Chiropractic treatment is a common healthcare service that years ago was not routinely covered in health-insurance policies. For more than 27 years, however, Wisconsin has required health insurers operating within the state to cover chiropractic care on an equal basis as other forms of medical care for the same condition.
More specifically, in 1987 the Wisconsin legislature adopted a statute, sec. 632.87, banning insurance companies from excluding coverage for chiropractic services if their policies covered the treatment of the same condition by a physician or osteopath:
- No policy, plan or contract may exclude coverage for diagnosis and treatment of a condition or complaint by a licensed chiropractor within the scope of the chiropractor’s professional license, if the policy, plan or contract covers diagnosis and treatment of the condition or complaint by a licensed physician or osteopath . . . .
Section 632.87, Wis. Stats.
The statute does not:
- Prohibit the application of deductibles or coinsurance provisions to chiropractic and physician charges on an equal basis.
- Prohibit 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 generally applicable to physician services and that is consistent with this section.
Id.
The legal premise of a recent Wisconsin class action, Larson v. United Healthcare Insurance Company, was that six major health-insurance companies were violating state law by requiring copayments for chiropractic care. The policy copayments for chiropractic visits were: $60 (United Healthcare); $60 (Wisconsin Physicians Service); $50 (Humana); $30/$35 (Network Health Plan); $50 (Blue Cross Blue Shield). The Larson suit alleged that although the insurers provided chiropractic coverage in their policies, the coverage came with strings attached—copayment requirements—and because chiropractic care is relatively inexpensive, the required copayments often approached or exceeded the cost of the treatment. The co-pays effectively shifted most or all of the cost of chiropractic care to the patient.
The Larson court found that Wisconsin law does not prohibit chiropractic copayments. “This language is clear. If an insurance policy covers treatment by a licensed physician or osteopath for a particular condition or complaint, then it cannot exclude treatment for the same condition or complaint by a licensed chiropractor acting within the scope of his license. The statute requires equal treatment of chiropractic services; it does not mandate a particular amount or level of coverage,” the Larson court reasoned.
The lesson taken from this case is that under current Wisconsin law, co-pays may be required of patients for chiropractic care. In the future, any significant reduction of the insureds’ co-pay expense must come either through legislation, or employers’ negotiation with the insurance companies for better policy coverage. It should be clear to insurers by now that better insurance coverage for chiropractic care will benefit all parties as a cost-effective alternative to more invasive and expensive medical treatments.
This article was written by Atty. Alan Olson
COMMUNITY.