Wisconsin Statutes & Annotations
Chapter 632 - Insurance contracts in specific lines.
632.875 - Independent evaluations relating to chiropractic treatment.

632.875 Independent evaluations relating to chiropractic treatment.
(1) In this section:
(a) “Chiropractor" means a person licensed to practice chiropractic under ch. 446.
(b) “Independent evaluation" means an examination or evaluation by or recommendation of a chiropractor or a peer review committee under s. 632.87 (3) (b) 1.
(c) “Patient" means a person whose treatment by a chiropractor is the subject of an independent evaluation.
(d) “Treating chiropractor" means a chiropractor who is treating a patient and whose treatment of the patient is the subject of an independent evaluation.
(2) If, on the basis of an independent evaluation, an insurer restricts or terminates a patient's coverage for the treatment of a condition or complaint by a chiropractor acting within the scope of his or her license and the restriction or termination of coverage results in the patient becoming liable for payment for his or her treatment, the insurer shall, within the time required under s. 628.46 (2m), provide to the patient and to the treating chiropractor a written statement that contains all of the following:
(a) A statement that an independent evaluation has been conducted under s. 632.87 (3) (b) 1.
(b) The name of the treating chiropractor.
(c) The name of the patient.
(d) A description of the insurer's internal appeal process that is available to the patient.
(e) A statement indicating that the patient may, no later than 30 days after receiving the statement required under this subsection, request an internal appeal of the insurer's restriction or termination of coverage.
(f) The address to which the patient should send the request for an appeal.
(g) A detailed explanation of the clinical rationale and of the basis in the policy, plan, or contract or in applicable law for the insurer's restriction or termination of coverage.
(h) A list of records and documents reviewed as part of the independent evaluation.
(3)
(a) In this subsection, “claim" means a patient's claim for coverage, under a policy, plan or contract covering diagnosis and treatment of a condition or complaint by a licensed chiropractor within the scope of the chiropractor's professional license, the restriction or termination of which coverage is the subject of an independent evaluation.
(b) A chiropractor who conducts an independent evaluation may not be compensated by an insurer based on a percentage of the dollar amount by which a claim is reduced as a result of the independent evaluation.
(4) Subject to sub. (2) (e), an insurer shall make available to a patient an internal procedure by which the patient may appeal an insurer's decision to restrict or terminate coverage.
(5) This section does not apply to any of the following:
(a) Worker's compensation insurance.
(b) Any line of property and casualty insurance except disability insurance. In this paragraph, “disability insurance" does not include uninsured motorist coverage, underinsured motorist coverage or medical payment coverage.
History: 1995 a. 94; 2001 a. 16; 2007 a. 20.

Structure Wisconsin Statutes & Annotations

Wisconsin Statutes & Annotations

Chapter 632 - Insurance contracts in specific lines.

632.05 - Indemnity amounts.

632.07 - Prohibiting requiring property insurance in excess of replacement value.

632.08 - Mortgage clause.

632.09 - Choice of law.

632.10 - Definitions applicable to property insurance escrow.

632.101 - Policy terms.

632.102 - Payment of final settlement.

632.103 - Procedure for payment of withheld funds.

632.104 - Funds released to mortgagee.

632.14 - Bonds need not be under seal.

632.17 - Validity of surety bonds.

632.18 - Rustproofing warranties insurance.

632.185 - Vehicle protection product warranty insurance policy.

632.22 - Required provisions of liability insurance policies.

632.23 - Prohibited exclusions in aircraft insurance policies.

632.24 - Direct action against insurer.

632.25 - Limited effect of conditions in employer's liability policies.

632.26 - Notice provisions.

632.32 - Provisions of motor vehicle insurance policies.

632.34 - Defense of noncooperation.

632.35 - Prohibited rejection, cancellation and nonrenewal.

632.36 - Accident in the course of business or employment.

632.365 - Use of emission inspection data in setting rates.

632.37 - Motor vehicle glass repair practices; restriction on specifying vendor.

632.375 - Motor vehicle repair practices; restriction on specifying vendor.

632.38 - Nonoriginal manufacturer replacement parts.

632.41 - Prohibited provisions in life insurance.

632.415 - Funeral policies.

