2020-2021 BadgerCare Plus - MEMBER HANDBOOK - Quartz
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2020-2021 BadgerCare Plus MEMBER HANDBOOK
2 Important Quartz Phone Numbers Important
3 Welcome Quartz Phone
Using Your ForwardHealth ID Card Numbers
Choosing A Primary Care Physician (PCP)
CUSTOMER SERVICE
4 Emergency Care (800) 362-3310
Urgent Care Monday through
Care When You Are Away From Home Thursday
5 Care During Pregnancy and Delivery 7 a.m. to 6 p.m.
When You May Be Billed for Services Friday 7 a.m. to 5 p.m.
Other Insurance
6 Covered Services EMERGENCY NUMBER
8 Mental Health and Substance Abuse Services (888) 297-0970
9 Family Planning Services Call 24 hours a day,
Dental Services seven (7) days a week
Chiropractic Services
Vision Services TTY
Autism Treatment Services 711 / (800) 877-8973
10 HealthCheck
11 Transportation Services
Pharmacy Benefits
If You Move
Getting a Second Medical Opinion
HMO Exemptions
Getting Help When You Have Questions or Problems
12 Filing a Grievance or Appeal
13 Quartz BadgerCare Plus Complex Case Management
14 Your Rights
16 Fraud and Abuse
Member Responsibilities
17 Interpreter Services
2WELCOME TO QUARTZ. As a member, you should get all your health care from
doctors and hospitals in the Quartz network. See the Quartz Provider Directory for a list of
these providers. If you have questions about a doctor, call Quartz at (800) 362-3310. Please
contact clinics for their hours. Providers accepting new patients are marked in the Provider
Directory. Providers are not employees of Quartz.
Using Your ForwardHealth ID Card Choosing A Primary Care Physician (PCP)
Your ForwardHealth ID card is the card you will When you need care, it is important to call your
use to get your BadgerCare Plus benefits. Your primary care physician (PCP) first. It is important
ForwardHealth ID card is different from your HMO to choose a PCP to manage all your health care.
card. Always carry your ForwardHealth ID card with You can choose a PCP from the list of doctors
you and show it every time you go to the doctor accepting new patients, as marked in the Provider
or hospital and every time you get a prescription Directory. HMO doctors are sensitive to the needs
filled. You may have problems getting health care of many cultures. To choose a PCP or to change
or prescriptions if you do not have your card with your PCP, call our Customer Service Department
you. Also bring any other health insurance cards at (800) 362-3310. Your PCP will help you decide if
you may have. This could include any ID card from you need to see another doctor or specialist and,
your HMO or other service providers. if appropriate, give you a referral. Remember, you
must get approval from your PCP before you see
You will also receive a red and white Quartz another doctor.
ID card.
Women may see a women’s health specialist,
such as an Obstetrician and Gynecologist (OB /
GYN), nurse midwife, or licensed midwife without a
referral from their primary care physician.
3ACCESSING THE CARE YOU NEED
Emergency Care emergency, call your doctor or our 24 hour
Emergency care is care that is needed right away. emergency number at (888) 297-0970 before you
Some examples are: go to the emergency room. If you do not know
if your illness or injury is an emergency, call your
• Choking doctor or clinic. We will tell you where you can
• Convulsions get care. A prior authorization is not required for
• Prolonged or repeated seizures emergency services.
• Serious broken bones
• Severe burns Urgent Care
• Severe pain Urgent care is care you need sooner than a
• Severe or unusual bleeding routine doctor’s visit, but it is not emergency care.
