For your benefit, we are no longer a blue cross and blue shield preferred provider
In order to continue to participate as a provider of Blue Cross and Blue Shield (BCBS), Chiropractors in Arizona are required to join the ASHN network (American Specialty Health Network) also known as ASH. Blue Cross Blue Shield of Arizona BCBSAZ has determined that the utilization of chiropractic services has been increasing at an alarming rate and in order to "curb" this utilization they chose to partner with ASH as a chiropractic utilization management company. According to BCBSAZ, this will "improve" the quality and utilization of chiropractic care. BCBSAZ has also stated that subscriber's benefits have not changed at all! Subscribers can continue to receive all the "medically necessary" chiropractic benefits they need. In addition, all the usual services are still allowed and can be performed by the subscriber's chiropractor. BCBSAZ has also stated that they are making the transition as smooth as possible for the providers and as a subscriber there will be no requirement on their part.
SOUNDS GOOD SO FAR RIGHT?
What BCBS has failed to mention is:
* ASH on average only allows 5 visits per year regardless of what your plan allows
* ASH will be paying the chiropractor directly (this means BCBSAZ pays the "ASH middleman")
* ASH caps all visits to no more than $44.00 per visit which is including the average patient copay of 35 to 45 dollars
* ASH on average will pay 1 to 10 dollars per visit leaving the majority of the charges to be covered by the patient.
* ASH reimburses at a rate LOWER that it cost to produce many of the services (the network chiropractor loses money on most services offered)
* The network chiropractor will not be able to provide most of the services simply because it will cause him or her to lose money
* The network chiropractor cannot charge the patient for the difference (This means it will not even be offered to the patient)
* The network chiropractor will have all these "benefits of being in network" to be applied to all BCBS plans - in and out of state plans (regardless of their plans too!).
* The BCBSAZ plan subscribers will be paying out of pocket for most of the care regardless if they see in or out of network providers.
* Out of state BCBS subscriber's who see in network providers will be required to follow the same rules as BCBSAZ's Subscribers as mentioned above.
* Out of state BCBS subscriber's who see out of network providers will get their benefits back after "out of network obligations are met - Deductibles"
Where is the benefit?
It appears there is very little to no benefit if you see an in network provider and while you may be paying a little more for out of network treatments, your treatments will be a lot more than what you get in network - not to mention your options are much better.
We cannot in good conscience treat our patients the way BCBSAZ requires and so we are not joining the new network. We will do everything we can to make it as affordable for all our BCBS patients and we think our patients will be happier with our "unrestricted" services. We feel a benefit that is rendered useless is not a benefit at all, but we could not convince BCBSAZ of that. What do you think?
Honestly, I cannot imagine a chiropractor stupid enough to join this or a patient happy to go to one who does.
SCAM ALERT!
SOME PROVIDERS ARE JOINING THE NETWORK ONLY TO ATTRACT UNSUSPECTING PATIENTS TO THIER CLINIC. ONCE ENROLLED IN THIER CLINIC, SOME ARE NOT EVEN BILLING ASHN, SOME ARE UP SELLING THE NON COVERED OR LIMITED BENEFITS TO THE PATIENT TO PAY OUT OF POCKET FOR SERVICES THEY ARE BY CONTRACT NOT ALLOWED TO DO!
BCBSAZ and ASH is breaking the law with the support of the Department of insurance!
I will address this in another blog. There is a law that protects against discriminatory actions by insurance companies to providers. The department of insurance is the only enforcing agency and they have decided to do nothing. No other health care provider is required to be managed and controlled - JUST CHIROPRACTORS! Physical therapist and medical doctors will be paid twice as much as a chiropractor to perform the same services. This sure sounds like discrimination to me
The profession agrees and are suing ASH, BCBS and the department of insurance because of their actions. BCBSAZ patients are also suing them for the burden placed upon them. The lawsuit blog will address these issues and what you can do to fight for your benefits and against discriminatory actions by BCBSAZ.
Stay tuned!
Feel free to post your comments - we welcome them! ( I will be glad to post any response from BCBSAZ, ASH or the Arizona department of Insurance.
