FAQ's

1. At OptimalMD, we've assembled a team of experts in the healthcare field to assist those without adequate insurance in finding better healthcare options. We support individuals who may be insured but struggle to meet high deductibles, even when paying full retail prices. We also aid those who are stuck in the "Status Quo" healthcare system, forced to pay full price for care and medications, sometimes without any insurance at all.

   Our mission extends to the millions of workers without insurance due to being part-time or holding 1099 contracting positions. Drawing from our extensive industry experience, relationships, partnerships, and purchasing power, we've pooled our resources to offer the most competitive prices and convenient access to everyday medical services and commonly prescribed medications at wholesale rates.

   One distinctive feature of OptimalMD is that it's the sole program to extend membership to parents of the primary member, aged 55 and older. Additionally, we never charge a membership fee for children under 26 who are dependents of the primary member, with a maximum of seven dependents including spouses, children, and parents.

   • 6 Million Users
   • 95% Member Satisfaction
   • 2000 Plus conditions managed

   We’re powering the next generation of healthcare—a world where virtual care is more powerful than traditional care. We think the smartest healthcare solutions are those that break down the barriers between providing and receiving lifesaving care. At OptimalMD we power Intelligent Virtual Care.

1. 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.

1. 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.

1. The answer is “No”.

   There is no perfect solution to America's healthcare crisis. However, our comprehensive membership undoubtedly provides the greatest value in healthcare.

   Some services still cost extra, but significantly less than you would pay even if you have insurance. Insurance is no guarantee of payment.

   We do not cover cancer treatments, surgeries, and high-cost services..Yet!

   We are a great complement to a high-deductible insurance plan.

1. Our membership covers a broad range of services including primary care, urgent care, mental health services, and prescription medications. For a detailed list of covered services, please refer to Access Services | Access Plus Services.

1. Our network of highly qualified doctors and specialists is available to you and has a 95% satisfaction rate. In our program, you get a Primary Care doctor and you keep that same doctor so they can build a strong relationship with you.

   Our physicians are rigorously trained, U.S. board-certified specialists with licenses and credentials. They hold Bachelor's (B.A. or B.S.) and either Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degrees.

   Our physician assistants are also extensively trained, NCCPA certified, licensed, and credentialed. They hold Bachelor's (B.A. or B.S.) and degrees in Physician Assistant Studies (MPAS), Health Science (MHS), or Medical Science (MMSc).

   Our nurse practitioners are proficiently trained, ANCC or AANP certified in their respective specialties, licensed, and credentialed. They possess Bachelor of Science in Nursing (BSN) and Master of Science in Nursing (MSN) degrees.

   Our behavioral health team consists of master's-level professionals, including Licensed Professional Counselors, Licensed Clinical Social Workers, Licensed Marriage and Family Therapists, and equivalent licensed professionals.

   Psychologists usually acquire a four-year university degree, often with postgraduate work required.

   To become a clinical psychologist, you will need an undergraduate degree (four to five years of college) plus a doctorate degree (four to seven years of graduate school). For this specialty area, most people will spend between eight to 12 years in higher education.

   All our providers undergo a meticulous credentialing process aligned with the National Committee for Quality Assurance (NCQA) guidelines.

   Additionally, they are licensed by the relevant state licensing boards where they practice.

1. The cost of OptimalMD memberships vary, depending on whether you sign up individually or if the services are provided to you as a benefit through an association or your employer’s health plan design. In some cases, your employer or association may pay for your membership partially or in full.

   • Our Access Plan is $47 per month for your immediate family. It includes the essential services needed to take care of your family, including access to immediate care, basic prescriptions if a family member is sick, and talking with a therapist if needed.
   • Our Access Plus Plan is $97 a month for your entire family and includes a comprehensive care plan with your own primary care physician, urgent care, and various specialties if you need them.
     1. It also includes full mental health with counselors, Psychologists* and Psychiatrists*.
     2. With this option, members get a robust prescription plan that covers 800 of the most prescribed medications at no additional cost and 4000 other medications at the manufacturer's cost. (For example, Insulin in our program is only $19, compared to most plans, where the monthly cost is $80 or more.)
        
