Your benefits will be paid at a lower rate if the healthcare provider is out of network. Make sure all doctors and others involved in any care or tests are in the QualChoice network. This means all specialists such as anesthesia doctors, medical supply houses and lab or xray testing. Specialty lab work is costly, but most can be done by our network partners! Certain genetic tests require Pre-Authorization (pre-approval).
Know beforehand which healthcare procedures need pre-authorization by checking the Medical Policies section of QualChoice.com, or calling Customer Service. Your claim could be denied if you needed a pre-auth and didn't get it.
3See a Primary Care Physician (PCP) Instead of a Specialist
Visit your PCP first for most medical needs; your doctor knows you and your health history. He or she can take care of most problems without the cost of specialty care.
4Ask for Generic Drugs
Ask your doctor if a less costly generic form of a drug will work as well as a name brand for you.
5Use Preventive Care Benefits and Health & Wellness Programs
Use the preventive care benefits in your plan for annual pap tests, mammograms, health checkups, flu shots and more. Enroll in our Kick the Nic! program to stop tobacco use. Get healthy lifestyle coaching or the support of a nurse care manager for ongoing or serious health issues. It could help you avoid a problem later.