Transitioning Medical CareOptima Health will work with you and your doctor to make sure your transition process is as smooth as possible.
You will have access to Optima Health resources to help you navigate your specific situation. 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 currently in the middle of a course of treatment 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. If you have specific questions about your condition or on-going course of care, you can call or email Optima Health directly to discuss your situation. Please identify yourself as a City of Suffolk employee.
Optima Health Clinical Care Services Team
Transitioning Pharmacy CareSome drugs require prior authorization by Optima Health in order to be covered.
Your prescribing provider is responsible for initiating prior authorization.
In order to ease your transition to the new plan, Optima Health has agreed to temporarily waive prior authorization requirements for members taking drugs that would usually require prior authorization. Your prescription must be filled within 60 days after your new plan becomes effective at a retail pharmacy (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.
If, after the plan effective date, you begin taking a new medication for which prior authorization applies then you will need to work with your doctor and pharmacist for approvals.