• Suspected heart attack Some examples are:
• Suspected poisoning
• Suspected stroke • Bruises
• Trouble breathing • Minor burns
• Unconsciousness • Minor cuts
• Most broken bones
If you need emergency care, try to go to a Quartz • Most drug reactions
network provider for help. If your condition • Bleeding that is not severe
cannot wait, go to the nearest provider (hospital, • Sprains
doctor or clinic). Call 911 or your local police
or fire department emergency services if the You must get urgent care from Quartz network
emergency is very severe and you are unable to doctors unless you first get our approval to see a
get to the nearest provider. non-Quartz network doctor. Do not go to a hospital
emergency room for urgent care unless you get
If you must go to a non-Quartz network hospital or approval from Quartz first.
provider, call Quartz at (800) 362-3310 as soon as
you can to tell us what happened. Care When You Are Away From Home
Follow these rules if you need medical care but
Remember, hospital emergency rooms are for are too far away from home to go to your regular
true emergencies only. Unless you have a true primary care physician (PCP) or clinic:
4⊲ For true emergencies, go to the nearest Copayments
hospital, clinic or doctor. Call Quartz at Under BadgerCare Plus, Quartz and its network
(800) 362-3310 as soon as you can to tell us providers and subcontractors may bill you small
what happened. service fees, called copayments. The following
⊲ For urgent or routine care away from home, you members do not have to pay copayments:
must get approval from us to go to a different ⊲ Nursing home residents
doctor, clinic or hospital. This includes children ⊲ Pregnant women
who are spending time away from home with a ⊲ Members younger than 19 years old who are
parent or relative. Call us at (800) 362-3310 for members of a federally recognized tribe
approval to go to a different doctor, clinic ⊲ Members younger than 19 years old with
or hospital. incomes at or below 100 percent of the federal
Care During Pregnancy and Delivery poverty level
If you become pregnant, please let Quartz and Medical Services Received Outside Wisconsin
your income maintenance (IM) agency know right If you travel outside Wisconsin and need
away, so you can get the extra care you need. You emergency care, health care providers in the area
do not have copayments when you are pregnant. where you travel can treat you and send the bill to
Quartz. You may have copayments for emergency
You must go to a Quartz network hospital to have services provided outside Wisconsin.
your baby. Talk to your Quartz doctor to make sure
you know which hospital you are to go to when it Quartz does not cover any services, including
is time to have your baby. Do not go out of your emergency services, provided outside the
plan’s service area to have your baby unless you United States, Canada and Mexico. If you need
have Quartz approval. Your Quartz doctor knows emergency services while in Canada or Mexico,
your history and is the best doctor to help you. Quartz will cover the service only if the doctor’s
or hospital’s bank is in the United States. Other
Also, talk to your doctor if you plan to travel in your services may be covered with HMO approval if
last month of pregnancy. We want you to have a the provider has a U.S. bank. Please call Quartz
healthy birth and a good birthing experience, so it if you get any emergency services outside the
may not be a good time for you to be traveling. United States.
When You May Be Billed for Services If you get a bill for services, call our Customer
Covered and Noncovered Services Service Department at (800) 362-3310 right away.
Under BadgerCare Plus, you do not have to Other Insurance
pay for covered services other than required
copayments. The amount of your copay cannot be If you have other insurance in addition to Quartz,
greater than it would have been in fee-for-service. you must tell your doctor or other health care
To help ensure that you are not billed for services, provider. Your doctor or other health care provider
you must see a provider in Quartz’s network. must bill your other insurance before billing Quartz.
The only exception is for emergencies. If you are If your Quartz doctor or other health care provider
willing to accept financial responsibility and make does not accept your other insurance, call the
a written payment plan with your provider, you may HMO Enrollment Specialist at (800) 291-2002. The
ask for noncovered services. Providers may bill HMO Enrollment Specialist can tell you how to use
you up to their usual and customary charges for both insurance plans.
noncovered services.
If you get a bill for a service you did not agree to,
please call (800) 362-3310.
5BADGERCARE PLUS COVERED SERVICES
Covered Services BadgerCare Plus Standard Plan
Ambulatory Surgery Centers ⊲ Coverage of certain surgical procedures and related lab
services.
Chiropractic ⊲ Full coverage.
Provided and administered by the State ⊲ $0.50 to $3.00 copayment per service.
of Wisconsin not Quartz.
Dental ⊲ Full coverage.
Provided and administered by the State ⊲ $0.50 to $3.00 copayment per service.
of Wisconsin not Quartz.
Disposable Medical Supplies (DMS) ⊲ Full coverage.
Drugs ⊲ Comprehensive drug benefit with coverage of generic
Provided and administered by the State and brand name prescription drugs and some over-the-
of Wisconsin not Quartz. counter (OTC) drugs.
⊲ Members are limited to five prescriptions per month for
opioid drugs.
⊲ Copayments are as follows:
• $0.50 for OTC drugs
• $1.00 for generic drugs
• $3.00 for brand name drugs
Durable Medical Equipment (DME) ⊲ Full coverage.
End-Stage Renal Disease (ESRD) ⊲ Full coverage.
Health Screenings for Children ⊲ Full coverage of HealthCheck screenings and other
services for individuals under age 21.
Hearing Services ⊲ Full coverage.
Home Care Services ⊲ Full coverage of PDN, home health and personal care
(Home Health, Private Duty Nursing services.
[PDN] and Personal Care)
Hospice ⊲ Full coverage.
Inpatient Hospital ⊲ Full coverage.
Quartz is responsible to pay for all medically necessary covered services under BadgerCare Plus. The charts
on these two pages show what is covered and list copay amounts. Full coverage is defined by Wisconsin law.
Please call Quartz Customer Service at (800) 362-3310 for detailed coverage information.
6BADGERCARE PLUS COVERED SERVICES
Covered Services BadgerCare Plus Standard Plan
Mental Health and Substance Abuse ⊲ Full coverage (not including room and board).
Treatment
Nursing Home Services ⊲ Full coverage.
Outpatient Hospital Emergency Room ⊲ Full coverage.
Outpatient Hospital ⊲ Full coverage.
Physical Therapy (PT), Occupational ⊲ Full coverage.
Therapy, and Speech and Language
Pathology (SLP)
Physician ⊲ Full coverage, including laboratory and radiology.
Podiatry ⊲ Full coverage.
Prenatal / Maternity Care ⊲ Full coverage including Prenatal Care Coordination
(PNCC) and preventive mental health and substance
abuse screening and counseling for women at risk for
mental health or substance abuse problems.
Reproductive Health Services ⊲ Full coverage, excluding infertility treatments, surrogate
parenting and related services, including but not limited
to artificial insemination and subsequent obstetrical care
as a noncovered service and the reversal of voluntary
sterilization.
Routine Vision ⊲ Full coverage including coverage of eyeglasses.
Transportation — Ambulance, ⊲ Full coverage of emergency and non-emergency
Specialized Medical Vehicle (SMV), transportation to and from a certified provider for a
Common Carrier covered service.
Inpatient Hospital ⊲ Full coverage.
Health care services provided under all Quartz policies are subject to medical necessity, all benefit maximums, policy
limitations, exclusions and eligibility requirements.
7Mental Health and Substance Abuse Services
Quartz provides mental health and substance abuse (drug and alcohol) services to all members. If you
need these services, call Behavioral Health Care Management (800) 683-2300.
Behavioral Health care services may be available for you at your Primary Care Clinic. Speak to your PCP
if you receive care at one of these clinics:
CLINIC ADDRESS PHONE NUMBER
UW Health – 20 South Park, Pediatrics and 20 South Park Street (608) 287-2580
Adolescent Medicine Madison, WI 53715
UW Health – 20 South Park, Internal Medicine 20 South Park Street (608) 287-2250
Suite 405
Madison, WI 53715
UW Health Deforest – Windsor Clinic 4131 Meridian Drive (608) 846-3741
Windsor, WI 53598
UW Health – Northeast Family Medical Center 3209 Dryden Drive (608) 241-9020
Madison, WI 53704
If you need immediate help, you can call:
⊲ (608) 280-2600 (24-hour Mental Health & Suicide Prevention Phone Line) Journey Mental Health
⊲ (800) 273-TALK
⊲ (800) SUICIDE
⊲ 911
All services paid for by Quartz are private.
8Family Planning Services • Call us if you need help with getting a ride to
or from your dental appointment.
