How care navigation helps you

January 31, 2022

Care navigation gives PPO, EPO, and HDHP members and their covered families their own personal support team to guide them on their healthcare journey and connect them with available resources. It’s a better way to experience healthcare. ​

No one should have to navigate today's complicated healthcare system alone. That's why the Board of Pensions, in partnership with Quantum Health, is introducing care navigation effective April 1, 2022. If you are enrolled in the PPO, EPO, or HDHP, care navigation is included at no additional cost to you as part of your medical coverage. Starting April 1, you automatically have access to Quantum Health's Care Coordinators — and your medical benefits remain the same:

  • You still have access to the same Blue Cross Blue Shield national provider network.
  • Express Scripts continues to administer prescription drug benefits.
  • Your deductible, coinsurance, copay, and out-of-pocket maximum amounts remain the same.

What's different is that instead of calling Highmark Blue Cross Blue Shield or Express Scripts customer service when you have a question about your medical or prescription drug benefits, you will now call Quantum Health.

About Quantum Health's Care Coordinators

Quantum Health's Care Coordinators are highly trained nurses, clinicians, and benefits specialists who can answer your questions. Your Care Coordinator serves as your personal healthcare guide, getting to know you and your health and wellness needs and working with your providers to ensure you receive safe, high-quality care.

Starting April 1, your Quantum Health Care Coordinators will be available to assist with anything to help make the healthcare process easier, including

  • verifying coverage;
  • explaining the copays, deductibles and/or coinsurance that may apply;
  • answering questions about a medical test or procedure;
  • precertifying care when required;
  • locating network providers, including Centers of Excellence;
  • answering claims or billing questions;
  • tracking refills through Express Scripts home delivery;
  • reordering replacement ID cards;
  • advocating for your care; and
  • connecting you with other benefits and resources available to you from the Board of Pensions.

In some cases, a Quantum Health Care Coordinator may proactively reach out to you. For instance, if you have been working with a Highmark Blue Cross Blue Shield nurse for support with a health issue, a Quantum Health Care Coordinator will contact you about transitioning to Quantum Health starting April 1.

You'll receive new medical and prescription drug ID cards in March with Quantum Health's contact information for you to connect with your Care Coordinators online, by mobile app, or by phone. Be sure to share your new cards with your providers, and reach out to Quantum Health starting April 1, for a better way to experience healthcare.

Have questions? The Board of Pensions remains responsible for all aspects of benefits, so if you have any questions, call the Board at 800-773-7752 (800-PRESPLAN) Monday through Friday, 8:30 a.m. to 7 p.m. ET. We are always here to serve!