No, none of the products sold by Optimal teleHealth are insurance, they are memberships that provide the member with access to medical services and/or participation in a like-minded group of people who join together into a community to share medical expenses.

The courts struck down the individual mandate of the ACA as unconstitutional in December of 2019.

All virtual healthcare services included in our Essential Care and Primary Care memberships are provided by Lyric Health, an industry leader in the delivery of virtual healthcare. The financial protection for major medical events is provided by Sedera, one of the originators of medical cost sharing outside of the faith based community.

Lyric Health requires no contractual agreement. Sedera requires execution of a “List Bill Agreement” which defines the terms of the relationship between Sedera, the Sedera cost sharing community and the member. Membership with either provider can be terminated at any time without cause.”

Membership dues for Essential Care and Primary Care are processed on the first day of every month via credit/debit card or ACH. For legal compliance reasons, monies transferred between parties in the cost sharing community are done via special bank accounts set up for that purpose. With Group memberships, monies come from the company or organization on the first of each month and with self-pay memberships, monies come from the member.”

Yes there is, both providers have an app that makes it more convenient to obtain services.

Your dedicate physician is available by appointment from 7am-7pm Monday thru Friday. Your call will be taken by our triage team and a determination will be made whether to connect you with our 24/365 Urgent care doctors or with your dedicated physician.

The exception to this are services like psychological and psychiatric counseling which are available on a pay-per-call basis. Less frequently used services like this are provided to members at no cost as a customer service. Neither Lyric Health nor Optimal teleHealth receives compensation for the use of these services.

No, there are no such limitations.  Our goal is your satisfaction, and we want you to spend as much time with the doctor as needed to make you comfortable with the treatment plan prescribed.

Yes they do, and that is part of your membership enrollment process with both Essential Care and Primary Care.  Lyric Health retains your medical history in an electronic medical records file. During onboarding with Lyric Health, you will go through a Q&A process to provide initial health related information which is recorded in their electronic medical records system. These medical records are shared between your Urgent Care and Primary Care doctors. After each consultation, the records are updated.

Absolutely, your primary care physician in both Essential Care and Primary Care will provide second opinions on most diagnosis.  You can even send them copies of lab reports or other documents provided by medical practitioners you’ve already consulted. Regarding a major diagnosis with Optimal Care, you are required to use their second opinion services in non-emergency situations to assure accurate diagnosis and treatment.

Although as much as 90% of your primary care medical needs can be handled virtually, it’s certain that at some point you will need to seek services outside your primary providers. Since we do not have a provider network, you are free to use any provider you wish, but your objective should be to seek a provider that extends reduced rates for cash patients, and almost all of them do. If you need assistance or have questions, both Lyric Health and Sedera have Care Navigators available to provide support. Another source of support would be your Patient Advocacy service with Lyric Health.

 Not currently.  All dues will be processed monthly.

Membership dues are processed in advance of the month services are provided.  At the point membership is terminated, no further dues will be collected, and your membership will remain in effect for the remainder of the month that was previously paid.  No refund will be made.

There are no restrictions on joining either of our virtual healthcare plans, Essential Care and Primary Care. Anyone over the age of 18 can join regardless of their current medical condition, residency, or alien status.  Children under the age of 18 can join as a family member in their parents’ membership, or as a primary member but they must have a parent or legal guardian present during every consultation. Membership in the Optimal Care plans requires you are in the United States legally. Membership is never refused due to pre-existing conditions but there are special conditions. Refer to the community guidelines for restrictions on pre-existing conditions.

You can consult with a board-certified doctor licensed to practice in the state or country from which you are calling if you’re within any of the 50 United States or Puerto Rico.  When you call to request a consultation, simply advise member services where you are calling from.  Services are not available for members traveling in foreign countries. With the Optimal Care cost sharing community, you can obtain services from any source you choose and receive reimbursement if the cost of services are reasonable. Your Sedera Care Navigator will assist in locating affordable services.

Yes, Lyric Health, our provider for Essential Care and Primary Care, will make doctor consultations available in both English and Spanish. Their website and member support are also available in Spanish.

It is up to you and what you are most comfortable with.  Some members feel that seeing the doctors face creates a more intimate and effective experience, and video can become valuable if you want to show the doctor a rash or injury.  Certain states require a video consultation, but most members consult by phone for convenience. Either technology is available in all consultations from any mobile devise or properly equipped computer.

In many cases a virtual healthcare service like Essential Care or Primary Care could be both convenient and cost effective when combined with a traditional insurance policy, assuming the insurance plan does not already include such services.