The complaint has been investigated and
resolved to the customer's satisfactionResolved American Specialty Health — Rip off
resolved to the customer's satisfaction
I have been covered under Anthem Blue Cross via COBRA since 1/1/09. Anthem is supposed to cover 20 combined acupuncture and/or chiro visits per year as per my plan agreement.
Anthem Blue Cross subcontracts with ASH (American Specialty Health) to administer eligibility, authorizations and pricing for both acupuncture and chiro care services. Although I have paid all premiums on time and contacted Anthem numerous times about my lack of eligibility, ASH keeps insisting that my husband and I are not in their database (meaning not eligible for benefits). Supposedly ASH has now finally "manually added me and my husband" to their databasse (it took 2.5 months to do this!) so that my acupuncturist can now submit authorizations and claims for me.
Two weeks ago, I received a letter from ASH telling me that they are authorizing 1 additional acupuncture visit past the 5 that are automatically granted. I have had 6 acupuncture treatments done and I still need more treatments for real medical conditions! And the plan says that 20 visits are supposed to be covered per calendar year!
Supposedly Anthem is working on a reconsideration of my authorization problem with ASHN. It has been 2 weeks since the auth was filed. How long is it supposed to take beyond that? I can't get a straight answer from Anthem on this and ASH is impossible to talk to. Believe me, I've tried talking to their customer service people a number of times!
ASH is committing insurance fraud in my opinion and I'm not the only victim of this. I've been told by my acupuncturist that ASH NEVER authorizes the full number of patient visits so that YOU can NEVER access your full chiro/acupuncture benefit (supposed to be 20 visits per calendar year). ASH drags their feet on authorizations, keeps screwing up your eligibility information (so that they can say you are ineligible for coverage), and they wait as long as possible to pay their claims. Does this sound like an ethical company to you? Or is it actually Anthem who is the problem since THEY PAY ASH to administer chiro and acupuncture benefits? Either way, stay away from ASH if at all possible. They are HORRIBLE to deal with for the patient and for providers!