        *Additional per visit fees apply

1. Adding your spouse and children incurs no additional cost, enhancing the value of our family-friendly memberships. You can also extend coverage to your parents for a nominal fee of $25 or $30 each (depending on your membership selection), which can result in significant savings on their healthcare expenses compared to traditional insurance. This flexibility makes our program one of the most inclusive available.

1. 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.

1. 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.

1. 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.

1. Many health plans and employers provide OptimalMD as part of their benefits. To check whether you are covered, reach out to your benefits manager.

1. 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.

1. There are no coverage limits on urgent or primary care, and you have access to unlimited Rx services.

1. Virtual Urgent Care offers 24/7/365 access to healthcare services that are fast, convenient, and affordable. It provides a solution for when doctors are hard to reach, illnesses occur at inconvenient times, or when you simply have a health-related question.

1. You should consider using OptimalMD Virtual Urgent Care in the following situations:

   Difficulty Reaching Doctors: If you're having trouble reaching your regular healthcare provider, especially during non-office hours or in emergencies.

   Urgent Medical Needs: When you or a family member has a medical concern that is not life-threatening but requires prompt attention. This could include symptoms like fever, minor injuries, colds, flu, infections, or other acute conditions.

   Accessibility: Access to licensed and board-certified physicians 24/7/365 ensures you can receive care anytime, anywhere, with just a call, tap, or click.

   Quick Access: If you need quick access to healthcare without incurring any costs, this program offers an exceptional service without financial burden.

   Convenience: Virtual urgent care allows you to receive medical care from the comfort of your own home or wherever you may be, saving you time and hassle associated with traditional doctor's visits.

   Medical Questions: Even if you don't necessarily have a pressing medical issue but have questions or concerns about your health, you can reach out to the medical team for guidance.

   Remember, while virtual urgent care can be convenient and accessible, it's important to use common sense and seek emergency medical attention if you or someone else is experiencing a life-threatening situation or severe symptoms that require immediate attention.

   When you need to save valuable time:
   Accessing medical professionals through our service is easy, affordable, and saves time. Say goodbye to long waits for doctor appointments and missing work. Our platform provides convenient access to physicians anytime, anywhere, 24/7, all year round.

   A typical doctor's appointment can eat up half of your workday. We understand your time is precious. With us, you can connect with a doctor swiftly, avoiding the hassle of scheduling appointments that can take up to 21 days.

   Emergency room wait times can be excruciatingly long, averaging around 4 hours. Don't waste your time waiting when you could be getting the care you need promptly.

   Don’t let the current healthcare system hold you back from receiving the care you deserve.

   When you want to save money:
   Our Virtual Care Model helps you cut costs by reducing unnecessary office and ER visits. Online consultations are completely free. Unlike traditional office visits, where you might have to pay out of pocket even with insurance, our service ensures you get the care you need without breaking the bank.

   When you need care for over 300 medical conditions:
   Contacting our Care Team opens up a world of options. Whether you need to speak with a physician, pediatrician, or behavioral therapist, we've got you covered.

   Our Convenient Care 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.

   Our mission is to provide you with accessible, affordable healthcare whenever you need it most, 24/7/365.

   We provide assistance in various situations:
   

   • In cases requiring immediate medical attention
   • When you seek professional advice for health-related inquiries
   • If you're contemplating a visit to the emergency room or urgent care center for a non-emergency matter
   • While you're traveling for leisure or business, or away from your usual residence
   • Even when you're attending school away from home.

1. To access Virtual Urgent Care services, call 877-309-0297, or visit www.portal.optimal.md. to log into your member portal and schedule a consultation with a state-licensed physician. The process is simple:

   1. Call, Tap, or Click - Contact the service through phone, app, or website.
   2. Triage - Speak to a Care Coordinator who will triage and update the patient's Electronic Health Record (EHR).
   3. Consult - Consult with a physician who will recommend a treatment plan. If medication is prescribed, it will be sent electronically.

Virtual Urgent Care can address a wide range of conditions, including but not limited to:

• Cold and flu symptoms
• Sinus problems
• Ear infections
• Allergies
• Urinary tract infections
• Nausea
• Pink eye
• Stomach viruses
• Infections
• Rashes
• Sore throat
• Acne

1. Yes! Our qualified medical professionals can usually address multiple health concerns during a single consultation.

1. Virtual Urgent Care is highly effective for treating low acuity illnesses, with 70% of such conditions being manageable virtually.

