QualChoice Health Insurance Review & Complaints: Health Insurance (2024)

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QualChoice is a recent entrant into the Arkansas health insurance market. Offering a wide range of group and individual health plans as well as Medicare plans, the young insurer has grown quickly to cover the entire state.

Keeping health care costs manageable and navigating the health insurance marketplace are not easy tasks. Taking the time to compare rates from multiple insurance companies can help you find affordable health coverage and a health plan that meets your needs.

What is QualChoice?

QualChoice was initially created in 1994 to be a third-party administrator for other health insurance plans. Founded by the University of Arkansas for Medical Sciences, it moved shortly thereafter into providing full-service health plans for groups and individuals, with HMO and PPO options.

In 2009, the acquisition of Community Bank Life resulted in restructuring and the formation of QualChoice Life and Health Insurance Company, Inc. under a holding company, QualChoice Holdings. In 2014, QualChoice was acquired by parent company Catholic Health Systems, making it part of one of the largest not-for-profit health insurance groups in the nation.

QualChoice offers individual health insurance both on and off the marketplace across the state. They also write short-term health coverage, and Medicare coverage; you can read our review of their Medicare plans here.

What Health Plans Are Offered?

QualChoice has a good range of health plans in several categories. Options include HMO and PPO as well as plans that include an HSA.

Classic Plans

The Classic Plan is available at either the Silver or Gold level and is a PPO plan offering both in and out of network coverage.

The Silver Classic 6500 has a $6,500 individual deductible that is doubled for a family. Primary care visits have a $45 copay, while specialist visits have an $80 copay. Prescriptions start at $20 for Tier 1. Most other services are subject to a 50% coinsurance after the deductible, including emergency care.

The Gold Classic 2000 has a lower $2,000 individual and $4,000 family deductibles. Primary care has a $25 copay, with specialist visits doubled to $50. Emergency room visits have a $100 copay, with most other services covered with a 30% coinsurance after the deductible. Prescriptions start at $10.

Classic Saver Plans

The three Classic Saver plans are also PPO, with both in and out of network coverage available. There is one Bronze and two Silver plans to choose from.

The Bronze Classic Saver 5000 has a $5,000 individual deductible, doubled for a family. All services are subject to the deductible, with a 50% coinsurance up until the out-of-pocket maximum is reached. This also applies to prescription drugs.

The Silver Classic Saver 4000 is a similar plan, with slightly lower deductibles of $4,000 individual and $8,000 family and a lower 45% coinsurance after the deductible is met.

The Silver Classic 3500 again drops the deductibles somewhat, to $3,500 individual and $7,000 family, but the coinsurance with this plan is only 10% after the deductibles. Services are covered in full after the out of pocket maximum is met.

Basic Plans

The Basic plans are HMOs, offering no out of network coverage. There are two plans: Silver and Gold.

The Silver Basic 6500 has a $6,500 individual deductible, which is doubled for family, mirroring the Silver Classic; in fact, all of the coverage mirrors the Silver Classic. The main difference between the two plans is the lack of out of network coverage, which limits the insured to those providers that are in-network.

Similarly, the Basic Gold has the same coverage as the Classic Gold; again the difference is the network access.

Basic Saver Plans

The two Basic Saver plans are the same as the Bronze 5000 and Silver 3500 plans in terms of deductibles and coinsurance amounts. As with the basic plans, these plans differ in terms of the network that is available.

Catastrophic

QualChoice offers one catastrophic plan. It has an individual deductible of $7,350, which is doubled for a family. As with most catastrophic plans, coverage is not offered until the deductible is met; one exception is that three primary care visits are allowed per the calendar year at no charge. As the deductible is also the out of pocket limit, all services are covered in full after it is met.

Short Term

QualChoice has short-term health insurance available with terms from 28 to 182 days. Coverage is available for individuals and families, with a 20% coinsurance amount after the deductible is met.

Additional Covered Health Care Options

QualChoice also offers additional group insurance options, including:

• QualChoice dental benefits
• QC life and health
• Vision services

Other health benefits and wellness programs include Medicare supplement plans, FSA, and COBRA administration.

