Texas Mutual Wins Appeal on VAX-D Therapy

June 19, 2006

Although health care providers rarely recommend traction for patients with back pain these days, a few have turned to vertebral axial decompression (VAX-D) therapy. Traction costs about $20 per session; a VAX-D session costs up to $235.

Twice before, Dr. Daniel A. Boudreau, D.O. had successfully challenged an insurance company’s reimbursement of VAX-D therapy. Each time, the State Office of Administrative Hearings (SOAH) judges ruled in Boudreau’s favor.

But when Boudreau billed $7,700 to Texas Mutual Insurance Company for VAX-D therapy to treat two workers’ compensation patients, Texas Mutual medical experts—an orthopedist, a chiropractor, and a physician specializing in physical medicine and rehabilitation—reviewed the treatment and determined that VAX-D was a type of traction. Boudreau received $300 reimbursement, the maximum amount allowed for 15 traction sessions, under the Texas Workers’ Compensation Commission Medical Fee Guideline.

Boudreau appealed his case to SOAH, where he testified that he believes VAX-D therapy actually decompresses vertebrae, something that traction cannot do. He also said that the VAX-D therapeutic table costs between $100,000 and $125,000, compared to the $3,000 cost of a traction table. Given the difference in price, VAX-D could not possibly be a subset of traction devices, according to Boudreau.

In rebuttal, Texas Mutual Insurance Company called on expert witnesses who testified that the American Medical Association (AMA), the U.S. Food and Drug Administration (FDA), and Medicare all view VAX-D therapy as a form of traction. Richard Ball, a Texas Mutual senior medical dispute specialist, added that Medicare does not cover VAX-D therapy due to insufficient scientific data to support its alleged benefits. The judge ruled that SOAH’s previous two decisions on VAX-D cases appeared to be based on incorrect information. The judge also agreed with Texas Mutual Insurance Company that the AMA, FDA, and Medicare view VAX-D as a form of traction, and that $20 is the correct payment for a VAX-D session.

This page was posted on June 19, 2006.