Complaints, Coverage Decisions, and Appeals

If you are a member of Optima Medicare HMO Plans, and you have a concern about your health plan, the quality of your care or your coverage for certain services, you may follow an established process to resolve your concern. You cannot be disenrolled from Optima Medicare plans or penalized in any way if you make a complaint, request a coverage determination or file an appeal. 

Complaints, Coverage Decisions, and Appeals Procedures for Part C and D

2018 Annual Notice of Change and Evidence of Coverage for Optima Prime plan - Peninsula
2018 Annual Notice of Change and Evidence of Coverage for Optima Prime plan - Southside
2018 Evidence of Coverage for Optima Value plan

2017 Annual Notice of Change and Evidence of Coverage for Optima Prime plan
2017 Evidence of Coverage for Optima Value plan

Complaints, Coverage Decisions, and Appeals Forms and Websites

Who to Contact

About general information or information about the number of Appeals, Grievances & Exceptions filed with Optima Medicare:

Optima Medicare 
Appeals Department
P.O. Box 62876
Virginia Beach, VA 23466-2876
Fax: 757-687-6232 or Toll-free Fax: 1-866-472-3920
TTY VA Relay Service 1-800-828-1140 or 711

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