Chiropractic services for treatment of neuromusculosketetal disorders of the spine, neck and joints are a covered benefit, under the member's medical plan through the participating physician group (PPG) or as purchased by the employer group through American Specialty Health Plans, Inc. (ASH Plans). ASH Plans is a specialized health care service plan that provides and arranges for delivery of chiropractic services through a network of ASH Plans-participating chiropractors. A referral from the PPG or primary care physician (PCP) is not required. A member requesting chiropractic services should be referred to their employer group or the Health Net Member Services Department.

Chiropractic services provided through a member's PPG are subject to the applicable copayment for either the specialist consultation or rehabilitation therapy, based on the diagnosis and procedure code. The member must adhere to referral and authorization protocol through their PPG and PCP and chiropractic services are subject to the medical benefits exclusions and limitations listed as in the Evidence of Coverage (EOC) or Certificate of Insurance (COI).The PPG is financially responsible through capitation, if the PPG has financial risk under the Division of Financial Responsibility (DOFR) for outpatient professional and/or rehabilitation services. X-ray services are covered when prescribed by a participating chiropractor and performed by the PPG's participating provider for verification of suspected tumors or fractures, not for routine care.

For plans with chiropractic coverage through ASH Plans, the member may self-refer to an ASH Plans-participating chiropractor located in California for an initial examination and development of a treatment plan. Subsequent visits are authorized by ASH Plans and the member is covered up to a maximum number of visits as stated in the Schedule of Benefits or the EOC. Additional services in subsequent visits may include:

Medically necessary chiropractic care is covered through the member's medical benefit in the same manner as any other specialist care when determined medically appropriate for the member's condition and authorized by the provider. The applicable specialist copayment applies.

Providers can refer to the member's Schedule of Benefits and Evidence of Coverage (EOC) for additional information on copayments, benefit coverage, exclusions and limitations.

Chiropractic care through the member's medical benefits is subject to the exclusions and limitations for medical benefits listed in the member's EOC or COI.

Services, laboratory tests and x-rays and other treatment not approved by ASH Plans and documented as medically/clinically necessary as appropriate or classified as experimental, and/or being in the research stage, as determined in accordance with professionally recognized standards of practice are not covered. If a member has a life-threatening or seriously debilitating condition and ASH Plans denies coverage based on the determination that the therapy is experimental, they may be able to request an independent medical review of ASH Plans’ determination. The member can contact ASH Plans for more information.

The following information does not apply to Individual & Family Plans (IFP) members.

Coverage is limited to employer group plans that include chiropractic care through ASH Plans and may be subject to the maximum allowable amount as listed in the member's Evidence of Coverage (EOC) or Certificate of Insurance (COI). The following chiropractic appliances are covered when prescribed by a participating chiropractor and approved by ASH Plans:

The following information does not apply to Individual & Family Plans (IFP) members.

ASH Plans provides the following management programs for plans with supplemental chiropractic coverage: