The benefits and coverage levels that Optum offers are generally determined by an individual’s state of residence. Certain states cover community center classes, urgent care services, specialty care, advanced care, surgeries, and primary care. Other states only cover a portion of these services, while others cover entirely different ones, such as pharmacy costs, palliative care, and hospitalizations. While an individual’s state of residence determines what Optum plans are available to them, ultimately the main factor is whether they have an HMO or PPO plan.
Both PPOs and HMOs cover basic services like dental, medical, and vision care. However, they are distinct in terms of the benefits they offer. If you have an Optum health insurance plan, it is crucial to understand which type of plan you are paying for. NuView Treatment Center can help verify which type of insurance plan you have, and we can also research what benefits you are entitled to under your Optum plan.
Optum HMO plans generally have lower out-of-pocket expenses. In most cases, Optum HMO policyholders have almost no copays whatsoever. On the other hand, policyholders generally need to obtain referrals to see specialists, including addiction counselors and outpatient rehabs. Services are also often required to be obtained from in-network providers. Out-of-network facilities and services are generally not covered at all by Optum HMO plans. Optum representatives can assist policyholders in finding providers within their extensive network of high quality treatment centers.
Optum PPO plans are associated with somewhat higher out-of-pocket expenses, including copays and coinsurance. Nonetheless, policyholders benefit because they are not required to obtain referrals when they need to see a specialist. They are also allowed to see any provider or attend any treatment center they wish, including rehabs outside of Optum’s network. While out-of-network coverage with PPO plans is better than HMO plans, the coverage is still somewhat less than people receive when they see in-network providers.