Quick answer
Quartz, a Wisconsin-based health plan, covers behavioral health and substance use disorder care, and coordinates it through UW Health Behavioral Health Care Management. Intensive levels of care - IOP, partial hospitalization, residential treatment, and psychiatric admissions - require prior authorization, and HMO members generally need in-network care, with out-of-network services covered only when prior authorized.
Quartz is not a national brand - it is a Wisconsin and tri-state regional plan - and its addiction treatment coverage is handled a little differently from what you would read about big insurers. The good news is that Quartz has a dedicated behavioral health coordination line rather than a generic customer service queue. The part to know up front: Quartz is largely an HMO-style plan, so the network matters more than it does elsewhere.
What Quartz plans cover
Quartz's certificates of coverage define behavioral health and substance use disorder services as the treatment of psychiatric illness or substance use disorders, provided on an inpatient, outpatient, transitional, and emergency basis. That benefit language appears across its HMO plan family. Your specific cost sharing and any visit limits come from your Schedule of Benefits and Certificate of Coverage, both viewable in MyChart.
The Behavioral Health line
Quartz does not route behavioral health care through its general prior authorization process. Its own prior authorization request form prints a note telling you not to use it for behavioral health, and instead to call (800) 683-2300 for Behavioral Health Prior Authorization. Quartz's Behavioral Health Case Management program provides one-on-one help coordinating care - connecting you to treatment, community support groups, and care between providers - with staff available to members in Wisconsin, Illinois, Minnesota, and Iowa.
That makes this number the single most useful one to call: the team coordinates care and handles authorization in one place.
Prior authorization for higher levels of care
Quartz's published member prior authorization list names the services that need approval before Quartz will cover them, including in the behavioral health column:
- Partial hospital programs (PHP)
- Residential treatment
- Psychiatric admissions
- Elective inpatient admissions generally - with urgent or emergent admissions instead requiring notification at the time of admission
Requirements vary by plan, and Quartz says it works to minimize prior authorizations and updates the list regularly, so check the list for your specific plan.
Quartz's request form states that non-urgent pre-service decisions come within 15 calendar days and post-service decisions within 30. Quartz's certificate language also carries an honest caveat worth repeating: preauthorization is not a promise that the plan will cover the cost - coverage still follows the terms of the policy.
Network rules by plan type
Quartz sells HMO, POS, and PPO plan types, and the type printed at the top of your ID card changes the rules:
- HMO: Quartz's certificate language says members are expected to obtain services from in-network providers, and elective out-of-network services must be prior authorized to be eligible for coverage - with benefits limited to the usual, customary, and reasonable charge, so you may owe the difference above that.
- POS and PPO: other plan types Quartz sells carry different network rules - check the plan type on your ID card and your plan's documents for how out-of-network care is handled.
Quartz's member prior authorization list also notes that non-emergency care received out of network needs prior authorization, with Customer Success available at (800) 362-3310 to help. If you are comparing treatment programs, check each one against the Quartz network before you commit - an out-of-network facility under an HMO plan may end up only partially covered even with authorization.
Parity protections you can lean on
MHPAEA requires that when a plan covers substance use disorder benefits, its financial requirements and treatment limitations for those benefits - including prior authorization and other review processes - be no more restrictive than what it applies to medical and surgical benefits. The ACA's essential health benefits rule keeps substance use care in scope for individual and small group plans. Employer self-funded plans handle their own parity compliance through the plan sponsor, which applies to some Quartz self-funded arrangements.
If you get a denial, or the answer is unclear
A denial letter should state the reason and your appeal rights. You can ask for the medical necessity criteria applied to your case and request a copy of how the decision compares to the plan's medical benefit rules. Document dates, names, and reference numbers. SAMHSA's Know Your Rights guide explains the appeal process, and SAMHSA's National Helpline (1-800-662-4357) is a free, confidential starting point for finding treatment in parallel.
If you would rather talk through options before calling the insurer, call (800) 653-9376. The call is free, and there is no judgment at either end of the line.
If you are in crisis right now, call or text 988 for the Suicide and Crisis Lifeline; call 911 for a medical emergency.
Questions about Quartz Coverage
Does Quartz cover rehab for drug or alcohol addiction?
Yes. Quartz's certificates of coverage list behavioral health and substance use disorder services as plan benefits - treatment of psychiatric illness or substance use disorders on an inpatient, outpatient, transitional, and emergency basis. Costs and network rules depend on your specific plan documents, so check your Schedule of Benefits and Certificate of Coverage in MyChart.
Who do I call at Quartz about alcohol or drug treatment?
Quartz runs a dedicated Behavioral Health line - call (800) 683-2300 to reach behavioral health staff who coordinate care and handle behavioral health prior authorization. Quartz's own prior authorization form prints a note saying it should not be used for behavioral health, directing those requests to this line instead.
What Quartz services require prior authorization?
Quartz's published member prior authorization list includes behavioral health services such as partial hospital programs (PHP), residential treatment, and psychiatric admissions, plus elective inpatient admissions generally - urgent or emergent admissions instead require notification at the time of admission. Requirements vary by plan, so check your plan's specific list.
Can I go out of network with Quartz?
It depends on your plan type. HMO members are expected to use in-network providers, and out-of-network services must be prior authorized to be eligible for coverage, with benefits limited to usual, customary, and reasonable charges. POS and PPO plans offer more flexibility to go out of network, at higher cost sharing. Check the plan type printed on your ID card.
How long does Quartz take on a prior authorization decision?
Quartz's prior authorization request form states that determinations are made within 15 calendar days of receipt for non-urgent pre-service decisions and within 30 calendar days for post-service decisions. Urgent situations follow expedited handling. If a decision stalls, you can check status in MyChart or contact Customer Service at (800) 362-3310.