May 2004

Judge rules against ACA in Trigon; Next steps being considered

The U.S. Fourth Circuit Court of Appeals has ruled against the American Chiropractic Association in the Trigon/Blue Cross Blue Shield of Virginia lawsuit. The ruling was handed down May 6, 2004. The ACA is determining its next course of action.

ACA plans to announce its next move pending a thorough review of the opinion handed down by the court. Meanwhile, ACA continues its suit against the U.S. Centers for Medicare and Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services.

“While we are obviously disappointed by this decision, we stand firm in our conviction that moving forward with the Trigon lawsuit was the right thing to do for the chiropractic profession,” said ACA President Donald J. Krippendorf, DC. “The ACA continues to fight tooth and nail for justice for the chiropractic profession — and our dedication and determination in the Trigon lawsuit has only underscored our willingness to stand tall for chiropractic.”

Through its lawsuit against Trigon — which addresses what ACA believes to be discriminatory reimbursement practices against doctors of chiropractic — ACA alleges antitrust violations, citing Trigon’s decision to pay doctors of chiropractic 40 percent less than what it pays medical doctors for identical services, block referrals to doctors of chiropractic, inappropriately reduce codes and establish discriminatory limits and caps. ACA’s lawsuit against CMS seeks to secure the Medicare chiropractic benefit, “manual manipulation of the spine to correct a subluxation,” as a chiropractic-only service.

Despite the setback, the chiropractic profession has already made significant progress in the insurance arena thanks to the Trigon litigation, according to the ACA. The National Blue Cross Blue Shield Association and the ACA have begun working cooperatively to improve chiropractic reimbursement in BCBS plans nationwide.

One tangible benefit that is a direct result of ACA’s legal action is a new chiropractic benefit worth an estimated $120 to $140 million per year in the Federal Employee Health Benefits plan administered by Blue Cross Blue Shield.

Another favorable outcome of the Trigon case is the launching of the Blue CCHiP program (Blues/Chiropractic Clinical Healthplan Program), a liaison program that has allowed doctors of chiropractic to become integrated into local Blue Cross Blue Shield medical policymaking committees across the country.

“These victories did not come by accident,” explained Krippendorf. “They are substantial benefits derived from the support we’ve received from so many in our profession who want what is best for chiropractic. We’ve received assistance in our legal battles from all corners of our profession because we’re doing the right thing. We remain dedicated to protecting the rights of doctors of chiropractic, and we will do what we believe is the next right thing to do. ”

Source: American Chiropractic Association, www.amerchiro.org

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