Chiropractic Care
The NAP only covers chiropractic services that are deemed to be Covered Health Services. In addition, the NAP only covers services that are expected to result in a significant improvement in the patient's level of functioning. If a measurable increase in the patient's level of functioning does not occur as a direct result of the skilled chiropractic therapy intervention, then the treatment is considered maintenance in nature and is not covered. The measurable increase in the patient's level of functioning must be documented in treatment notes.
Under the NAP, pre-approval for chiropractic care is required. The office visits to a chiropractor are covered at 80% of the negotiated rate, after deductible, when visits are to a provider who participates in the Anthem Blue Cross PPO network and the care is pre-approved by American Specialty Health Network (ASHN). You can locate network providers by calling Anthem Blue Cross directly or by visiting its website. To obtain pre-approval, call ASHN at 800-678-9133. Non-network chiropractic care is covered at 70% of Customary and Reasonable Charges (Eligible Expenses) and is limited to 15 visits per year.
You can locate chiropractic providers who participate in the Anthem Blue Cross PPO network by calling Anthem Blue Cross Member Services at 800-964-0530 or you may visit the Anthem Blue Cross website at www.anthem.com/ca/pge or www.anthem.com/ca. If there is not a network chiropractor within 30 road miles of your residence, you may seek care from a non-network provider and receive network benefits. If this is the case, call Anthem Blue Cross Member Services before receiving services, to verify there are no network chiropractors within 30 miles and request the network level of benefit reimbursement.