Initiating an Appeal

To initiate the appeal process, submit your request in writing to:

Optima Health

Appeals Department

P.O. Box 62876

Virginia Beach, VA 23466-2876

OR

Fax:  757-687-6232 or 1-866-472-3920

You or your authorized representative have the right to submit written comments, documents records or any other information relevant to your case. If you have difficulty in obtaining this information, please contact the Appeals Department for assistance.

Relevant information includes:

• The Appeal Request Form describing the services or procedures requested and an explanation of why you feel Optima Health's decision was incorrect;
• Office notes from physicians that you have seen regarding the services or procedures in question;
• Medical records from hospitals and other health care providers;
• Physician correspondence;
• Physical, occupational, or rehabilitative therapy notes;
• Copies of bills you have received;
• Any additional information you would like Optima Health to consider in reviewing your appeal.

Upon Optima Health's receipt of your written request, you will have ten (10) days to submit any additional medical information. Any documentation received after the 10th day may not be considered in your appeal review.

Quick Links:

 Download Member Appeal Packet