Coverage Explanation

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

Chiropractic services for treatment or diagnosis of musculosketetal and related disorders and pain syndromes are a covered benefit for some Health Net HSP members. Refer to the member's Evidence of Coverage (EOC) to confirm if the member is eligible for chiropractic services.

Chiropractic services are administered by the American Specialty Health Plans, Inc. (ASH Plans) network of participating chiropractors without a referral from the member's primary care physician (PCP) as stated in the EOC.

Refer the member to ASH Plans or the Health Net Member Services Department as directed by the member's EOC or Schedule of Benefits for more information.

Coverage Criteria

Chiropractic services are subject to the medical benefits exclusions, limitations and authorization protocols listed in the EOC. Members 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 as stated in the Schedule of Benefits or EOC.

Additional services in subsequent visits may include:

• Manipulations, adjustments, therapy, X-ray procedures, and laboratory tests in various combinations.
• Adjunctive therapy, as set forth in a treatment plan approved by ASH Plans, which may involve therapies, such as hot packs, cold packs, electrical muscle stimulation, and other therapies.

Medically Necessary Services

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; the applicable specialist copayment applies.

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. The following services or supplies are not covered:

• Examinations or treatments for conditions other than those related to musculoskeletal disorders and physical therapy not associated with spinal, muscle or joint manipulation.
• Laboratory services.
• Surgical procedures.
• Durable medical equipment (DME).
• Medications (prescription or non-prescription).
• Hypnotherapy, behavior training, sleep therapy, and weight programs.
• Thermography, magnets used for diagnostic or therapeutic use, nerve conduction studies (for example, EEG, EMG, SEMG, SSEP, and NCV), electrocardiogram (EKG) studies, or interpretation or electrodiagnostic (EDX) studies performed at an outside facility.
• MRI and any types of diagnostic radiology, other than X-rays.
• Transportation costs, including local ambulance charges.
• Education programs, non-medical self-care, self-help training, or any related diagnostic testing.
• Vitamins, minerals, nutritional supplements, or other similar products.
• Anesthesia.
• Chiropractic care that is investigatory or an unproven chiropractic service that does not meet generally accepted and professionally recognized standards of practice in the chiropractic provider community.
• Charges for hospital confinement and related services.
• Massage therapy.
• Services provided by a chiropractor practicing outside the service area, except for emergency or urgent services.