Have a question? Our Frequently Asked Questions section can help. Please check it out for answers to commonly asked questions. If you are unable to find answers to your questions in the Frequently Asked Questions, you can contact us.
First, check your benefit levels for using QCP providers. Next, call the provider, tell them you are a QCP participant and confirm they are participating with QCP. Schedule your appointment. Be sure to show your medical ID card with the QCP logo at your visit.
Be sure you understand your benefits and costs before seeking care. Your individual plan may require co-pays and/or deductibles, even though they are in-network. These costs are often substantially less than going to an out of network provider. You are responsible for all costs not covered by your healthcare plan.
Please be prepared to pay any copays at the time of service.
QCP is a medical provider network and medical management company. We do not determine or verify eligibility or any benefit levels. Your insurance plan determines which services are covered, and at what levels. Please refer to your certificate of coverage provided by your health plan or contact customer service by calling the number on your medical ID card.
Patients are responsible for payment for non-covered services, deductibles and coinsurance.
In an emergency, always seek medical care immediately. Go directly to the nearest emergency facility or call 911. An emergency is an accident or sudden illness that a person with an average knowledge of medical science believes needs to be treated right away or it could result in loss of life, serious medical complications or permanent disability.
Some examples of emergencies could include:
Your plan may require that you contact QCP within 48 hours of an Emergency Room visit to pre-certify your visit. Please refer to your plan document for details on pre-certification requirements for ER visits.
These are physicians who identify themselves as Family Practice, Internal Medicine, or Pediatric doctors. A primary care physician (PCP) is the physician you should establish a relationship with so you have a 'medical home'. A medical home can assist you when you are acutely ill as well as perform annual physicals to identify any conditions you may have. Please check with your human resources office or plan administrator to clarify the specifics of your health plan. The plan administrator's number is located on your medical ID card.
If you need to find a primary care physician in your area, please use our Provider Search.
If you have difficulty establishing with a primary care physician, please contact QCP. Our staff is here to assist you.
A co-payment (co-pays) is a designated dollar amount paid by the insured to receive specified services. This is payable at the time of service. Some plans require co-pays for doctor visits, prescription drugs and emergency room visits. Co-payments are separate from the deductible amount and normally do not apply toward the annual deductible. Additionally, the deductible does not usually need to be satisfied before a co-payment applies. Please refer to the Summary of Benefits provided by your health plan for specifics of your health plan.
Coinsurance is a cost-sharing requirement under certain health insurance policies. It requires the insured (patient) and the insurer (the employer or health plan) to pay a portion or percentage of the costs for covered services. For example, a plan with an '80/20' coinsurance design would require the employer to pay 80% of the allowable and the patient to pay 20%. Please refer to your plan document for your actual benefit.
The deductible is the amount of money an insured needs to satisfy after making a claim before their insurance company provides benefit coverage. With health insurance, deductibles usually range from $500 to $5,000. So if the insured has a $1,000 deductible, for example, and has a $10,000 claim, he/she will be responsible to pay $1,000 before the insurer starts paying coverage.
The out-of-pocket maximum is a predetermined limited amount of money that an individual must pay out of their own pocket, before an insurance company will pay 100 percent for an individual's health care expenses.
UCR stands for Usual, Customary, and Reasonable – the maximum amount allowed for a covered service based on the following criteria:
Costs are lower for covered services in the Network for the following reasons:
Brand-name drugs are more expensive than generics because the manufacturers have spent years on research and clinical studies in developing a new medication. As a result, drug manufacturers look to recover some of these research and development costs through drug pricing strategies. Because there are no drug price controls, manufacturers can set the price of their drug at whatever level they want.
However, once a patent on a brand-name drug expires, generic manufacturers may produce an equivalent generic drug. Because generic drug manufacturers are not introducing a new drug, they avoid the related expenses associated with developing a new medication, which is reflected in the lower price.
There are many myths and misconceptions about generic drugs. Some people believe that quality is tied to costs, and that a less expensive product is of lower quality. In the case of generic drugs, that is simply not true.
A generic drug can be produced once the brand-name drug patent has expired. However, the Food and Drug Administration (FDA), which approves brand-name drugs, must also approve all generic drugs before they can be sold. To gain approval by the FDA, a generic drug must:
A generic drug must contain the same active ingredients in the same amounts as the brand-name drug. However, the inactive ingredients, as well as the color or shape of a generic drug, may be different from its brand-name counterpart.
Individuals who are experiencing a 'reaction' to a particular generic drug may be allergic or sensitive to these inactive ingredients or dyes. Switching to another product from a different generic manufacturer may relieve the problem.