergency and you see an out-of-network provider when you have access to a network provider, you will be responsible for all costs.
Express Scripts administers the prescription drug program; to find network pharmacies, visit the Express Scripts website. You can also call Quantum Health at 855-497-1237 and a Care Coordinator will assist you.
If you’re enrolled in the PPO: Your coverage includes out-of-network benefits for covered services. However, you’ll pay more out of your pocket if you see an out-of-network provider when you have access to a network provider. Emergency services provided by an out-of-network provider are the only exception.
Out-of-network providers may require you to pay for services upfront and then file a claim for reimbursement. See Guide to Your Healthcare Benefits for more information or call Quantum Health.
If you’re enrolled in the EPO or HDHP: These options do not cover care received from out-of-network providers except for emergency services. If you use an out-of-network provider when you have access to a network provider, you will be responsible for all costs incurred.