ASH Networks

December 4, 2006

They just sent me a letter and I was curious what people's experience is with

them? Good/Bad?

Thanks

Julie

December 5, 2006

Run away. As fast as you can.

This carve-out network is evil, and is currently being sued by the

California Chiropractic Association. In Connecticut, where I reside,

Anthem tried to have ASH take over the management of its chiropractic

panel. All of the 768 chiropractic physicians on Anthem's panel in the

state have quit, with only 4 remaining. For all intents and purposes,

Anthem no longer has a chiropractic panel (even though they are selling

policies with chiropractic benefits), and the state Attorney General is

now looking into it.

There is absolutely no good reason to belong to this network. None. They

lie, cheat and steal. I had a representative from ASH in my office a

couple of months ago, and their sub-par reimbursement came up for

discussion. He said that, to increase my reimbursement on the initial

visit, I should bill for additional procedures -- even if I did not

perform them. " We're set up for that, " he said.

Hmm. I wonder whom he was trying to set up.

Years ago, when insurance first began accepting chiropractic, we signed up

for any panel, willy-nilly, just to get the patients. Now we are paying

the piper, in the form of insanely low reimbursements, absurdly

restrictive practice guidelines, and absurd paperwork/administrative

requirements. I would hate to see acupuncturists make the same mistake.

Throw ASH in the trashcan.

Avery

On Mon, 04 Dec 2006 17:41:14 -0500, Julie Ormonde, L.Ac.

<cariadanam wrote:

> They just sent me a letter and I was curious what people's experience is

> with them? Good/Bad?

>

> Thanks

> Julie

>

December 5, 2006

I CONCUR!!!! This network is a nightmare. I agree with everything said

below. Many in my area have dropped them too, and one of the insurance

companies who contracted with them in the beginning stopped honoring them

and started paying providers themselves because they received so many

complaints from consumers (not just providers in the ASH network).

Chinese Medicine

Chinese Medicine On Behalf Of Dr. Avery

Jenkins

Tuesday, December 05, 2006 6:45 AM

Chinese Medicine ; Alumni - San Diego

Re: ASH Networks

Run away. As fast as you can.

This carve-out network is evil, and is currently being sued by the

California Chiropractic Association. In Connecticut, where I reside,

Anthem tried to have ASH take over the management of its chiropractic

panel. All of the 768 chiropractic physicians on Anthem's panel in the

state have quit, with only 4 remaining. For all intents and purposes,

Anthem no longer has a chiropractic panel (even though they are selling

policies with chiropractic benefits), and the state Attorney General is

now looking into it.

There is absolutely no good reason to belong to this network. None. They

lie, cheat and steal. I had a representative from ASH in my office a

couple of months ago, and their sub-par reimbursement came up for

discussion. He said that, to increase my reimbursement on the initial

visit, I should bill for additional procedures -- even if I did not

perform them. " We're set up for that, " he said.

Hmm. I wonder whom he was trying to set up.

Years ago, when insurance first began accepting chiropractic, we signed up

for any panel, willy-nilly, just to get the patients. Now we are paying

the piper, in the form of insanely low reimbursements, absurdly

restrictive practice guidelines, and absurd paperwork/administrative

requirements. I would hate to see acupuncturists make the same mistake.

Throw ASH in the trashcan.

Avery

On Mon, 04 Dec 2006 17:41:14 -0500, Julie Ormonde, L.Ac.

<cariadanam wrote:

> They just sent me a letter and I was curious what people's experience is

> with them? Good/Bad?

>

> Thanks

> Julie

>

December 6, 2006

I do not belong to ASH but I sid look into it and it was my understanding

that as an acupuncturist we can not be a provider with them, only a part of

their options discount plan. In doing this we would provide to any ASH client

a

direct discount (10-30%) off of our standard pricing. The client would pay

us directly and there would be no paperwork to fill out after each visit,

because they are recieving a discount on services instead of just paying a co

pay and having us get reimbursed. I am not clear however, if this varies state

to state, as I live in maryland maybe it is different in other states and

you can be a provider. Anyone know or have any experience in their discount

options program?

