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I have health insurance through Cigna. They outsource all their health maintenance billing to American Specialty Health Services. I have been to my Chiropractor six times in 3 months for adjustments and therapeutic massages. I have paid my $40 copay each time. American Specialty Health Services has paid my Chiropractor a total of $1.00 for all my visits.
American Specialty Health Services SUCKS! This company is a rip-off. Their business practices are effecting my relationship with my medical care provider. Further, it reflects poorly on Cigna as well for doing business with such disreputable companies.
I have nothing good to say here about American Specialty Health Services.
The complaint has been investigated and resolved to the customer’s satisfaction.
After you work for years to pay for Medicare, you pick an insurance company (Kaiser, in my case) and money is taken out of your social security to pay that insurance company. Kaiser then pays a company like ASH to provide specialty services (acupuncture, in my case.)
The problem is that ASH treats people who need the medical services for which they have already paid as if they are barbarians at the gate. They play every game in the book in order to hold on to YOUR money.
If you are able to get past their lame website which doesn't work, and if your doctor's staff is able to find the exact right code (not just spinal fractures, but the exact number of the bones which were broken, which was not in the Kaiser doctor's referral), then you get to their third game. That's the one where they flip and coin and deny services either because:
You have not improved enough, therefore your services are denied.
OR
You have improved enough, therefore your services are denied.
The stress level that they put people through does not help people THRIVE. I am leaving Kaiser because of ASH.
I'm finding that it's a "takes two to tango" kind of business. My chiropractor filed claim directly to Cigna instead of ASH and I was let in on an EOB for services I didn't receive. "Physical therapy" and "Spinal Care" listed twice with amounts next to them totaling an amount over $200 and I went in for a routine adjustment. Im thinking chiropractic offices do this all the time and that's why ASH starts denying or asking for proof. I'd be going back to your chiro and asking for a complete list of their services and costs! They may be one of the reasons you are being denied in the first place! Sorry for your frustration and no I do not work for ASH, just doing some of my own research.
It's common for offices to bill that amount but the contract they have with ASH and Cigna makes them take whatever ASH says is "allowable". Mostly $40 or less. Meaning even if you are spending an hour in the office ASH refuses to pay and also refuses to allow a patient to pay, so often the patient gets rushed out the door quicker because the chiropractor can't make any money for their work.
ASH and Cigna are still ripping off people. I use an out--of-network chiropractor and they have not given him any of the forms and procedures used to process the claims. Of course ASH does not want to talk to the client, only to the provider. After the first denial of service, i requested copies of all the information used to arrive to that decision and never received it. I also found out about a clinical medical necessity form that the chiropractor has to fill with the treatment plan (pre-authorization aka permission) but my chiropractor was never informed.
My chiropractor is asking payment up front from Cigna patients and they will not file claims for out of network patients anymore because it takes too much time and money to deal with them.
ASH does not want to talk to me, it will not accept requests from Cigna either. Their representative had the nerve to suggest that i go to an in-network chiropractor. I am filing an appeal with Cigna describing all the shady practices of ASH. I will also call my congresswoman and ask for her help too.
I am going to file a formal complain with the Bureau of Insurance of Virginia about ASH and Cigna sketchy practices. The more the merrier!
ASH is a classic middle man, they do nothing to help the patient and end up costing the health plan more money for the service they supposedly provide. Their entire program is a rip off and criminal, which that god is finally being taken up by several state attorney generals. I don't understand why big companies like Blue Cross and Cigna use a company with such a bad track record.
I too am insured by Cigna and out of the blue this ASH company starts denying payments to my chiropractor for much needed adjustments and therapy. They have not paid a dime since June, continue to claim that I didn't get pre- authorization (Which Cigna did not require), the doctor submitted plan too late etc. They are refusing to pay 1242.00 to a chiropractor for 23 visits. However they pay a neurologist an amazing amount of money to do nothing for me. I don't understand how a plan can be so drastically changed in the middle of a policy period and why I cannot see the claims from my Chiropractor on the Cigna site. This is a total sham and is putting good decent alternative care doctors out of business. I pay 7500.00 a year for insurance do I not have any rights at all. I am totally disgusted with this company and their lies, avoidance of questions and downright criminal activity. I don't' see anything on Internet about anyone suing them... If anyone out there that has been ripped off by this company is willing to group up we should do something like file one of those class action suits against Cigna and ASH. Cigna is just as bad for covering for this company, not notifying us that our coverage had changed and not doing a thing about it at all but stall. They hope you and the doctor will get beat down and will give up. PLEASE FOR YOUR RIGHTS AND EVERYONE ELSE'S DO NOT QUIT COMPLAINING ABOUT THIS SCAM OF A COMPANY
American Specialty Health is a sleezy organization that harms the insured. Their job is to cut care to the patient in order to save money for the insurance company. If your Doctor is required to justify their services to ASH complain to you carrier immediately. Don't let insurance companies rip you off any more than they already do!
The following are reasons why American speciality health, who manages cigna chiropractic benifits in tennessee...
Your pain level was considered moderate. A moderate pain level is apain that is rated 5-7 on a scale of one to ten.
Your condition was not caused by trauma.
Your condition was considered acute.
Your condition and response to care should be monitored and re-evaluating befor you receive treatment beyond the 4 visits that we approved.
Your pain level was reported as severe and should be re-evaluated.
Your pain was constant and should be re-evaluated beyond 4 visits.
Your ability to perform your daily activities are severly affected must be re-evaluated beyond 4 visits.
These are word for word the reasons care has been denied on two patients..and they must be re=evaluated..beyond 4 visits..and A.S.H. will not approve a re-evaluation unless it has been beyond 30 days. So patient with severe sciatica...is approved by a.s.h. (cigna) for 4 visits..and wait a month..then attemp another approval.
Unfortunatly patients are being denied...have to fill out disability questioneer. that is confusing..tricky...and all that to deny any care..for any reason possible...IT IS A CRIME and Patients should report to their Attorney General..the FRAUD that is being committed on a HUGE scale..across the country...by A.S.H...
Cigna is charging you for chiropractic benifits..and not delievering them...because the company they outsourced to..is Deny or make your life a living hell filling out paper work..