Out-of-Network Medical Care

There are a few situations where you can receive medical care from a provider who is not in the Optima Medicare network. Here are some examples when you can do this:

  • If you need emergency or urgent care; 
  • If you have End-Stage Renal Disease and need dialysis services, and are outside of the Optima Medicare service area;
  • If your Optima Medicare provider notifies us that they are leaving our network, we will let you know. If you are in critical stage of a current course of treatment that would be best continued with your current provider, you can ask us for approval to keep seeing this provider for up to 90 days. We can also help you transition your care to an Optima Medicare provider;
  • If you need specialized treatment or a procedure that is only done by a few providers and none of these providers are in our network, you or your current provider can ask us for approval to see this new provider. If we find that the service is available by an in-network provider, you may be redirected to one of our in-network providers.

Note: Optima Medicare only provides care within the United States and its territories.

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