Obesity is a significant health concern, elevating the risk of heart disease, diabetes, depression, and even cancer. Managing chronic conditions like obesity can be tough. Optima Health Insurance offers various resources and programs to support its members' health and well-being. This article explores Optima Health Insurance's coverage of weight loss medications, alongside other relevant health programs and resources.
Understanding Optima Health Insurance Plans
Vantage Health Maintenance Organization (HMO) and Point of Service (POS) plans are issued and underwritten by Sentara Health Plans. Plus Preferred Provider Organization (PPO) products are issued and underwritten by Sentara Health Insurance Company. Medicare products are administered under an agreement with Sentara Health Plans and the Centers for Medicare and Medicaid Services (CMS). Medicaid and Family Access to Medical Insurance Security (FAMIS) products are administered under an agreement with Sentara Health Plans and the Virginia Department of Medical Assistance Services (DMAS). All plans have benefit exclusions and limitations, and terms under which the policy or plan may be continued in force or discontinued.
When you need care, Optima Medical is here. Optima Medical providers will refer you to specialists when you need advanced care.
Prescription Drug Coverage: Formularies, Pricing, and Prior Authorizations
A prescription drug list, also known as a formulary, includes all medications covered by your plan. These lists help prescribers and their patients choose cost-effective treatments that can treat a health condition. A prescription drug list does not include all medication that is available. Optum® Rx regularly reviews medication for safety, effectiveness and cost. When appropriate, medication is added or removed from prescription drug lists. Contact your prescriber to discuss your options.
Medication costs vary from pharmacy to pharmacy. Find the lowest prices through home delivery or at a pharmacy near you. You can search for a medication in the Drug Pricing tool. If the drug is covered, the tool will show pricing at different pharmacies. If it’s not covered, a Drug not covered message will appear. This means your insurance will not pay for that medication. Enter a medication to see if it’s on your plan’s prescription drug list.
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Prior authorization is an approval process used to determine if a treatment or prescription is safe, cost-effective or medically necessary. Your prescriber may need a to get a PA before a treatment, service or prescription can be covered by your health plan.
Chronic Care Management (CCM) Program
Managing chronic conditions like diabetes, high blood pressure, or obesity can be tough. Optima Medical’s Chronic Care Management (CCM) program provides you with a dedicated CCM coordinator to assist with medications, referrals, appointments, and more.
Remote Patient Monitoring (RPM) Program
Optima Medical’s Remote Patient Monitoring (RPM) program helps track your health from home using digital devices. We provide devices like a digital scale, blood pressure cuff, pulse oximeter, and glucometer based on your conditions, all covered by your insurance.
Preventative Care
A yearly wellness visit with your provider is dedicated to disease prevention and screening. It creates a personalized wellness and prevention plan to improve your health. Millions of Americans suffer from anxiety, depression, and addiction each year. Approximately 40% of Americans will develop cancer at somepoint in their lives making regular screenings an important part ofyour healthcare routine. Pulmonary diseases like asthma, and COPD affect millions of Americans each year. With cardiovascular disease affecting 48% of American adults, regular screenings are critical to your health. Diagnostic tests provide your primary care providers with a better picture of your health.
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