stroke pt vs ASHN

[Guest guest]

To all concerned, here's a warning about a devious insurance company located in

Southern CA:

 

My m/c with American Health Specialty Network: Yes, I'm incensed with the

company!! I'll eat them all for lunch if their reps happen to darken my clinic

doorway!

 

Female, 54 y/o, stroke patient: STROKE, mind you not a simple muscle pain,

right!!!???

Her m/c occurred 4/12/04 and AHSN is DENYING more treatment if over 12 x, which

they just authorized, w/o filling out 2 full pages of their forms, again!!!(have

just begun tx and she's had 5 AP including 5/17 initial tx). Left side face,

arm/hand, leg paralysis, some memory failure (not as much as most) . No previous

health problems; MD stated could have been an aneurysm, not sure. I was

authorized by MD to tx pt at care facility and am currently txing 3 consecutive

days weekly, working w/Occupational Therapist. FYI, pt gets 5 tx before

practitioner has to refile, and the 5th tx isn't paid UNTIL practitioner files

for more future tx.

 

I have spoken to the company reps (transferred 5, yes FIVE times before anyone

would answer a very polite question: Can we use your forms for initial intake?

NO Answer. Practitioners must fill out the forms again, and again, and

again.....ask for more tx, get a couple. Rep stated: If you tx 100 new pts and

have been in system for 3yrs (of course, ASHN hasn't been around that long!),

then maybe we'll reconsider. Is this company for the pt? Absolutely NOT. This

is the only company in our fair state of OR who forces upon us all this

paperwork. Perhaps our Insurance Commission should be advised. Now that's an

great idea!

 

So Richard and David, if you want a REAL cause, forget the US Government,

that'll that you many years. Fight ASHN in your state, you'll get results

faster.

 

Very p..sed off Aries practitioner,

 

Pam Price PhD LAc DiplAc

Acupuncture Advantage Clinic

Clinic: 401 Ratcliff Dr SE Ste 130

Mailing: 4676 Commercial SE #185

Salem OR 97302

(503) 365-0848

 

 

 

[Guest guest]

One for you Richard!

 

Kind regards

 

Attilio

 

www.chinesedoctor.co.uk <http://www.chinesedoctor.co.uk/>

 

 

Pam Price [needledoc]

26 May 2004 04:57

Chinese Medicine

stroke pt vs ASHN

 

 

To all concerned, here's a warning about a devious insurance company located

in Southern CA:

 

My m/c with American Health Specialty Network: Yes, I'm incensed with the

company!! I'll eat them all for lunch if their reps happen to darken my

clinic doorway!

 

 

 

 

[Guest guest]

At 08:57 PM 5/25/04 -0700, you wrote:

>To all concerned, here's a warning about a devious insurance company

located in Southern CA:

>

>My m/c with American Health Specialty Network: Yes, I'm incensed with the

company!! I'll eat them all for lunch if their reps happen to darken my

clinic doorway!

 

American Health Specialty something-or-other has been around for quite a

while. The " Network " instrument may be newer.

 

Ask chiropractors about AHS.

 

A colleague of mine once worked for them in San Diego as an L.Ac case

reviewer, briefly...

 

They actively market practitioners, send me unsolicited application packets

several times a year. With phone calls too.

 

The CEO/founder -- forgot his name -- is somewhat notorious.

 

Caveat.

 

(All the above is relatively hear-say, but from multiple sources.)

 

 

[Guest guest]

Hello, Chris, here in OR, Providence and Health Net (both were at one time

under Complimentary Health Plan) are now with ASHN (yes, the network is

new). Since we already had quite a few pts with Prov & HN, we joined up to

continue treating these pts. When the contract expires, we will not join

ASHN again. I'm definately going to have a long chat with our State

Insurance Commissioner about the problem. Thanks for your input, Pam

[Guest guest]

Hi Pam,

 

I wanted to try to offer some feedback about your complaints with ASHN. I should

state first that I work with this company as a part-time consultant for their

acupuncture programs. While some may thus consider me a bad guy, I hope you give

me a chance to offer my perspective with an open mind. ASHN specializes in

managed care plans. It seems your main complaints have to do with the number of

treatments you are authorized to do before being required to submit more

paperwork and get more authorization. Unfortunately, such requirements are the

very essence of managed care. That is the nature of the beast. Virtually all

managed care plans will require their providers to submit some sort of proof

that additional treatments/services are " medically necessary. " This is the same

requirement all Physical Therapists, Occupational Therapists, and others who

work in managed care struggle with. The fact that ASHN allows up to 12

treatments before asking for information detailing more treatment is necessary

is actually fairly liberal. Some companies do not authorize more than 4-5

treatments at a time. As for the problems you had being transferred 5 times and

so forth, I don't know what to tell you. Obviously, it should not be that

difficult to get a straight answer.