1. Virtual Primary Care allows patients to have face-to-face visits with their physicians across various devices. This service enables patients to connect with a physician via phone or video technology, facilitating the establishment of a patient-physician relationship without the need for a physical visit to the doctor’s office.

1. To access Virtual Primary Care services, you can call (877) 309-0297, or visit www.portal.optimal.md to log into your member portal and schedule a consultation with a state-licensed physician.

1. The process is simple:

   1. Login to your member portal and click “Connect with a Doctor”
   2. Click the “Schedule a Consultation” button and select the Primary Care option.
   3. Select your preferred provider and the date and time for your appointment. You will need to update your Electronic Health Record (EHR) and you will receive confirmation reminders prior to your appointment.

1. 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.

1. You should use Virtual Primary Care for the management of routine and ongoing health conditions, medication management, preventive care, lab tests and routine screening, health assessment screening and evaluation, and when you need a referral to see specialists.

1. Benefits include no consultation fees, caregiver support that allows family or specialists to join video appointments, the ability to build a relationship with a chosen provider, scheduling routine checkups, ordering labs, refilling medications, monitoring key vitals virtually, and 24/7 direct access to a collaborative care team for unlimited ongoing health care needs.

1. Integrated Primary Care is designed to uncover unknown conditions, integrates all services for continuity of care, provides immediate and long-term savings through redirected healthcare and continued care, and offers 24/7/365 collaborative care team support for treatment adherence and medication management.

1. Yes, our providers 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.

1. Generally, birth control prescriptions are dependent on your medical history and the provider's assessment of the risks and benefits to you. If medically appropriate, OptimalMD providers can start you on a new birth control regime.

   If you are currently taking birth control medication, an OptimalMD provider can discuss your health history and assess whether a refill is safe at this time, or whether it would be prudent to see a physician in person.

1. 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.

1. Access is available 24/7/365 through www.portal.optimal.md. After logging into your member portal, you can schedule a consultation with a dermatologist.

1. Log-in to Request a Consult - Use the OptimalMD member portal to schedule your consultation.

   Upload Images - Describe your condition and upload at least three images of the affected area.

   Dermatologist Review - A dermatologist reviews your consultation details, health records, and images within 72 hours, providing a treatment plan and prescriptions if necessary.

   Prescription Delivery - Prescriptions will be sent electronically to your pharmacy.

1. Use Virtual Dermatology:

   • When you need care immediately.
   • If you have health-related questions and need professional guidance.
   • If you're considering the ER or an urgent care center for a non-emergency issue.
   • While on vacation, a business trip, or away from home.

1. Virtual Dermatology can address a wide range of conditions, including but not limited to:

   • Acne, alopecia (hair loss), boils, cold sores, cysts, eczema, folliculitis.
   • Hives, fungal skin infections, keratosis, dermatitis (including maskne), rosacea, moles, warts, suspicious spots, athlete's foot, ringworm, poison ivy, shingles, psoriasis, rash, skin infections, and much more.

1. The average turnaround time to receive a diagnosis is 12 hours, with a treatment plan and prescription provided within 72 hours after the interview intake.

1. Virtual Dermatology is highly effective, with 87% of cases fully treated via a virtual visit and a 94% member satisfaction rate.

1. 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.

1. Virtual Counseling: For short-term problem resolution with a Master's Degreed Counselor.

1. Virtual Counseling is suitable for:

   • Substance abuse
   • Depression
   • Stress and anxiety
   • Death of a loved one
   • Relationship issues
   • Parenting issues

1. Access is available by visiting www.portal.optimal.md. After logging into your member portal, you can schedule your consultation with the appropriate mental health professional.

1. Psychologist studies normal and abnormal mental states, perceptual, cognitive, emotional, and social processes, and behavior by experimenting with, and observing, interpreting, and recording how individuals relate to one another and to their environments. Psychologists usually acquire a four year university degree, often with postgraduate work required.

   To become a clinical psychologist, you will need an undergraduate degree (four to five years of college) plus a doctorate degree (four to seven years of graduate school). For this specialty area, most people will spend between eight to 12 years in higher education.

1. Each counseling session will last around 50 minutes.

1. Yes. You select and can keep your same provider throughout your treatment.

1. Unlike Psychiatrists, Psychologists CANNOT prescribe medication to patients.

1. If you are not feeling like yourself, confused about a personal situation, experiencing anxiety or depression, or overwhelmed with life.

