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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!
The complaint has been investigated and resolved to the customer’s satisfaction.
Hey, Chiropractic providers who are contract with these bozos: just TRY to terminate your contract. ASHN will make up new rules as they go to try to refuse to allow you to terminate. Just got off the phone with "Josh" in Provider Relations [protected] ex 3436) who refused to accept our termination which fully complied with the provider contract. This company has been sued numerous times for everything under the sun that a company is not supposed to do. If you are an employer or patient, steer clear of any insurance company that contract with ASHN (Cigna, Providence Preferred, some Blue Cross plans such as Florida Blues, etc., etc., etc.). If you are a doc, beware: ASHN will eat its young.
Good news for everyone and more lawsuits against ASH are coming soon!
I am a practicing chiropractor in GA and this year especially, ASH is killing my cigna patients reimbursements. Doctors and patients should united against Cigna and Ash to stop them from getting away with this! This is absolutely illegal and unethical practice by Cigna to hire Ash as the entity that slows and stops payments to providers. The people loose at the end!
American Specialty Health also is known as "ASH", is a huge scam to patients and providers. Before they took over chiropractic and acupuncture benefits for part of Blue Cross, Cigna, Aetna, Healthnet, Kaiser Permanente...you name it.
Healthcare providers used to get an average of $80 per office visit and treatment for acupuncture. After ASH took over, it became $41 minus the patient's copay. Which means if the copay is $10, providers will get paid $31 in total for the office visit and treatment and they require providers to submit medical records every 5th visit. More than 50% pay cut and more paperwork to do!
Actually, patients are still paying the same price for their insurance before, whether they pay a couple hundred dollars per month or otherwise.
Now, some very simple question arises; "Where did the pay cut money go?" "Did ASH took $40 out of the provider's paycheck while all they do is administrative work for the main insurance company?"
Numerous of Chiropractors and Acupuncturists had to close their office due to this change. Providers had to stop taking insurances that are affiliating with ASH or, they won't even have enough money to pay the office staff.
But now that ASH is dominating across major insurances, providers don't have a choice but accept the pay cut and working extensive hours just trying to meet ends, because almost all the major insurances are affiliating with ASH now. This is directly affecting the ability to provide quality service to patients.
ASH is abusing the rights of patients and providers, they are taking away the chance of using the best alternative for replacing narcotics from patients.
The existence of ASH is only for saving money for the affiliated insurance companies and is solely toxic and abusive for patients and providers.
Dear patients and providers, we need to stand up and speak up to stop this unethical matter.
Thank you for the very thorough letter. I have taken the time to explain to patients the predicament as well. Patients assume that when their insurance company says that they cover acupuncture, that they are paying the acupuncturist their rate, or close to their rate. Things couldn't be further from the truth. It is an absolute fraudulent system. I would like to post your letter here as part of a blog on my website. I am asking for your permission to do so.
I am on the phone with FloridaBlue trying to figure this mess out. They say I get 26 visits per year, but ASH is allowed to limit my treatment? Not OK. I see I'm not their only victim. I welcome any comments about how you got resolution so you could receive your full benefits. Is it up to each provider to decide whether to contract with ASH, or is a FloridaBlue wide policy to contract with them? If it's the prior, I can try to find a provider that doesnt contract with them. If its the latter, I wont be able to get the treatment I need anywhere. WHY do they make it so difficult?! Oh yeah, Greed.
I honestly cannot wrap my mind around the fact ASH is willing to pay Medical Doctors, Physical Therapist, Surgeons, and for Drugs so much and will not pay reasonable amounts to Chiropractors? Chiropractors are so much less expensive and is a much better wholesome approach to wellness!
They are OK forking out millions to the drug industry and allowing their patients unnecessary surgeries, but want to exclude the amazing benefits that Chiropractors have to offer at a fraction of the cost? I have read above that it is all about their "bottom line for profits". The only thing that does not add up is Chiropractic cost is so much less than Medical Doctors, Surgeons, and Rehab?
