376.1230. Chiropractic care coverage, rates, terms, conditions, limits, and exclusions.
Chiropractic care coverage, rates, terms, conditions, limits,and exclusions.
376.1230. 1. Every policy issued by a health carrier, as defined insection 376.1350, shall provide coverage for chiropractic care delivered bya licensed chiropractor acting within the scope of his or her practice asdefined in chapter 331, RSMo. The coverage shall include initial diagnosisand clinically appropriate and medically necessary services and suppliesrequired to treat the diagnosed disorder, subject to the terms andconditions of the policy. The coverage may be limited to chiropractorswithin the health carrier's network, and nothing in this section shall beconstrued to require a health carrier to contract with a chiropractor notin the carrier's network nor shall a carrier be required to reimburse forservices rendered by a nonnetwork chiropractor unless prior approval hasbeen obtained from the carrier by the enrollee. An enrollee may accesschiropractic care within the network for a total of twenty-six chiropracticphysician office visits per policy period, but may be required to providethe health carrier with notice prior to any additional visit as a conditionof coverage. A health carrier may require prior authorization ornotification before any follow-up diagnostic tests are ordered by achiropractor or for any office visits for treatment in excess of twenty-sixin any policy period. The certificate of coverage for any health benefitplan issued by a health carrier shall clearly state the availability ofchiropractic coverage under the policy and any limitations, conditions, andexclusions.
2. A health benefit plan shall provide coverage for treatment of achiropractic care condition and shall not establish any rate, term, orcondition that places a greater financial burden on an insured for accessto treatment for a chiropractic care condition than for access to treatmentfor another physical health condition.
3. The provisions of this section shall not apply to any health planor contract that is individually underwritten.
4. The provisions of this section shall not apply to benefitsprovided under the Medicaid program.
5. The provisions of this section shall not apply to a supplementalinsurance policy, including a life care contract, accident-only policy,specified disease policy, hospital policy providing a fixed daily benefitonly, Medicare supplement policy, long-term care policy, short-term majormedical policy of six months' or less duration, or any other similarsupplemental policy.
(L. 2003 H.B. 121 §§ 376.1230 and 376.1231)