Health Care Advocacy

Quantum Health is staffed with a team of experts who can help you:

• Understand your health plan coverage and your Explanation of Benefits (EOB) for care received, and estimate costs for a test or procedure
• Find in-network doctors, specialists, urgent care, and other providers based on your preferences
• Connect to virtual care providers
• Access clinical support from nurses, understand your symptoms, learn about a condition, or explore treatment options
• Manage acute or chronic health conditions like diabetes, high blood pressure, high cholesterol, asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure, kidney disease, high-risk pregnancy, and more
• Get answers to your claims, billing, and benefits questions
• Get service authorizations and make preadmission or post-discharge plans for hospital stays
• Save on out-of-pocket costs
• Understand your prescription drug coverage and what you’ll pay, and your options for filling prescriptions in person and by mail order

No request is too big or too small for your Quantum Health Care Coordinators. For medical claims, benefits, prescriptions, and so much more, you can expect expert guidance at no cost to you.

Quantum Health nurse Care Coordinators are licensed clinicians who provide personalized support to you and your family, if you’re enrolled in one of our CareFirst medical plans. When you need clinical support, one nurse Care Coordinator is assigned to support both you and your family. Your nurse Care Coordinator can help you:

• Prepare for and recover from inpatient hospital stays
• Ensure that you understand your coverage and have prior approval for treatments or procedures, when needed
• Advocate for your needs with your providers
• Manage health conditions and provide tips on how to improve or maintain your health, and proactively reach out to you

Quantum Health, CareFirst, and Capital Rx partner together behind the scenes 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. Quantum Health can help you manage your health and connect you to services you may need. They can also help you get preauthorizations for treatments and procedures so that you get the best possible care management plan.

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 our 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 doctor or provider will bill CareFirst for services. CareFirst will then pay their portion of your medical claim and will provide you with an Explanation of Benefits (EOB).

If you have questions, reach out to Quantum Health. You do not need to contact CareFirst.

Capital Rx – Pharmacy benefits manager

Capital Rx manages the drug formulary (i.e., the list of prescription drugs covered by insurance), your retail networks of pharmacies, and the mail-order pharmacy through Optum Home Delivery and processes your prescription drug claims.

Quantum Health can answer questions about coverage, finding a pharmacy, or the cost of a drug.

How do I register for Quantum Health?

Visit quantum-health.com to register. Note: Quantum will recommend that you register with a personal email account rather than with your JHU email account.

How can I download the mobile app?

Search for the Quantum Health app through Apple’s App Store or through Google Play.

Which health care resources will I have direct access to?

Through the Quantum Health member portal, you can review your claims, how much you’ve paid toward your deductible and out-of-pocket maximum, and Flexible Spending Account (FSA) or Health Savings Account (HSA) balances. Also, by having direct access to the following websites, you never have to sign in to them separately:

• CareFirst
• Capital Rx
• Delta Dental
• EyeMed
• WEX

Plus, you’ll find links to:

• MDLIVE, your new telehealth provider
• JHEAP, the Johns Hopkins Employee Assistance Program
• A locator for in-network providers
• Links to other features your plan offers

Is it free to use Quantum Health for help in navigating health care issues?

Yes. JHU employees and their family members who are enrolled in CareFirst medical plans have free access to Quantum Health and its health care coordinators.

Whom should I contact first when I have a question about my health care benefits?

Quantum Health is your portal to all your health care resources. Quantum Health is designed to be your first contact for questions or concerns about your health care needs, from replacing ID cards to dealing with more complicated matters, such as billing, pharmacy issues, or chronic illness management.

Do I need different accounts with each of my health care services to use Quantum?

You have direct access to your health care services through Quantum Health, and you never have to sign in to them separately.

Can I choose not to use Quantum Health or opt out of using it and talk directly to CareFirst representatives?

JHU employees and their family members who are enrolled in CareFirst plans are automatically enrolled in Quantum Health. It is your one place to go for health care and benefits help. Quantum Health is an industry leader in health care navigation and care coordination for employees and their families.

