Coverage Policies

Use the index below to search for coverage information on specific medical conditions.

Note: For Arkansas State or Public School employees, services subject to pre-authorization are managed by Active Health Management, as noted in their Summary Plan Description.

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Medical Providers: Payment for care or services is based on eligibility, medical necessity and available benefits at time of service and is subject to all contractual exclusions and limitations, including pre-existing conditions if applicable.

Future eligibility cannot be guaranteed and should be rechecked at time of service. Verify benefits by signing into My Account or calling Customer Service at 800.235.7111 or 501.228.7111.

QualChoice follows care guidelines published by MCG Health.

QualChoice reserves the right to alter, amend, change or supplement medical policies as needed. QualChoice reviews and authorizes services and substances. CPT and HCPCS codes are listed as a convenience and any absent, new or changed codes do not alter the intent of the policy.

INDEX:
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Effective Date: 09/18/1995 Title: Alternative or Complementary Healing
Revision Date: 10/04/2006 Document: BI070:00
CPT Code(s): None
Public Statement

Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

A number of nonstandard healing techniques are referred to as Alternative or Complementary Healing. Except as specifically noted as being covered, these are all not covered services. Examples of treatments not covered are vitamin therapy, homeopathy, acupuncture, naturopathy, trace mineral therapy, massage therapy and faith healing.

 

See policies regarding specific diagnosis and therapy types for more specific statement.


Medical Statement

Alternative or Complementary Healing is generally not covered. For more specific information, see policies regarding specific types of healing systems.

 

Background: Alternative and Complementary Healing are disciplines for which, as yet, there is little or no objective scientific evidence to support its effectiveness.  Generally, the sources of illness and the cures are both undocumented and frequently contradict what is taught in medical schools.  

 

Physical and mental ailments are said to be the result of:

 

  • Imbalances in the blood, or
  • Imbalances in certain hormones, or
  • Deficiencies in trace minerals or vitamins, or
  • Unsuspected allergies to the environment, or
  • Dental stress.

Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.
This policy has recently been updated. Please use the index above or enter policy title in search bar for the latest version.