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Services
Participating chiropractors
Chiropractic benefit—$15/20 visit
Chiropractic services are administered by American Specialty Health Plans of California, Inc.® (ASH Plans)
Office visit copayment: $15 per visit
Office visit limit: 20 visits per calendar year
Chiropractic appliance benefit: Chiropractic
appliances are provided up to a maximum of
$50 per year when prescribed and provided
by an ASH Plans participating chiropractor as
part of your chiropractic care.
X-ray and laboratory tests: $0
Employee
$2
Employee + spouse
$4
Employee + child(ren)
$3
Family
$6
Chiropractic benefit—$15/20 visit
Monthly premiums
ASH Plans contracts with participating chiropractors and other participating providers to provide covered chiropractic
services, including laboratory tests, X-rays, and chiropractic appliances. You must receive covered services from a
participating provider, except for emergency chiropractic services and services that are not available from participating
providers that are prior authorized by ASH Plans. A list of participating chiropractors is available on the ASH Plans Web
site at ashcompanies.com or from the ASH Plans Member Services Department at 1-800-678-9133.
To obtain covered services, call a participating chiropractor to schedule an initial examination. If additional services are
required, your participating chiropractor will prepare a treatment plan. The ASH Plans clinical services manager will authorize
the treatment plan if the chiropractic services are medically necessary for you. ASH Plans will disclose to you, upon request,
the process that it uses to authorize a treatment plan. If you have questions or concerns, please contact ASH Plans Member
Services Department.
Emergency services: Covered chiropractic services are provided for the sudden and unexpected onset of an injury or
condition affecting the neuromusculoskeletal system that manifests itself by acute symptoms of sufficient severity, including
severe pain, such that a reasonable layperson with