632.42 - Trustee and deposit agreements in life insurance.

632.43 - Standard nonforfeiture law for life insurance.

632.435 - Standard nonforfeiture law for individual deferred annuities.

632.44 - Required provisions in life insurance.

632.45 - Contracts providing variable benefits.

632.46 - Incontestability and misstated age.

632.47 - Assignment of life insurance rights.

632.475 - Life insurance policy loans.

632.48 - Designation of beneficiary.

632.50 - Estoppel from medical examination.

632.56 - Required group life insurance provisions.

632.57 - Conversion option in group and franchise life insurance.

632.60 - Limitation on credit life insurance.

632.62 - Participating and nonparticipating policies.

632.63 - Unclaimed life insurance and annuities.

632.64 - Certification of disability.

632.65 - Annuities exempt from regulation.

632.66 - Annuity contracts without life contingencies.

632.67 - Effect of power of attorney for health care.

632.69 - Life settlements.

632.695 - Applicability of general transfers at death provisions.

632.697 - Benefits subject to department's right to recover.

632.71 - Estoppel from medical examination, assignability and change of beneficiary.

632.715 - Reports of action against health care provider.

632.72 - Medical benefits or assistance; assignment.

632.725 - Standardization of health care billing and insurance claim forms.

632.726 - Current procedural terminology code changes.

632.729 - Prohibiting discrimination based on COVID-19.

632.73 - Right to return policy.

632.74 - Reinstatement of individual or franchise disability insurance policies.

632.745 - Coverage requirements for group and individual health benefit plans; definitions.

632.746 - Preexisting condition; portability; restrictions; and special enrollment periods.

632.747 - Guaranteed acceptance.

632.748 - Prohibiting discrimination.

632.749 - Contract termination and renewability.

632.7495 - Guaranteed renewability of individual health insurance coverage.

632.7497 - Modifications at renewal.

632.75 - Prohibited provisions for disability insurance.

632.755 - Public assistance and early intervention services.

632.76 - Incontestability for disability insurance.

632.77 - Permitted provisions for disability insurance policies.

632.775 - Effect of power of attorney for health care.

632.78 - Required grace period for disability insurance policies.

632.79 - Notice of termination of group hospital, surgical or medical expense insurance coverage due to cessation of business or default in payment of premiums.

632.793 - Notice of loss of primary insurance coverage due to age.

632.795 - Open enrollment upon liquidation.

632.797 - Disclosure of group health claims experience.

632.798 - Out-of-pocket costs.

632.80 - Restrictions on medical payments insurance.

632.81 - Minimum standards for certain disability policies.

632.82 - Renewability of long-term care insurance policies.

632.825 - Midterm termination of long-term care insurance policy by insured.

632.83 - Internal grievance procedure.

632.835 - Independent review of coverage denial determinations.

632.84 - Benefit appeals under certain policies.

632.845 - Prohibiting refusal to cover services because liability policy may cover.

632.85 - Coverage without prior authorization for treatment of an emergency medical condition.

632.853 - Coverage of drugs and devices.

632.855 - Requirements if experimental treatment limited.

632.857 - Explanation required for restriction or termination of coverage.

632.861 - Prescription drug charges.

632.865 - Pharmacy benefit managers.

632.866 - Step therapy protocols.

632.867 - Oral and injected chemotherapy.

632.87 - Restrictions on health care services.

632.873 - Restrictions relating to fees for dental services.

632.875 - Independent evaluations relating to chiropractic treatment.

632.88 - Policy extension for handicapped children.

632.885 - Coverage of dependents.

632.89 - Coverage of mental disorders, alcoholism, and other diseases.

632.895 - Mandatory coverage.

632.896 - Mandatory coverage of adopted children.

632.897 - Hospital and medical coverage for persons insured under individual and group policies.

632.8985 - Prohibiting abortion coverage.

632.899 - Medical savings accounts study.

632.91 - Definition.

632.93 - The fraternal contract.

632.95 - Fraud in obtaining membership.

632.96 - Beneficiaries in fraternal contracts.

632.97 - Application of proceeds of credit insurance policy.

632.975 - Portable electronics insurance.

632.977 - Travel insurance.

632.98 - Worker's compensation insurance.

632.99 - Certifications of disability.