At Inovalon your continued health is important to us. Our goal is to provide you with meaningful choices to fit your needs while ensuring you have access to quality and affordable care.
Medical Insurance
You have two medical plan options through Allegiance utilizing the Cigna Open Access Plus (OAP) network:
- Open Access Plus (OAP)
- High Deductible Health Plan (HDHP) with HSA
Under both plans:
- Medical coverage is provided through Allegiance utilizing Cigna’s large national network of quality providers and facilities with competitive network discounts.
- You may see any doctor. Referrals are not required to see a specialist. You will save money if you use in-network providers.
- Prescription drug coverage administered by Cigna is also included.
- For less cost than a typical in-office doctor’s visit, you can see a doctor by phone, secure video, or mobile app for minor medical conditions, preventive wellness screenings, and behavioral health services.
The key differences between the plans are the deductibles, copays, out-of-pocket maximums, and the amount you’ll pay each paycheck for plan coverage. In addition, the High Deductible Health Plan includes a health savings account (HSA).
Managing Your Medical and Prescription Benefits
Healthcare doesn’t have to be confusing. To make things easier, Inovalon has partnered with Quantum Health to simplify your healthcare experience, get the most out of your benefits, and save you money.
When asked, “Who is your health insurance carrier?” simply reply your coverage is through Allegiance, with the Cigna Open Access Plus network. Quantum Health is also available every step of the way to help you navigate the health care system. Together, they work behind the scenes to ensure your best overall member experience. Here is how they partner for you:
- Provides support for all your medical and prescription drug benefit related questions or issues
- Assists you in finding the highest quality in-network providers by procedure and location
- Pre-certifies care when required
- Processes your health care claims
- Manages your provider network, Cigna Open Access Plus
Visit myinovaloncarecoordinator.com or call 1-866-885-1125 for support.
Quantum Health Care Coordinators are an expert team of nurses, patient services representatives, and benefit specialists who are ready to help you through every single step of your healthcare journey. Think of Care Coordinators as your personal health care team — they fight hard to help you save money and make sure you get the best possible care for you and your family.
Your Quantum Health Care Coordinator can help you with:
- Receiving ID cards
- Answering claims, billing and benefit questions
- Finding in-network providers
- Managing a health condition
- Saving money on out-of-pocket costs
- Understanding how to get the most out of your benefits
- Pre-certifying care when required
- Learning simple steps to improving your health
- Helping with medical needs – anything that can make the healthcare process easier for you
You have one phone number to call for your health care needs, call Quantum Health at 1-866-885-1125.
“Sarah uncovered the reason my claims were not being paid. She followed-up with my surgeon, the facility, and anesthesia, ensuring that all claims were submitted, processed, and paid. I am very thankful for Sarah helping me resolve these issues and relieve the stress that goes along with them.”
“I just had an amazing conversation and interaction with Myranda. When I originally called in, I was extremely upset about the process of looking for a doctor, my anxiety was through the roof, and she was able to calm me down. Myranda took it to the next level and shared tools to help navigate the website and help me narrow down my search, she simplified the process. I want to share how amazing and patient she was. I really appreciated her help.”
“I am so happy that Inovalon chose to have Quantum Health as our Care Coordinators! I know that if I were calling my insurance directly, they would not provide half the customer service that Quantum Health does. I just wanted to let you know that I love Quantum!”
“My Care Coordinator answered all my questions and offered great feedback in explaining how my deductible worked!”
Filing an Out-of-Network Claim with Allegiance
Online: Visit the Allegiance Submit a Claim web page and complete the online form.
By Mail: Download the form and mail to Allegiance.
Allegiance
P.O. Box 3018
Missoula, MT 59806-3018
Need Help?
Quantum Health Care Coordinators are available to help with questions regarding your medical and prescription drug plans. Call Quantum Health at 1-866-885-1125 for all your health care needs.
Get the MyQHealth app
Follow these simple steps to obtain your medical and prescription drug member ID card:
- Open the Apple App Store or Google Play
- Search for “MyQHealth — Care Coordinators”
- Select the app and tap “Install” to begin downloading
- Open the app and register your account
Quantum Health handles all precertification of services for our medical plans. Precertification means that a healthcare service must be reviewed and approved in advance to be covered by the medical plan. The precertification process helps to ensure you receive high-quality, safe, and effective care in the appropriate setting.
If you or a covered family member needs to have any of the following services, your healthcare provider should call Quantum Health at the number on your insurance card to confirm eligibility, determine coverage, and initiate precertification. Your Quantum Health Care Coordinators will work directly with the provider to obtain the necessary documentation.
Medical services requiring precertification
- MRI/MRA/PET scans
- Outpatient surgeries
- Oncology services (chemotherapy and radiation)
- Genetic testing
- Dialysis
- Transplants
- Home healthcare
- Hospice care
- Durable medical equipment (all rentals and purchases over $1,500)
- Partial hospitalization and intensive outpatient care for behavioral health and substance use
- Hospitalizations to include acute care, skilled nursing, skilled rehabilitation, and behavioral health/ substance disorder
The precertification process helps ensure care is medically necessary and appropriate. If you fail to pre-certify services when required, benefits may be denied.
Whether you are enrolling in the medical plan coverage for the first time or changing your plan election for the upcoming plan year, you will receive new ID cards.
- When will new ID cards be mailed? You will receive new ID card(s) prior to the new plan year.
