"Direct access to chiropractic is not a mandated benefit," explained Lori Bielinski, director of government relations and membership for the Washington State Chiropractic Association (WSCA). "Patients first must have benefits for chiropractic services for conditions covered by their health plan. The services covered by that insurance also must be within the chiropractic scope of practice." Subscribers must still use the preferred providers within their health plans or network.
Before the passage of the bill, those with health insurance that included chiropractic benefits were required to go to a primary care physician to get a chiropractic referral. The bill, Ms. Bielinski specified, "eliminates the need for a prior referral to those services."
The WSCA has contacted insurers across the state who say they will comply with the direct access provision. Those insurers include: Aetna U.S. HealthCare; First Choice Health; Group Health Cooperative; Premera Blue Cross; and Regence BlueShield.
To clarify, the direct access provision applies to all health plans with chiropractic benefits that are regulated by the Washington State Office of the Insurance Commissioner, the Washington State Health Care Authority, and the Medical Assistance Administration (MAA), a division of the Washington State Department of Social and Health Services. This would include state employees and MAA subscribers, according to the WSCA, and will apply to policies that are new, or renewed after July 1, 2001.
The direct access to chiropractic services does not apply to employer self-insureds, Taft Hartley (union-negotiated) or Medicare and Medicare-supplemental plans. However, when self-insured and Taft Hartley groups purchase employee health benefits, they may request from their carriers direct access to chiropractic for their employees.
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