AB 809

Summary

This bill makes a number of changes to requirements for and prohibitions on

health insurers with respect to coverage of chiropractic services and requires health

insurers to file annual reports on their compliance with the requirements and

prohibitions.

Policy prohibitions on excluding, restricting, or denying coverage

Under the bill, a health insurance policy may not restrict or deny coverage for

the diagnosis and treatment of a condition or complaint by a chiropractor acting

within the scope of his or her license and may not exclude, restrict, or deny coverage

of items or services provided by a chiropractor acting within the scope of his or her

license if the policy covers the diagnosis and treatment of the condition or complaint

by a physician and the same items or services provided by a physician. This

prohibition applies even if different nomenclature or codes are used to describe the

condition or complaint or items or services.

Under current law, a policy is already prohibited from excluding coverage for

the diagnosis and treatment of a condition or complaint by a chiropractor if the

diagnosis and treatment of the condition or complaint are covered when provided by

a physician, even if different nomenclature is used to describe the condition or

complaint. Current law explicitly states that this prohibition does not preclude the

application of deductibles or coinsurance to chiropractic and physician charges on an

equal basis or the application of cost containment or quality assurance measures to

chiropractic services in a manner that is consistent with cost containment or quality

assurance measures that generally apply to physician services. The bill removes this

statement of what is not precluded and provides that the new prohibition against

excluding, restricting, or denying coverage of chiropractic services prohibits a policy,

among other things, from applying cost containment measures or quality assurance

or performance measures unequally to chiropractors and primary care physicians

with respect to items or services that may be provided by chiropractors and primary

care physicians and from requiring an insured to pay a higher copayment or

coinsurance amount for services provided by a chiropractor than the copayment or

coinsurance amount that the insured must pay for the same or similar services

provided by a primary care physician.

Insurer requirement to provide timely access

Current law prohibits an insurer, under a health insurance policy that covers

chiropractic services, from doing a number of things, including establishing

underwriting standards that are more restrictive for chiropractic care than for care

provided by other health care providers. The bill removes this prohibition and

replaces it with another related to access to chiropractic services. The bill prohibits

an insurer from establishing or maintaining a policy or provider network that fails

to do either of the following: 1) provide insureds with reasonable and timely access