Hello, how can we help?

Questions? We’ve got answers.

We’re always happy to help with any questions that you may have. Don’t see the answer to your question below? Our Customer Experience Team is here to provide extra support 8 AM to 5 PM, Central Time, Monday through Friday: (844) 869-5640.


Healthcare Highways processes your medical and pharmacy claims. Do you have a claims question? Call: 844.869.5640.

FAQ Topics


Your Health Plan.

Do I need to get approval in advance for some services?

Pre-certification is required on certain services or healthcare facilities depending on your plan. Notification of in-patient hospitalization is required prior to admission or within 48-hours of an emergency admission. Certain outpatient procedures may also require pre-certification.


If you have questions or need help with pre-certification, please contact our Customer Experience Team at 888.869.5640.


Who processes my claims?

Healthcare Highways processes your medical and pharmacy claims. If you have claims questions, please contact us at 888.869.5640.


Setting up a new account.

Can I enroll online into the Healthcare Highways Health Plan?

If the group number on your ID card begins with the letters HCH, then you can easily enroll online through your member portal.


Add or delete family members

Please reach out to your employer’s Human Resources department to add or delete a family member as a covered dependent.


Healthcare Highways ID Cards Eligibility

Am I covered? What about my dependents?

You can find an explanation of who is covered under your plan and what benefits are available by logging into your member portal.


Order a new ID card

You can request a new member ID card by logging into your member portal or by calling our Customer Experience Team at 844.869.5640.


Benefits

Find a benefit summary

One way to track your healthcare expenses is through your monthly Explanation of Benefits, or EOB. This statement is easily found on your member portal, and lets you see what medical treatments and/or services were paid for on your behalf.


I have a question about my benefits

For benefit plan questions, please call 888.869.5640. You may also access your plan benefits through your HCH member portal.


CerpassRx, Prescriptions & Pharmacy

Meet CerpassRx

We are the Pharmacy Benefit Manager. We assist your employer in keeping your overall drug costs to a minimum and fill your prescriptions. Learn more about us here.


Can I still use my retail pharmacy?

Our broad pharmacy network includes all national chains and may local pharmacies. Our customer service area can also provide additional participating pharmacies in your area by calling (844) 636-7506.


Your pharmacy should call this number if there are issues processing my prescription?

The pharmacy should call the number on the back of your ID card (844-636-7506).


Prior Authorization

Some drugs your physician prescribes will require special approval or authorization before being filled to ensure you meet the plan’s conditions and requirements for coverage. Prior Authorizations are valid for a specific time period. Should you decide to obtain the medication without a prior authorization, you will be required to pay the full cost of the medication.


Prescription Quantity Limit

Quantity limits are used to ensure medications are being used safely and correctly. These rules may limit the amount of medication you are able to receive over a certain period of time.


Our Formulary

A formulary is a list of medications frequently used by members and prescribers to identify and select a safe, effective and affordable treatment option.


The formulary for Healthcare Highways Health Plan members is updated twice a year.


Step Therapy

Step therapy is a prior authorization program built to help you save money and stay healthy. This program encourages the use of the most cost-effective and appropriate medications available for treating your condition, before more expensive medications are approved.


Zero Copay Program?

We recognize the value of remaining compliant to your drug therapy. As a result, select generic medications for certain chronic disease states are available to you at no cost ($0 copay) when covered by our pharmacy benefit manager CerpassRx.


Providers


Do I have to use the Healthcare Highways in-network providers for all my healthcare needs?

You always have a choice where to seek care, but coverage depends on your health plan benefits. If your plan does not include an out-of-network benefit, then it is unlikely to cover any expenses related to an out-of-network provider. Even if you do have out-of-network coverage, your out-of-pocket costs will be less if you use in-network providers.


You had a bad experience with a Healthcare Highways provider.

Your member rights matter. You can file a grievance about the quality of care you received from a participating in-network provider by contacting us in writing at:


Healthcare Highways
Hall Park
3001 Dallas Pkwy., Ste. 700
Frisco, TX 75034
Attn: Corporate Quality Management


Find a new doctor with Healthcare Highways

Search for a provider, here.


Telemedicine

Sign up for Telemedicine

Your health plan may include telehealth services like MDLive. Look on your member ID card to verify coverage. If you do have this valuable service that allows you to have consultations with healthcare professionals using your phone, tablet, or computer, then we recommend setting up your account now so that you won’t spend extra time registering when the need for care arises.


For members covered by MDLive, there are three quick, convenient ways to register.