Specialty Care

Most Quartz members do not need to get a Prior Authorization from their primary care provider (PCP) for in-network specialty care. *

HMO, State of Wisconsin and Local Government Members

Most Quartz members do not need to get a Prior Authorization from their primary care provider (PCP) for in-network specialty care.*

If your PCP wants to send you to a doctor or nurse who is not in the Quartz network, a Prior Authorization Request Form must be filled out. These requests are only approved if Quartz’s in-network providers do not offer the service. (Learn more about Prior Authorizations).

To learn about your benefits, login to MyChart and check your –

  • Schedule of Benefits or Summary of Benefits and Coverage
  • Certificate of Coverage
  • Wisconsin State and Local government participants should refer to the It's Your Choice book

*Exception: State of Wisconsin and Local Government members must get a referral from their PCP to visit or be treated by a neurosurgeon or orthopedic surgeon for low back pain.

Estimate Your Out-of-Pocket Costs

Determine costs you may incur prior to receiving health care services using the Determination of Benefits Form in MyChart. To complete the form, you will have to ask your provider for certain medical coding information including procedure codes, procedure modifiers and unit codes for the services.

POS, Choice, Choice Plus, OR PPO

POS and PPO plans offer members the choice to stay in-network or go out-of-network for services.

Behavioral Health and AODA Services

For assistance coordinating your behavioral health services, including alcohol and drug treatment services, please contact UW Health – Behavioral Health Care Management at (608) 422-8380 or toll free at (800) 683-2300.

Hospital Services

For elective (non-emergency) services where you will be admitted to the hospital, the doctor who will admit you must contact Quartz for prior authorization and approval. If the hospital is not in Quartz’s network, please notify Quartz Customer Service.

Please access your plan's prior authorization list to see if the health care service you are seeking requires prior authorization.

Learn about your Pharmacy Benefits

Learn more about hearing aid benefits


Questions?

Get in touch with Quartz Customer Service by sending a secured message through MyChart.