Chiropractic Care
The CAP only covers chiropractic services that are deemed to be Covered Health Services. In addition, the CAP 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 CAP, pre-approval for chiropractic care is required after the initial visit. The office visits to a chiropractor are covered at 80% of the negotiated rate or Customary and Reasonable Charges, after deductible, when visits are 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 approval, call ASHN at 800-678-9133.