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Chiropractic under anesthesia? Insurers balk

Usually an unpaid hospital bill wouldn't attract much attention. But it's a different story when the bill is for a controversial procedure on a pro football player, captured on YouTube.

The video shows two chiropractors performing manipulation under anesthesia – “MUA” for short -- on Tampa Bay Buccaneer linebacker Adam Hayward. The bill for three 15-minutes sessions of treatments in an outpatient surgical facility: $25,000.

When Cigna United Healthcare wouldn’t pay, saying the treatments were “not medically necessary" on Hayward, the chiropractic practice – Team MUA – filed suit. The practice has filed about 11 such suits against insurers in the past two years, said Amber White, who does billing for Team MUA.

“They think we're going to give up,” White said. “But we'll take it as far as we need to take it because they can't get away with not paying us.”

What, exactly, is MUA?

Chiropractor Brian Wolstein of Team MUA said the procedure can eliminate pain and re-establish full range of motion for football players and other athletes who have exhausted their options. He said he has not treated any other professional ball players.

As the video shows, Hayward was injected with a “twilight” anesthetic, the same type used in colonoscopies. It put him to sleep and relaxed his muscles enough for the chiropractors to stretch them farther than he could tolerate if he had been awake. They broke up scar tissue that had built up in his hip, shoulder, knee, ankle, pelvis, wrist and lower spine.

Medical literature indicates that the procedure is beneficial for a frozen shoulder, replaced knee and certain types of spinal injuries, but little else.

Whether MUA is a valid and accepted form of treatment depends on whom you ask. And coverage of the procedure varies widely by plan.

Daniel Abeckjerr of Miami, former president of the Florida Chiropractic Society, said MUA is respected but rare.

He said many chiropractors shy away from it because they prefer to do things naturally, without drugs. Also, most chiropractors don't work in a hospital or surgery center where anesthesia can be given.

Patients are always under some risk when they go under anesthesia, but complications are rare, according to the American Chiropractic Association website.

Wolstein said MUA is not standard, but is for people who have tried other things.

“Some have had injections, some have had surgery, but they still are non-functional,” he said.

When followed up with a training and stretching regimen, the procedure is effective for at least five years in most patients, he said.

Hayward “had a great year in football” after the treatment, Wolstein added.

Is it worth the money?

Dr. Robert Gordon, executive director of the National Academy of MUA Physicians, said every procedure Hayward received has been approved in the American Medical Society's code book for chiropractics.

He said insurance companies have increasingly denied claims for MUA in recent years as some chiropractors overused MUA – or just overbilled.

Most plans require chiropractors to prove that the procedure is medically necessary and that more conservative measures have been tried.

“To stop abuse, insurance companies began doing everything they could do deny the claims,” Gordon said.

Wolstein says Cigna approved the codes for Hayward's procedure and then reneged.

“We don't do anything without having it pre-approved by insurance,” he said.

Cigna Healthcare spokeswoman Gwyn Dilday said the insurance company always pays for procedures that are authorized in advance, and a team of medical experts regularly updates the coverage policies. She could not comment on the specific case.

Wolstein said 60 percent of private insurance plans will cover the procedure in some circumstances.

He said Hayward is not involved in the lawsuit and probably doesn't know anything about it. A spokeswoman at the Buccaneer press office said she could not comment on the case.

Cigna first denied the claim as “investigational,” said White, Team MUA’s biller. She appealed the decision, which is when Cigna said the procedure was “not medically necessary.”

--Reporter Brittany Davis, who is based in South Florida, can be reached at 954-495-6766 or