Optum Urgent Care (New York and New Jersey) accepted insurance plans guide
This page lists accepted insurance plans by state for urgent care services only.”
New York
- Aetna: HMO, Health Network Only HMO, Select EPO, Open Access Elect Choice EPO, Quality Point of Service, Managed Choice POS, Open Access Managed Choice POS, Choice POS II, Health Network Option, Open Choice PPO, Signature Administrators, Aetna Premier Care Network (APCN), Aetna High Performance Network, Medicare HMO and PPO Plans, Local 1199 (Long Island Locations Only)
- Affinity by Molina Healthcare: Medicaid Managed Care, Child Health Plus, Essential Plans, Molina Healthcare Plus – HARP
- Anthem Blue Cross Blue Shield (formerly known as Empire Blue Cross Blue Shield): HMO, EPO, PPO, Mediblue HMO and PPO, Blue Access (Excludes Connection Networks, Medicare Advantage Select Plans & HealthPlus Medicaid Plans)
- Centivo
- Cigna: HMO, POS, PPO, EPO and Oscar (Excludes Cigna Local Plus & Cigna Medicare)
ConnectiCare: ConnectiCare, Inc., ConnectiCare Insurance Company, ConnectiCare of Massachusetts, Inc. - Coventry: PAR through Aetna Partner Network
- EmblemHealth Insurance Company (formerly HIPIC): Prime Network, Bridge Network (Excludes Select Care Network and Millenium Network)
- EmblemHealth Plan, Inc. (formerly GHI): CBP Network, HMO, EPO, PPO, Bridge Network, Medicare PPO
- Empire Blue Cross Blue Shield (now known as Anthem Blue Cross Blue Shield)
- Fidelis Care: Medicaid Managed Care, Child Health Plus, Essential Plans, HealthierLife (HARP), Ambetter Qualified Health Plans (Bronze, Silver, Gold, Platinum), Wellcare by Fidelis (Medicare Advantage and Dual Advantage Plans)
- First Health: PAR Through Aetna Partner Network
- Great-West Healthcare: PAR through Cigna
- Healthfirst: Medicaid Managed Care, Child Health Plus, Personal Wellness Plan (HARP), Basic Health Plan, Essential Plans, Medicare Advantage Plans, Qualified Health Plans, Commercial Plans, Dual Advantage Plans, Medicaid Advantage Plus
- Health Insurance Plan of Greater Network (HIP): Prime Network (Includes Child Health Plus) (Excludes VIP Bold Network, VIP Prime Network, VIP Reserve Network, Millennium Network, Select Care Network, Enhanced Care Prime Network Medicaid Plans)
- MagnaCare
- Medicare
- MultiPlan
- Northwell Direct
- The New York State Health Insurance Program (NYSHIP): Empire Plan, Excelsior Plan, Student Employee Health Plan (SEHP)
- Oscar
- Oxford: Freedom, Liberty and Metro
- Partners Health Plan
- Private Healthcare Systems (PHCS): PAR through MultiPlan
- UnitedHealthcare: EPO, HMO, POS, HMO Plus, PPO (includes Choice Plus, Select Plus), Nexus ACO, AARP Medicare Advantage Plans HMO and PPO (excludes Mosaic), UHC Group Medicare Advantage Plans HMO and PPO, UHC Medicare Advantage Plan 1 and 2 (excludes UHC Community Plans – Medicaid Plans, UHC Medicare Advantage Regional Plans)
- NY State Exchange Plans
- Individual Exchange: Affinity Essential, BCBS HealthPlus Essential/Gatekeeper, CDPHP, Fidelis, HealthFirst Leaf Plans or Qualified Health Plans
- “SHOP” Exchange (small business health plans): CDPHP, MVP, HealthFirst Pro Plans
New Jersey
- Aetna: Aetna Better Health
- America’s Choice Provider Network
- AmeriHealth
- Cigna
- Not participating with Cigna Medicare Plans
- Consumer Health Network (CHN)
- Coventry
- Devon
- Fidelis Care (Formerly known as WellCare)
- First Health
- Geisinger Health Plan
- Participating at Southern NJ locations only
- HealthSmart Payor Organization
- Horizon Blue Cross Blue Shield of New Jersey
- Horizon NJ Health
- Imagine Health
- Independence Blue Cross
- Independent Medical Systems (IMS)
- Intergroup
- MagnaCare
- Medicaid NJ
- Medicare: Including Railroad Medicare
- Multiplan/PHCS
- Northwell Direct
- QualCare
- Partner Direct Health
- Prime Health Services (PPO Provider Network)
- Stratose (NPPN)
- Three Rivers Provider Network
- Tricare: Authorized non-network provider
- UnitedHealthcare: Including Oxford, UHC Community Plan, Veterans Affairs CCN
- US Family Health Plan (USFHP)
- Wellcare Health Plans of New Jersey
- Workers Comp
- Wellpoint (Formerly known as Amerigroup Community Care)
Not sure whether you’re in-network?
Optum accepts most major health insurance plans. Before selecting a provider, please check with your insurance company to verify your eligibility and coverage to ensure the provider participates in your plan.
If your health insurance provider is not listed among our accepted plans, the services are likely considered “out-of-network”, and you may be responsible for a greater out-of-pocket expense. If you do not currently have insurance coverage, your visit will be considered self-pay.
For help selecting a plan that participates with Optum, please Contact us.
What if my insurance doesn’t cover my service?
Self-pay means you are financially responsible for the full cost of your medical services at the time of your visit. This applies to patients who are uninsured or whose insurance is considered out-of-network – meaning we do not have a billing agreement with your insurance company. A self-pay waiver will be required if your insurance does not participate with Optum. Following your visit, you will also need to submit the claim to your insurance company for potential reimbursement.
If you are out-of-network or choosing to pay out of pocket, services are still available. Here’s what you need to know:
- You have the right to request a good faith estimate of expected charges prior to receiving services.
- You will not be billed more than the out-of-pocket maximum limit established by your health plan. This includes the billing of all applicable deductibles, copay and coinsurance.
- In compliance with the “No Surprise Act”, a patient is held harmless from the cost of unanticipated out-of-network bills.
Contact us if you have questions or need more information about participating plans, billing or the “No Surprise Act”.