I'm just now dealing with ASH with similar issues about pre-authorizing limited visits only. I, too, have a medical condition that cannot be cured and massage therapy is a critical part of pain management. I will need massage therapy for the rest of my life. Having said that, I've run into a bigger issue -- on our EOBs, ASH shows a different amount billed by my provider than what was actually billed! I've been told, but haven't yet confirmed, that ASH has been sued over this illegal practice in the past. Why do the large insurers insist on using ASH? Are they using this as a way to avoid paying for "specialty" services, such as acupuncture and massage therapy, even though we have contracted with them to cover these services and pay our premiums accordingly? Stay tuned. It may be that a class action lawsuit is in order. If the insurers continue to enable ASH to break the law and continue with this highly unethical practice, they'll be on the hook as well.
I love it I pay for all my insurance and ash tells me I can only go 6 times I thought this was Obama crap no its the government [censor] . my be trump should fire all u people to.cant wait until one of u need care.
Total scam is ASH. Agree with other critiques here so wont be redundant. I appealed their denial of my benefit and Anthem Blue Cross of California accepted and approved payment for my Dr. ASH paid one of the 5 bills from that appealed claim. I called Blue Shield again and they concurred that claim should be paid, 3 calls later, still tracking them down. As of this moment the Blue Cross agent is on call with ASH agent after having faxed the claims that need to be paid. Guess what? Yep, ASH says they never got the FAX and they said, oh use another FAX number. How is this place allowed to operate? Why does Blue Cross and others continue to use this scam company, must be low capitation rate. Lets do a class action suit, they deserve to go down. Blue Cross has helped but need to dump ASH.
Wolf of Wall Street, The Big Short...those rip-offs have nothing on these guys. The misrepresntation and callus attitude of their management is second to none. Make no mistake, this company, and others like it, are in no way interested in providing optimum health care to it's members. It is completely about the bottom line...profits. ASHN was designed and developed as a way to make big insurers more profitable...and of course to take a slice of the health insurance premium pie while doing it. Health insurance premiums have been consistently rising over the past 20 years, yet the reimbursement to medical providers has been drastically declining over the same period. So basically, we have been paying much more to get much less in return from our health insurane. If the government doesn't do something to regulate the insurance industry our health care system is doomed.
We are a massage therapy clinic on Oahu, HI. Just spent 5 months getting credentialed with ASHN. The first client I took in, had 5 pre-approved visitation without a need for medical referral. In the handbook I found among years codes forLMTs Initial examination fee with the approved amount. I used that code for client'side first visit (spent time examiningetting her and more time documenting prior to the beginning of her massage). They immediately denied it. When I called it was told that only code LMT can use is 97124 (Swedish massage). When I asked how the he'll am I supposed to know what's wrong with the client and come up with the proper assessment and treatment plan if I don't examine her, I was told I can examine her but they only cover it once in 3 years and there has to be medical necessity review. Then I asked if I can bill the client for the exam, they said "I don't think so". These people force me to accept 40% paycut for my services, do more paperwork then I ever done with any no-fault or workman's comp cases and pay nothing for examining a client while requiring diagnosis codes (which I legally can't provide without medical prescription from CPC). My question is, does anyone has experience of just dropping the contract and trying to get your clients partially reimbursed for out of network service?
I'm going to try to get partial reimbursement from my insurer, Cigna. My husband and I have had different massage therapists for several years and have never had an issue. Now, with ASH's unethical practices -- unwilling to make timely payments, require multiple submissions, etc. -- our massage therapists are going to stop billing Cigna/ASH. So, we'll need to pay the entire amount billed and we intend to seek reimbursement.