Read more: QualChoice Medicare Insurance Review & Complaints: Health Insurance

Are the Company’s Rates Affordable?

We ran a quote for a single 30-year-old non-tobacco user living in QualChoice’s headquarters’ county. The least expensive rate returned was $282.78 a month for the Bronze Basic Saver 5000 plan. The next cheapest was the Bronze Classic Saver at $297.66 a month, which is not much of an increase to add out-of-network coverage.

Surprisingly, the most expensive plan was not a Gold plan, but the Silver Classic 6500, at $432.81.

Without comparison to other companies operating in the same county and state, it is difficult to make a clear statement on the value offered by these plans. Certainly, the rates seem in line with what we have seen for similar plans in other states, perhaps a little on the high side considering the generally high deductibles and coinsurance amounts.

Additional Covered Health Care Options

QualChoice also offers additional group insurance options, including:

• QualChoice dental benefits
• QC life and health
• Vision services

Other health benefits and wellness programs include Medicare supplement plans, FSA, and COBRA administration.

QualChoice Health Insurance Claims Process

Ease of Filing a Claim

QualChoice Health Insurance offers a relatively straightforward claims process. Most claims are handled directly with healthcare providers, which simplifies the filing process for policyholders. The company also provides claims forms on its website for download, although these may not be frequently needed for standard claims.

Average Claim Processing Time

The average claim processing time at QualChoice Health Insurance can vary depending on the nature of the claim and the healthcare provider involved. In general, claims are processed promptly, but specific processing times may differ. Policyholders can check the status of their claims through the online account management system.

Customer Feedback on Claim Resolutions and Payouts

Customer feedback on claim resolutions and payouts at QualChoice Health Insurance is mixed. While some policyholders have reported positive experiences with efficient claim resolutions and fair payouts, there are also complaints about denied claims and disputes over coverage.

It’s important for policyholders to thoroughly review their policy terms and understand what is covered to avoid potential issues with claims.

Digital and Technological Features of QualChoice Health Insurance

Mobile App Features and Functionality

QualChoice Health Insurance offers a mobile app that provides policyholders with convenient access to their insurance information. The app allows users to view policy details, access digital ID cards, and even submit claims electronically. It simplifies the management of insurance on the go, making it easier for users to stay informed about their coverage.

Online Account Management Capabilities

The company’s online account management system provides policyholders with a user-friendly platform to manage their insurance accounts. Users can log in to access policy documents, review claims history, and make premium payments online. This digital feature enhances the overall customer experience by offering convenience and accessibility.

Digital Tools and Resources

QualChoice Health Insurance offers various digital tools and resources on its website to assist policyholders in understanding their coverage and healthcare options.

These resources include educational articles, FAQs, and online tools for estimating healthcare costs. The company’s commitment to digital resources helps empower policyholders to make informed decisions about their health insurance.

Overall, QualChoice Health Insurance leverages digital and technological features to enhance the customer experience and simplify various aspects of policy management. Policyholders can take advantage of these tools to access information, file claims, and make informed healthcare decisions.

Does the Company Have Positive Ratings and Consumer Reviews?

QualChoice Holdings, the holding company created for the corporation, has an A- rating with the Better Business Bureau (BBB). This lowered rating is due to failure to respond to one of the four complaints on file in the past three years. One complaint was closed in the past 12 months.

The company is not rated by the National Committee for Quality Assurance due to a lack of data reported for 2017.

There are two Yelp reviews for QualChoice, both of which are negative, resulting in a one-star rating overall. There are a couple of positive reviews among the 14 total reviews on Google, but the rest are overwhelmingly negative, resulting in a 1.6-star rating overall. Most complaints are focused on common issues like poor customer service and denial of claims.

Generally, the complaint volume isn’t high for this company.

What’s the Bottom Line?

QualChoice may be worth considering for those who are seeking a high deductible plan with reasonable monthly costs. They appear to have a fairly good reputation but may be on the expensive side for those who have a lot of health expenses. Their plan coverage should be carefully compared to other options before making a final choice.

Keep your search for health insurance simple. Compare quotes from local and national health insurance providers to find affordable rates and comprehensive health care coverage.