Provider Network
The percentage of hospitals and physicians that participate in the Optima Health network across the state are1:
| Location | Hospitals | Physicians |
|---|---|---|
| Hampton Roads | 100% | 98% |
| Richmond | 100% | 96% |
| Charlottesville | 100% | 98% |
| Harrisonburg | 100% | 98% |
| Roanoke | 100% | 96% |
| Lynchburg | 100% | 96% |
| Winchester | 100% | 99% |
As part of a not-for-profit, integrated delivery system, Optima Health has a unique approach to provider contracting.
With more than 30,000 providers and facilities across Virginia, our committed, high-quality network includes the Optima Health statewide networks, PHCS®, MDLIVE®, EyeMed, and American Specialty Health®.
Key clinically integrated networks within the Optima Health provider network offer members the benefit of new models of care from a custom care team, to deliver the right care, in the right place, at the right time.
The percentage of providers with a favorable impression of Optima Health is 93%.
— Optima Health Customer Service Monthly Report Cards, May 2018.
OptimaDirect® and OptimaSelect® Networks
Our network designs offer lower cost options that allow you to choose what works best for your employees and your budget.
Direct network plans include the full network of over 30,0002 doctors and facilities, in a two-tier structure to maximize cost savings. Members can save money when they get services from a Tier 1 doctor or facility.
Select network plans utilize local doctors and facilities within key clinically integrated networks, to provide high-quality and efficient care. Members can save more if they get services from a regionalized group of doctors and facilities.
Select and Direct At–A–Glance Comparison Chart
| OptimaDirect | OptimaSelect | |
|---|---|---|
| Who can buy |
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| Where plans are available |
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| Product Lines available |
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| Spending Account Options3 |
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| In–Network Coverage |
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UVA Health System is not in the Select Network |
| Out–of–Network Coverage |
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| Features and Benefits |
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More Information
For more information, get detailed plan information from a local broker.
If you are already an Optima Health member, please contact your broker or Optima Health representative for more information.
1 Provider Network Penetration, January 1, 2019
2 Sentara Health Plans, Inc. Provider Database, 2019
3 May only be available in certain Product Lines, depending on group size
4 Value-Added services; not a covered benefit
5 Office Visit copayment or coinsurance may apply