Kaiser Permanente is known for integrating various healthcare approaches, and this extends to Complementary and Alternative Medicine (CAM). For members of a Kaiser Permanente medical care program wondering what plan allows access to these services, this guide provides a comprehensive overview. Kaiser Permanente offers options for members to utilize complementary and alternative care and manipulative therapy services, often referred to as CAM. These encompass a range of services including acupuncture, naturopathy, massage therapy, and chiropractic care. However, it’s crucial to understand that eligibility and coverage details are dependent on your specific health plan and benefit level within Kaiser Permanente.
For situations where your chosen alternative or complementary care doesn’t fully meet coverage criteria, or if you’ve used up your self-referral visits, Kaiser Permanente provides access to the ChooseHealthy™ discount program. This program offers discounted rates on professional fees from a network of participating providers.
What Complementary and Alternative Medicine Services are Covered?
Generally, most Kaiser Permanente plans include coverage for a set number of self-referred visits for acupuncture, naturopathy, and chiropractic services (manipulative therapy). Coverage for massage therapy usually requires a referral from your primary care physician or personal doctor. To confirm the specifics of your coverage and any visit limitations, both members and providers can easily contact Member Services at 1-888-901-4636. It’s always a good practice for providers to verify a member’s coverage before providing any services.
Kaiser Permanente partners with Tivity Health to manage the network of contracted providers for chiropractic care, naturopathy, acupuncture, and massage therapy. All healthcare professionals within this network meet Kaiser Permanente’s rigorous credentialing standards and adhere to all relevant state and local licensing requirements. Members can easily find in-network providers by using the Kaiser Permanente Provider Directory.
These CAM services are subject to the same copayment and billing standards as any other covered medical service under your Kaiser Permanente plan. For detailed questions about benefit visit limits, copayments, coinsurance, and other specific coverage aspects, members should always contact Member Services directly.
| Service | Requires Prior Authorization |
|---|---|
| Acupuncture and Naturopathy | Typically No, if the total annual visits are within the member’s self-referral limit. Using self-referral for initial access is encouraged. For additional visits beyond the self-referral limit, the acupuncturist or naturopathic physician will usually request prior authorization directly from Kaiser Permanente. Personal physician involvement is generally not needed for this process. |
| Chiropractic Care | No for most commercial plans, which often include a limited self-referral manipulative therapy benefit. For Medicare plans, services must meet Medicare’s medical necessity guidelines for coverage. If authorization or medical necessity review is required under the member’s plan, the chiropractor will request prior authorization from Tivity for continued care. Personal physician involvement is not typically required. Prior authorization needs vary by plan, so it’s advisable to call Provider Assistance at 1-888-767-4670 to confirm specific requirements. |
| Massage Therapy | Yes, massage therapy is covered as part of the rehabilitation therapy benefit. It necessitates an order and referral from a personal or attending physician as part of a comprehensive rehabilitation plan of care. Coverage is contingent on medical necessity and meeting Kaiser Permanente’s clinical review criteria. It is important to note that massage therapy for relaxation, stress reduction, prevention, or general maintenance is not covered. |
Radiology Services for CAM Providers
When CAM providers need to order radiology procedures for Kaiser Permanente members, they are required to use the Radiology imaging request form (PDF). These procedures should be scheduled at Kaiser Permanente facilities.
Since January 1, 2009, Kaiser Permanente has transitioned to providing digital copies of patient X-rays. More details on ordering and utilizing the PACS (Picture Archiving and Communication System) digital images can be found in the Tivity Kaiser Permanente Provider Manual Supplement. Additionally, information on viewing Kaiser Permanente radiology images on encrypted discs with EZDicom Viewer is available in this PDF document with padlock icon.
Utilizing the ChooseHealthy™ Discount Program for Additional Savings
The ChooseHealthy program is a valuable resource for Kaiser Permanente members. It offers discounts on professional fees from participating providers when your complementary or alternative care needs fall outside of standard coverage criteria, or after you have exceeded your plan’s self-referral limits. By using the ChooseHealthy program, members can typically save up to 25% off a provider’s usual rates when booking appointments through the program.
Finding Participating Providers for Acupuncture, Chiropractic Care, and Massage Therapy
To locate providers for massage therapy, acupuncture, and chiropractic care who participate in the ChooseHealthy program, Kaiser Permanente members need to register on the ChooseHealthy website specifically for Kaiser Permanente Washington. On the website’s homepage, under the “Find a Provider” section, simply select the type of care you are seeking and enter your search criteria, such as ZIP code or provider name.
Once you’ve identified a provider that meets your needs, you can schedule an appointment directly with them. Remember to present your Kaiser Permanente health plan ID card at the time of your appointment to receive the negotiated discount.
Important Limitations: It’s important to note that the ChooseHealthy discount program does not extend to laboratory tests, X-rays, or any products that a provider might recommend. Furthermore, the discounts cannot be applied to copayments or coinsurance for services that are already covered under your Kaiser Permanente plan.
*ChooseHealthy, Inc. is a subsidiary of American Specialty Health Incorporated. The ChooseHealthy program is not responsible for providing or guaranteeing services and does not assume any liability for the quality of services provided. This program is not an insurance plan; it is offered as a supplementary resource to your Kaiser Permanente health plan coverage.
Content on this page is derived from the provider manual | Disclaimer
CAM Provider Manual Supplement for Contracted Providers
For contracted acupuncturists, chiropractors, massage therapists, and naturopaths, detailed information and guidelines can be found in the Tivity Kaiser Permanente Provider Manual Supplement, accessible on the Tivity website.