1. No sessions are recorded nor stored.

1. Psychiatry is the branch of medicine focused on the diagnosis, treatment, and prevention of emotional and behavioral disorders. Psychiatrists are qualified to assess both the mental and physical aspects of psychological problems and provide a picture of a patient’s physical and mindful state. Psychiatrists often prescribe medications in combination with psychotherapy.

1. • Lexapro
   • Effexor
   • Paxil
   • Elavil
   • Zoloft
   • Cymbalta
   • Wellbutrin
   • Remeron
   • Celexa
   • Prozac
   • Prestiq
   • And more…

1. Each counseling session will last around 50 minutes.

1. No sessions are recorded nor stored.

1. • DEA-controlled substances (ADHD stimulant medications, sleep medications, anti-anxiety benzodiazepines)
   • Stimulants (e.g., Adderall, Ritalin, etc.)
   • Medications intended for intra-muscular injections
   • Detox Medications (e.g., Suboxone, Methadone)
   • Other drugs with potential for abuse, such as muscle relaxants, pseudoephedrine
   • Medications that require regular lab work and monitoring (e.g., Lithium, Depakote, Tegretol) when lab work is not present for review

1. • Emergency situations (suicidal, homicidal, self-harm)
   • ADHD prescription of stimulant (therapy and non-stimulant medication management are in scope)
   • Active hallucinations or delusions
   • Substance use in an active medical detox program
   • Moderate to severe autism spectrum disorders
   • Internationally located patients
   • Conditions that require laboratory or diagnostic imaging to determine final treatment recommendations without lab work present for review
   • Children under the age of 12

1. With OptimalMD you can request an urgent care visit 24/7/365.

1. You should request a consultation in the state where you are physically located at the time of the visit. If a provider determines that a prescription is medically necessary, the prescription can be submitted to a local pharmacy of your choice.

1. Yes, you can cancel your appointment by logging into the member portal at www.portal.optimal.md

1. Yes! Our primary care providers can treat most conditions, but we cannot prescribe any DEA controlled substances.

1. Login to your member portal and click “Schedule a Consultation” then follow the prompts.

1. Both of our membership options allow you to send a secure message to a doctor without having to schedule an appointment. Simply log in and go to “Message a Doctor” or “Message a Specialist” to start a conversation.

1. Our virtual care providers cannot treat children under 2 years old. Our Psychiatrists cannot treat children under 12 years old.

1. OptimalMD providers do not treat emergencies. If you are having an emergency, please call 911.

   Although our plan does not directly cover emergency services, we offer guidance on managing emergency care costs effectively, even providing potential avenues for cost reduction based on income. For more details on how to navigate emergency situations under our plan, please consult our emergency services guide.

1. Yes! If necessary, OptimalMD providers may order lab tests for Virtual Primary Care and Psychiatry patients. Please note that our Urgent Care providers will not order lab tests.

1. At OptimalMD, our aim is to offer affordable access to commonly prescribed medications at very low or no cost.

   This program includes the top 125 most commonly prescribed generic medications and is available at no cost to you or your family members. If you need other medications, easily search our member portal for deeply discounted prices.

1. Yes, you can begin using it immediately for home delivery, and at retail pharmacies 24 hours after you sign up.

1. A significant aspect of our program is to educate members about generic equivalents of brand name drugs.

   Many brand name drugs have a generic alternative that is equally effective but more affordable.

   Our program provides access to free generic medications, If you require a brand name medication without a generic equivalent, we won't be able to provide it.

1. There is no limit!

1. A digital member card will be available from the online portal to download or print after you enroll.

1. Yes, present your membership card to your local pharmacy when filling covered acute medications.

1. The uninsured and underinsured people who have insurance, but their deductibles are so high they never meet them, and they are paying full price for medicine. With decades of relationships, partnerships and buying power, we have pooled our resources and are providing the lowest prices on medications in the country.

1. All generic medications on our formulary are free.

1. Yes, you can begin using it immediately for home delivery, and at retail pharmacies 24 hours after you sign up.

1. Signing up is easy, it will only take a few moments to answer the required information. We can help you sign up.

1. Only your generic medications on the formulary are free with your monthly subscription.

1. Our pharmacists can help determine if there is an equivalent drug to help meet your medical needs. Or, you may obtain brand name medications through your retail pharmacy at a lower contracted cost.