I also work for a provider's office in Northern VA. We have learned from patients bringing in their Cigna EOB's that Cigna is paying for multiple therapies, and ASH is keeping all that payment, with the exception of the adjustment and one therapy. Instead of getting the full $96 from Cigna, we only receive $36 from ASH. So, they keep $60 that should have gone to the provider. They have their own "bundling" which allows multiple therapies, but only pays for one. It doesn't matter what modifiers and Dx pointers you use, they bundle it and keep the rest for profit. We started only billing one therapy to avoid them keeping too much profit. With only billing a 98941, and 1 unit of therapy (usually 97110 or 97140), ASH still makes profit of $14.91 per visit, rather than the approximate $60 if we billed the visit that was actually done. We are now on the provider tier 6, where we no longer have to submit paperwork, but when we did it was constant denials for no reason, with lots of extra work for the doctor, of which we do not get paid an acceptable amount per visit, nor do we get paid for our notes. ASH is one of the bigger rip-offs I have seen of any company.
I am just curious, do you know for certain that ASH is collecting and keeping the fees that you are writing about? I do not understand how ASH makes its' money.
We are a chiropractic office in the panhandle and are experiencing the same discrimination against chiropractors and the patients that love chiropractic. Then benefits that they pay for - 4 modalities per day have been replaced with a dollar per day amount of $24 max for 2 services. As of April 1st the plan ares processed under the ASH - American Specialty Health Fee Schedule not the Blue Cross Fee Schedule. Apparently Blue Cross can change your benefits without notifying you. We are encouraging all of our patients to contact Blue Cross and the Florida Insurance Commissioner. Medical doctor are not targeted, only chiropractors are discriminated against. Blue Cross hired ASH to save paying out benefits just like Cigna did. Members have a right to the benefits and coverage they originally purchased. Members also have a right to utilized chiropractic rather than medication or surgical procedures for pain relief and restoration of range of motion and mobility.
Marilyn Miller
ASH might quite possibly be the most incompetent organization I have ever spoken with. They have repeatedly sent checks to wrong addresses, have made mistakes on my claims, failed to follow up on any of my complaints. And I'm out a significant amount of money because of their incompetence. I will not choose a health plan ever again that contracts chiro services out to ASH, and I'm filing a complaint with the BBB.
My employer provides us with Florida Blue insurance. They pay 100% of my premium and I pay a monthly premium for my wife to be covered. The plan allows for 26 combined chiropractic/ deep tissue massage visits per year. Since April, American Specialty Health has taken over the billing. Now we are denied massage. I have never used it, but my wife has. She has a terrible knot on her shoulder and massage takes care of it rather than cracking her neck. When we signed our contract in January, we were guaranteed a certain right to expectation of service. To remove something from that contract 4 months into it is breach of contract. Moreover, every time we visit the chiropractor, we have to fill out this ridiculous paper that is meant to be a trap. It wants to know how you feel and if your treatment plan is helping. There is NO treatment plan. I visit once and I'm usually OK for several months. I called our FL. Blue rep and she said they are just making sure your injury wasn't from and accident where someone else's insurance should be paying for it. I bought that at first, but now I know better. Additionally, what used to be a $25.00 copay, is now $45.00. The contact I signed called for $25.00, another breach of contract. If ASH decides my treatment was necessary, I will get a $20.00 credit. What if I don't visit again before the end of the year, what happens to my $20.00 credit? If they decide it wasn't necessary, I don't get a refund and all further visits will be denied. From what I understand, they are denying full payment to the doctors as well. A good chiropractor is hard to find. This is a scam perpetrated by ASH to make money for themselves. Florida Blue better wake the heck up and realize what this company is doing. I'm sure there are already class action law suits against ASH and soon there will be against Florida Blue as well if there aren't already. I will be writing to the Attorney General. After all, she is supposed to represent me.
