Medical: Chiropractic and Airrosti Coverage

Is chiropractic and Airrosti treatment covered by our plan?

Yes, the Austin Stone Health and Wellness Plan offers limited Chiropractic and Airrosti treatment coverage!

Chiropractic and Airrosti treatment is provided through the Austin Stone Component (EBC HRA/out of pocket/Health Fund) of our health plan.

CHM does not provide any coverage for Chiropractic or Airrosti treatment or any care prescribed by a chiropractor. For example, if a chiropractor orders an x-ray (which would normally be a reimbursable expense by CHM if ordered by a non-chiropractic physician), the bill for the x-ray is not eligible for sharing with CHM.  

What treatment is covered?

• Regular adjustments are covered.
• Treatment ordered by a chiropractor, such as an X-ray, is covered.
• Medically necessary massages that are prescribed by a physician for a specific medical condition are covered.  See below for more details.
• Care provided by an Airrosti chiropractic provider is covered.

What treatment is NOT covered?

• Acupuncture is not covered.
• Prepayment agreements are not covered.  See below for more details.
• Tips for chiropractors are not covered.

What are the coverage limits?

Chiropractic and Airrosti treatment coverage limits are not based on number of visits.  Instead, each year, you are allowed a certain dollar amount of coverage for all chiropractic and Airrosti treatment based on your coverage level.

Employee only: you are allowed $750 for chiropractic and Airrosti treatment

Employee + Spouse: you are allowed a total of $1,125 for chiropractic and Airrosti treatment

Employee + Family: you are allowed a total of $1,500 for chiropractic and Airrosti treatment

All treatment prescribed by a chiropractor or Airrosti provider is considered chiropractic care and will fall under these coverage limits.  For example:

• A chiropractor prescribes you a medical massage.  The charges associated with the medical massage are considered chiropractic care, even if they are provided by a non-chiropractor.
• An Airrosti provider sends you to get x-rays.  The charges associated with the x-rays are considered chiropractic care, even if they are provided by a non-chiropractor.

How is treatment covered?

Here is how Chiropractic and Airrosti coverage works through the Austin Stone Component of The Austin Stone Health and Wellness Plan.

• When you have EBC HRA dollars in your account and have not met your chiropractic coverage limit, use your EBC HRA to pay for chiropractic and Airrosti treatment.
• If you have run out of EBC HRA dollars and are in your Out of Pocket and have not met your chiropractic coverage limit, then use your personal funds to pay for chiropractic and Airrosti treatment.  Know that these costs are applied to your Out of Pocket total.
• If you have run out of HRA dollars, have spent all of your Out of Pocket and have not met your chiropractic coverage limit, then use your personal funds to pay for chiropractic and Airrosti treatment.  These funds will be reimbursed to you from the Health Fund.

Once you have met your chiropractic coverage limit for the year, you can no longer use your EBC HRA to pay for chiropractic and Airrosti treatment, you can no longer apply chiropractic and Airrosti treatment costs to your out of pocket, and you will not be reimbursed by the Health Fund for chiropractic or Airrosti treatment.

Do I need an itemized bill or documentation?

Keep in mind that you should always get an itemized statement for the services provided.  The documentation needs to be an itemized statement of charges from the provider and must include: 1) Date of service, 2) Description of service, 3) Name of provider, and 4) Dollar amount charged.   You will need this statement if EBC requires documentation, to apply charges to your Out of Pocket balance, and/or to be reimbursed by the Health Fund.

Are massages covered?

Our EBC HRA will only cover medically necessary massages that are prescribed by a physician for a specific medical condition.  

If the massage was prescribed by a chiropractor, then, even if the massage is done by someone else, the charge for the massage applies to your chiropractic coverage limit (see above).

If you get a massage, please make sure you have documentation showing that a physician prescribed it for a listed medical condition.  Here is the Letter Of Medical Necessity that EBC needs completed and submitted:

EBC-Letter-of-Medical-Necessity.pdf

Can I enroll in a Pre-payment plan to get the discount?

Pre-payment agreement payments are not covered by our plan!  Our plan requires that we collect itemized statements showing the services provided, the date the service was provided, and the cost for that service.  A pre-payment agreement, such as paying for bundle of services that you will receive in the future, cannot show the date service was provided and is therefore not covered by our plan.

A possible work around for this process is...   You purchase a pre-payment agreement with your personal funds and then each time you receive services from the chiropractor, you receive an itemized statement showing the service provided, the date of the service, and the cost of that service.  If you can get that itemized statement each time you receive services, then you can submit the statement for reimbursement (from your EBC HRA or from the Health Fund) or apply that cost to your Out of Pocket balance.  You would be slowly repaid for the cost of the prepayment agreement.  This work around only works if you can get an itemized statement each time you receive services!

Can I tip my chiropractor?

If you would like to tip your Chiropractor, please use your personal funds to do so!  
Tips are not an eligible EBC HRA expense, therefore you should not use your EBC HRA card to pay for them.