We provide for private family planning services for
all members, including minors. If you do not want ⊲ If you do not currently have a dentist who is in
to talk to your primary care doctor about family the Quartz network:
planning, call our Customer Service Department • Call Quartz at (800) 362-3310. Tell us that you
at (800) 362-3310. We will help you choose a or your child is having a dental emergency.
Quartz network family planning doctor who is We can help you get dental services.
different from your primary care doctor. • Tell us if you need help with getting a ride to
or from the dentist’s office.
We encourage you to receive family planning
services from a Quartz doctor so that we can Chiropractic Services
better coordinate all your health care. However, Chiropractic services are a covered benefit under
you can also go to any family planning clinic that BadgerCare Plus. You may get covered chiropractic
will accept your ForwardHealth card even if the services from a Medicaid-enrolled provider who
clinic is not part of the Quartz network. will accept your ForwardHealth ID card. To find a
Medicaid-enrolled provider follow these steps:
Dental Services
Dental services are a covered benefit under 1. Go to www.forwardhealth.wi.gov.
BadgerCare Plus. You may get covered dental 2. Click on the Members link or icon in the middle
section of the page.
services from a Medicaid-enrolled provider who
3. Scroll down and click on the Resources tab.
will accept your ForwardHealth ID card. To find a
4. Click on the Find a Provider link.
Medicaid-enrolled provider follow these steps: 5. Under Program, select BadgerCare Plus.
1. Go to www.forwardhealth.wi.gov. Or, you can call ForwardHealth Member Services
2. Click on the Members link or icon in the middle at (800) 362-3002.
section of the page.
3. Scroll down and click on the Resources tab. Vision Services
4. Click on the Find a Provider link. Quartz pays for covered vision services, including
5. Under Program, select BadgerCare Plus.
eyeglasses; however, some limitations apply.
Or, you can call ForwardHealth Member Services For more information, call our Customer Service
at (800) 362-3002. Department at (800) 362-3310.
If you have a dental emergency, you have the Autism Treatment Services
right to obtain treatment within 24 hours of
Behavioral treatment services are a covered
your request. A dental emergency is a need for
benefit under BadgerCare Plus. You may get
immediate dental services to treat severe dental
covered autism treatment services from a
pain, swelling, fever, infection or injury to the teeth.
Medicaid-enrolled provider who will accept your
If you are experiencing a dental emergency, you
ForwardHealth ID card. To find a Medicaid-enrolled
can follow these steps:
provider follow these steps:
⊲ If you already have a dentist who is in the
1. Go to www.forwardhealth.wi.gov.
Quartz network:
2. Click on the Members link or icon in the middle
• Call the dentist’s office. section of the page.
• Tell the dentist’s office that you or your child is 3. Scroll down and click on the Resources tab.
having a dental emergency. 4. Click on the Find a Provider link.
• Tell the dentist’s office what the exact dental 5. Under Program, select BadgerCare Plus.
problem is. This may be something like a Or, you can call ForwardHealth Member Services at
severe toothache or swollen face. (800) 362-3002.
9HealthCheck
HealthCheck is a program that covers complete health checkups, including treatment for health
problems found during the checkup, for members younger than 21 years old. These checkups are
very important. Doctors need to see those younger than 21 years old for regular checkups, not just
when they are sick.
The HealthCheck program The HealthCheck Review the following HealthCheck
has three purposes: checkup includes: and Lead screening schedules:
1. To find and treat health ⊲ Age-appropriate Your Child's
problems for those younger immunizations (shots) Well-Child Schedule
than 21 years old. ⊲ Blood and urine lab tests VISIT TO PROVIDER
2. To increase awareness of the (including blood lead level First Week (3 to 5 days old)
special health services for those testing when age appropriate) 1 Month
younger than 21 years old. ⊲ Dental screening and a 2 Months
3. To make those younger than referral to a dentist beginning 4 Months
21 years old eligible for some at 1 year old
6 Months
CHILD'S AGE
health care not otherwise ⊲ Health and developmental
9 Months
covered. history
12 Months
⊲ Hearing screening
15 Months
⊲ Physical examination
⊲ Vision screening 18 Months
24 Months
To schedule a HealthCheck exam
or for more information, call our 30 Months
Customer Service Department at 3 Years
(800) 362-3310. Every Year After Age 3
If you need a ride to or from a Your Child's Blood Lead Tests:
HealthCheck appointment, please Two by Year Two
call the Department of Health FIRST TEST SECOND TEST
Services (DHS) non-emergency At 1 Year By the child's
medical transportation (NEMT) 2nd birthday
manager at (866) 907-1493 Call your clinic to schedule.
