Frequently Asked Questions:
General FAQs
What do I get when I sign up for OptimalMD?
When you sign up for OptimalMD, you gain access to a range of health services designed to cater to various medical and behavioral health needs. Our Access Plus plan includes urgent care, primary care, behavioral health counseling, dermatology, and specialty services. OptimalMD focuses on providing these services in a convenient, virtual format to ensure accessibility and efficiency in healthcare delivery.
Can OptimalMD work with my existing insurance?
Yes! Actually, 20% of members utilize OptimalMD as a supplementary solution to access more affordable healthcare services.
While health insurance is beneficial for situations like cancer treatment, it may not be as effective in covering everyday health issues such as colds, allergies, burns, cuts, or COVID.
By adding OptimalMD to your coverage for only $97 per month, our annual plan enables you to combine low-cost health insurance with comprehensive coverage for common health concerns.
Can I add family members?
Yes. After becoming a paid member, you can add up to 10 family members including your spouse and children at no extra cost.
How is this so inexpensive? What is the catch?
The current healthcare system is 33% fraud, waste and abuse, 33% administration and profit costs, and only 33% of the cost is for clinical services.
To reduce the costs, contract directly with physicians, pharmacies, labs, and other services. By doing this, we eliminate the expense of fraud, waste and abuse along with the overinflated administration and profit costs.
Billing and insurance
What are the deductibles?
There are no deductibles in our plans, meaning your care starts immediately without any out-of-pocket threshold to meet. This can drastically reduce your annual healthcare spending and simplify your financial planning.
What is the copay?
There is no copay for the vast majority of services, ensuring straightforward access to healthcare without additional fees per visit. A copay may apply to specialty treatments such as Psychology and Psychiatry visits. In cases like this where a copay might apply, we will be very transparent and will be more affordable than other similar options.
What are my payment options?
OptimalMD accepts all major credit cards and e-checks. If you have a visit fee, you will be shown the amount prior to confirming your visit request.
Does OptimalMD accept my health insurance?
Many health plans and employers provide OptimalMD as part of their benefits. To check whether you are covered, reach out to your benefits manager.
What are coverage limits?
There are no coverage limits on urgent or primary care, and you have access to unlimited Rx services.
What's the process for filing claims?
There's no need to file claims with our program. All services are pre-paid, which not only simplifies your experience but also ensures you're not dealing with paperwork or waiting for reimbursements. This immediate access to care without the hassle of claims lets you focus on what’s important—your health.
Services
When should I use virtual urgent care?
Our virtual urgent service treats over 300 conditions, including but not limited to flu symptoms, sinus problems, ear infections, allergies, urinary tract infections, nausea, pink eye, stomach viruses, rashes, sore throat, acne, men’s and women’s health issues, and more.
When should I use virtual primary care?
Virtual Primary Care provides a wide range of services including the establishment of a primary care physician, management of health conditions over time, medication management including ongoing refills, lab tests and routine screenings, health assessment screening and evaluation, and review and interpretation of lab test results. Additionally, it offers in-network recommendations and referrals for specialty care services.
How do I get my prescriptions refilled?
Virtual primary care doctors will discuss your health history and assess whether a refill is safe at the time of your visit or whether it's prudent to see a physician in person. The decision to provide a prescription for a refill and the quantity of the prescription is at the sole discretion of the provider.
What is virtual dermatology and virtual counseling?
Virtual Dermatology offers on-demand access to board-certified dermatologists from the comfort of your home, providing reliable care for thousands of skin, hair, and nail conditions, including treatment for suspicious spots, rashes, cold sores, fungal infections, and more.
Virtual Counseling provides access to Master Degreed Counselors for short-term problem resolution, referral, and crisis intervention services. It's designed for those feeling overwhelmed, experiencing anxiety or depression, with no visit fee for counseling sessions, which are determined to be clinically appropriate based on the issue.
What other behavioral health services do you offer?
Virtual psychology and psychiatry.
Psychologists cannot prescribe medications. But, they are helpful if you are not feeling like yourself, confused about a personal situation, experiencing anxiety or depression, or overwhelmed with life.
Psychiatrists can prescribe medications except for controlled substances.
Prescription Program
Will all prescribed drugs be free; at no cost to me?
All generic medications on our formulary are free.
What about branded medications?
Our pharmacists can help determine if there is an equivalent drug to help meet your medical needs. Or, you may obtain brand name at a heavily discounted rate.
How do I get my prescriptions refilled?
Virtual primary care doctors will discuss your health history and assess whether a refill is safe at the time of your visit or whether it's prudent to see a physician in person. The decision to provide a prescription for a refill and the quantity of the prescription is at the sole discretion of the provider.
How do I get my prescription transferred?
Our pharmacist will contact your local pharmacy or physician and have your prescription transferred to us.
Is there a limit to how many prescriptions I can get filled?
There is no limit!
How does my doctor contact you?
Escribe: 04229971 | Efax: (888) 870-3823 is on our e-fulfillment cards. Otherwise, they can call Customer Service at (855) 798-2538 for assistance or our pharmacists can reach out to them directly.
