The following opinion is presented on-line for informational use only and does not replace the official version. (Mich Dept of Attorney General Web Site - www.ag.state.mi.us) STATE OF MICHIGAN FRANK J. KELLEY, ATTORNEY GENERAL Opinion No. 6797 May 13, 1994 INSURANCE: Reimbursement for physicians and chiropractors PHYSICIANS AND SURGEONS: Reimbursement for physicians and chiropractors CHIROPRACTORS: Reimbursement for physicians and chiropractors An insurer may not refuse to provide reimbursement for a service which may be legally performed by a licensed chiropractor if that service is reimbursable for other providers under the applicable insurance policy. An insurer may establish different reimbursement rates for the same procedure provided by an allopathic or osteopathic physician and by a licensed chiropractor based upon differences in the scope of practice permitted by law for those three professions. Honorable Lynn F. Owen State Representative The Capitol Lansing, Michigan Honorable Mary Brown State Representative The Capitol Lansing, Michigan You have asked two questions relating to reimbursement for chiropractic services by health and disability insurers. Your first question may be stated as follows: 1. May an insurer refuse to provide reimbursement for a service which may be legally performed by a licensed chiropractor if that service is reimbursable for other providers under the applicable insurance policy? Section 3475 of the Insurance Code of 1956, 1956 PA 218, MCL 500.3475; MSA 24.13475, states, in relevant part: 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 chiropractor ... reimbursement under the insurance policy or certificate shall not be denied if the service is rendered by ... a chiropractor ... within the statutory provisions provided in his or her individual practice act. The Legislature has provided, in plain and unambiguous language, that an insurer may not deny reimbursement to a chiropractor who performs a service covered by the insurance policy that is within the scope of chiropractic practice permitted by law. When the language of a statute is clear and unambiguous, no additional interpretation is necessary. Owendale-Gagetown School Dist v State Bd of Education, 413 Mich 1, 8; 317 NW2d 529 (1982). This result is consistent with the result reached in OAG, 1989-1990, No 6621, p 179, 180-182 (July 13, 1989), which concluded that chiropractors must be reimbursed by Blue Cross and Blue Shield of Michigan for those services that they are licensed to perform and that are covered by the applicable insurance policy. It is my opinion, therefore, that an insurer may not refuse to provide reimbursement for a service which may be legally performed by a licensed chiropractor if that service is reimbursable for other providers under the applicable insurance policy. Your second question may be stated as follows: 2. May an insurer establish different reimbursement rates for the same procedure provided by an allopathic or osteopathic physician and a licensed chiropractor acting within the scope of the practice of chiropractic? In OAG, 1967-1968, No 4497, p 212 (March 19, 1968), a similar question was raised with regard to payments for eye examinations made by optometrists and ophthalmologists. Section 2243 of the Insurance Code of 1956, MCL 500.2243; MSA 24.12243, provides that group accident and health insurance subscribers are entitled to reimbursement for optometric services rendered by physicians (ophthalmologists) or by optometrists. OAG, 1967-1968, No 4497, concluded that the differences in practice between the two professions justified different fee schedules. The opinion stated, at p 214: Consequently there can be no direct answer to your questions since they contain an assumption that the services of ophthalmologists and optometrists may be identical when, in actual fact, each of these professionally trained persons are engaged in performing different services. Differences arise not only from procedures employed, which may or may not be identical, but also from differences in knowledge, skill, training, approach and professional responsibility. It is therefore my opinion that, by virtue of the distinctions between the practice of ophthalmology and optometry, different fee schedules for similar services are permissible. [ Emphasis added.] By the same token, distinctions between the practice of chiropractic and the practice of medicine support a similar answer to the question you raise. This is because the practice of chiropractic is more limited than the practice of medicine. Section 16401(1)(b) of the Public Health Code, MCL 333.16401(1)(b); MSA 14.15(16401)(1)(b), defines the practice of chiropractic as follows: (b) "Practice of chiropractic" means that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. Practice of chiropractic includes: (i) Diagnosis, including spinal analysis, to determine the existence of spinal subluxations or misalignments that produce nerve interference, indicating the necessity for chiropractic care. (ii) The adjustment of spinal subluxations or misalignments and related bones and tissues for the establishment of neural integrity utilizing the inherent recuperative powers of the body for restoration and maintenance of health. (iii) The use of analytical instruments, nutritional advice, rehabilitative exercise and adjustment apparatus regulated by rules promulgated by the board pursuant to section 16423, and the use of x-ray machines in the examination of patients for the purpose of locating spinal subluxations or misaligned vertebrae of the human spine. The practice of chiropractic does not include the performance of incisive surgical procedures, the performance of an invasive procedure requiring instrumentation, or the dispensing or prescribing of drugs or medicine. [ Emphasis added.] Clearly, chiropractors may only diagnose and treat spinal subluxations or misalignments. A chiropractor, unlike allopathic and osteopathic physicians, may not perform comprehensive medical examinations, perform surgery or dispense prescription drugs. Attorney General v Beno, 422 Mich 293, 317, 327, 337, 343; 373 NW2d 544 (1985). Allopathic and osteopathic physicians may treat the same conditions using a similar procedure to that used by chiropractors, but, because of differences in knowledge, skill, training, approach and professional responsibility, the services rendered are not the same. Indeed, OAG, 1979-1980, No 5503, p 223, 226 (July 5, 1979), concluded that only a chiropractor could provide chiropractic services within the meaning of a section of the Public Health Code. Thus, insurers may establish different reimbursement rates, including deductibles, co-pays and reasonable maximum annual service limits, for allopathic and osteopathic physicians than for chiropractors providing a similar procedure based upon differences in the scope of practice permitted by law for these three professions. It is my opinion, therefore, that an insurer may establish different reimbursement rates for the same procedure provided by an allopathic or osteopathic physician and by a licensed chiropractor based upon differences in the scope of practice permitted by law for those three professions. Frank J. Kelley Attorney General