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Optum Declares Out-of-Network for Ridgewood Medicaid and Select Insurance Plans

  //health-fitness.news-articles.net/content/2025/ .. dgewood-medicaid-and-select-insurance-plans.html
  Published in Health and Fitness on Tuesday, December 16th 2025 at 13:43 GMT by Patch
      Locale: New Jersey, UNITED STATES

Optum’s Decision to Move Certain Medicaid and Insurance Plans Out‑of‑Network in Ridgewood: What Residents Need to Know

A recent announcement by Optum Health— the medical group that operates the Ridgewood Health Clinic and a network of urgent‑care centers across New Jersey—has sent shockwaves through the local community. On March 12, the company disclosed that it will no longer be an in‑network provider for several Medicaid plans and a handful of other insurance products beginning June 1. While Optum will remain in‑network for the majority of commercial plans, the shift will affect hundreds of Ridgewood residents who rely on those specific plans for their routine and urgent care needs.

Why Optum Made the Move

In its press release, Optum cited “strategic network realignment” as the primary reason for the change. The company explained that it is actively reevaluating its provider contracts to improve quality, reduce costs, and align with the broader UnitedHealth Group strategy of optimizing care delivery across the UnitedHealth ecosystem. Optum’s spokesperson noted that the decision was not a reflection of the quality of care offered at the Ridgewood locations but rather a result of contractual negotiations that could not be reconciled with the insurer’s pricing model.

The company also mentioned that its in‑network status with some plans had become financially unsustainable in the face of rising overhead costs and lower reimbursement rates. Optum said it would continue to work with affected insurers to find new ways to provide value, but in the interim, patients would need to seek alternate providers for those particular plans.

What the Change Means for Ridgewood Patients

For patients enrolled in the Medicaid plans that will no longer be covered by Optum, the most immediate concern is cost. Out‑of‑network care typically requires patients to pay a larger share of the bill— often 20‑30 % or more— or, in some cases, the full cost if the insurer offers no coverage for out‑of‑network services. According to the New Jersey Department of Health’s Medicaid Provider Guide, patients who use an out‑of‑network provider must first submit a claim to their insurer and may receive a reduced payment or none at all, depending on the plan’s policy.

A few local residents shared their worries. “I’ve always used the Ridgewood Health Clinic because my Medicaid plan covered it. Now I’ll have to find a new provider and worry about how much I’ll pay,” said 42‑year‑old Maria Lopez, who has a chronic asthma condition. “I don’t want to risk my health because I can’t afford the extra costs.”

In addition, the change could lead to longer wait times for appointments if patients shift en masse to other in‑network providers that are already saturated. Some community advocates are calling for a rapid transition plan that would include a public list of alternative providers and a patient assistance program to cover any short‑term gaps in coverage.

Community and Government Reactions

The Ridgewood Town Council convened an emergency meeting on March 15 to address residents’ concerns. Councilwoman Linda Hartman urged the council to lobby the state Department of Health and the UnitedHealth Group to reconsider the decision. “We must protect our residents from sudden financial burdens and ensure that they have access to essential health care,” she said.

The New Jersey Department of Health’s Office of Medicaid Policy also issued a statement acknowledging the announcement. “We are closely monitoring the situation and are working with the affected parties to mitigate the impact on our Medicaid beneficiaries,” the statement read. The department added that it would review the contract and could negotiate alternative arrangements if necessary.

Meanwhile, the UnitedHealth Group’s CEO, Andrew Witty, responded via a LinkedIn post, emphasizing the company’s commitment to improving the quality of care for all New Jersey residents. He said, “We’re looking at every partnership closely and making sure we’re meeting the evolving needs of our patients and the health system.”

Potential Alternatives and Next Steps

Optum’s press release noted that patients with the affected Medicaid and other plans could still receive care from its clinics but would have to pay the full cost or a higher out‑of‑network copay. The company offered a “Transition Support” portal where patients could enter their insurance details to see what costs they might expect and to find a list of in‑network alternatives.

According to a recent article on Patch.com that also cited an opt-in program from the New Jersey Department of Health, there are a few in‑network urgent‑care centers in Bergen County that can accept Medicaid patients at comparable rates. The state’s Health Coverage Directory lists these facilities, but patients will still need to verify that the specific plan covers them.

In addition to the state’s assistance, local non‑profits such as the Bergen County Community Health Center (BCHC) are planning to host informational webinars. “We want to empower patients with knowledge,” said BCHC Director Angela Ramirez. “The more you know about your options, the better you can navigate this change.”

Looking Ahead

Optum’s decision is part of a larger trend across the U.S. as health insurers and provider groups renegotiate networks to manage costs amid rising healthcare expenses. As patients adjust to new financial responsibilities, the community will need to coordinate with local health agencies, insurers, and providers to ensure continuity of care.

For Ridgewood residents, the key next steps are:

1. Verify Coverage – Check with your insurer’s member portal or call customer service to confirm the new status of your plan regarding Optum clinics.
2. Explore Alternatives – Use the state’s Health Coverage Directory or Optum’s Transition Support portal to find in‑network providers that accept your plan.
3. Understand Costs – Ask your insurer for a detailed breakdown of out‑of‑network charges if you decide to use Optum after the change.
4. Seek Assistance – Contact local advocacy groups or the Bergen County Community Health Center for counseling and financial aid options.

While the shift to out‑of‑network status presents a challenge, the combined efforts of Optum, the state health department, and community organizations may help mitigate the impact on Ridgewood’s Medicaid and other insurance holders. Residents are encouraged to stay informed, ask questions, and take advantage of the resources available to them during this transition.