1. We do offer over the counter medications through mail order at 50% or more off retail prices. Call to place an order 1-800-383-8316.

1. Standard shipping is free. Expedited shipping is $44.95 for next day and $15.00 for second day. If you are purchasing over the counter medications only, shipping is $5.99

1. All family members must live at the same address. Shipping address can change depending upon circumstances.

1. Our pharmacist will contact your local pharmacy or physician and have your prescription transferred to us.

1. The quantity will be per the doctor's order on the prescription. However, there is a maximum qty limit allowed by the program. Charges may occur for maximum quantity limits exceeded.

1. Yes, we support 30 day and 90- day prescriptions. The most economical will be a 90-day supply!

1. There is no limit!

1. A digital member card will be available from the online portal to download or print after you enroll.

1. Your card will be available after you enroll.

1. Once in the pharmacy section of the member portal, click on “Drug Search” located on the menu bar at the top or call our customer service 1-800-383-8316.

1. Our pharmacists will reach out to your doctor to request a new prescription or refill.

1. By phone (800) 383-8316, e-scribe (npi#1356814529/ncpdp #36866675) or fax855-636-5473

1. Yes, present your membership card to your local pharmacy when filling covered acute medications

1. Yes,expedited shipping is $44.95 for the next day and $15.00 for the second day.

1. Standard shipping time is 3-5 business days. Expedited shipping is also available, and is $44.95 for the next day and $15.00 for the second day.

1. Yes, we can ship to P.O. Box.

1. Yes, your delivery courier provides tracking information.

1. If the medication is not on the formulary, call customer service at (800) 383-8316 to see if we can special order the medication. Additionally, our pharmacists can help determine an equivalent drug to help meet your medication needs.

1. If your medication is damaged, give customer service a call at (800) 383-8316 and we assist you with the next steps to obtain your medication.

1. Yes, your prescription can be mailed to America's Pharmacy Source, Customer Service, 947 W. Waterloo Akron, OH 44314.

1. At this time, we don't offer automatic refills, however; we can set you up for SMS text reminders to remind you when your next refill is due.

1. If your account is affiliated with an organization (e.g. an employer, an association, or a nonprofit), check with your organization administrator or email us at support@optimalmd.com to confirm your onboarding path.

   To set up a new individual/family account, visit https://www.optimalmd.com/patient-onboarding and submit the form to get started. You’ll receive an email with a link to our member portal, and a username and password to access and finish setting up your account.

1. You will be prompted to enter your billing information in the member portal if a membership fee is due upon registration. You can always update your billing information at any time by going to the “My Profile” page on portal.optimalmd.com.

1. Some states require a video connection for telehealth visits. Even where it is not required, we recommend a video connection to help our providers deliver the best possible care. When a provider can see you, she/he can better assess and monitor visual cues.

1. A valid email address is required to create your account
2. Users must have a high-speed Internet connection.
3. OptimalMD Virtual Care works best with the following browsers: Chrome for computers, androids, and MacBooks; and Safari for iPhone/iPads.
4. For video consultation, users must have a webcam or video-enabled mobile device.
5. JavaScript and Cookies should remain enabled.

1. Our platform is designed to be private, secure, and HIPAA-compliant, allowing you to safely consult with one of our therapists online. Our Code of Ethics ensures your sessions are completely confidential.

1. Yes! Simply log into OptimalMD's patient portal to print or download your medical records. We store medical records as PDF documents, so they are easy to keep or share with your physician.

1. Yes, if you would like us to send or disclose your medical records on your behalf to another person or entity, we require written authorization and signed consent.

1. Yes, OptimalMD and its parent company, Optimal MD, strictly adhere to guidelines aimed at safeguarding all data and are dedicated to upholding the privacy of all members. Our practices align with applicable state, national, and international laws and regulations, notably the U.S. Health Insurance Portability and Accountability Act of 1996, commonly known as HIPAA. Except where permitted or mandated by law, your medical information will not be disclosed without your explicit consent.

   We enforce the same rigorous privacy standards on all our partners as we do on ourselves.

   We require all partners we engage with to adhere to proper protocols and maintain adequate insurance coverage, including liability and cybersecurity protection.