Chiropractic
Care – 80%
Benefits
are provided for services and supplies provided by a chiropractor for treatment
of the spine with an annual maximum of $750. These services always require 20
percent coinsurance and these coinsurance expenses do not apply toward the
$2,300 annual coinsurance maximum. If expenses exceed the $750 annual maximum,
this plan will not pay the additional costs.
- Initial
office call and evaluation per spinal condition, whether or not a spinal
manipulation is performed on the same day.
- Initial
plane film diagnostic x-rays of the spine per condition performed or ordered by
a chiropractor.
- Spinal
manipulations.
- Medical
supplies prescribed or dispensed by the chiropractor but limited to a lumbar
brace and cervical collar only.
Benefits
are not
provided for:
- Manipulations
of any parts of the body which are not articulations of the spine.
- Treatment
which is not within the scope of the chiropractor’s license.
- Office
calls in addition to spinal manipulations on the same day, except as provided
above.
- Physical
therapy prescribed by a chiropractor.
- Massage
therapy performed by a massage therapist or prescribed by a
chiropractor.
- Laboratory
or pathology services performed or ordered by a chiropractor.
- Prescription
drugs, medical supplies (except as described above) or durable medical equipment
prescribed or dispensed by a chiropractor.
- Treatment
by machine including, but not limited to, vibrasonic therapy, ultrasound
therapy, and hydrotherapy.
- Acupuncture.
- Any
imaging technique not specified as covered including, but not limited to,
videofluroscopy and magnetic resonance imaging (MRI), unless
ordered by a physician and preauthorized with the Trust
Office.
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