Physical and Occupational Therapy
Therapy and You
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 therapy provider much easier.
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Qualifications
OptumHealth Physical Health of California has an extensive credentialing process. We give you peace of mind knowing that any
therapy provider listed in our directory has been reviewed and approved by our credentialing committee.
OptumHealth Physical Health of California's credentialing process for the physical and occupational therapy has URAC accreditation.
Therapy providers in our network offer evidence-based, best practice care to their patients. By accessing the physical/occupational
therapy list in the directory or on this Web site, you are assured of choosing a qualified, participating health care professional.
Benefits
Our coverage includes the following, up to specific group plan limitations:
- 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.
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 therapist 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 therapist for your health care needs?
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friends and family members if they can recommend a therapist that they have seen and was satisfactory to them. They may be part of the OptumHealth Physical Health of California network.
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Give your therapist 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.
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Make sure that you are comfortable with your therapist, the staff and their facility. Your comfort level will directly affect the success of the treatment plan that you and your therapist create.
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Does having a male or female therapist 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.
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Expect your therapist 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
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The Plan’s service standard for hold time when receiving a call from a member/provider is less than 10 minutes.
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The Plan’s services standard for access to care from the time of the request of an appointment from a member are as follows:
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Urgent care – Within twenty-four (24) hours |
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Routine care – Within ten (10) business days |
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Urgent patient calls are to be returned within 30 minutes. |
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Plan's service standard for waiting time in a provider’s office (to see the provider) is less than thirty (30) minutes.
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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.
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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
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