ASH does not have any BCBS or Cigna customer's best interest. I have no qualms about calling them what they are ASHOLES! They are nothing but hired guns to eliminate or significantly reduce the benefits that customers are being told they have by Cigna and Blue Cross. Cigna and BCBS save billions across the nation. They sell policies with good coverage but when the customer goes to use their benefits ASH steps in and cuts them to the bone. Cigna and BCBS get to sit back at a safe distance while ASH does the dirty work. BCBS and Cigna pay ASH to pay the doctors. Majority of the X-rays are denied as well as many of the visits and services provided during the patients visit. They force doctors to use their forms which are not user friendly and require many things to be written out which adds to the frustration. We have had ASH doctors tell us our notes are canned and yet all their responses to cutting necessary care are canned as well. One of our doctors was told by an ASH doctor if you want to get paid for your X-ray the patient has to have a radicular symptom. So in other words lie to get paid. Every Floridian needs to see ASH for what it is. NOT IN YOU OR YOUR LOVED ONES BEST INTEREST. Call CIGNA and complain. Call BCBS and complain. File a complaint with your congressman and with the Florida Insurance Commissioner. When enough people rise up and put pressure on our state representatives change will come
I live in Florida and as of April 1, 2015 ASHP is now doing the chiropractic billing for Florida Blue Cross. Most chiropractors will have to close there practice do to this change. We need to get this fraud taken care of. Not only are the chriropractors getting hurt, but all the patients that are paying for plans with Blue Cross for either 20, 50 or 80 visits are only get 5 visited. Blue cross of Florida has to relize that all the public school teachers and employers are covered by Fl Blue along with Florida power and light etc. Carry FL. Blue Cross Indurance and when everyone starts to relize it I hope they all cancel FLories Blue Cross and protect Florida's residence especial the teachers. We need to get FL Blue to change this terrible decision before we lose our teachers and workers along with all the hard working and extremely needed Chiropractors that will have to and are already leaving Florida. Some people don't understand how much medical schooling and that they are one of the few Dr's that have to even touch there patients and help them feel better without just giving medicine. They correct many people problems and just don't see a patient and send then for tests They are hands on . This is really an injudtise. Please help! We most do something maybe starting with our politicians and maybe the news stations! We can
Anyone having any success in dealing with ASHP. A scam if I've ever seen one . As a provider for them they continually deny my pts treatment for bogus reasons. Evidently you can't treat a lower back complaint if the pt has:: an elevated BP, an unexplained ankle pain or if the provider can't talk with their review Dr. On his schedule. I've had care denied for all of the above. They always call to talk with me when I'm on lunch or during my high pt load times knowing I'm not available. They then deny care if you don't talk with them. Their Drs aren't available after 2:30. Another reason they use for denying care is their claim the pt isn't getting any better with treatment. This inspite of reported progress by the pts and with objective findings. No matter what you provide them in regards to charting and reporting pt progress etc. they always will require more. You can not satisfy them so they deniy treatment for forever ongoing changing reasons.
I am trying to reach local political representatives and media.
There are many upset people over this issue. I m emailing this website
To local human resource chapters. This is a scam.
I have figured out today while comparing a patient's HSA account to what we were paid by ASHN and WOW is all I can say. It doesn't matter if the patient has 10-20-50 chiropractic visits, ASHN barely will approve 5 spinal manipulations (if that). Then they will take more out of the patient's HSA account, turn around and pay the chiropractor 10-100$ less than what they took out. It's a scam!
For instance, we billed the insurance $600 dollars of treatment that had multiple dates of service. They only approved $100 worth and turned around and took 150 out of the patient's HSA. I was told this from our state chiro board: I have seen this with ASH. What they do is pay you one rate and take a different rate from the payer. For example: if the allowed amount for a manip is $25 from ASH they will charge $35 from the insurance (Cigna or the HSA) and keep the difference. It is gross and unethical but legal.
The best thing to do is have your patient complain to Cigna and tell them this is wrong.
Rumor is BCBS has not signed a contract with ASHN PPO. as of Jan. 01 2011.
Patients need to start fighting!
