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Suit filed by Virginia chiropractors against Trigon moves ahead

A federal judge ruled July 31, 2001, that a suit filed by the American Chiropractic Association (ACA) and the Virginia Chiropractic Association (VCA) charging Trigon Blue Cross Blue Shield with discriminatory reimbursement policies can move forward.

The ACA and VCA contend that Trigon companies discouraged doctors of chiropractic from offering treatment to patients by "setting unconscionably inadequate reimbursements for services."

The ACA, VCA, five doctors of chiropractic, and 18 chiropractic patients filed suit in U.S. District Court for the Western District of Virginia on Aug. 18, 2000, against Trigon (Virginia's largest managed health care company), and the national Blue Cross Blue Shield (BCBS) Association. The suit raises allegations of racketeering, extortion, mail fraud, antitrust violations, and other state and federal violations.

In VCA's opinion, managed care groups like Trigon and the national Blue Cross Blue Shield association have been conspiring with managed care bureaucrats and medical doctors to keep the chiropractic profession "from encroaching on the medical establishment's market share."

Six of the eight original counts in the suit were permitted by Judge James P. Jones: conspiracy to restrain interstate trade, attempt to monopolize the market, tortious interference with business expectancy, attempt to cause injury to business under state law, breach of contract, and conspiracy to injure doctors of chiropractic in their trade or practice.

The lawsuit contends that Trigon has imposed a $500 cap on spinal manipulation services by chiropractors and pays them less than medical doctors who perform similar procedures.

Specifically, the lawsuit contends that Trigon has imposed a $500 cap on spinal manipulation services by chiropractors, and pays them less than medical doctors who perform similar procedures. The suit also states that chiropractors were paid the lowest level treatment code possible, despite performing a higher level treatment, and that Trigon refuses to reimburse for the services of chiropractic assistants.

In the suit, the ACA and VCA contend that Trigon companies discouraged chiropractors from offering treatment to patients by "setting unconscionably inadequate reimbursements for services." Judge Jones did dismiss two other allegations, including one that claimed violation of the Racketeer Influenced and Corrupt Organizations Act (RICO) and the chiropractors' claim that Trigon's chiropractic coverage violates Virginia statutory insurance laws. The court noted that its dismissal of the RICO claim was supported by prior decisions of both the Virginia Bureau of Insurance and the Virginia Supreme Court.

Trigon strongly disputes the chiropractors' factual claims and says it will address those issues as the case moves forward.

"We are pleased with the court's decision and look forward to the opportunity to bring the rest of this case to a conclusion," says Trigon CEO Tom Snead. "We continue to believe the plaintiffs' remaining claims are without merit, and we anticipate that through the judicial process the claims that were not dismissed by the court at this phase will also be resolved in Trigon's favor." Trigon Blue Cross Blue Shield provides services to 2 million members.

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