A reminder about Optima Health's Direct POS and Direct HMO plans. While our traditional HMO and POS plans still require a referral for specialist care, these "Open Access" plans do not require a referral for specialist care.
The Direct POS & HMO Member ID Cards are clearly marked “No Referral Required.”
Keep this in mind if your patients tell you that their HMO no longer requires a referral for specialist care. For example, Federal Employees have chosen the "Open Access" benefit plan, titled Optima Health Direct, for their employees beginning Jan. 1, 2006.
Here are some of the benefits of the Open Access plans:
- Primary care physician (PCP) still provides/coordinates care.
- Preventive care is always part of the covered benefits.
- No referral required for specialist care.
Although members still select a PCP, these plans do not require a referral to see a specialist.
Refer to the Optima Health Member ID card for:
- Effective date identifies month employer changes take effect
- Quick reference to copay amounts
- Phone number for pre-authorizations
- Claims mailing address
Contact us if you have any questions.