I work for a provider. We are doing all we can fighting them, bottom line is patients and employers will have to fight this battle. My heart breaks and I have screamed at them and tried to work with them. They are impossible to deal with. I am begging patients and employers both to fight them. Don't let them take away your rights.
If you look on the internet...there is not a single postive experience from ###..i mean I a.S.h...
The attorney general must be getting a kick back from cigna..bcbs...
Why isnt this being looked into? numberous complaints have been filed...by citizens and doctors..because Attorney General is not doing anything and will not do anything...until a chiropractor breaks the law...
it is a shame for the Goverment ..who is talking about HEALTH CARE..and eliminating the worlds LARGEST DrugFree Choice for Health...
I will list all the excuses that patients have been given...like...it was not a tramua thus should resolve with no treatment.. Acute...it just happened..so it may get better on its own..
you only listed the pain as a 7 of 10 moderate..shouldnt need but three adjustments
the pain was too severve and only minimal care should be needed..
Also speaking with clinician on phone.."no matter what you request you will only get half" or "you need to do a exam every thirty days...you will have to do exam first...then get authorized ..dont worry they will cover the exam"
we authorize one therapy...and one segment...and patient has cervical pain...and mid back pain..and sciatica..
so when I call clinician...Ok which segment did you authorize? its not up to me to make that decision..that is yours DR. So you are telling me to pick one out of the three or four? we authorized two...dr. it is your clinical decision..I am making a form letter for patients to send to attorney generals office...and having patients send them thru Post office...so attorney general will have to sign for them... If anyone is thinking of paying for chiropractic with Cigna..in tennessee BEWARE BEWARE BEWARE...you will find out YOU HAVE BEEN SCAMMED into believeing you will recieve Care...and there isnt ANY CARE with CIGNA regarding chiropractic...more like malpractic neglect...and guesss who ASH will blame.. the dr..and cigna...
I am in accord with all past postings... we are a chiropractic office in the San Francisco Bay Area...
Same story here... allow the first 5 - and be quick to deny deny deny - I have mentioned to my patients that THEY too must CALL and COMPLAIN... to get the visits that they require and need... the The January/February newsletter states:
"we exemplify a professional relationship with you and resolve your questions efficiently and competently to allow you to focus on providing high quality services to our members and your patients" I sent a complaint about the "service" on the 28th and to date have had no response.
Several times now, I have been on hold for a total of 90 minutes each time - only to have their phone system hang up on me. And as someone above mentioned, DOCUMENT DOCUMENT DOCUMENT - we now have 3 forms for our patients to fill out... and I think I will start coping the forms and mail in my claims... showing that my patients do need the additonal tmts!
I am heartened to see complaints (like mine) regarding ASHN tactics. They appear to automatically approve 5 chiropractic visits and then deny further visits. They used the same "reason" each time: other patients with similar complaints had successfully completed treatment and needed no further treatment after 5 chiropractic treatments. Imagine how that "reasoning" would affect people with heart disease, kidney disease, diabetes, etc. Medical insurance should not be based on statistics or averages and at the same time, I don't think ASHN can back up their statistics. I am fighting with my insurance company (who turned over chiropractic claims to ASHN in March 2010) and ASHN has agreed to pay some of the claims. I would join any class action suit against them, in case any lawyers are interested.
Here is the Arizona Chiropractic Society's Four Point Plan to deal with ASHN: http://www.azchiropractors.org/documents/TheACSFourPointPlantoDealWithASH.pdf. We are the state association for chiropractors in Arizona, and ASH is moving into AZ big time on Jan. 1, 2011. It is our belief that none of our legal strategies has ever been tried before. You can follow our efforts by signing up for our free newsletter and checking in for breaking news at our home page at www.AZChiropractors.org. We have had all we can take and we just are not going to take anymore!
how did you do with your efforts?
