SERVICES OF DISPENSING OPTICIAN UNDER HEALTH CARE SERVICE CONTRACT

INSURANCE ‑- HEALTH ‑- OPTICIANS ‑- SERVICES OF DISPENSING OPTICIAN UNDER HEALTH CARE SERVICE CONTRACT

A health care service contractor registered under chapter 48.44 RCW may offer to provide or to pay reimbursement for the services of a licensed dispensing optician.

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                                                                   April 28, 1982

Honorable Larry L. Vognild
St. Sen., 38th District
1710 32nd Street
Everett, Washington 98201                                                                                                                 Cite as:  AGLO 1982 No. 9

Dear Sir:

            By recent letter you requested our opinion on a question which we paraphrase as follows:

            May a health care service contractor registered under chapter 48.44 RCW offer to provide or to pay reimbursement for the services of a licensed dispensing optician?

            We answer your question in the affirmative for the reasons set forth in our analysis.

                                                                     ANALYSIS

            Chapter 48.44 RCW regulates what is, in effect, a form of medical insurance offered by firms or organizations known as "health care service contractors."  RCW 48.44.010(3) defines that term as meaning,

            ". . . any corporation, cooperative group, or association, which corporation, cooperative group, or association is sponsored by or otherwise intimately connected with a group of doctors licensed by the state of Washington or by a group of hospitals licensed by the state of Washington; or doctor licensed by the state of Washington; or group of doctors licensed by the state of Washington, who or which not otherwise being engaged in the insurance business, accepts prepayment for health care services from or for the benefit of persons or [[Orig. Op. Page 2]] groups of persons as consideration for providing such persons with any health care services.  The term also includes any corporation, cooperative group, or association, sponsored by or otherwise intimately connected with a group of pharmacists registered by the state of Washington; or any pharmacist, or group of pharmacists, registered by the state of Washington; who or which not otherwise being engaged in the insurance business, accepts prepayment for health care services from or for the benefit of persons or groups of persons as consideration for providing such persons with any health care services."

            Registration by health care service contractors is required in accordance with RCW 48.44.015(1) which reads:

            "(1) No person shall in this state, by mail or otherwise, act as or hold himself out to be a health care service contractor, as defined in RCW 48.44.010 without being duly registered therefor with the commissioner."

            "Health care services" are defined by RCW 48.44.010(1) to mean, and include,

            ". . . medical, surgical, dental, hospital and other therapeutic services.  Ambulance services licensed in this state, the services of an optometrist licensed by the state of Washington, and the services of a pharmacist registered by the state of Washington are also declared to be health care services for the purposes of this chapter."

            And finally, subsection (4) of the same section of the law defines "participant" to mean:

            ". . . a doctor, hospital, or licensed pharmacy, drug storeor dispensary, who or which has contracted in writing with a health care service contractor to accept payment from and to look solely to such contractor according to the terms of the subscriber contract for any health care services rendered to a person who has previously paid such contractor for such services."  (Emphasis supplied)

            Clearly, a licensed dispensing optician may, by signing an agreement with a health care service contractor, bring himself [[Orig. Op. Page 3]] within the scope of this last quoted definition of the term "participant," in accordance with the above underscored language thereof.  The critical issue, however, is that of whether or not the services of a dispensing optician represent a form of "health care services"‑-as that term is defined in RCW 48.44.010(1),supra.

            We answer in the affirmative for the following two reasons.

First, RCW 48.44.010(1), supra, is clearly broad enough to include the services of professionals not specifically listed therein.  Note, once again, the additional language ". . . and other therapeutic services."  Thus, for example, the services of a registered nurse may be offered through a health care service contractor; and, in fact, RCW 48.44.290 expressly requires that a health care service contract provide benefits for such services, under certain conditions.  Similarly, there would seem to be little question that the services of a licensed physical therapist are "therapeutic services" which could be offered by a health care service contractor.  The services of a dispensing optician in the fabrication and fitting of lenses prescribed to correct vision deficiencies would similarly appear to fall within the broad scope of "therapeutic services."