Optum (New York) accepted insurance plans guide

Optum accepts most major insurances, including:

• 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, Aexcel, Signature Administrators, Aetna Premier Care Network (APCN), Aetna High Performance Network, Medicare HMO and PPO Group Plans (Individual MA plans only in select counties), Local 1199 (excludes Manhattan and Staten Island)
• Affinity by Molina Healthcare: Medicaid Managed Care, Child Health Plus, Essential Plans (Excludes Molina Healthcare Plus – HARP)
• Anthem Blue Cross Blue Shield (formerly known as Empire Blue Cross Blue Shield): HMO, PPO, EPO, Connection Network, Blue Access Network, Medicare Advantage (HMO, PPO, DSNP, Select, Full Dual Advantage, Veteran), HealthPlus Gatekeeper, HealthPlus (Medicaid, CHP, Essential Plan, HARP) (excludes Blue Priority Networks)
• CDPHP: Commercial Plans (Excludes Medicare plans, Essential Plans, Child Health Plus, Family Health Plus & Medicaid). Note: Plans only cover Northern regions (excludes the 5 boroughs and Long Island)
• Centivo
• Cigna HMO, POS, PPO, EPO, Oscar, Cigna True Choice Medicare PPO Plans: Access, Courage, Plus, Savings (Excludes Cigna Local Plus )*
• Connecticare: PAR through Emblem Health Prime Network
• Consumer Health Network (CHN)
• Coventry: PPO (Through First Health)
• EmblemHealth Insurance Company (formerly HIPIC): Prime Network, Bridge Network (Excludes Select Care Network & 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: Medicaid Managed Care, Child Health Plus, Essential Plans, HealthierLife (HARP), Ambetter Qualified Health Plans (Bronze, Silver, Gold, Platinum) (excludes Wellcare by Fidelis Medicare Advantage and Dual Advantage Plans)
• First Health Network: PPO, Coventry PPO
• Great West Healthcare: HMO & PPO
• Healthfirst: Medicaid Managed Care, Child Health Plus, Personal Wellness Plan (HARP), Basic Health Plan, Essential Plans, Medicare Advantage Plans, Qualified Health Plans, Dual Advantage Plans, Medicaid Advantage Plus
• Health Insurance Plan of Greater Network (HIP): Prime Network (Includes Child Health Plus, Vyrtra, Connecticare), Enhanced Care Prime Network (Medicaid Plans) (Excludes VIP Bold Network, VIP Prime Nework, VIP Reserve Network, Millenium Network, Select Care Network)
• Humana: Medicare Network PFFS, Medicare HMO &  Medicare PPO, Medicare Humana Choice Partnered (PPO)
• Magnacare: Includes Brighton Health Plan Solutions
• Medicare: Traditional (Includes Railroad Retirees), Aetna Medicare HMO and PPO Group Plans (Individual MA plans only in select counties), Anthem BCBS Medicare Advantage (HMO, PPO, DSNP, Select, Full Dual Advantage), GHI Medicare PPO, MVP (excludes the 5 boroughs and Long Island), Partners Health Plan, AARP Medicare Advantage Plans HMO and PPO (excludes Mosaic), UHC Group Medicare Advantage Plans HMO and PPO, UHC Medicare Advantage Plan 1, 3 and 4, UHC Medicare Advantage Patriot Regional PPO, UHC Community Plan Dual Complete, Humana Medicare Network PFFS, Humana Medicare HMO and PPO, Medicare Humana Choice Partnered (PPO), Cigna True Choice Medicare PPO Plans: Access, Courage, Plus, Savings) (Excludes CDPHP, HIP and WellCare)
• Multiplan: PPO Only
• MVP Health Care: Commercial, Medicare and Medicaid (Excludes Essential Plan and Premier Individual) (excludes the 5 boroughs and Long Island)
• Northwell Direct Network
• The New York State Health Insurance Program (NYSHIP): Empire Plan, Excelsior Plan, Student Employee Health Plan (SEHP)
• Oscar: PAR through Cigna
• Oxford: Freedom and Liberty (Excludes Non-AARP Medicare Plans and Metro Network)
• Partners Health Plan: Commercial and Medicare
• Private Healthcare Systems (PHCS): PPO Only
• Tricare (authorized non-network provider): East, West, US Family Health Prime, Martins Point, Overseas, TriCare for Life Health Insurance
• United Healthcare: EPO, HMO, POS, HMO Plus, PPO (includes Choice Plus, Select Plus, Navigate, Surest Plan), Nexus ACO, AARP Medicare Advantage Plans HMO and PPO (excludes Mosaic), UHC Group Medicare Advantage Plans HMO and PPO, UHC Medicare Advantage Plan 1, 3 & 4, UHC Medicare Advantage Patriot Regional PPO, UHC Community Plan Dual Complete (Excludes UHC Community Plan – Medicaid Plans)

Additional participating plans in Long Island, Brooklyn and Queens:

• Aetna-Medicare Advantage Individual Plans (PCPs are not participating with Aetna Medicare Value Select Plan HMO)
• Fidelis-Medicare Advantage Plans
• Local 1199
• Medicaid
• Metroplus (legacy ProHealth in Brooklyn, Queens and Manhattan)
• Oscar
• United Healthcare-Compass, Nexus & Oxford Metro
• Insurance plans accepted in Long Island and NYC Ambulatory Surgery Centers may vary

• 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

Optum participates in the following New York 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

Contact us to check your coverage or get help selecting a plan covered by Optum.

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 you have insurance coverage from a company that is not listed above, the services are probably “out-of-network” and you will be responsible for a greater out-of-pocket expense.

For help selecting a plan that participates with Optum, please contact our patient assistance department at 1-888-859-9473.

 What if my insurance doesn’t cover my service?

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”.