Kaiser Permanente recognizes the growing interest in complementary and alternative medicine (CAM) and provides its members with access to a range of these services. If you’re wondering What Plan Allows Members Of Kaiser Permanente Medical Care Program to utilize CAM therapies, it’s important to understand that coverage specifics are tied to your individual health plan and benefit level. Kaiser Permanente offers options for accessing services like acupuncture, naturopathy, massage therapy, and chiropractic care, also known as manipulative therapy.
Overview of CAM Services at Kaiser Permanente
Kaiser Permanente integrates CAM services as part of a holistic approach to healthcare. These services are designed to complement conventional medical treatments and offer members a broader range of options for managing their health and well-being. While specific coverage can vary, Kaiser Permanente aims to provide pathways for members to access these therapies, whether through direct plan benefits or discount programs.
Covered CAM Services and Plan Variations
Many Kaiser Permanente plans include coverage for a set number of self-referred visits for acupuncture, naturopathy, and manipulative therapy (chiropractic) each year. Massage therapy coverage typically requires a referral from a primary care physician or personal physician and is often associated with rehabilitation therapy.
Acupuncture and Naturopathy
For acupuncture and naturopathy, many plans allow members to self-refer for a limited number of visits annually without needing prior authorization, as long as they remain within their plan’s visit limits. Should you require additional visits beyond your self-referral limit, the acupuncturist or naturopathic physician can typically request prior authorization directly from Kaiser Permanente. This process is designed to be streamlined and generally does not require involvement from your personal physician for these initial self-referred visits.
Chiropractic Care
Chiropractic services, categorized as manipulative therapy, are also often included in Kaiser Permanente plans with a self-referral benefit. Similar to acupuncture and naturopathy, most commercial plans offer a limited number of self-referral visits for chiropractic care. For members with Medicare, coverage for chiropractic services adheres to Medicare’s medical necessity guidelines. If your plan necessitates authorization or a medical necessity review for continued chiropractic care beyond the self-referral limit, the chiropractor will handle the prior authorization request through Tivity, Kaiser Permanente’s network manager for chiropractic services. It’s worth noting that prior authorization requirements can differ between plans, and many plans do not require it for initial visits within the self-referral limit.
Massage Therapy
Massage therapy coverage under Kaiser Permanente is generally provided as part of a rehabilitation therapy benefit. To access massage therapy, it must be ordered and referred by a personal or attending physician as part of a comprehensive rehabilitation plan of care. Crucially, massage therapy services need to be deemed medically necessary and meet Kaiser Permanente’s clinical review criteria. It is important to understand that massage therapy for purposes such as relaxation, stress reduction, prevention, or general maintenance therapy is typically not covered.
Self-Referral and Prior Authorization
Understanding the self-referral and prior authorization processes is key to utilizing your CAM benefits effectively. For acupuncture, naturopathy, and chiropractic care, the self-referral system allows you to directly access these services without needing to consult your primary care physician initially, provided you stay within your plan’s annual visit limits. This offers convenient and direct access to these therapies.
When your self-referral limit is reached or if your plan requires it for massage therapy or extended care, the prior authorization process comes into play. For acupuncture and naturopathy beyond the self-referral limit, the CAM provider usually manages this request. For chiropractic care requiring authorization, the chiropractor will coordinate with Tivity. Massage therapy authorization is linked to physician referral and medical necessity within a rehabilitation plan.
To confirm the specifics of your coverage, including visit limits and any prior authorization requirements, contacting Kaiser Permanente Member Services at 1-888-901-4636 is always recommended. Providers are also encouraged to verify member coverage before delivering services to ensure a smooth process.
The ChooseHealthy™ Discount Program
Kaiser Permanente provides an additional resource for members whose CAM needs might fall outside of their covered benefits or after they’ve used their self-referral visits. The ChooseHealthy™ discount program offers Kaiser Permanente members discounts on professional fees from a network of participating CAM providers. This program is beneficial when services don’t meet coverage criteria or after self-referral limits are reached. Through ChooseHealthy™, members can receive up to 25% off a provider’s standard rates when booking appointments through the program.
The ChooseHealthy™ program includes providers for acupuncture, chiropractic care, and massage therapy. To find participating providers, members can register on the ChooseHealthy™ website specifically for Kaiser Permanente Washington (ChooseHealthy). The website allows you to search for providers by type of care and location. When you schedule an appointment through ChooseHealthy™, remember to present your health plan ID card to receive the discounted rate. It’s important to note that the discount applies to professional fees but not to laboratory tests, X-rays, products recommended by the provider, or copayments and coinsurance for covered services.
Radiology Services and CAM
While discussing CAM services, it’s relevant to mention radiology services, as they may sometimes be integrated into the diagnostic or treatment process. If your CAM provider orders radiology procedures at Kaiser Permanente, they are required to use a specific Radiology imaging request form. It’s also important to be aware that Kaiser Permanente provides digital copies of X-rays. Further details on ordering and using the PACS (Picture Archiving and Communication System) for digital images can be found in the Tivity Kaiser Permanente Provider Manual Supplement.
Conclusion
In summary, Kaiser Permanente plans offer varying levels of coverage for complementary and alternative medicine services like acupuncture, naturopathy, chiropractic care, and massage therapy. The specific benefits available to you depend on the details of what plan allows members of Kaiser Permanente medical care program they are enrolled in. Self-referral options and the ChooseHealthy™ discount program enhance access to these services. For the most accurate information about your individual coverage, always verify your benefits by contacting Kaiser Permanente Member Services and consulting your plan documents. You can also utilize the Provider Directory to find contracted CAM providers within the Kaiser Permanente network.
