BOISE, Idaho -- In a March 15, 1999 ruling, the Idaho Supreme Court found no justification for the state's department of insurance to promulgate rules limiting insurance coverage for chiropractic services to $1,000 annually. The insurance department was not applying the same limitation to PTs and MDs who were doing manipulations.
The court declared the insurance regulations unconstitutional, because they discriminated against chiropractors as a group, not the nature of the services.
Background
The problem began in 1993 and 1994 when the Idaho legislature enacted the Small Employer Health Insurance Availability Act and the Individual Health Insurance Availability Act. The legislation was deemed necessary to assist small employer groups and individuals who had trouble obtaining affordable health insurance coverage. Limitations and exclusions of some services were made to develop an affordable basic plan. While such plans make economic sense, the "Limitations and Exclusions" section of the Small Employer and Individual Act had this proviso:
"Spinal manipulation. Chiropractic services will be subject to a one thousand ($1,000) per year limit, subject to the policy deductible and co-insurance."
The Idaho Association of Chiropractic Physicians (IACP) filed suit against the Idaho State Department of Insurance and its director.
The IACP claimed, reasonably, that the rules discriminated against chiropractors, as no monetary limit was placed on PTs or MDs doing manipulation. Further, the IACP said the rule discriminated against those Idaho citizens that desire to have their musculoskeletal disorders treated by chiropractors.
Inexplicably, the district court denied summary judgment to the IACP. Fortunately, the supreme court in a 3-1 vote reversed that decision and awarded costs to the IACP. The concurring judges saw "no rational basis to say that a service provided by one health care professional is covered, but the identical service provided by another health care professional is not covered."
Most chiropractors would cringe over the "identical service" assertion, but will applaud the supreme court justices for calling discrimination by its name when they see it.
