By Karen Pallarito

NEW YORK (Reuters Health) - Chiropractic groups on Friday charged Virginia's largest managed healthcare company with illegally conspiring against the chiropractic profession by imposing unfair payment terms for services.

The lawsuit filed in federal court in Virginia accuses Trigon Healthcare Inc. and the national Blue Cross and Blue Shield Association of engaging in numerous illegal acts, including racketeering, extortion, mail fraud and antitrust violations.

``This is the chiropractic profession's first assault on the discriminatory practices under managed care and insurance reimbursement as it is exhibited in the polices of Blue Cross and Blue Shield, so it's an historic action for us,'' said Thomas Daly, legal counsel to the American Chiropractic Association (ACA), a plaintiff in the case.

ACA, along with the Virginia Chiropractic Association, led the action against Trigon, which is the second largest publicly traded Blue Cross and Blue Shield plan in the US, and the national Blues association.

This it the ACA's second major lawsuit over payment and fairness issues. In late 1998, the ACA sued the US Department of Health and Humans Services claiming that the Medicare+Choice guidelines illegally allow Medicare managed care plans to substitute spinal manipulation services performed by healthcare providers other than chiropractors as a benefit.

Daly said the ACA started getting complaints about the managed care industry's practices about 2-1/2 years ago. He said that the suit targets Trigon because ``some of the most flagrant problems come up in Virginia.''

Virginia chiropractors have been in talks with the insurer over that 2-1/2-year period but that negotiations have been ''exhausted.''

The lawsuit contends that Trigon companies discouraged chiropractors from offering treatment to patients by ``setting unconscionably inadequate reimbursements for services.'' Trigon also misrepresented its policies in document with the Securities and Exchange Commission, it says.

It further charges the Blue Cross and Blue Shield Association with conspiring with Trigon by allowing it to offer plans under the Blues imprimatur while it discriminated against chiropractors.

At issue is a $500 reimbursement cap that Trigon allegedly has imposed on ``manipulation services'' performed by chiropractors but not other healthcare providers, such as osteopaths. The suit also asserts that Trigon pays chiropractors 40% less than medical doctors for the same or similar services.

Brooke Taylor, a Trigon spokesperson, said on Friday that officials had not seen the complaint. ``Based on the press release, I have to say we don't believe there's any basis for any of the allegations,'' she added.

The issue of the $500 benefit has been fought previously and upheld some years ago by the Virginia Supreme Court, Taylor told Reuters Health. She added that Trigon pays the same for spinal manipulation no matter who performs the service.

Trigon does pay chiropractors less than medical doctors for similar services, such as office visits, Taylor noted, suggesting that the lower payments are appropriate given chiropractors' status as limited license practitioners.

Trigon makes chiropractic benefits available to any customers that want them--as a rider to HMO plans and as a standard benefit under the company's traditional and preferred provider organization plans, Taylor said. The company also has added an alternative medicine program that provides access to a chiropractic network.

``More than 75% of chiropractors in Virginia participate in our networks. We think that speaks to the fairness of the way we deal with them,'' Taylor said.

At deadline, the Blue Cross and Blue Shield Association had no immediate comment.

(From Yahoo)