Your chiropractic benefit is provided through American Specialty Health.

 

 

Important Documents from American Specialty Health

• Schedule of Benefits
  
• Booklet - Chiro Only
• Booklet - Chiro & Acupuncture
  
• Enrollment Form
  
• Welcome Letter
  
• Continuity of Coverage Rights
  
• Privacy Notice
  
• Language Survey
  
• Language Survey Q&A

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Chiropractic Benefit

 

No Deductibles
$10 Copayment Per Visit
30 Visit Annual Maximum
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Benefits include Chiropractic Services and Acupuncture Services that are Medically/Clinically Necessary Services provided by a Contracted Provider. In case of Acupuncture Services, the services must be for treatment and diagnosis of Neuromusculoskeletal Disorders, Nausea, and Pain.

Covered Services

A new patient examination is performed by the Contracted Chiropractor to determine the nature of the Member's problem, to provide or commence, in the new patient examination, Medically/Clinically Necessary Services that are Covered Services to the extent consistent with professionally recognized standards of practice, and to prepare a treatment plan of services to be furnished. A new patient examination will be provided to a Member if the Member seeks services from a Contracted Chiropractor for any injury, illness, disease, functional disorder, or condition with regard to which the Member is not, at that time, receiving services from the Contracted Chiropractor. A Copayment will be required for such examination.

Subsequent office visits, as set forth in a treatment plan approved by ASH Plans, may involve an adjustment, a re-examination, and other services, in various combinations. A Copayment will be required for each visit to the office.

Adjunctive therapy, as set forth in a treatment plan approved by ASH Plans, may involve therapies such as ultrasound, hot packs, cold packs, electrical muscle stimulation and other therapies.

A re-examination may be performed by the Contracted Chiropractor to assess the need to continue, extend or change a treatment plan approved by ASH Plans. A re-examination may be performed during a subsequent office visit or separately. If performed separately, a Copayment will be required.

X-rays and laboratory tests are payable in full when referred by a Contracted Chiropractor and approved by ASH Plans. Radiological consultations are a covered benefit when approved by ASH Plans as Medically/Clinically Necessary Services and provided by a licensed chiropractic radiologist, medical radiologist, radiology group, or hospital which has contracted with ASH Plans to provide those services.

Chiropractic Appliances are payable up to a maximum of $50 per year when prescribed by a Contracted Chiropractor and approved by ASH Plans; which includes: elbow supports, back supports (thoracic), cervical collars, cervical pillows, heel lifts, hot or cold packs, lumbar braces and supports, lumbar cushions, orthotics, wrist supports, rib belts, home traction units (cervical or lumbar), ankle brace, knee brace, rib supports, and wrist brace or other related services.