Chiropractic
Care – 80%
Benefits are
provided for services and supplies provided by a chiropractor 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 this $750 annual maximum, this plan will not pay the
additional
costs. Services
and supplies include:
- Initial
office visit and evaluation per condition, whether or not a spinal manipulation
is performed on the same day.
- Initial
plane film diagnostic x-rays of the spine per condition.
- One
spinal manipulation per day.
- Medical
supplies but limited to a back 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.
- More
than one office visit per condition or one spinal manipulation per
day.
- Physical
therapy performed or prescribed by a chiropractor.
- Laboratory
or pathology services performed or prescribed 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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