(or TTY 711) to schedule a ride.
10Transportation Services Getting a Second Medical Opinion
Non-emergency medical transportation (NEMT) is If you disagree with your doctor’s treatment
available through the DHS NEMT manager. The recommendations, you may be able to get a
NEMT manager arranges and pays for rides to second medical opinion. Contact your doctor
covered services for members who have no other or our Customer Service Department at
way to receive a ride. Non-emergency medical (800) 362-3310 for information.
transportation can include rides using:
HMO Exemptions
⊲ Public transportation, such as a city bus
Generally, you must enroll in an HMO to get health
⊲ Non-emergency ambulances
care benefits through BadgerCare Plus. An HMO
⊲ Specialized medical vehicles
exemption means you are not required to join
⊲ Other types of vehicles, depending on a
an HMO to get your health care benefits. Most
member’s medical and transportation needs
exemptions are granted for only a short period of
Additionally, if you use your own private vehicle time, primarily to allow you to complete a course
for rides to and from your covered health care of treatment before you are enrolled in an HMO.
appointments, you may be eligible for mileage If you think you need an exemption from HMO
reimbursement. enrollment, call the HMO Enrollment Specialist at
(800) 291-2002 for more information.
You must schedule routine rides at least two
business days before your appointment. You Getting Help When You Have Questions
can schedule a routine ride by calling the NEMT
or Problems
manager at (866) 907-1493 (or TTY 711), Monday
through Friday, from 7 a.m. until 6 p.m. You may Quartz Member Advocate
also schedule rides for urgent appointments. A Quartz has a Member Advocate to help you
ride to an urgent appointment will be provided in get the care you need. You should contact your
three hours or less. Member Advocate for help with any questions
about getting health care and solving any
Pharmacy Benefits
problems you may have getting health care from
You may get a prescription from a Quartz network Quartz. You can reach a Member Advocate at
doctor, specialist or dentist. You can get covered (800) 362-3310.
prescriptions and certain over-the-counter items at
any pharmacy that will accept your ForwardHealth Enrollment Specialist
ID card. To get information about what managed care
is and other managed care choice counseling,
You may have copayments or limits on covered you can call the HMO Enrollment Specialist at
medications. If you cannot afford your copayments, (800) 291-2002 for assistance.
you can still get your prescriptions.
State of Wisconsin HMO Ombuds Program
If You Move The state has designated Ombuds (individuals
If you are planning to move, contact your current who provide neutral, confidential and informal
Income Maintenance (IM) agency. If you move assistance) who can help you with any questions
to a different county, you must also contact the or problems you have as an HMO member. The
IM agency in your new county to update your Ombuds can tell you how to get the care you
eligibility for BadgerCare Plus. need from your HMO. The Ombuds can also
help you solve problems or complaints you may
If you move out of Quartz’s service area, call the have about the HMO program or your HMO. Call
HMO Enrollment Specialist at (800) 291-2002. The (800) 760-0001 and ask to talk to an Ombuds.
HMO Enrollment Specialist will help you choose a
new HMO that serves your new area.
11Filing a Grievance or Appeal The address to file a grievance with the BadgerCare
Grievances Plus program is:
A grievance is any complaint about your HMO or BadgerCare Plus
health care provider that is not related to a denial, Managed Care Ombuds
limitation, reduction, or delay in your benefits. P.O. Box 6470
Grievance topics include things like the quality Madison, WI 53716-0470
of services you were provided, rudeness from a (800) 760-0001
provider or an employee, and not respecting your
rights as a member. You may file a grievance at any time. You will not
be treated differently from other members because
We would like to know if you ever have a grievance you file a complaint or grievance. Your health care
about your care at Quartz. Please call Quartz’s benefits will not be affected.
