How
does my OptiMed Limited Benefit plan work?
Your plan is an Indemnity based plan, which also includes
an Assignment of Benefits provision for providers. Benefit
amounts are shown within the Schedule of Benefits. If you
utilize a PPO provider or hospital, your fees/charges for
services will be reduced. Your
OptiMed Plan is not a major medical plan.
Does my plan cover maternity?
- Yes. Maternity is covered as the same as any other
illness, and the plan will pay benefits out for whatever
line of coverage it falls under, subject to the limits of
the plan.
If I have other coverage, will my OptiMed Limited Health
plan still pay benefits?
- Yes. Your OptiMed Limited Health Plan pays in addition
to any other coverage.
How do I find PPO Providers?
- Please see the "Provider Directory" link under the OptiMed for Employers tab on the left navigation bar.
If my doctor is not a PPO provider will that change the
benefit I will receive?
- No. The Plan will pay you the same benefits in
your schedule of benefits whether you go to a PPO provider
or a Non-PPO provider.
Why should I use a PPO provider?
If
I do not have my ID card with me when I visit the doctor,
what should I do to make sure the doctor’s office is
aware of the coverage my OptiMed Limited Health plan provides?
- Please have the doctor’s office call the OptiMed
Customer Service Department at (800) 603-5006. We will
provide them your group number and PPO Network information.
Who do I contact when I have
a problem or a question about my OptiMed Limited Health plan?
- Please contact OptiMed Customer Service at (800) 603-5006.
- Hours of Operation – 9am through 5pm EST - Monday
– Friday.
If
I am going to a Non-PPO hospital, what address do I give
the hospital to assign benefits, so that the hospital will
bill the carrier directly, and I do not have to submit a
claim form?
OptiMed Health Plans
4 Terry Drive Building 1
Newtown, PA 18940
If I am going to a PPO hospital,
what address do I give the hospital to assign benefits,
so that the hospital will bill the carrier directly and
I will receive a PPO discount, and I do not have to submit
a claim form?
OptiMed Health Plans
4 Terry Drive Building 1
Newtown, PA 18940
Who may I contact for assistance
if I am unable to pay or having difficulty paying a provider
bill?
- OptiMed’s
Patient Advocacy Department
will assist you. Our Patient Advocacy service acts as
a liaison between you and your medical providers. Our
objective is to assist you in:
- Receiving the highest quality
services.
- Receiving the most cost effective
care.
- Resolving problems you have
paying a provider.
OptiMed's promise of delivering to you the highest level
of customer service means we care about answering any
questions or resolving any provider payment difficulties
you may have.
For more information on OptiMed’s Patient Advocacy
Services, please call Customer Service at (800) 603-5006.
| One of the best features
of your OptiMed Limited Health plan is that it is a true indemnity
plan that can pay benefits directly to the provider. |
HOW TO FILE A MEDICAL CLAIM
Your plan includes an Assignment of Benefits provision.
When you assign benefits, you sign a document allowing your
hospital or doctor to collect your health insurance benefits
directly from your health carrier. By assigning benefits you
will not have to file a claim with the insurance carrier to
be reimbursed.
The process does differ slightly for PPO Network and Non-PPO
Network claims, so please read the following carefully:
PPO and Non-PPO OUTPATIENT
& INPATIENT CLAIMS (Doctor Visits and Lab & X-Ray
Services, Hospital Stays and Inpatient Surgery)
- Member phones Optimed Customer Service or visits the
Providers
link at www.optimedhealth..com to locate a Network
Provider. OptiMed’s Customer Service Department
can also assist in locating a Network provider.
- Member schedules an appointment with the Network Provider,
if available. If not, member can access the provider of
their choice.
- Member presents OptiMed Identification Card upon arrival.
- Provider renders services.
- Provider sends claim to OptiMed Health Plan for reimbursement.
- OptiMed Health plan re-prices the bill and United
Group Programs pays the provider directly.
- Provider bills member for the balance due.
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