Optima Healthcare Network Changes

Optima Health's members’ healthcare is important to them, and one of their goals is to keep clients and agents informed about changes that could affect them.

At this time, Bon Secours has initiated a termination with Optima Health and has declined multiple requests to extend the contract beyond March 1. A letter regarding this matter has been sent to members on January 24 to keep them informed, as well. Certain Bon Secours hospitals, ancillary providers and physicians, and select specialists in Tidewater and Richmond areas will no longer be covered in network under Optima Health benefits for care received on or after March 1, 2023, across all commercial, Medicaid, and Medicare lines of business.

In addition, the following facilities are not party to the termination:

• Rappahannock General Hospital
• Southside Regional Medical Center
• Southampton Memorial Hospital
• Southern Virginia Medical Center

Alternative Hospital Options
Optima Health contractual relationships with other facilities and providers are not impacted. To find other providers in the Optima Health network, members can look online at www.optimahealth.com/findadoc. Please note Bon Secours hospitals will still display as in-network in the online and print directories up until the termination on March 1.

Changes in Coverage
For now, members can continue to use all Bon Secours facilities and providers with no change in coverage. However, if an agreement is not reached, members on HMO plans will no longer have coverage for select Bon Secours hospitals, ancillary providers, and physicians in Tidewater and Richmond after March 1. PPO and POS members accessing services from select Bon Secours hospitals, ancillary providers, and physicians will do so under their out-of-network benefit, which will result in a higher out-of-pocket cost.

Transition of Care
In accordance with CMS and DMAS requirements, our care management team will follow our standard transition of care protocols for members with approved prior authorizations, in their 2^nd or 3^rd trimester of pregnancy, in active treatment for chronic or acute medical conditions, or with hospitalizations. We have identified members who have accessed services through an impacted Bon Secours facility or provider; we will notify and work with these members to find appropriate in-network alternatives for their care, if necessary.

Optima Health working to negotiate appropriate market pricing for their members for medical services. They will continue to keep you informed if there are any changes.

If you have any questions, call us today at 866-568-9649!