Using care navigation
Care navigation helps Medical Plan members and their covered family members receive the right care, at the right place, at the right time.
Navigating today's healthcare system can be complicated. If you’re enrolled in the PPO, EPO, or HDHP option of the Medical Plan, you can simplify your experience by accessing care navigation through Quantum Health.
Quantum Health is your primary point of contact when you have questions about your medical or prescription drug benefits or need help with a healthcare issue. Care navigation works seamlessly with your Medical Plan benefits:
- Speak directly with a Care Coordinator, who will get to know your needs and support you at every stage of your healthcare journey.
- Manage a new chronic health condition diagnosis or complex medical issue with the help of a Care Coordinator, who works with your providers to get you high-quality, safe, and cost-effective care.
- Rely on your Care Coordinator’s clinical expertise and healthcare industry knowledge whenever you have a question about your medical and prescription benefits or are facing a healthcare decision.
Important: Contact Quantum Health for assistance if you are billed at the out-of-network rate for services received at a network ancillary provider, such as a lab, when the doctor ordering the service is in a different state. This may occur if you visit an urgent care facility while traveling in another state and are given a lab work order for follow-up bloodwork that you have done once you return home.
Contacting your Care Coordinator
Quantum Health Care Coordinators are just a call, click, or tap away.
You can call a Care Coordinator directly or schedule a call or chat live through the MyQHealth website. You can also access benefits, claims information, and more on the go through the website or mobile app.
Call: 855-497-1237, Monday through Friday, 8:30 a.m. to 10 p.m. ET
Click: myqhealthpcusa.org
Tap: Download the Quantum Health mobile app from the iOS App Store or Google Play.
Bilingual support is available for Korean and Spanish speakers.
How can a Care Coordinator help?
Care Coordinators are well-versed in your benefits and can 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
- ordering replacement ID cards
- advocating for your care
- connecting you with the other Board of Pensions benefits and resources available
Members enrolled in Triple-S and GeoBlue should refer to their plan provisions for details about their benefits and contact those plans if they have questions. Retired members enrolled in the Humana Group Medicare Advantage PPO plan should contact Humana at the number on the back of their ID card.
Questions about your other Board of Pensions benefits?
Quantum Health can help you navigate your healthcare better, but we’re here to answer any of your questions about your income protection and retirement benefits through the Board. Call us at 800-PRESPLAN (800-773-7752) (TTY: 711) with any questions you have.