Chiropractic 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 chiropractor much
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.
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:
Your employer's benefit administrator can give you
a detailed explanation of your group's benefits.
Coverage should fall within these ranges:
- Initial office visit
- Subsequent visits and treatment
- Durable medical equipment and appliances
OptumHealth Physical Health of California chiropractor
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
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
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
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
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
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
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 twenty-four (24) hours
||Routine care – Within ten (10) business days
||Urgent patient calls are to be returned within 30 minutes.
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.
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:
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 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
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