Beth

Beth Grubb

Licensed Acupuncturist

Certified Animal Acupuncturist

410-591-2644

SG1532

www.bethgrubb.com

December 6, 2006

Hi Julie,

ASH is the main insurance provider in my area, and I investigated enrolling

with them earlier this year, but decided not to. First, it was a hassle just to

get the information about applying, because the company that oversees them (I

forget their name) is a chiropractic entity in my state (Arizona), and they are

not accustomed to working with acupuncturists. Secondly, I would have had to

agree to a set fee that is less than the local usual and customary, and also

less than what I charge. Third, I would have had to wait for payments from

them, rather than having them reimburse my patients, which is how I have chosen

to work with insurers. There was also an enrollment fee, an application period,

an inspection, paperwork for each visit, waiting to be paid, a limited number of

treatments that would be covered, and on and on. I am not that eager to give up

so much of my autonomy, time, and money to an insurance company that will not,

in the end, give me a fair fee.

I don't know if you remember Kevin McNamee coming to the Practice Management

class, but I took his story to heart about how insurance companies drove

chiropractor fees down to the point where they have to see 10 people per hour in

order to make ends meet, because what insurance companies pay them is so low -

and the number of treatments that are covered are also curtailed by the

insurers. I worked hard to earn my license and have the ability to make

decisions about how often to see patients, and how to set my fees. I don't want

to sign those liberties away. I'd rather see fewer patients, or see patients in

exchange for just their copay, rather than deal with their insurers. It's like

selling my soul to the devil.

Just my 10 cents! How are things going with you, and where are you now?

Andrea Beth

" Julie Ormonde, L.Ac. " <cariadanam wrote:

They just sent me a letter and I was curious what people's experience

is with them? Good/Bad?

Thanks

Julie

December 7, 2006

This is the same deal that many HMOs use to offer therapeutic massage

" benefits. " Basically, what you are doing is accepting a discount in

return for advertising in their preferred provider directory.

Think of it this way: If you are taking a 20% discount, and say you charge

$75 a visit, you are essentiallly paying $15 for each patient visit you

receive via the HMO's listing. Say that you average 5 patient visits per

week from that HMO. That means, over the course of the week, you have paid

the HMO $75 for those patients. Over the course of a 50-week year, it has

cost you $3,750 to be in the preferred provider listing.

I don't know about you, but I can think of much better ways to spend

$4,000 in marketing.

Avery

On Wed, 06 Dec 2006 17:19:28 -0500, <sg1532 wrote:

> I do not belong to ASH but I sid look into it and it was my understanding

> that as an acupuncturist we can not be a provider with them, only a part

> of

> their options discount plan. In doing this we would provide to any ASH

> client a

> direct discount (10-30%) off of our standard pricing. The client would

> pay

> us directly and there would be no paperwork to fill out after each

> visit,

> because they are recieving a discount on services instead of just

> paying a co

> pay and having us get reimbursed. I am not clear however, if this

> varies state

> to state, as I live in maryland maybe it is different in other states

> and

> you can be a provider. Anyone know or have any experience in their

> discount

> options program?

> Beth

> Beth Grubb

> Licensed Acupuncturist

> Certified Animal Acupuncturist

> 410-591-2644

> SG1532

> www.bethgrubb.com

>

December 9, 2006

As for ASH in California they pay you $40 per visit (suppose to pay) but patient

pay co-payment from $5 t0 $20 rest up to $40 - from ASH. Usually they do not

send you any patient and they do not do any marketing for you. It is just a

chance to have a Kaiser patient/ASH. They approve only 6 visits usually, then

the paper work and negotiations begin. Say the patient has in his plan 20 visits

per year, you can make 6 treatments w/o problems - then it is up to you how you

can get others. It is very dificult to get approval for more and takes a lot of

time. But if you do not have enough patients it is good to start to be provider

of any insurance, including ASH. Just remember they want to make money not only

on patients but on you also.

Yuri

docaltmed

Chinese Medicine

Wed, 6 Dec 2006 4:00 PM