Optima Health

optimaheath-logo

4417 Corporation Lane
Virginia Beach, VA 23462
Telephone: (757) 552-7401
Fax: (757) 552-7396
Member services: (757) 522-7410 or (800)-543-3359
Provider services: (757) 552-7474 or (800) 229-8822

Web site: www.optimahealth.com

Key Staff
President – Michael M. Dudley
Medical Director – Thomas Lundquist, MD
Director of Provider Relations – Rachel Schneider
Government Relations – Megan Padden

Other Contacts
General Company Information – Darleen Mastin, COO
Grievance/Appeals Procedures – Stephanie Blue
Quality Improvement – Jan Elion
Pharmacy Benefits – Tim Colligan
Provider Contracting – Mike Ryder

Specialized Health Care Services
Service In-House Contracted
Mental Health X
Pharmacy Benefit Mgmt. X-Catamaran
Vision Care X-EyeMed
Dental Care X- Cigna
Disease Mgmt. X
Utilization Mgmt. X

 

Market Segment
Market Segment HMO/POS PPO Medicare Advantage  
Individual  33,235 1,294
Small Group (2-49 Employees) 38,451 6,418  –
Large Group (50+ Employees) 57,301 10,548  –
Administrative Services Only (ASO) 102,460 40,486  –

 

Network Providers Under Contract (numbers are combined HMO/PPO)
Network Providers HMO PPO PAR
PCPs 3,895 3,895
Physician Specialists 11,086 11,086
Hospitals 101 101
OB/GYNs 654 654

 

Enrollment (as of January 31, 2015:  459,772)
Standard HMO 123,416
Medicaid HMO 159,284
Point-of-Service (POS) 5,571
PPO 16,966
Medicare Advantage PPO + FAMIS 12,755

 

Virginia HMO Service Area:
Counties
Accomack, Albemarle, Alleghany, Amelia, Amherst, Appomattox, Augusta, Bath, Bedford, Botetourt, Buena Vista, Brunswick, Buckingham, Campbell, Caroline, Charles City, Charlotte, Chesterfield, Clark, Covington, Culpeper, Cumberland, Dickenson, Dinwiddie, Essex, Fauquier, Floyd, Fluvanna, Franklin, Frederick, Giles, Gloucester, Goochland, Greene, Greensville, Halifax, Hanover, Henrico, Henry, Highland, Isle of Wight, James City, King George, King & Queen, King William, Lancaster, Loudoun, Louisa, Lunenberg, Lynchburg City, Madison, Mathews,  Mecklenburg, Middlesex, Montgomery, Nelson, New Kent, Northampton, Northumberland, Nottoway, Orange, Page, Patrick, Pittsylvania, Powhatan, Prince Edward, Prince George, Pulaski, Rappahannock, Richmond, Roanoke, Rockbridge, Rockingham, Russell, Scott, Shenandoah, Smyth, Southampton, Spotsylvania, Stafford, Suffolk, Surry, Sussex, Warren, Washington, Westmoreland, Wise, York

Cities
Bedford, Bristol, Charlottesville, Chesapeake, Clifton Forge, Colonial Heights, Danville, Galax, Emporia, Franklin, Fredericksburg, Hampton, Harrisonburg, Hopewell, Lexington, Lynchburg, Martinsville, Newport News, Norfolk, Norton, Petersburg, Portsmouth, Poqouson, Radford, Richmond, Roanoke, Salem, Staunton, Suffolk, Virginia Beach, Waynesboro, Williamsburg, Winchester