Trigon Blue Cross Blue Shield of Virginia Balks at Providing
Evidence for its Lower Chiropractic Payments

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

Thanks to the ACA for permission to reproduce this information

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ACA obtained a court order March 18 from the federal court in Abingdon, VA hearing ACA vs. Trigon that requires Trigon Blue Cross Blue Shield of Virginia to respond to specific questions about the manner in which it determines reimbursement rates for chiropractic services, and specifically to explain why the company pays doctors of chiropractic less than medical doctors for the same exact services.

U.S. District Court Judge James Jones in Abingdon, Va., recently ruled that Trigon must answer questions comparing the education and training of doctors of chiropractic and medical doctors. Trigon officials must also justify the reimbursement amounts they provide to doctors of chiropractic and medical doctors under the applicable CPT codes.

ACA has supplied Trigon with a compendium of studies and reports detailing the effectiveness of chiropractic care and the superior nature of chiropractic education in the treatment of neuromusculoskeletal conditions. In turn, the court order compels Trigon to provide studies and other information on which it relies to support its policy of lower reimbursement for services provided by chiropractors, or to admit its policy is not based on any objective evidence.

It is apparent that Trigon is using every effort to refrain from providing information that would demonstrate its particular discrimination against chiropractors and chiropractic services.

However, confronted by an avalanche of studies in referred journals that provide evidence that MDs have little or no education in diagnosis and care of the neuromusculoskeletal system and that prove chiropractors are in fact much better educated in this area and achieve greater effectiveness with patients, Trigon's latest court documents appear to retreat from any claim to educational superiority of medical doctors.

Specifically the court has ordered Trigon to:

• Identify every market survey, study, analysis, and/or other information on which the defendants rely as supporting or tending to support the amounts of payments to chiropractors, the amounts of payments to medical doctors, or both.
  

• Identify every medical doctor who consulted, was in any way involved with, or in any way participated in, any decision and/or policy to pay chiropractors less than medical doctors for procedures billed under the same CPT code.

Under the court order, Trigon will be forced to disclose any studies that back up its contention that a doctor of chiropractic should be paid less than a medical doctor for providing the same service, or simply state that no such studies exist.

Through the legal process of discovery, ACA aims to demonstrate the close working relationships among medical physicians, medical societies and Trigon, versus the almost totally hostile and arms-length relationship between Trigon and doctors of chiropractic.

“It should be obvious that any portion of the 40 percent savings extracted from chiropractors is available for higher payments to medical physicians,” noted Garrett F. Cuneo, ACA executive vice president.

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