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? OptumHealth Physical Health of California has just made the first steps to finding your chiropractor much easier.

Qualifications

OptumHealth Physical Health of California has an extensive credentialing process. We give you peace of mind knowing that any chiropractor 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. Chiropractors in our network offer evidence-based, best practice care to their patients. By accessing the chiropractor list in the directory or on this Web site, you are assured of choosing a qualified, participating health care professional.

Benefits

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

Initial office visit
Subsequent visits and treatment
Durable medical equipment and appliances

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

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
100% coverage for durable medical equipment up to $50
No referrals required - just make an appointment with a participating

OptumHealth Physical Health of California chiropractor

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 doctor is a personal experience. Your comfort level with any health care professional can be integral to the success of your treatment plan. What can you do to further ensure that you have chosen the right chiropractor for your health care needs?

Ask friends and family members if they can refer you to a chiropractor that they have seen and been satisfied with. They may be part of the OptumHealth Physical Health of California network.
Give your chiropractor 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 chiropractor, the staff and their office. Your comfort level will directly affect the success of the treatment plan that you and your chiropractor create.
Does having a male or female doctor 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 chiropractor to actively involve you in your treatment and rehabilitation. Home exercises, lifestyle changes, and short-term goals will be addressed when appropriate. Successful care plans actively involve the patients.

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

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