What steps can I take to get coverage for acupuncture or chiropractic care if it's included in my California plan benefits?

To get coverage for acupuncture or chiropractic care included in your benefits, you must first follow your plan's authorization process and, if denied, use the state-mandated grievance and Independent Medical Review system. Step 1: Verify Benefits and Obtain a Referral Review your health plan's "Evidence of Coverage" (EOC) document to confirm the specific benefits and any limitations, such as a maximum number of visits. If your plan requires a referral, ask your Primary Care Physician (PCP) to provide one and to submit a treatment authorization request to your health plan. Step 2: File a Grievance if Your Plan Denies the Request If your health plan denies the authorization request, you must file a formal appeal, known as a "grievance." You have 180 days from the date of the denial to file. Submit your grievance in writing to your health plan. Include your member ID number, a copy of the denial letter, and any supporting documents, such as a letter from your doctor explaining why the treatment is medically necessary. Step 3: Await the Grievance Decision Your health plan must resolve a standard grievance and send you a written decision within 30 calendar days. If your health is at immediate risk, you can request an expedited (urgent) grievance, which must be resolved within 72 hours. Step 4: Request an Independent Medical Review (IMR) If the health plan denies your grievance, they must give you an IMR application form and instructions. You can ask the California Department of Managed Health Care (DMHC) to conduct an IMR. You must file this request within six months of your plan's final denial. The DMHC's decision is legally binding on your health plan. You can find the application on the DMHC website. Important Details and Nuances Always document every phone call and save copies of all correspondence with your health plan. Denials are often based on a lack of "medical necessity," so a detailed letter from your doctor is your most powerful tool. California's "timely access" regulations require plans to provide a specialist appointment within 15 business days; if they cannot, you may be able to see an out-of-network provider at the in-network cost. Warnings and Limitations Following these steps does not guarantee a successful outcome. Missing a deadline for filing a grievance or an IMR can permanently waive your right to appeal that specific denial. This is general information and does not constitute legal advice. For complex situations, you should consult with a qualified California attorney who specializes in health insurance law.