Appeals Specialist at (800) 362-3310 or write to us
at the following address if you have a grievance: Appeals
Quartz You have the right to appeal if you believe your
840 Carolina Street benefits are wrongly denied, limited, reduced,
Sauk City, WI 53583-1374 delayed, or stopped by Quartz. Your authorized
representative or your provider may request an
If you want to talk to someone outside Quartz about appeal for you if you have given them consent to
the problem, call the HMO Enrollment Specialist at do so. When requesting an appeal, you must appeal
(800) 291-2002. The HMO Enrollment Specialist may to Quartz first. The request for an appeal must be
be able to help you solve the problem or write a made no more than 60 days after you receive notice
formal grievance to Quartz or to the BadgerCare of services being denied, limited, reduced, delayed,
Plus program. or stopped.
12If you need help writing a request for an Quartz BadgerCare Plus
appeal, please call Quartz's Appeals Specialist Complex Case Management
at (800) 362-3310, the BadgerCare Plus and
Quartz’s BadgerCare Plus Complex Case
Medicaid SSI Ombuds at (800) 760-0001, or the
Management program is for members who could
HMO Enrollment Specialist at (800) 291-2002.
use some extra support. Along with your doctor
If you disagree with your HMO Program’s decision or nurse, we can help you take steps to improve
about your appeal, you may request a fair hearing your health.
with the Wisconsin Division of Hearing and
With this program, a registered nurse or social
Appeals. The request for a fair hearing must be
worker can help you:
made no more than 90 days after your HMO/PIHP
• Get care
makes a decision about your appeal.
• Understand your doctor or nurse’s care plan
If you want a fair hearing, send a written request to: • Address the challenges of your health condition
Department of Administration • Connect with resources and services
Division of Hearings and Appeals This program is free, does not affect your health
P.O. Box 7875 insurance coverage and is done over the phone.
Madison, WI 53707-7875
The hearing will be held with an administrative Call Medical Management at (888) 829-5687 for
law judge in the county where you live. You have more information.
the right to be represented at the hearing, and
you can bring a friend for support. If you need a
special arrangement for a disability or for language
translation, please call (608) 266-3096 (voice) or
(608) 264-9853 (hearing impaired).
You will not be treated differently from other
members because you request a fair hearing. Your
health care benefits will not be affected.
If you need help writing a request for a fair hearing,
please call either the BadgerCare Plus and
Medicaid SSI Ombuds at (800) 760-0001 or the
HMO Enrollment Specialist at (800) 291-2002.
You may request to have the disputed services
continued while the HMO Program appeal and
State fair hearing process are occurring. The
request to continue services must happen within
10 days of receiving the notice that services were
denied or changed, or before the effective date of
the denial or change in benefits. You may need to
pay for the cost of services if the hearing decision
is not in your favor.
13Your Rights directive, living will or power of attorney wishes
Knowing About Physician Incentive Plan are not followed. You may request help in filing a
You have the right to ask if we have special grievance.
financial arrangements with our physicians that Transition of Care
can affect the use of referrals and other services If you have moved from ForwardHealth or a
you might need. To get this information, call our BadgerCare Plus HMO to a new BadgerCare Plus
Customer Service Department at (800) 362-3310 HMO, then you have the right to:
and request information about our physician
⊲ Continue to see your current providers and
payment arrangements.
access your current services for up to 90 days.
Knowing Provider Credentials Please call your HMO upon enrollment to let
You have the right to information about our them know who your provider is. If this provider
providers including the provider’s education, is still not in the HMO network after 90 days, you
board certification and recertification. To get this will be given a choice of participating providers
information, call our Customer Service Department to make a new choice.
at (800) 362-3310. ⊲ Receive services that would pose a serious
health risk or hospitalization if you did not
Completing an Advance Directive, Living Will receive them.
or Power of Attorney for Health Care
You have the right to make decisions about your Right to Medical Records
medical care. You have the right to accept or You have the right to ask for copies of your
refuse medical or surgical treatment. You have the medical records from your provider(s). We can
right to plan and direct the types of health care help you get copies of these records. Please call
you may get in the future if you become unable to (800) 362-3310 for help. Please note that you may
express your wishes. You can let your doctor know have to pay to copy your medical records. You
about your wishes by completing an advance may correct inaccurate information in your medical
directive, living will or power of attorney for health records if your doctor agrees to the correction.
care. Contact your doctor for more information.
