I don't have time for a long report, forgive me, but.
Blue Cross and Blue Shield had always covered my chiropractor's care for our family for the past 10 years. Last year, BC introduced a middle layer-- American Speciality Health -- to review and demand more paperwork from the chiropractor and client to "prove" why they needed the services received.
Ever since then, I'm not longer getting coverage, despite the fact that my primarcy insurance approves more chiropractor visits than I use in a year. My chiropractor says she has spent hours providing forms and asking their questions, but ASH always denies coverages due to "incomplete information". They're require hours more of her time, denying my coverage, but the reasons for the visits and treatment have always been the same.
Furthermore, things got complicated last year when I tried to understand what was happening. I got ASH and Blue Cross on the phone together. BC admitted it seemed "odd" that they weren't getting the claims that ASH was theoretically processing and sending to them. BC said they'd open an investiagation and would get back to me in 3 weeks. They never did, and when I followed up on the "investigation" BC couldn't find it...
I see other complaints similar. Am going to try to appeal to our state insurance commissioner but would prefer a class action lawsuit.
On July 2016 we started getting letters asking for more information about chiropractic services I had received. Our plan allows 30 visits per year. The letters from American Specialty Health asked for more information about the last 3 visits to determine if they were medically necessary. Just got a claim denial for my last visit from Cigna after the review from American Health Specialty decided I did not need the chiropractic services. I can only appeal to the state Bureau of Insurance. The reason for the denial is that the medical examination notes were too similar therefore duplicates and the service is deemed not medically necessary. They are denying payment for services covered under our insurance.
American Specialty Health Reviews
I don't have time for a long report, forgive me, but.
Blue Cross and Blue Shield had always covered my chiropractor's care for our family for the past 10 years. Last year, BC introduced a middle layer-- American Speciality Health -- to review and demand more paperwork from the chiropractor and client to "prove" why they needed the services received.
Ever since then, I'm not longer getting coverage, despite the fact that my primarcy insurance approves more chiropractor visits than I use in a year. My chiropractor says she has spent hours providing forms and asking their questions, but ASH always denies coverages due to "incomplete information". They're require hours more of her time, denying my coverage, but the reasons for the visits and treatment have always been the same.
Furthermore, things got complicated last year when I tried to understand what was happening. I got ASH and Blue Cross on the phone together. BC admitted it seemed "odd" that they weren't getting the claims that ASH was theoretically processing and sending to them. BC said they'd open an investiagation and would get back to me in 3 weeks. They never did, and when I followed up on the "investigation" BC couldn't find it...
I see other complaints similar. Am going to try to appeal to our state insurance commissioner but would prefer a class action lawsuit.
On July 2016 we started getting letters asking for more information about chiropractic services I had received. Our plan allows 30 visits per year. The letters from American Specialty Health asked for more information about the last 3 visits to determine if they were medically necessary. Just got a claim denial for my last visit from Cigna after the review from American Health Specialty decided I did not need the chiropractic services. I can only appeal to the state Bureau of Insurance. The reason for the denial is that the medical examination notes were too similar therefore duplicates and the service is deemed not medically necessary. They are denying payment for services covered under our insurance.