We must carefully execute a plan of action that succeeds where the CCA failed years ago. Accurate data collection and presentation is key. We must make it impossible for their defense to find lack of merrit with our case. The facts are there. Our power will be the power of the consumer. They must be side by side with us against ASHN. It is the consumer who the politicians and attorney generals represent and answer to...
I am a NYC chiropractor. The unethical tactics and protocols solely created by ASHN for financial benefit with complete disregard for patient care or proper utilization of the benefits they are entitled to and pay for is unacceptable. I have experienced and documented the discriminatory and fraudulent activities of ASHN this year. This upsets me a great deal. Our only course of action is a legal one against ASHN, and more importantly bringing their faces into the media. Watchgroups and agencies tend to react when the public eye is on them. You are not alone. I will set up a webpage shortly looking to gather as much nationwide support to confront ASHN. Their actions on an interstate level will have stronger reprocusions than if percieved by a few in specific areas. I will list the webpage as soon as it is running.
There is a successful case against ASH and their mother insurance in Pennsylvania. Hope to see all chiropractors, acupuncture and other provider come together fight against ASH and their mother insurance for unethical deny and cut back doctor cost. To prevent them using ridiculous low reimbursement in purpose to control doctors provide good care to their patient. In my opinion all doctors should boycott to ASH
to the points doctor can not provide the good care to their patient because of to avoid
I am a health care provider who has many patients with CIGNA health insurance but as of 4/1/2010 the benefits have all changed to be processed through ASHN. They are NOT honoring the same benefits that the patient (employee) is paying for! I am VERY upset by this, but I have no idea who to voice my concerns to. I have not received a single payment from ASHN from patient visits in April, May, June or July. When I called Cigna to check on the benefits, they tell me that the patient still has active coverage and the benefits should be honored (for instance; a 20% co-insurance for covered charges) and they said that payment for my dates of service have been sent to ASHN, but I have not received anything from ASH in this time. So, just like "Powder Monkey" I'm wondering where that money went. It was supposed to be coming to me, but I have a feeling that ASH is re-routing it and taking their fees off the top. And I have a feeling that Cigna is completely unaware of what's happening. But this is not fair to the patients/members who are going to end up paying more out of pocket than their 20%. Does anyone have any similar experience with this and if so, do you know who I should contact about my complaints?
ASH has put holds on payments for the first five visits for my physical therapy, which are not required to have pre-approval, and then pre-approved subsequent visits, but will not authorize payment of those first five. Anthem says they need ASH to release the payments, ASH says Anthem can pay and they are not required to provide release for the payments. Both have denied requests for a three-way call to discuss it openly. My wife has been waiting for her normal reimbursement for pre-approved therapy and instead we received a statement saying that we need pay nothing and the therapist gets nothing since another insurance provider will pay. We have already paid and there is no other insurance provider, just another ruse by ASH to force us to resubmit the request for payment. When I call Anthem, they say that ASH must have its reasons for wanting more information. When I call about the phantom "other insurance provider, " they will say we should resubmit and make it clear that there is no other insurance provider. One must ask if this is Anthem playing a game similar to paying off one credit card bill by charging it to another credit card. Is this a sign that Anthem Blue Cross is insolvent and stalling payments as long as possible to avoid payment since the money is not there? I have reported this to Feinstein and Boxer to alert them that some serious solvency problems should possibly be anticipated regarding Anthem Blue Cross.
i think its best to put your complaint to your state insurance commissioner, paid your bill and take your bill personally send back to ASH plus interest asking for reimbursement. if ASh does not pay within the time demand period. send them both ASH and Anthem to small claim court. then your voice will be hear
good luck
ASHP is a substandard program that continually denies benefits to patients. They discourage X-rays which are very important to see before perfoming adjustments. How are Chiropractors suppose to know the health of the spine if they don't see it on xray? They require constant reports from Doctors that take time, which they should have to pay for. Then they pay nothing for treatment. If you are considering ASHP all I can say is DON'T!