FAQs | QualChoice

Here are just a few of some frequently asked questions. If you still need more information please call (501) 228-7111.

Q.	I have recently become a member and do not have my new ID card yet. I need to see a doctor, what do I need to do?
A.	You can see your physician and advise their office you have QualChoice, they should contact us directly to verify benefits or you may contact our Customer Service Department and we will be glad to issue a temporary ID card until yours is received.
Q.	Do I need to select an OB/GYN doctor as a primary care physician (PCP)?
A.	You no longer need to select an OB/GYN as your PCP. You now have direct access to see any in-network OB/GYN doctor and you will be responsible for the PCP co-pay for office visit services.
Q.	Will you continue to cover my dependent child who is going to college?
A.	Yes. You would need to refer to your Summary Plan Description Document or Evidence of Coverage, under "Eligible Dependents." Covered student ages may vary depending on which employer group plan in which you are enrolled, or you may contact our customer service department and we will be glad to provide you this information.
Q.	What is "Direct Access"?
A.	This means you have direct access to see any QualChoice "in-network" provider without a referral from your PCP.
Q.	Can I go to any Emergency Room?
A.	We ask that you go to the nearest network emergency room when you are in need of emergency care. We define Emergency as those health care services provided on a 24-hour/365-days-a-year basis to evaluate and treat medical conditions of a recent onset and severity, leading a prudent lay person, possessing an average knowledge of medicine and health, to believe his or her condition, sickness, or injury is of such a nature where failure to seek immediate medical care could result in: placing the patient's health in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part. If you have to go to an Out of Network facility and need inpatient care you must notify QualChoice as soon as possible or within 48 hours of your stay so that we may attempt to get you transferred to a network facility.
Q.	Do I have to notify QualChoice when I am admitted to the hospital?
A.	QualChoice does require notification of your admission, if you are admitted to a network facility. Our network facility will notify us on your behalf. If you are admitted to an Out of Network Provider, you as the member are responsible for notifying QualChoice.
Q.	Is my baby automatically added to my insurance policy?
A.	Regardless of whether you will add your baby to QualChoice or to another insurance plan, you should contact the employee benefits office at your employer and ask about their individual requirements and time frames for adding a new baby. Most employers require a completed enrollment form to be returned to the employee's Human Resource Department. DO NOT SEND YOUR COMPLETED ENROLLMENT FORM TO QUALCHOICE. This will only delay the process.
Q.	Am I required to pre-register my delivery with the hospital?
A.	QualChoice does not require that you pre-register your delivery with the hospital. This process can prevent unnecessary delays at the time of your admission. You can call the admission office, at the hospital you have chosen, and ask about their pre-registration process for expectant mothers.
Q.	Does QualChoice cover OB Ultrasounds? How many? What do I have to do?
A.	QualChoice does provide coverage for a routine fetal survey done between 16-24 weeks. If additional ultrasounds are needed, it is the responsibility of the OB/GYN to get prior authorization. With proper authorization, additional ultrasounds are reimbursable.
Q.	Does the enactment of Any Willing Provider (AWP) legislation mean that I can go to any provider that I choose whether or not they are listed in the QualChoice Directory?
A.	No. The AWP legislation says that insurers must allow providers to join their networks if the providers agree to the insurer's terms and conditions, and if they meet the insurer's criteria for participation. Even if a doctor is willing to accept the terms and conditions of a plan, approval can routinely take 90 - 180 days. Be sure to check the online Directory for the most current information on participating providers.