Choosing any practitioner can be an overwhelming experience. Where do you start looking? How do you know that you are choosing the most qualified professional? Is this office part of your participating network? If you have never seen a licensed acupuncturist for health care before, you may have more questions about treatment and care. OptumHealth Physical Health of California has just made the first steps to finding your licensed acupuncturist much easier.

Qualifications

OptumHealth Physical Health of California has an extensive credentialing process. We give you peace of mind knowing that any acupuncturist listed in our directory has been reviewed and approved by our credentialing committee. OptumHealth Physical Health of California's credentialing process has National Committee for Quality Assurance (NCQA) accreditation. Our participating acupuncturists meet or exceed licensing standards of the Medical Board of California. By accessing the list of acupuncturists in our directory or on this Web site, you are assured of choosing a qualified, participating health care professional. From their treatment philosophy to their office staff, we do the research to try and offer you the best acupuncture experience possible.

Benefits

With an OptumHealth Physical Health of California acupuncture rider, you open the door to additional health care choices. Our coverage includes the following, up to specific group plan limitations:

Initial office visit
Subsequent visits and treatment
Acupressure and other adjunct therapies

Your employer's benefit administrator can give you a detailed explanation of your group's benefits. Coverage should fall within these ranges:

Office visits with co-payments ranging from $0 - $40, coinsurance 5% - 50% per visit
Office visits ranging from 6 to an unlimited number of visits per year
No referrals required - just make an appointment with a participating
OptumHealth Physical Health of California licensed acupuncturist

Please Note: All services after the treatment plan threshold require verification of medical necessity. Other services are not covered. This is a brief summary of the proposed benefits. The Group Agreement issued following approval of coverage will include a complete description.

Making the Right Decision for You

OptumHealth Physical Health of California knows that choosing a health care professional is a personal experience. Your comfort level with any practitioner can be integral to the success of your treatment plan. What can you do to further ensure that you have chosen the right acupuncturist for your health care needs?

friends and family members if they can refer you to a licensed acupuncturist that they have seen and been satisfied with. They may be part of the OptumHealth Physical Health of California network.
you have never visited a licensed acupuncturist or have questions about what type of treatment to expect, ask the office staff or the practitioner. They will be happy to explain what to expect during your visits and why.
Give your acupuncturist the name and contact information for other health care specialists that you see. Keeping all of your health care professionals informed of each other allows them to work together for your benefit.
Make sure that you are comfortable with your acupuncturist, the staff and their office. Your comfort level will directly affect the success of the treatment plan that you and your acupuncturist create.
Does having a male or female practitioner make you feel more comfortable? Are the office hours and location convenient? Do not overlook details outside of direct patient care when making your decision.
Expect your acupuncturist to actively involve you in your treatment and rehabilitation. Successful care plans actively involve the patients and take each individual's lifestyle into account.

Accessibility Standards

Plan�s service standard for hold time when receiving a call from a member/provider is less than 10 minutes.
The Plan�s services standard for access to care from the time of the request of an appointment from a member are as follows:

Urgent Care -

Within 48 hours if the services do not require a prior authorization.
Within 96 hours if the services require a prior authorization.

Routine Care � Within 15 business days

Urgent patient calls are to be returned within 30 minutes.

The Plan's service standard for waiting time in a provider�s office (to see the provider) is less than thirty (30) minutes.
These same standards are expected to be met by any provider who offers �on call� coverage for contracting providers; as stated in the plan Provider Operations Manual it is the responsibility of contracting providers to inform the covering providers of these standards. �On call� provider coverage can only be provided by contracted providers.
Standards for geographic access and proximity are as follows:

To the extent feasible, all members shall have a residence or workplace within 30 minutes or 15 miles of a contracting provider. For rural areas, to the extent feasible, all members shall have a residence or workplace within 60 minutes or 60 miles of a contracting provider.

There shall be contracted providers in sufficient numbers and distribution as to accord all members a ratio of at least one contracted chiropractic and one contracted physical/occupational therapy provider to each 5000 members, and one contracted acupuncture provider to each 25,000 members.

Interpreter Services

Interpreter services are available to Optum members at the time of the appointment, as requested by the member or provider. To request interpreter services contact Optum at 1-800-428-6337. Language interpretation services are available at no cost to the member.

If a patient/member is unable to obtain a timely referral to an appropriate provider, provider or member/patient can contact Optum at1-(800) 428-6337 to obtain assistance or may contact the DMHC Health Plan Help Center at 1-(888)-466-2219 to file a complaint.

Contact Us for More Information

OptumHealth Physical Health of California
P.O. Box 880009
San Diego, CA 92168-0009
(800) 428-6337

Back to Top