Launched this year, Quantum Health is a service available to faculty and staff and their family members who are enrolled in any of JHU's CareFirst health plans. Many employees have asked HR's Benefits Service Center for clarification about Quantum Health and how it works with CareFirst and Capital Rx, the university's pharmacy benefits manager, so here are some background and tips to help you get the most from the service.
Why JHU is offering Quantum Health
The university partnered with Quantum Health so you have access to exceptional health care service and support. Your experience with Quantum Health is confidential and intended to take the hassle out of navigating the health care system. Quantum Health is free to use; its services are included in your CareFirst health plan benefits.
Nothing could be more personal than your health and the experience you have when you need health care, but the health care system can often feel anything but personal; from finding a doctor or therapist to resolving claims issues, you're often left on your own to deal with a complex and confusing system. You can ask your Quantum Health care coordinator questions like:
- Is this procedure covered by my health insurance? How much will I pay if I get the procedure?
- Why does my medication cost this much? Is there a more affordable alternative?
- Can you help me find a doctor based on my needs and preferences?
- Where is the nearest urgent care facility?
- Can you help me prepare for my next doctor's visit?
- Do we have access to virtual care? How do I get started?
- Can you help me understand the information on my claim or the EOB (explanation of benefits) from my last visit to my doctor?
How Quantum Health works with CareFirst and Capital Rx
Quantum Health, CareFirst, and Capital Rx partner to provide the best experiences. Here's how:
Quantum Health—your personal health care advocate
Quantum Health is your first stop when you have questions or need help. Additionally, Quantum Health can help you navigate procedures that require prior authorization, to better help you manage your health and connect you to the services that you need. Its staff includes care coordinators, registered nurses, claims specialists, and others who can help you:
- Access doctors, specialists, and therapists, in person or virtually
- Understand symptoms, learn about a condition, or explore treatment options
- Understand your medical plan coverage and costs, claims, and bills
CareFirst—medical plan provider network and claims administrator
CareFirst manages your provider network and processes your claims. When you or a family member who is enrolled in one of the university's CareFirst plans needs care, you have access to CareFirst's network of doctors, behavioral health providers, urgent care centers, specialists, hospitals, and other medical facilities.
When you receive medical care, your provider will bill CareFirst for services. CareFirst will then pay its portion of your claim and will provide you with an explanation of benefits, known as an EOB.
When you have questions, you can reach out to Quantum Health. You do not need to contact CareFirst.
Capital Rx—pharmacy benefits manager
Capital Rx manages your retail networks of pharmacies and the mail-order pharmacy Optum Home Delivery, and it processes your prescription drug claims.
Quantum Health can answer questions about coverage, finding a pharmacy, or the cost of a drug.
Get started
Contact Quantum Health care coordinators at 844-460-2801 from 8:30 a.m. to 10 p.m., Monday through Friday, or access your Quantum Health member portal here.
Posted in Benefits+Perks, Health+Well-Being
Tagged hr newswire
