ACA Legal Action
Trigon Lawsuit Talking Points
American Chiropractic Association and the Virginia Chiropractic Association File Suit Against Trigon Blue Cross Blue Shield and National Blue Cross Blue Shield Association
Taking their outrage over discriminatory reimbursement policies to court, the American Chiropractic Association (ACA), the Virginia Chiropractic Association (VCA), five doctors of chiropractic and 18 chiropractic patients have filed suit in U.S. District Court against Virginia's largest managed health care company, Trigon Blue Cross Blue Shield and the national Blue Cross Blue Shield (BCBS) Association, raising allegations of racketeering, extortion, mail fraud and antitrust violations and other state and federal law violations. The suit also seeks to invalidate the BCBS trademark because of these illegal activities.
Chiropractic patients in Virginia and across the country have been subjected far too long to denial of much-needed chiropractic care. This lawsuit is by far the most significant and aggressive legal action ever taken by the chiropractic profession against the insurance industry. In fact, the lawsuit argues emphatically that insurance companies must scrupulously adhere to accepted legal standards.
Blue Cross Blue Shield has a long, sorry history of discrimination against the chiropractic profession -- holding on to an outdated attitude that doctors of chiropractic have no place in the nation's health care system. With the advent of state insurance equality laws that made it illegal to discriminate against doctors of chiropractic, BCBS had to find another way to discriminate against the chiropractic profession. Their current tactics are a sorry attempt to circumvent insurance equality laws by discriminating against the specific services doctors of chiropractic provide.
What Impact Could this Lawsuit Have on the Managed Care Industry?
The impact of this lawsuit on the managed care industry could be far-reaching, with national significance beyond just Trigon and the BCBS Association. Many BCBS plans and other insurers have adopted policies that single out doctors of chiropractic for special discriminatory treatment. The ACA/VCA lawsuit directly draws into question the legality of this special treatment, drawing upon federal anti-trust, trademark and RICO statutes, as well as state statutes and common law. It is intended to also change the way managed care plans nationwide have ignored accepted legal standards.
In an effort to further explain the enormity and seriousness of the charges against Trigon, the BCBS Association and their medical co-conspirators, the ACA provides below a detailed description of each of the lawsuit's eight counts and a practical explanation for what each of these counts means to the chiropractic profession - and the managed care industry.
Count I - Trademark and Anti-Trust Violations Against Trigon Companies, the Blue Cross Blue Shield Association and Medical Doctors: This count alleges that Trigon and its medical doctor co-conspirators - the BCBS Association and MD advisors - have launched an illegal boycott against doctors of chiropractic and have tried to force them out of the marketplace by refusing to pay for recognized services or by providing unreasonable and unconscionably low reimbursement. This count also demands the revocation of the BCBS trademark and anti-trust remedies.
Specifically, Trigon and BCBS have:
Count V - Violating State Law by Willfully and Maliciously Harming a Trade Business Reputation: According to Virginia law, it is illegal to intentionally harm a person's trade business reputation and profession - something Trigon, the BCBS national association and medical doctors have conspired to do against doctors of chiropractic. This type of state statute is common to most states.
Count VI - Breach of Contract with Doctors of Chiropractic: There is an implied notion under Virginia law that compensation under a contract be reasonable. Trigon's enforcement of its contract with doctors of chiropractic is completely unreasonable.
Count VII - Common Law Conspiracy to Injure the Practices of Doctors of Chiropractic: Similar to Count V, this count uses notions of common law, rather than state statute, to charge Trigon, the BCBS Association and medical doctors with intentionally injuring the practices of doctors of chiropractic.
Count VIII - Violation of the Insurance Equality Laws of the Commonwealth of Virginia: Because Trigon is paying doctors of chiropractic 40 percent less than it is paying medical doctors for the exact same services and is imposing a cap on chiropractic services, it is violating state insurance equality laws.
What Are We Asking for?
We are seeking a restraining order against Trigon companies and the BCBS Association, three times the amount of the actual damages doctors of chiropractic have suffered, plaintiffs' costs and attorneys' fees, the revocation of the BCBS trademark and punitive damages against Trigon.
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