Chiropractic care
Your Trust group health plan covers chiropractic treatment that meets all of these conditions:
- You have an illness or an injury that requires treatment. This includes a previously diagnosed condition that has been reinjured.
- You receive treatment from a Doctor of Chiropractic that is within the scope of his or her professional license.
- The services are expected to promptly and significantly heal or cure an acute health condition or an acute exacerbation of a chronic health condition and normalize body function.
- The services are medically appropriate. In other words, the treatment is considered by most chiropractors (and taught in the core curriculum of most chiropractic colleges) to be effective in diagnosing or correcting your condition. And, the duration, frequency, and intensity of treatment correspond with the severity of your condition.
We may request your records
If we find your chiropractic treatment to be unusual in its amount, frequency, duration, or intensity, we will request your medical records so that we can examine them to verify whether treatment continues to be medically necessary and appropriate. These records must include:
- Objective documentation of the reason you are receiving care, including the date of the illness, injury, or reinjury for which you are being treated.
- An assessment of your condition.
- Your treatment plan—a description of the type of treatment you will receive, what it is expected to achieve, and how long it will take to achieve it.
- Medically appropriate radiographic studies and reports.
- Daily progress notes about your current status, your chiropractor’s subjective and objective findings, documentation of the specific treatment you received, your response to treatment, and progress toward achieving the results outlined in the treatment plan. Note: If your chiropractor does not provide adequate documentation, we cannot verify whether your care is covered, and we may deny your claim for services you receive.
What’s not covered?
Treatment that doesn’t meet the previously described conditions is never covered, even though it may be beneficial to you or is recommended by your chiropractor. Here are some examples:
- Treatment that continues after you have reached maximum medical or chiropractic improvement.
- Treatment that continues after there is no reasonable expectation that you will significantly improve beyond your current condition, and further meaningful progress will be minimal or difficult to measure.
- Ongoing or prolonged services that are intended to prevent a relapse, reversal, or exacerbation of your condition.
- Routine or scheduled services that you receive in the absence of functional impairment, even when they are intended to preserve optimal functioning.
- Treatment of a chronic condition—or any condition—when it appears that your symptoms will continue despite ongoing care.
The following are examples of other types of chiropractic services and supplies that are not covered by your health plan:
- Services performed by a massage therapist.
- Services to treat an illness or an injury that is eligible for payment by Worker's Compensation.
- Supplies, or counseling in connection with any supplies, such as vitamins, herbs, nutritional supplements, cervical pillows, heel lifts, and lumbar rolls.
- Orthotic devices, unless they are prescribed by your physician or chiropractor and custom made for you.
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