April 2002

Court Orders Trigon to Justify Lower Chiropractic Payments

Arlington, Va. - A federal judge has ordered a Virginia managed-care organization to explain why the company pays doctors of chiropractic less than medical doctors for the same services.

The American Chiropractic Association (ACA) filed suit against Trigon Blue Cross/Blue Shield in August 2000, alleging conspiracy, racketeering, extortion, mail fraud, and anti-trust violations.

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.

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.

The Virginia Chiropractic Association (VCA), five doctors of chiropractic, and 18 chiropractic patients are supporting the ACA's lawsuit against Trigon.

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