You have the right to file a grievance with the DHS
Division of Quality Assurance if your advance
14Moral or Religious Objection ⊲ You have the right to make decisions about your
The HMO will inform members of any covered health care. You can also refuse care.
Medicaid benefits which are not available through ⊲ You have the right to be treated with dignity
Quartz because of an objection on moral or and respect.
religious grounds. Quartz will inform members ⊲ You have the right to be free from any form of
about how to access those services through restraint or seclusion used as means of force,
the State. control, ease or reprisal.
⊲ You have a right to know how to file a complaint,
Your Member Rights appeal or grievance. You have the right to
privacy and confidentiality in all communications
⊲ You have the right to ask for an interpreter
and records about your health care.
and have one provided to you during any
⊲ You have the right to be free to exercise your
BadgerCare Plus covered service.
rights without adverse treatment by the HMO
⊲ You have the right to receive the information in
and its network providers.
another language or another format.
⊲ You have the right to disenroll from the HMO
⊲ You have the right to pick a personal doctor
Program if:
from Primary Care Physicians who participate in
your plan’s network. • You move out of the HMO service area
⊲ You have the right to get information about your • Your HMO does not, for moral or religious
Rights and Responsibilities as a Quartz member. objections, cover a service you want
⊲ You have the right to give us ideas about these • You need a related service performed at
Rights and Responsibilities. the same time, not all related services are
⊲ You have a right to know about doctors you available within the provider network, and
can see. your PCP or another provider determines that
⊲ You have the right to receive health care receiving the services separately could put
services as provided for in federal and state you at unnecessary risk .
law. All covered services must be available and
• Other reasons, including poor quality of care,
accessible to you. When medically appropriate,
lack of access to services covered under
services must be available 24 hours a day,
the contract, or lack of access to providers
seven days a week.
experienced in dealing with your care needs.
⊲ You have the right to receive information about
treatment options including the right to request Your Civil Rights
a second opinion. All medically necessary covered services are
⊲ You may switch HMOs without cause during the available and will be provided in the same manner
first 90 days of Quartz enrollment. to all members. All persons or organizations
⊲ You have the right to switch HMOs, without connected with Quartz that refer or recommend
cause, if the State imposes sanctions or members for services shall do so in the same
temporary management on Quartz. manner for all members.
⊲ You have the right to receive information from
Quartz regarding any significant changes with Quartz provides covered services to all eligible
members regardless of the following:
Quartz at least 30 days before the effective date
• Age • National origin
of the change.
• Color • Race
⊲ You have the right to get preventive care
• Disability • Sex
information.
15Fraud and Abuse If you suspect fraud or abuse of the Medicaid program, you may report it. Please go to www.reportfraud.wisconsin.gov. Member Responsibilities ⊲ It is your responsibility to pick a personal doctor from Quartz’s list of Primary Care Physicians. ⊲ It is also your responsibility to create a relationship with that doctor. ⊲ It is your responsibility to read this book and ask questions about information you don’t understand. ⊲ It is your responsibility to carry your ForwardHealth ID card and your Quartz ID card with you and show them when you go to your doctor and hospital. ⊲ It is your responsibility to be honest with your doctors and give them information they need to take care of your health. ⊲ It is your responsibility to ask questions about your health. ⊲ It is your responsibility to follow the instructions your doctor gives you. ⊲ It is your responsibility to make healthy choices. 16
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840 Carolina Street | Sauk City, WI 53583 QuartzBenefits.com/BadgerCare | Quartz Customer Service | (800) 362-3310 QA00176 (0220)
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