If you have a problem or concern about Optima Health and/or the quality of care, services and/or policies and procedures of Optima Health, contact Member Services.
Optima Health has a formal process that allows for your concern to be addressed with the appropriate departments/persons within Optima Health. Research into your concerns are conducted in a timely manner to accommodate any clinical urgency of the situation. Upon research and completion, you will be notified of the resolution to your concern.
If your concern involves a denial of a covered service or claim, Optima Health includes a formal appeals process.
You may be eligible for a routine appeal, or an expedited appeal if an emergency medical condition exists. Download an appeal packet or contact Member Services at the number listed on your Member ID card to initiate the appeals procedure.
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