Preheat oven to 375°F. Lightly grease a 9x13-inch baking dish.
If using sausage or ground beef, cook in a skillet over medium heat until browned. Drain excess grease.
In a large bowl, mix marinara sauce, heavy cream, garlic, Italian seasoning, salt, and pepper.
Add tortellini and cooked meat (if using) to the sauce mixture. Stir to coat evenly.
Fold in fresh spinach if using.
Spread half of the mixture into the baking dish. Sprinkle with half of the mozzarella and Parmesan.
Add remaining tortellini mixture and top with remaining cheese.
Cover with foil and bake for 20 minutes.
Remove foil and bake an additional 5–10 minutes until cheese is melted and golden.
Let rest 5 minutes before serving.