In general, how do I contact Quantum Health?

Call 844-460-2801, Monday to Friday, 8:30 a.m. to 10 p.m. ET, or visit the member portal.

Whom do I contact to escalate an issue about Quantum Health?

Contact the Benefits Service Center at 410-516-2000 or [email protected] if you’re unable to resolve an issue by contacting Quantum Health.

Does Quantum Health provide language services and accessibility options?

Quantum Health staff have access to secure and confidential translation services. Care Coordinators also are equipped to take calls from members who are hearing impaired.

Who are the Quantum Health Care Coordinators?

Quantum Health’s Care Coordinators are unbiased and independent of our medical insurance providers. Your personal Care Coordinator leads a team of nurses and medical benefits experts who work with you and your providers to make your care simpler and more affordable. They can help you find providers who understand your unique needs and background and advocate on your behalf to ensure that you receive the best possible care. When you need help solving a claims issue, learning about your medical benefits, or anything else that can make your health care easier, you can contact Quantum Health online or over the phone.

How do Care Coordinators give personalized support and help?

Nothing could be more personal than your health and the experience you have when you need health care. 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 will the Care Coordinators handle my issue?

Your dedicated JHU Care Coordinators will stick with you through the resolution of your issue.

Is my experience with Quantum Health and my information confidential?

Your experience with Quantum Health is confidential.

How does HIPAA come into play with Quantum?

Quantum Health is committed to protecting your personal health information (PHI) in compliance with the Health Insurance Portability and Accountability Act (HIPAA) requirements. Stringent measures and policies are in place to safeguard your PHI and prevent any unauthorized sharing of this information with unauthorized parties.

Can my Quantum Health information be shared with my primary care physician or medical team?

Yes, your Care Coordinators can share information with your medical providers. Contact Quantum Health for details about your specific health care needs.

Does Quantum Health replace my primary care doctor?

No, Quantum Health does not replace your primary care physician (PCP). They can, however, work alongside your PCP.

Can Quantum Health help me find care?

Quantum Health’s staff includes Care Coordinators and registered nurses who can help you access doctors, specialists, and therapists, in person or virtually.

If a prior authorization is needed, how does Quantum Health help?

Quantum Health will work with your provider to gather the necessary information for any preauthorization that is needed.

How does Quantum Health help me to obtain prescription medications?

Quantum Health can answer questions about coverage, finding a pharmacy, or the cost of a drug. They also can reach out to your provider to request a refill or a different formulary option.

I’m having trouble getting a prescription filled. Can Quantum Health help?

Yes. Quantum Health can help you with your prescriptions, including mail-order prescriptions. For example, they could research an issue or call a doctor when needed.

The copay for my medication seems expensive. Can Quantum Health do anything to lower it?

Costs for prescription drugs are determined by several different factors, such as the national supply of prescription drugs, the availability of generic brands, and the approved medications—known as formularies—available through pharmacy benefits managers. Quantum Health can work with you to find the lowest-cost options available to you through your benefits.

Are all billing questions answered through Quantum Health?

Yes. If you have questions about your claims and billing, reach out to Quantum Health.

Will Care Coordinators know which health care procedures are covered by my health insurance?

If you’re enrolled in one of the CareFirst medical plans and you have questions about what’s covered by our medical plan, start with Quantum Health. You can reach out to your Care Coordinator to confirm coverage or view your benefits in your online account.

If my claims and Explanation of Benefits (EOBs) are confusing or incorrect, how will Care Coordinators help?

Quantum Health Care Coordinators are experts at understanding your coverage and can help work with you to ensure that even the most complex medical bills are correct.

Can Care Coordinators let me know my estimated out-of-pocket costs and suggest how I can save on health care expenses?

Yes. Care Coordinators understand both the health care system and JHU’s medical plans. They can help you determine where to go for care when you need it and estimate costs.