For questions about your complex condition, an upcoming procedure or for assistance with case management, you may contact our Clinical Care Services Team. Please identify yourself as a City of Suffolk employee.
Phone: 1-866-503-2730
Email: CBCM_COMM@sentara.com
If you are new to Optima Health and are undergoing a course of care with an in-network provider, we recommend that you call your doctor’s or specialist’s office and tell them your coverage is changing to Optima Health. Your doctor can work with the Optima Health Clinical Care Services team to provide clinical notes and update any authorizations necessary.
If you are new to Optima Health and are undergoing a course of care with a provider who is not in the Optima Health network, then Optima Health will work with you to transition your course of care. Optima Health will review your case with you and your treating physician. Depending on your situation, you may be able to receive benefits at the in-network level for a period of time.
New Members: Optima Health will temporarily waive prior authorization requirements for members taking drugs that would usually require prior authorization. Your prescription must be filled within 90 days after your plan becomes effective (if filling at a retail location) or 120 days after the effective date (if filling through mail order). There are some exceptions to this and Optima Health representatives can help you with your transition. After this period, if you begin taking a new medication for which prior authorization applies then you will need to work with your doctor and pharmacist for approvals.
Optima Health Clinical Care Services Team
8 a.m. to 5 p.m. Monday through FridayPhone: 1-866-503-2730
Email: CBCM_COMM@sentara.com
If you are new to Optima Health and are undergoing a course of care with an in-network provider, we recommend that you call your doctor’s or specialist’s office and tell them your coverage is changing to Optima Health. Your doctor can work with the Optima Health Clinical Care Services team to provide clinical notes and update any authorizations necessary.
If you are new to Optima Health and are undergoing a course of care with a provider who is not in the Optima Health network, then Optima Health will work with you to transition your course of care. Optima Health will review your case with you and your treating physician. Depending on your situation, you may be able to receive benefits at the in-network level for a period of time.
Pre-Authorization
Certain healthcare services may require pre-authorization which is an evaluation process of the proposed treatment to determine medical necessity and whether the treatment is being provided is at the appropriate level of care. The provider is responsible for getting pre-authorization.Pharmacy Care
Some drugs require prior authorization by Optima Health in order to be covered. Your prescribing provider is responsible for initiating prior authorization.New Members: Optima Health will temporarily waive prior authorization requirements for members taking drugs that would usually require prior authorization. Your prescription must be filled within 90 days after your plan becomes effective (if filling at a retail location) or 120 days after the effective date (if filling through mail order). There are some exceptions to this and Optima Health representatives can help you with your transition. After this period, if you begin taking a new medication for which prior authorization applies then you will need to work with your doctor and pharmacist for approvals.