 

Please feel free to contact me directly if you have any more problems I may be

able to help you with. No one likes the paper work - they actually used to

require 3 pages to be filled out for every treatment authorization! Once you get

used to their forms, it goes quicker. Personally, I would rather fill out those

sort of forms than write progress reports as required here for Workers

Compensation cases. Amway, sorry to hear about your problems but I have the

feeling you would have similar problems with any managed care network. Matt

Bauer

 

-

Pam Price

Chinese Medicine

Tuesday, May 25, 2004 8:57 PM

stroke pt vs ASHN

 

 

To all concerned, here's a warning about a devious insurance company located

in Southern CA:

 

My m/c with American Health Specialty Network: Yes, I'm incensed with the

company!! I'll eat them all for lunch if their reps happen to darken my clinic

doorway!

 

Female, 54 y/o, stroke patient: STROKE, mind you not a simple muscle pain,

right!!!???

Her m/c occurred 4/12/04 and AHSN is DENYING more treatment if over 12 x,

which they just authorized, w/o filling out 2 full pages of their forms,

again!!!(have just begun tx and she's had 5 AP including 5/17 initial tx). Left

side face, arm/hand, leg paralysis, some memory failure (not as much as most) .

No previous health problems; MD stated could have been an aneurysm, not sure. I

was authorized by MD to tx pt at care facility and am currently txing 3

consecutive days weekly, working w/Occupational Therapist. FYI, pt gets 5 tx

before practitioner has to refile, and the 5th tx isn't paid UNTIL practitioner

files for more future tx.

 

I have spoken to the company reps (transferred 5, yes FIVE times before anyone

would answer a very polite question: Can we use your forms for initial intake?

NO Answer. Practitioners must fill out the forms again, and again, and

again.....ask for more tx, get a couple. Rep stated: If you tx 100 new pts and

have been in system for 3yrs (of course, ASHN hasn't been around that long!),

then maybe we'll reconsider. Is this company for the pt? Absolutely NOT. This

is the only company in our fair state of OR who forces upon us all this

paperwork. Perhaps our Insurance Commission should be advised. Now that's an

great idea!

 

So Richard and David, if you want a REAL cause, forget the US Government,

that'll that you many years. Fight ASHN in your state, you'll get results

faster.

 

Very p..sed off Aries practitioner,

 

Pam Price PhD LAc DiplAc

Acupuncture Advantage Clinic

Clinic: 401 Ratcliff Dr SE Ste 130

Mailing: 4676 Commercial SE #185

Salem OR 97302

(503) 365-0848

 

 

[Guest guest]

wrote:

<<<American Health Specialty something-or-other has been around for quite a

while. The " Network " instrument may be newer.>>>

 

Hi Chris, and all,

 

Actually, American Specialty Networks (ASN) and American Specialty Health Plans

(ASHP) are related, but separate companies. Along with American Specialty Health

and Wellness (ASHW), a health products company, these companies make up the

American Specialty Health Systems (ASHS) " complementary managed health care

system. " ASHP manages the insurance billing side of ASHS, while ASN is a network

of providers in the complementary medicine field, (acupuncturists,

chiropractors, massage therapists, etc.), although the two seem to frequently

overlap.

 

I was solicited by ASN back in 1998 for a provider network designed to offer

insurance billing options and other benefits to NSCA certified professionals

(National Strength & Conditioning Association - Strength & Conditioning

Specialists and Certified Personal Trainers) from major insurance providers, a

proposed network that was promplty dismissed after ASN decided to focus on

taking their Acupuncturist Network nationwide. They offered all kinds of

benefits to the NSCA professional community, through heavy marketing and

solicitation, only to dismiss us within a few months in favor of the " bigger

fish, " i.e., acupuncture. (Apparently, they weren't aware of how many folks in

exercise physiology related fields they were actually dissing.) I can honestly

say this is how I now see them.

 

Ironic it is that they solicited me as a NSCA professional only to dismiss me

" in favor of their acupuncture network program. " Now that I'm going into TCM, I

expect I'll be returning the favor!

 

Hope this info proves useful.

