Simple MSK Chiro-Acupuncture

 

 

When you’re seeking relief from pain caused by an accident, injury, or muscle strain, or just looking for a natural healthcare approach, our Chiropractic and/or Acupuncture Benefits may be able to assist you. These benefits offered by SimpleMSK provide you access to licensed professionals at a discounted rate.

Chiropractic Plan Highlights	Medical Plan Options A, B & C
Chiropractic Services by SimpleMSK Provider (deductible waived)	$5 Copay then 100% of the SimpleMSK contract rate
Chiropractic Services by Non-SimpleMSK Provider (after deductible) – Outside 100 miles of Fresno ONLY – Referral must be given by a Physician & Pre-Certified by SimpleMSK	Plan A & C: 60% UCR after $100 deductible Plan B: 50% UCR after $100 deductible
Chiropractic Diagnostic X-Ray Benefit (after deductible)	100% UCR Limited to $100 per Benefit Calendar Year
Visits	Up to 28 visits per Calendar Year Note: For treatment exceeding 12 visits per calendar year, chiropractor must submit a “twelve visit review” and SimpleMSK must pre-certify additional visits for the remainder of the calendar year.

Acupuncture Medical Plan A & B Highlights	SimpleMSK Provider	Non-SimpleMSK Provider
Acupuncture Visit (20 visits per Calendar Year)	$20 Copay (Deductible waived)	Up to $20 reimbursement (Deductible waived)

The above are brief benefit summaries only. Please refer to the Plan Booklet (Plans A and B) and the Kaiser Permanente Evidence of Coverage for additional information.

The following protocol will apply for chiropractic treatment for minor children:

Treatment For Dependents 15 years of age and under requires Special pre-certification by calling SimpleMSK at (559) 447- 3375. All children fifteen (15) years of age and under must have a written precertification for treatment before any claims will be paid. In the case of an Emergency or where authorization was unable to be obtained on the first visit, then ONLY the first visit will be covered.

”Chiropractic Care” means chiropractic treatment from a licensed Chiropractor (D.C.) for a musculoskeletal disorder (bone, muscle, tendon and joint) and for related diagnostic x-rays performed and billed by the chiropractor.

**A SimpleMSK chiropractic doctor must be used within one hundred (100) miles of Fresno; when outside 100 miles, services for any non-Preferred Provider Organization chiropractic doctor must be referred by a Physician and pre-certified by SimpleMSK

Note: Acupuncture benefits for Plan Option C are covered through Kaiser facilities at a $15 Copay (deductible waived).

Check out SimpleMSK website at www.simpletherapy.com or contact them at 877.519.8839 to discuss how to use the program and find a participating provider near you.