Understanding Your Explanation of Benefits (EOB)
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Understanding Your Explanation of Benefits (EOB)

As a QualChoice member, you will receive an EOB every 14 days if you have had any claims during that time. Review the EOB closely and compare it to the receipt or statement from your doctor.* Keep it for your records, along with your medical bills..

Beware of Balance Billing!
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Beware of Balance Billing!

Balance billing by out-of-network providers can be a nasty surprise. But what does it mean exactly?

How to Have a Successful Doctor’s Appointment
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How to Have a Successful Doctor’s Appointment

Regular health exams by a Primary Care Physician (PCP) can stop problems before they start or catch problems early, giving you better chances for treatment and cure.

Managing Your Drug Coverage with OptumRx
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Managing Your Drug Coverage with OptumRx

To manage your OptumRx drug coverage, sign in to My Account at QualChoice.com to access the Optum member website. Because the Optum site has been updated, previous users will need to re-register.

Coverage for Routine and Complex Procedures
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Coverage for Routine and Complex Procedures

In the past, you may have had to go to a hospital for certain healthcare services. Today, many of those same things are done in your doctor’s office. How much you pay for those services depends on if they are routine or complex.

How We Make Coverage Decisions
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How We Make Coverage Decisions

We work to make sure our members get the right healthcare in every care setting. We support proper care decisions based on medical necessity and the member’s specific health plan. When a service needs pre-authorization, our Medical Director and clinical staff follow QualChoice Medical Coverage Policies. They also follow the peer-reviewed and nationally noted guidelines of MCG Health, LLC.

Making the Most of Your Benefits
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Making the Most of Your Benefits

Healthcare can be confusing — and costly. Here are some ways you can make the most of your health insurance benefits. Master these points to stay healthy and save on your healthcare costs!