 

Andrea

 

 

[Guest guest]

Matt Bauer wrote:

 

<<<ASHN specializes in managed care plans.>>>

 

Hi Matt,

 

Thanks for this info. It appears ASHS changed their name to ASHN. Any idea when

this took place? The info I last had came from the last letter they sent me a

couple of years ago. Does this mean the network (ASN) and plans (ASHP)

companies merged? Is the provider network still its own entity, or is it all run

together now? Just curious.

 

Thanks,

 

Andrea

 

 

[Guest guest]

Ok... a web search confirmed what I first stated... that ASHN (formerly ASN) and

ASHP are still separate, but related entities.

 

Their provider network web site is:

http://www.ashn.com/

 

" American Specialty Health Networks (ASH Networks) is a participating provider

organization and third-party administrator providing complementary health care

networks, administrative services, and clinical management services for

self-funded employers, insurance carriers, and health plans. "

 

Their health benefit plans web site is:

http://www.americanspecialtyhp.com/

 

" American Specialty Health Plans of California, Inc. (ASH Plans) is California's

first and largest specialty health plan for chiropractic and acupuncture benefit

programs. "

 

I knew they took the provider networks nationwide, but does this mean their

insurance coverage went nationwide as well?

How does that work, anyway?

 

Still curious...

 

Andrea

 

 

 

[Guest guest]

Hi Andrea,

 

ASHP is their California company and ASHN serves the rest of the country. They

first started as a California company doing chiropractic plans then added

acupuncture in about 1996 and then " went national " in 1998/99(?) and also added

massage therapy, naturopathy, dietetics and fitness facilities around the same

time. There are several companies but all operate under one ownership. Matt

 

-

Ai An Meng

Chinese Medicine

Wednesday, May 26, 2004 1:27 PM

Re: stroke pt vs ASHN

 

 

Matt Bauer wrote:

 

<<<ASHN specializes in managed care plans.>>>

 

Hi Matt,

 

Thanks for this info. It appears ASHS changed their name to ASHN. Any idea

when this took place? The info I last had came from the last letter they sent me

a couple of years ago. Does this mean the network (ASN) and plans (ASHP)

companies merged? Is the provider network still its own entity, or is it all run

together now? Just curious.

 

Thanks,

 

Andrea

 

[Guest guest]

Sorry I missed your next message. No, their networks and coverage are two

different things. The vast majority of their business comes from serving as a

middle-man between the big insurance companies and employer groups. They, in

effect, " lease " their network of credentialed providers to Cigna, Blue Cross,

etc. who in turn try to sell these policies as additional " rider " plans to

employer groups just as is done with vision or dental plans. These plans are

known as " Specialty " insurance plans - hence the name American " Specialty " etc.

In California, ASHP is the third largest specialty health plan behind one dental

and one vision plan. They have recently acquired their own company that will

allow them to sell their policies directly to employer groups. There is a lot of

complex state regulations that have to be met before they can do this and it is

very difficult to tell what impact this approach will have in the long run.

While their chiropractic plans sold well and seem to have been fairly well

established, the market for buying rider acupuncture plans has not taken off. It

seems employers are scrambling to hold on to (afford) their basic medical plans

and not that interested in buying additional acupuncture coverage. Hope this

helps - Matt

-

Ai An Meng

Chinese Medicine

Wednesday, May 26, 2004 1:55 PM

Re: stroke pt vs ASHN

 

 

Ok... a web search confirmed what I first stated... that ASHN (formerly ASN)

and ASHP are still separate, but related entities.

 

Their provider network web site is:

http://www.ashn.com/

 

" American Specialty Health Networks (ASH Networks) is a participating provider

organization and third-party administrator providing complementary health care

networks, administrative services, and clinical management services for

self-funded employers, insurance carriers, and health plans. "

 

Their health benefit plans web site is:

http://www.americanspecialtyhp.com/

 

" American Specialty Health Plans of California, Inc. (ASH Plans) is

California's first and largest specialty health plan for chiropractic and

acupuncture benefit programs. "

 

I knew they took the provider networks nationwide, but does this mean their

insurance coverage went nationwide as well?

How does that work, anyway?

 

Still curious...

 

Andrea

 

 

[Guest guest]

Thanks for clearing that up Matt!

 

Kindest regards,

 

Andrea

 

 

 

you wrote:

ASHP is their California company and ASHN serves the rest of the country. They

first started as a California company doing chiropractic plans then added

acupuncture in about 1996 and then " went national " in 1998/99(?) and also added

massage therapy, naturopathy, dietetics and fitness facilities around the same

time. There are several companies but all operate under one ownership.