In order to continue to participate as a provider of Blue Cross and Blue Shield (BCBS), Chiropractors in Arizona are required to join the ASHN network (American Specialty Health Network) also known as ASH. Blue Cross Blue Shield of Arizona BCBSAZ has determined that the utilization of chiropractic services has been increasing at an alarming rate and in order to "curb" this utilization they chose to partner with ASH as a chiropractic utilization management company. According to BCBSAZ, this will "improve" the quality and utilization of chiropractic care. BCBSAZ has also stated that subscriber's benefits have not changed at all! Subscribers can continue to receive all the "medically necessary" chiropractic benefits they need. In addition, all the usual services are still allowed and can be performed by the subscriber's chiropractor. BCBSAZ has also stated that they are making the transition as smooth as possible for the providers and as a subscriber there will be no requirement on their part.
SOUNDS GOOD SO FAR RIGHT?
What BCBS has failed to mention is:
* ASH on average only allows 5 visits per year regardless of what your plan allows
* ASH will be paying the chiropractor directly (this means BCBSAZ pays the "ASH middleman")
* ASH caps all visits to no more than $44.00 per visit which is including the average patient copay of 35 to 45 dollars
* ASH on average will pay 1 to 10 dollars per visit leaving the majority of the charges to be covered by the patient.
* ASH reimburses at a rate LOWER that it cost to produce many of the services (the network chiropractor loses money on most services offered)
* The network chiropractor will not be able to provide most of the services simply because it will cause him or her to lose money
* The network chiropractor cannot charge the patient for the difference (This means it will not even be offered to the patient)
* The network chiropractor will have all these "benefits of being in network" to be applied to all BCBS plans - in and out of state plans (regardless of their plans too!).
* The BCBSAZ plan subscribers will be paying out of pocket for most of the care regardless if they see in or out of network providers.
* Out of state BCBS subscriber's who see in network providers will be required to follow the same rules as BCBSAZ's Subscribers as mentioned above.
* Out of state BCBS subscriber's who see out of network providers will get their benefits back after "out of network obligations are met - Deductibles"
Where is the benefit?
It appears there is very little to no benefit if you see an in network provider and while you may be paying a little more for out of network treatments, your treatments will be a lot more than what you get in network - not to mention your options are much better.
We cannot in good conscience treat our patients the way BCBSAZ requires and so we are not joining the new network. We will do everything we can to make it as affordable for all our BCBS patients and we think our patients will be happier with our "unrestricted" services. We feel a benefit that is rendered useless is not a benefit at all, but we could not convince BCBSAZ of that. What do you think?
Honestly, I cannot imagine a chiropractor stupid enough to join this or a patient happy to go to one who does.
SCAM ALERT!
SOME PROVIDERS ARE JOINING THE NETWORK ONLY TO ATTRACT UNSUSPECTING PATIENTS TO THIER CLINIC. ONCE ENROLLED IN THIER CLINIC, SOME ARE NOT EVEN BILLING ASHN, SOME ARE UP SELLING THE NON COVERED OR LIMITED BENEFITS TO THE PATIENT TO PAY OUT OF POCKET FOR SERVICES THEY ARE BY CONTRACT NOT ALLOWED TO DO!
BCBSAZ and ASH is breaking the law with the support of the Department of insurance!
I will address this in another blog. There is a law that protects against discriminatory actions by insurance companies to providers. The department of insurance is the only enforcing agency and they have decided to do nothing. No other health care provider is required to be managed and controlled - JUST CHIROPRACTORS! Physical therapist and medical doctors will be paid twice as much as a chiropractor to perform the same services. This sure sounds like discrimination to me
The profession agrees and are suing ASH, BCBS and the department of insurance because of their actions. BCBSAZ patients are also suing them for the burden placed upon them. The lawsuit blog will address these issues and what you can do to fight for your benefits and against discriminatory actions by BCBSAZ.
Stay tuned!
Feel free to post your comments - we welcome them! ( I will be glad to post any response from BCBSAZ, ASH or the Arizona department of Insurance.