- How many cards will be mailed? You will receive two ID cards to the primary account holder. If you wish to order additional cards, you can do so at no additional cost by calling Quantum Health at 1-866-885-1125.
- Do I need a separate ID card for prescription drug benefits? No, your medical plan ID card can be used for both prescription drugs and medical plan provider services.
- Will I receive a new HSA debit card if I am currently enrolled in the HSA medical plan? No, you may continue to use your current HSA debit card. You will not receive a new card.
As a reminder, a temporary ID card is available if you ever need one. If you need an ID card before your new one arrives in the mail, you may download or print your ID card by logging onto myinovaloncarecoordinator.com. You may also print or view ID card information right from your mobile device when you download the Quantum Health app. Then, you can show it to your doctor or pharmacist.
Find high-quality, cost-effective, in-network care – all with a single search tool
New to town and need a doctor? Out of town and need a doctor? Looking for the best place to have joint surgery? For all your healthcare research and decisions, now there’s only one place you need to go – and it’s as close as your computer or mobile device.
Found on your Quantum Health member portal at myinovaloncarecoordinator.com, Care Finder™ helps you find and compare healthcare providers and facilities so you can make informed choices about the care you’ll receive. Checking cost and quality rankings in advance can save you hundreds or even thousands of dollars and ensure you receive the best possible care.
Comparing Your Medical Plan Options
- The Cigna Care Network (CCN) consists of Health Care Professionals that are assigned the Cigna Care Designation (CCD), meaning that they meet Cigna’s criteria for certain quality and cost-efficiency measures. The Cigna Care Network (CCN) provides a higher level of in-network benefits (coinsurance and/or copayment), so you pay less when you visit a CCN provider. Visit myinovaloncarecoordinator.com.
- When a generic is available and you request a preferred brand or non-preferred brand drug, you pay the brand cost share plus the cost difference between the brand and generic drugs up to the cost of the brand drug (unless your physician indicates “Dispense as Written”).
- Certain prescriptions that are considered to be preventive under federal law are mandated to be covered in full and the noted cost sharing does not apply. For a list of ACA approved preventive care, go to healthcare.gov.
Additional Details:
Precertification is required for certain services. For a list of services, refer to the back of your ID card.
If you cover any dependents on the Choice Fund OAP HSA plan, the full family deductible must be met before the plan will start to pay.
The above is a brief summary of the plans.
Medical and Prescription Biweekly Payroll Contributions
Prescription Drug Coverage
Inovalon offers a prescription drug plan through Cigna. Each medical plan automatically comes with prescription drug coverage. You will use your medical plan’s ID card to fill prescriptions at one of Cigna’s participating pharmacies. You can fill a 30-day supply at any retail pharmacy in the network, including CVS, Walmart, Publix, and several others. Or, you may fill a 90-day supply at a select in-network retail pharmacy including CVS, Walmart, etc. For a full list of participating chain retail pharmacies, go to Cigna.com, or go to cigna.com/rx90network.
How Quantum can help you make the most of your pharmacy benefit
Get your meds at the lowest cost available. Your dedicated Quantum Health Care Coordinators are familiar with your health plan’s drug formulary (a tiered list of generic and brand-name prescription drugs that are covered by your plan). Medications in the lower tiers will cost you less. Below are a few other ways Quantum Health Care Coordinators can help you save:
- Comparing prices from different pharmacies
- Investigating same-class alternatives in generic versions
- Finding available savings programs through specific pharmacies and drug manufacturers
- Using discount card programs, coupons, and coinsurance assistance programs
- Researching home delivery options
- Engaging the Quantum Health in-house pharmacy team
Call a Care Coordinator for support at 1-866-885-1125.
Learn more about your condition, medications, and specialty drug programs available to you. Condition-specific support programs can improve treatment participation, help you build a sense of community with fellow patients and caregivers, and provide a source of the latest information about treatment.
If you have questions related to covered medications, view the Cigna drug list or contact Cigna customer service for assistance at 1-800-325-1404.
For those with chronic conditions, autoimmune diseases, or complex illnesses, your Quantum Health Care Coordinator can help you manage your drug therapy.
- If you are prescribed infusion therapy, Quantum Health Care Coordinators help you find less-costly sites of service
- If you are prescribed a medication that is only available through a specialty pharmacy, Quantum Health Care Coordinators can help you find an in-network specialty pharmacy and help with prior authorizations
- If there are barriers to taking your medications as prescribed, the Quantum Health Care Coordinators will suggest ways to promote adherence
- The Quantum Health Care Coordinators will provide support, continuous education, and ongoing monitoring
- The Quantum Health in-house pharmacy team can perform a thorough review of all the medications you take, to ensure safety
Call a Care Coordinator for support at 1-866-885-1125.
The Quantum Health Care Coordinators will engage their in-house pharmacy team to support those with numerous prescriptions, costly prescriptions, or adherence issues. Their pharmacy professionals will review your records to identify any patterns and potential problems with drug therapy, which can alert them to the need for therapeutic intervention. Then, they’ll call the prescribing physician to discuss potential dosage adjustments or replacement, if necessary.
Quantum Health Pharmacy Review includes:
- Medication appropriateness
- Drug-disease interactions and serious treatment risks
- Drug-drug interactions
- Therapeutic duplication
- Clinical abuse and misuse
- Drug-allergy interactions
- Generic substitution
- Incorrect dosage
- Inappropriate frequency or duration of drug treatment
- Potential and actual adverse effects
- Pregnancy alerts