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Bulletin No. 90-07

Interpretive statement issued pursuant to act 306 of the public acts of 1969, as amended

Issued and entered October 3, 1990 by Dhiraj N. Shah, Acting Commissioner of Insurance


BACKGROUND

The purpose of this bulletin is to explain to insurers the provisions of Section 3475 of the Michigan Insurance Code, MCLA 500.3475. It has come to the attention of the Insurance Bureau that confusion exists among insurers with regard to the meaning of Section 3475. Specifically, complaints have been made regarding coverage for chiropractic care.

Section 3475 of the Code states:

Notwithstanding any provision of any policy of insurance or certificate, if an insurance policy or certificate provides for reimbursement for any service which may be legally performed by a person fully licensed as a psychologist under part 182 of the public health code, Act No. 368 of the Public Acts of 1978, being sections 333.18201 to 333.18237 of the Michigan Compiled Laws; by a podiatrist licensed under part 180 of the public health code, Act No. 368 of the Public Acts of 1978, being sections 333.18001 to 333.18033 of the Michigan Compiled Laws; by a chiropractor licensed under part 164 of the public health code, Act No. 368 of the Public Acts of 1978, being sections 333.16401 to 333.16431 of the Michigan Compiled Laws; reimbursement under the insurance policy or certificate shall not be denied if the service is rendered by a person fully licensed as a psychologist under part 182 of the public health code, Act No. 368 of the Public Acts of 1978; by a podiatrist licensed under part 180 of the public health code, Act No. 368 of the Public Acts of 1978; or by a chiropractor licensed under part 164 of the public health code, Act No. 368 of the Public Acts of 1978; within the statutory provisions provided in his or her individual practice act. This section shall not be construed as requiring the coverage for a psychologist in any insurance policy. This section shall not apply to a policy or certificate written pursuant to section 3405, 3631, or 3709 involving a prudent purchaser agreement.

INTERPRETIVE STATEMENT

The scope of professional services which are appropriately performed by licensed podiatrists, psychologists or chiropractors is defined by the Michigan Code of Public Health.

Under Section 3475, if a health or disability insurance policy provides reimbursement for a service that may legally be performed by a licensed podiatrist, psychologist, or chiropractor, then reimbursement under the policy cannot be denied if the service is in fact rendered by a licensed podiatrist, psychologist, or chiropractor.

Further, defining the term "physician" so as to exclude podiatrists, psychologists or chiropractors acting within the scope of their professional license and limiting the number of or maximum benefit for treatments or services performed by podiatrists, psychologists or chiropractors while not placing limits on the same treatments and services performed by other practitioners would be improper under Section 3475.

Information regarding the scope of professional medical practice may be obtained from the Podiatric Medicine and Surgery Board, Psychology Board or Chiropractic Board at:

Bureau of Health Services
Ottawa Building North
Fourth Floor
P.O. Box 30018
Lansing, Michigan 48909
(517) 373-3596

Questions concerning this statement may be directed to:

Michigan Insurance Bureau
P.O. Box 30220
Lansing, MI 48909

Attention: Ms. Mary K. Van Drasek (517) 335-1724

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