Optum offers products for complex medical conditions such as:
Chronic Kidney Disease
Congenital Heart Disease
Women's Health Services
- Neonatology
- Pregnancy


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Health Care Provider Recommendations

Because medical centers can vary considerably in experience and quality of care, choosing the right health care provider to treat your complex medical condition can make an enormous difference in the outcome of your treatment. At Optum, we have experts on staff to help you compare medical centers and choose the best possible health care provider for your specific needs.

Optum's Stringent Evaluation Process

Optum has been reviewing health care providers who specialize in complex medical conditions since 1986. Each year we conduct a rigorous evaluation process of medical centers throughout the country. We invite only the most experienced and successful of these medical centers to be part of our Centers of Excellence networks. There is different criteria and a separate Center of Excellence network for each condition we serve. Find out more about our evaluation criteria and process.

Selecting the Health Care Provider for You

When you (or a family member) are diagnosed with a complex medical condition, we help you select the Centers of Excellence network medical center that best meets your needs. In most cases, an Optum account manager provides your case manager with information about medical centers and treatment options. Your case manager will discuss these options with you and help you make informed decisions about your care. With Optum, you will have access to the most elite hospitals in the nation for your specific condition.

Sometimes It Pays to Go the Extra Mile

Although your first instinct may be to find a medical center close to home, the best option for care may require some travel. Most patients have a Centers of Excellence network medical center within 250 miles of their home. Some patients, however, choose to go across the country if they find a doctor or a hospital that specializes in the type of care they require.

The Optum Centers of Excellence Advantage

By choosing an Optum Centers of Excellence network medical center, you will be more likely to have the following experiences: 

  • A more accurate diagnosis
  • Higher success rates
  • Care that is planned, coordinated and provided by a team of experts who specialize in your condition
  • Appropriate therapy (neither too much nor too little)
  • Fewer complications
  • Shorter length of stay in a medical center
  • Decreased out-of-pocket costs


NCQA has reviewed and certified Optum's Credentialing and Utilization Management functions only. Date granted: 7/1/2014. Expiration date: 7/1/2016. For complete details on the scope of this review, visit www.ncqa.org.