Chiropractic and Acupuncture Benefits
For Access+ HMO Plan 5, Access+ HMO Plan 10, Access+ HMO Plan 15, Access+ HMO Plan 20, Access+ HMO Plan 25, Access+ HMO Plan 40 and Added Advantage POS Plan
Blue Shield Chiropractic and Acupuncture Care coverage lets you self-refer to a network of participating chiropractors and acupuncturists. Benefits are provided through a contract with American Specialty Health Plans of California, Inc. (ASH Plans).
Plan Advantages
• No physician referral required • $10 copayments • No deductibles or claim forms • More than 2,800 chiropractors and 1,000 acupuncturists statewide • Provider credentialing and quality management programs
How the Program Works
You can visit any participating chiropractor or acupuncturist from the ASH Plans network without a referral from your Access+ HMO® or Added AdvantageSM POS Personal Physician. Simply call a participating provider to schedule an initial exam. At the time of your first visit, you’ll present your Blue Shield member identification card and pay only your copayment. Because participating chiropractors and acupuncturists bill ASH Plans directly, you’ll never have to file claim forms. If you need further treatment, the participating chiropractor or acupuncturist will submit a proposed treatment plan to ASH Plans and obtain the necessary authorization from ASH Plans to continue treatment up to the calendar-year maximum of 30 combined visits.
Extensive Provider Network and Quality Programs
ASH Plans offers more than 2,800 licensed chiropractors and more than 1,000 licensed acupuncturists conveniently located throughout California. These participating practitioners are screened to meet rigorous credentialing standards by a quality management committee. In addition to overseeing the credentialing of ASH Plans providers, this committee monitors quality improvement programs, quality of care issues, and the development of clinical continued on next page policies and procedures.
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A12114-LOGO (1/06)
What’s Covered
The plan covers medically necessary chiropractic services including: • Initial and subsequent examinations • Office visits and adjustments (subject to annual limits) • Adjunctive therapies • X-rays and laboratory tests (chiropractic only) • $50 calendar-year chiropractic appliance benefit1 All covered services, except the initial examination, are subject to prior authorization from ASH Plans.
Friendly Customer Service
Helpful Member Services representatives are available Monday through Friday from 6 a.m. to 5 p.m. to answer questions, assist with problems, or help locate a participating chiropractor or acupuncturist. American Specialty Health Plans of California, Inc. Member Services (800) 678-9133
Benefit Plan Design
Calendar-Year Maximum Calendar-Year Deductible Copayment Per Visit Calendar-Year Chiropractic Appliance Benefit1 Out-of-Network Coverage
1
30 combined visits None $10 $50 None
Chiropractic appliances are covered up to a maximum of $50 in a calendar-year as authorized by ASH Plans.
As authorized by ASH Plans, this allowance is applied toward the purchase of items determined necessary, such as supports, collars, pillows, heel lifts, ice packs, cushions, orthotics, rib belts and home traction units.
This is only a summary of the Blue Shield Chiropractic Benefits. Please see the Evidence of Coverage and the plan contract for exact terms and conditions of coverage as well as exclusions and limitations.
®
Blue Shield and the Shield symbols are registered marks of the BlueCross BlueShield Association, and Association of Independent Blue Cross and Blue Shield Plans.
Access + HMO is a registered mark and Added Advantage POS is a service mark of Blue Shield of California.