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Combined Acupuncture and Chiropracticprogram Groups of 51-100 Combined Acupuncture and Chiropractic Program Quality, affordable coverage through Health Net and ASH Plans Pam White Health Net Acupuncture care for the following injuries, illnesses, diseases, Health Net has teamed up with American functional disorders or conditions, when Specialty Health Plans of California, Inc. determined to be medically necessary. (ASH Plans) to offer quality, affordable What’s covered acupuncture coverage. Although you’re Covered conditions always welcome to consult your primary • Neuromusculoskeletal conditions, care physician, you won’t need a referral to including conditions such as fibromyalgia see a participating acupuncturist. With this and myofascial pain program, you’re free to obtain care by self- • Pain, including low back pain, postoperative referring to a participating acupuncturist pain and postoperative dental pain from our acupuncture directory. • Nausea, including adult postoperative Covered services may require verification of nausea and vomiting, chemotherapy nausea With this program, medical necessity by ASH Plans except for: and vomiting, and nausea of pregnancy (a) an initial examination by a participating you’re free to obtain • Carpal tunnel syndrome acupuncturist; and (b) emergency and care by self-referring urgent care acupuncture services. When • Headaches to a participating ASH Plans approves a treatment plan, the • Menstrual cramps approved services for each subsequent acupuncturist from our • Osteoarthritis office visit covered by the treatment plan • Stroke rehabilitation acupuncture directory. also includes a brief re-examination in each subsequent office visit if deemed necessary • Tennis elbow by the participating acupuncturist, without Office visits1 additional approval by ASH Plans. • $10 per visit, 20 visits per calendar year Definition of acupuncture covered services (visit maximums are combined for Services provided by a participating acupuncture and chiropractic services) acupuncturist (or emergency and urgent • Initial examination, subsequent office visits, care acupuncture services provided by a re-examination nonparticipating acupuncturist) are covered (continued) 1Includes emergencies and urgent care visits and referral visits to nonparticipating acupuncturists. CA96226 (9/12) Health Net of California, Inc. is a subsidiary of Health Net, Inc. Health Net is a registered service mark of Health Net, Inc. All rights reserved. Other covered services – Chiropractic only on a determination by ASH Plans that the • Medically necessary X-rays and laboratory therapy is Experimental or Investigational, tests except as otherwise approved by ASH the Member may be able to request an Plans Director of Acupuncture Services or independent medical review of ASH Plans’ Health Net. determination. The Member should contact ASH Plans’ Member Services Department at What’s not covered 1-800-678-9133 for more information. Services or supplies excluded under the acupuncture care program may be covered • Services or treatments for pre-employment under the medical benefits portion of physicals or vocational rehabilitation. your plan. Consult your plan’s Evidence of • Any services or treatments for conditions Coverage for more information. caused by or arising out of the course of employment or covered under workers’ Limitations and exclusions2 compensation or similar laws. • Air conditioners, air purifiers, therapeutic mattresses, supplies, or any similar devices Chiropractic care or appliances, and all support appliances or durable medical equipment, except as Health Net has teamed up with ASH Plans defined elsewhere. to offer quality, affordable chiropractic coverage. With this program, you’re free to • Thermography, magnets used for diagnostic obtain this care by selecting a participating or therapeutic use, ion cord devices, chiropractor from our chiropractor directory. manipulation or adjustments of the joints, Although you’re always welcome to consult physical therapy services, iridology, hormone your primary care physician, you won’t need replacement products, acupuncture point a referral to see a participating chiropractor. or trigger-point injections (including injectable substances), laser/laser biostim, Covered services may require verification of colorpuncture, NAET diagnosis and/or medical necessity by ASH Plans except for: treatment, and direct moxibustion. (a) an initial examination by a participating • Services, exams (other than an chiropractor; and (b) emergency or urgent initial examination to determine the care chiropractic services. When ASH Plans approves a treatment plan, the approved Although you’re appropriateness of Acupuncture Services) services for each subsequent office visit always welcome to and/or treatments for conditions other than Neuromusculoskeletal Disorders, covered by the treatment plan also includes consult your Primary Nausea, Pain or pain syndromes. a brief re-examination, if deemed necessary Care Physician, you by the participating chiropractor, without • Hypnotherapy, behavioral training, sleep additional approval by ASH Plans. won’t need a referral therapy, and weight programs to see a participating • Education programs, non-medical lifestyle Definition of chiropractic covered services chiropractor. or self-help, or self-help physical exercise Services provided by a participating chiropractor training or any related diagnostic testing. (or a nonparticipating chiropractor, when emergency or urgent care chiropractic • Services and other treatments that are services are provided or a referral is classified as Experimental or Investigational. approved by ASH Plans) are covered for the If ASH Plans denies coverage for a therapy treatment of neuromusculoskeletal disorders for a Member who has a life-threatening or pain syndromes when determined to be or seriously debilitating condition based medically necessary. (continued) 2 Refer to Evidence of Coverage for details. What’s covered • Education programs, nonmedical lifestyle or Office visits3 self-help, or any self-help physical exercise • $10 per visit, 20 visits per calendar year (visit training or related diagnostic testing. maximums are combined for acupuncture • Services, exams (other than an initial and chiropractic services). There is a $50 examination to determine the appropriateness annual chiropractic appliance allowance of chiropractic services), and/or treatments for toward the purchase of medically necessary conditions other than neuromusculoskeletal items such as supports, collars, pillows, heel disorders or pain syndromes. lifts, ice packs, cushions, orthotics, rib belts • Hypnotherapy, behavioral training, sleep and home traction units. therapy, and weight programs. • X-rays and clinical laboratory tests are payable • Services, clinical laboratory studies, X-rays, in full when provided by or referred by a supports and appliances, and other treatments contracted chiropractor and approved by or products that are classified as experimental ASH Plans. Radiological consultations are a or investigational. If ASH Plans denies covered benefit when approved by ASH Plans coverage for a therapy for a member who as medically necessary and when provided by has a life-threatening or seriously debilitating a licensed chiropractic radiologist, medical condition based on a determination by radiologist, radiology group, or hospital that ASH Plans that the therapy is experimental has contracted with ASH Plans to provide or investigational, the member may be able those services. to request an independent medical review What’s not covered of ASH Plans’ determination. The member Services or supplies excluded under the should contact ASH Plans’ Member chiropractic care program may be covered Services Department at 1-800-678-9133 under the medical benefits portion of your plan. for more information. Consult your plan’s Evidence of Coverage for • Services or treatments for pre-employment more information. physicals or vocational rehabilitation. Limitations and exclusions4 • Any services or treatments for conditions • Air conditioners, air purifiers, therapeutic caused by or arising out of the course of mattresses, supplies, or any other similar employment or covered under workers’ devices or appliances; and all support compensation or similar laws. appliances or durable medical equipment, For additional information, please except as defined elsewhere. contact Health Net at 1-800-361-3366 or • Thermography; magnets used for diagnostic 1-800-522-0088. or therapeutic use; nerve conduction studies This is only a summary. Chiropractic and (e.g., EEG, EMG, SEMG, SSEP, and NCV); or acupuncture services can be added to any electrocardiogram (EKG) studies. of our HMO, Elect Open Access or • Magnetic resonance imaging, CAT scans, bone Select 3-Tier POS plans. Consult your scans, nuclear radiology, therapeutic radiology plan’s Evidence of Coverage, which you and any diagnostic radiology other than receive after you enroll, to determine the covered plain film studies. exact terms and conditions of your coverage. 3Includes emergencies and urgent care visits and referral visits to nonparticipating chiropractors. 4Refer to Evidence of Coverage for details..
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