Optum Accepted Insurance Plans Guide
New York Insurance Plans
(If you are a New Jersey patient, click here for accepted insurance)
Optum accepts most major insurances, including:
- *†AETNA: HMO, POS, PPO, EPO Aexcel, Aetna Signature Administrator, Elect Choice, Managed Choice, Open Access, Open Choice, Premier Care Network (APCN), Performance Network (APN), Local 1199, Medicare HMO and PPO Group Plans. Optum will remain participating in Aetna Medicare group plans provided by an employer or union.
- **AFFINITY by MOLINA HEALTHCARE: Medicaid, Child Health Plus, Essential Plans (Excludes Harp Molina Healthcare Plus)
- *CDPHP: Commercial Plans (Excludes Medicare plans, Essential Plans, Child Health Plus, Family Health Plus & Medicaid)
- CENTIVO: Focus Plan (Effective September 1, 2022)
- CIGNA: HMO, POS, PPO and EPO and Oscar
- CONNECTICARE: (Through EmblemHealth Prime Network)
- CONSUMER HEALTH NETWORK (CHN)
- COVENTRY: PPO (Through First Health)
- EMBLEMHEALTH Insurance Company (formerly HIPIC): Bridge Network (Excludes Select Care)
- EMBLEM HEALTH PLAN, Inc (formerly GHI): CBP (PPO), HMO, Emblem Health (EPO & PPO), Bridge Network & Medicare PPO (Excludes Family Health Plus, Child Health Plus, Medicaid Managed Care, Medicare HMO and Medicare Plus Choice, Select Care)
- EMPIRE BLUE CROSS/BLUE SHIELD: HMO, PPO, EPO, Health Plus, Health Plus Gatekeeper, Mediblue HMO and PPO, Blue Access, Connection Networks and Pathway Network (Effective September 1, 2022), (Excludes Blue Priority Networks)
- †FIDELIS: Medicaid, Child Health Plus, Essential Plans, Gold, Platinum, Bronze, and Silver (Excludes Medicare Plans)
- FIRST HEALTH: PPO, Coventry PPO
- GREAT WEST HEALTHCARE: HMO & PPO
- HEALTHFIRST: Medicaid-Health and Recovery Plan (HARP), Basic Health Plan (BHP), Essential Plan (EP), Child Health Plus (CHP), Qualified Health Plans (QHP), IB Dual Connection, Medicare Advantage HMO/PPO, Medicaid Advantage Plus, Commercial Plans (Effective November 1, 2022)
- HIP: EmblemHealth Prime Network (EPO & HMO), Bridge Network, Child Health Plus, Connecticare, Vytra Plans, Enhanced Care Prime Network, Medicaid (Effective September 1, 2022) (Excludes HIP Classic, Comprehealth, Medicare, Medicare Essential, Family Health Plus, Millennium, and Select Care)
- HUMANA: Medicare Network PFFS, Medicare HMO & Medicare PPO, Medicare Humana Choice Partnered (PPO)
- MAGNACARE: Including Brighton Health Plan Solutions
- †MEDICARE: Traditional (Includes Railroad Retirees), Aetna HMO and PPO, BCBS Mediblue HMO and PPO, GHI PPO, MVP, Partners Health Plan, Humana PFFS, PPO and HMO, UHC Medicare Complete PPO, AARP HMO and PPO, UHC Community Plan Dual Complete, AARP Medicare Advantage Value Care (PPO) and Medicare Humana Choice Partnered (PPO) (Excludes CDPHP, HIP and Wellcare)
- MULTIPLAN: PPO Only
- *MVP: Commercial, Medicare and Medicaid (Excludes Essential Plan & Premier Individual)
- Northwell Direct Network
- NYSHIP (Empire Plan)
- OXFORD: Freedom and Liberty (Excludes Non-AARP Medicare Plans and Metro Network)
- PARTNERS HEALTH PLAN: Commercial and Medicare
- PHCS: PPO Only
- TRICARE: East, West, US Family Health Prime, Martins Point, Overseas, TriCare for Life Health Insurance
- UNITED HEALTHCARE: EPO, HMO, POS, HMO PLUS, PPO, Choice Plus, Select Plus, Nexus ACO, Medicare Complete PPO, AARP HMO and PPO, AARP Medicare Advantage Value Care (PPO), UHC Medicare Advantage Choice Plan 1, 3 & 4 and UHC Medicare Advantage Patriot (Regional PPO) Community Plan Dual Complete Medicare (Excludes Community Plan Medicaid, Essential Plans, Compass, Medicaid, and Mosaic Plans)
*Local 1199, CDPHP and MVP plans are currently non participating in the Manhattan region
**Affinity by Molina plans are currently participating with select providers in the Manhattan region
†Important Optum Medicare updates 2022: Effective January 1, 2022 Optum will no longer participate in Fidelis Medicare and Aetna Individual Medicare plans. Optum will remain participating in Aetna Medicare group plans provided by an employer or union.
Additional participating plans in Long Island, NY:
- AgeWell New York
- Aetna-Medicare Advantage Individual Plans
- Fidelis-Medicare Advantage Plans
- Local 1199
- United Healthcare-Compass, Nexus & Metro
- Insurance plans accepted in Long Island and NYC Urgent Cares and Ambulatory Surgery Centers may vary
NY State Exchange Plans
Optum participates in the following New York State Exchange Plans:
- Affinity Essential
- BCBS HealthPlus Essential/Gatekeeper
- HealthFirst Leaf Plans or Qualified Health Plans
“SHOP” Exchange (Small Business Health Plans)
- HealthFirst Pro Plans
Contact us to check your coverage, or for help selecting a plan covered by Optum.
Not sure whether you’re In-Network?
We recommend contacting your insurance company before your appointment to confirm whether your plan is in-network or out-of-network, as some unlisted plans may offer coverage. And remember, because every plan is different, some levels of coverage are partial and may still result in out-of-pocket costs. So to avoid surprise bills, we’ll notify you of any services that are determined to be out-of-network.
Contact us If you have any questions about your bill.
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”.