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Dynamic Chiropractic – September 24, 2002, Vol. 20, Issue 20
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dynamicchiropractic.com >> Billing / Insurance / Records

Potential Impact of the Anthem-Trigon Merger

By Tom Daly, ACA Legal Counsel

In April 29, 2002, Anthem Blue Cross and Blue Shield and Trigon Blue Cross and Blue Shield announced a merger agreement that would create the second largest Blue Cross and Blue Shield entity in the nation. Trigon would add its 2.2 million members from the Commonwealth of Virginia into Anthem's more than eight million members in eight states, including: Indiana; Kentucky; Ohio; Connecticut; New Hampshire; Colorado; Nevada; and Maine. According to the Trigon press release, Trigon's Chairman of the Board Mr. Tom Snead stated, "Each organization will be able to share with the other its best practices." Unfortunately, Trigon's "best practices" as it relates to the chiropractic profession is the subject of ACA's wide-ranging litigation, which among other things, alleges blatant discrimination in terms of reimbursement of chiropractic services by the insurance giant, which controls 35 percent of the market share in Virginia.

The track record for Anthem is somewhat more mixed, with four of the eight states currently covered by Anthem reporting problems in connection with chiropractic services to the ACA. Whether Trigon's "best practices" as it relates to chiropractic will impact the eight existing Anthem states is yet to be seen. Conversely, it is not known if Anthem's acquisition of Trigon will have any effect to moderate the blatantly anti-chiropractic positions and policies adopted by Trigon. What is known with certainty is that the merger of the two health care giants underscores the importance of ACA's current litigation efforts.

The specter of the nation's second largest Blue Cross and Blue Shield plan adopting and spreading Trigon chiropractic policies to the other eight states under the program is a possibility that ACA's litigation is attempting to stop. In addition, the policies and approaches used by Trigon that will be found to violate the federal antitrust laws, if we are successful, will send a clear and unambiguous message throughout the Anthem system as well as to all insurance and managed care plans under the control and domination of competitive medical physicians, that may seek to specifically target chiropractors for special economic discrimination in order to benefit competitive medical providers.

Anthem's "best practices" were the subject of an April 7, 2002 front page article in the Indianapolis Star. The article detailed growing frustration among providers in Indiana and the growing signs of discontent with Anthem, including a class-action lawsuit; a complaint to state insurance regulators; and stalled contract talks with major physician groups of the state. The various complaints concerning Anthem detailed in the article are problems commonly encountered by chiropractic practices, including bundling of charges; downcoding; late payment of claim; arbitrary denial of claims; and burdensome payment policies.

Under the merger arrangement, Anthem will assume all of Trigon's assets and liabilities. Three Trigon board members will serve on the Anthem board, including Mr. Snead. Anthem will assume any liability that may result from the ACA litigation against Trigon. Such liability may include injunctive relief to treble damages and attorneys fees. In the David and Goliath struggle in which the ACA is now engaged, Goliath will become four times larger with the Anthem/Trigon merger.

Note: If you wish to contribute to the National Legal Action Fund, you may send a check to:

National Chiropractic
Legal Action Fund
P.O. Box 75359
Baltimore, MD 21275

Tom Daly
ACA Legal Counsel

Dynamic Chiropractic

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