Quartz welcomes member and participant input. We work hard to resolve problems that our members and participants share with us. If you are dissatisfied with your plan, you have the right to share your thoughts. Contact Customer Service at (800) 362-3310 to discuss your complaint.
Sometimes our Customer Service staff cannot clear up the matter. In that case, our Appeals Specialists will help you with the appeal process. Please check your Certificate of Coverage or Summary Plan Document for a full description of your appeal rights.
840 Carolina Street
Sauk City, Wisconsin 53583
Fax: (608) 644-3500
Phone: (800) 362-3309, extension 101901
To verify if your employer offers Appeals, please refer to your Summary Plan document.
All appeals must be submitted in writing within 180 days following the receipt of a notification of an Adverse Benefit Determination. If the appeal qualifies as an Expedited case, then the appeal request can be taken verbally. Appeals Specialists will work with appropriate staff to determine if an appeal qualifies to be expedited.
Appeals Specialists will determine if an appeal is a valid appeal by verifying that Quartz has processed the issue correctly. Valid appeals will be acknowledged within five business days by a mailed letter to the participant. The appeal will be resolved within 30 days for pre-service requests and 60 days for post service claims. Participants have the right to submit relevant testimony with the appeal.
Providers can file appeals on behalf of participants, with the participants' permission. In order to obtain proper authorization, the Appointment of Authorized Representative form will need to be signed by the participant.
Once a decision has been reached and if it is unfavorable for the participant, you may have the option to file a request for external review. If this is an option for your appeal, the external review rights will be given to you with the final internal determination.