Optima Health

optimaheath-logo

4417 Corporation Lane
Virginia Beach, VA 23462
Telephone: (757) 552-7410 or (800)  543-3359
Fax: (757) 552-7116
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
VP, Network – Rachel Schneider
VP, Government Relations – Megan Padden and Paul Speidell

Other Contacts
Chief Operations Officer – N/A
Grievance/Appeals Procedures – Stephanie Blue
Quality Improvement – Jan Elion
Pharmacy Benefits – Tim Colligan
Provider Contracting – Mike Ryder, Dir. Network Management

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

 

Market Segment
Market Segment HMO/POS PPO Medicare Advantage  
Individual  22,805 2,402
Small Group (2-49 Employees) 34,179 2,107  —
Large Group (50+ Employees) 53,685 6,425  —
Administrative Services Only (ASO) 104,843 3,130  —

 

Network Providers Under Contract (numbers are combined HMO/PPO)
Network Providers HMO PPO PAR
PCPs 3,804 3,804
Physician Specialists 16,360 16,360
Hospitals 101 101  0
OB/GYNs 725 725

 

Enrollment (as of March 1, 2017: 408,625)
Standard HMO 104,151
Medicaid HMO 168,083
Point-of-Service (POS) 6,518
PPO 8,532
FAMIS (SCHIP) MCO 10,966

 

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

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