ASCs Sue Insurers for Denying Manipulation Under Anesthesia Claims

Manipulation under anesthesia, the controversial and lucrative chiropractic procedure that involves lightly anesthetizing patients so that you can twist, bend and adjust them in an effort to improve or even restore range of motion, is at the center of a lawsuit pitting 2 Florida surgery centers against 4 of the country's leading insurers.

In one corner, you have Sanctuary Surgical Centre in Boca Raton and Gladiolus Surgery Center in Fort Myers claiming that payors first reduced and later denied their out-of-network claims for manipulation under anesthesia, otherwise known as MUA, despite giving the ASCs pre-authorizations and pre-certification for individual patients' MUA procedures. The ASCs are hoping to collect "many hundreds of thousands of dollars," says Stephen Lampf of Lampf, Lipkind, Prupis & Petigrow in West Orange, N.J.

In the other corner, you have Aetna, United Healthcare, Cigna and Blue Cross, which ceased reimbursing the ASCs for MUA in late 2007 because, the suit claims, MUA is "experimental, investigatory, not medically necessary" or not "a covered benefit under the plan."

Performed by either an osteopath or an orthopedic surgeon with a chiropractor in the room assisting, MUA typically requires 3 consecutive days of treatment, each treatment lasting around 30 minutes. Reimbursement ranges from $25,000 to $60,000 per patient, says Mr. Lampf. The insurers reimbursed for the procedures when the ASCs began performing them in late 2006. Months later, however, the payors began discounting the MUA claims. Soon thereafter, they began systematically denying all MUA claims, says Mr. Lampf.

"Our position is that the insurance companies said one day, 'We're not paying for it.' They violated their own contracts," says Mr. Lampf. "We believe it was arbitrary, capricious and violates federal law."

Efforts to reach attorneys representing the payors were unsuccessful. Phone messages left with the ASCs were not returned.

Critics of MUA call it a lucrative and largely unnecessary procedure. Supporters say it's been practiced safely and successfully for years on patients who don't respond to more conventional treatment.

Incidentally, Gladiolus Surgery Center stopped accepting patients on a voluntary basis last year after state inspectors found problems that could be harmful to the health and safety of patients, according to state records. The center has since reopened.

Dan O'Connor