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Insurance — chiropractic copayments

United States Court of Appeals For the Seventh Circuit

Civil

Insurance — chiropractic copayments

Wis. Stats. Sec. 632.87(3)(a) does not prohibit insurers from requiring copayments for chiropractic care.

“[T]he state statute provides that no insurance ‘policy, plan or contract may exclude coverage for diagnosis and treatment of a condition or complaint by a licensed chiropractor . . . if the policy, plan or contract covers diagnosis and treatment of the condition or complaint by a licensed physician or osteopath.’ WIS. STAT. § 632.87(3)(a) (emphasis added). 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. More to the point, it does not expressly prohibit chiropractic copayments. The Wisconsin insurance code makes it clear that prohibitions do not arise by implication: ‘[W]hat chs. 600 to 655 do not prohibit is permitted unless contrary to other provisions of the law of this state.’ Id. § 600.01(1)(a). The plaintiffs have not identified any other provision of Wisconsin law prohibiting copayment requirements on chiropractic coverage.”

Affirmed.

12-1256 Larson v. United Healthcare Ins. Co.

Appeal from the United States District Court for the Western District of Wisconsin, Crabb, J., Sykes, J.

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