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We’re on your team

Oct 05, 2021
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Beyond routine care and wellness, one of the major reasons for having health insurance is to protect yourself and your family in case of serious illness or injury. At Health Options, our medical management approach ensures that you also have a team of healthcare experts at your side in times of a serious medical crisis. In addition, our Care Managers are here for everyday wellness questions and at every step of recovery after a major medical incident.

Our Care Management Team partners with local agencies to find the help our Members need, from financial assistance to transportation, housing, and other issues affecting wellness and recovery. On-staff medical, pharmacy and healthcare experts help Members access medication and durable medical equipment, receive authorization support and assistance with provider outreach, and drug formulary education. The team also makes outbound calls to our Members to assist with chronic illness support or to provide post-discharge coordination from hospital stays. This collaborative approach to medical management focuses on improving care, creating positive health outcomes, and reducing the total cost of care.

What does a medical management approach look like to our Members? On a day-to-day basis, our in-house pharmacy team keeps Members updated about drug recall changes in medication availability and ways to access prescription medications at lower costs. Our team will also reach out to encourage immunizations, wellness visits, and other low-cost, or $0 cost-share benefits that can help our Members live their healthiest lives. In cases of hospitalizations and transitions to home, our medical management’s Site of Care Program offers Members the option to transition certain medications and infusions to a preferred site of care, including in-home care. 

If a Member needs extra care for a particular condition, our team is instrumental in securing assistance. For example, one Member of our asthma outreach program had concerns about her condition combined with possible COVID-19 symptoms when the virus first emerged. Her COVID-19 symptoms kept her from seeing her primary care provider. After using a walk-in clinic for testing to determine she was COVID-19 negative, she continued to have a cough, low-grade fever, and fatigue. Our Care Management team was able to quickly find her an in-network pulmonologist who treated her with antibiotics for suspected pneumonia. She also had her asthma medications adjusted, and her condition improved.

Our hands-on strategies have resulted in more than $12.1+ million saved through Care Management programs since 2017, a 48 percent total reduction in our hospital readmission rate from 2018 to 2020. Our Script Saver program, led by in-house pharmacists, provided personal outreach to Members that led to out-of-pocket savings of $98,000 on medications in 2020.  All of these efforts combined help improve health and reduce costs for our Members.

Call us if you have a question about prescription drug costs, need support for an upcoming medical procedure, or have a serious medical crisis. Our medical management team is in your corner, and they can be reached through Member Services at (855)624-6463, or use our secure email messaging.


Many forms of insurance are policies you have and hope to never use, like in the case of a car crash or when lightning strikes. Health insurance is different. Yes, you have health insurance in case you - Heaven forbid - are faced with a serious health issue. However, you also have health insurance to get the care you need to maximize and maintain your best health.

At Health Options, we believe that our networking is key to providing you with great care. We partner with a comprehensive New England network that includes all Maine hospitals, most New Hampshire hospitals, and many facilities in Massachusetts. This vast network of 48,000 providers including clinicians, hospitals, and pharmacies means the care you need - whether it’s time for your yearly wellness check or you have a more urgent need - is never far away.

Plus, we’ve expanded our telehealth options to make healthcare more convenient and easier to access. Non-HSA Members can use Amwell urgent care telehealth at a $0 cost; and HSA Members pay a $64 fee, with $0 after reaching their deductible.

With Amwell digital services, you can use a smartphone, tablet, or computer and an internet connection to get the care you need without leaving the comfort of home. If you haven't signed up, no worries - Amwell includes an automatic enrollment when you sign up for healthcare coverage with Health Options!

Our Amwell partnership includes Urgent Care telehealth for 24/7 access to care for non-emergency medical needs from medical professionals trained in internal medicine, family medicine, emergency medicine, and pediatrics. Telehealth is a convenient way for you and your family to see a provider for a range of common illnesses, such as the flu, colds, rashes, or even just starting a prescription.

Telehealth is also a great option for expanding access to behavioral healthcare, including psychiatrists, counseling, and therapy services for a full range of mental health and substance use disorders. Scheduling is easy, and care is available days, nights, and weekends. Additionally, your first 3 visits are at no cost to you.

So, there are hundreds of thousands of reasons not to wait until you need healthcare to use your healthcare plan. We encourage you to get started today!