Quality Management Information for Members
Access to and Availability of Services
You must call Quest to obtain pre-authorization for all mental health and substance abuse services. This will ensure payment for the services. The telephone number is 1-800-364-6352.
For routine services, call weekdays between 8 a.m. and 5 p.m. Assessment counselors are available 24 hours a day, seven days a week, if you have an emergency. The counselor will identify the type of treatment you need and refer you to an appropriate provider in our network of practitioners and facilities.
Quest sets standards for the amount and types of providers that must be available to members within certain distances. We measure our performance against our standards annually.
Our goal is for a Quest member living in an urban area to travel 20 miles or less to see a provider and travel 45 miles or less if the member is living in a rural area. We meet and / or exceed our standards for the amount and type of providers within travel distances.
We go to our high volume providers annually and make sure they have appointments available for our members. We also set time standards for providers to offer appointments.
If you have a life-threatening emergency go directly to your nearest emergency room.
Sometimes a member needs to be seen “right away”. Our standards are for providers to offer appointments within:
- 6 hours for members with non-life-threatening emergencies.
- 48 hours for members with urgent needs.
Our care managers work with members to ensure that all Quest members have been offered an appointment based on the urgency of their situation.
Other times members are seen “as soon as they want to be seen”. Our standard is for a provider to offer an appointment within:
- 10 business days for a member with routine needs.
We study routine appointments for access. When our data shows us there are delays in accessing appointments we implement interventions and add additional providers to the Quest network in those areas. On a regular basis, we are adding all types of providers to offer greater amounts and types of providers for our members.
Please let us know if you have difficulty obtaining an appointment within the time you desire; or if you have any special needs or cultural preferences. From time to time we will ask you about this when you call our office. We collect this information to be sure we meet your special needs and preferences.
