American Specialty Health Inc

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.
"Providers, like Mr. [redacted]’s chiropractic provider, who are contracted with ASH, will contact ASH to verify eligibility and ASH responds to those inquiries based on the information available to ASH from the member’s health plan at the time of the inquiry.  While health plan clients update benefit information with ASH on a routine basis, the information may not always be the most current and discrepancies can arise.  In such circumstances, ASH will conduct outreach to our health plan clients to confirm the applicable benefit information to resolve the situation. " - As I said in my first complaint [redacted]. . . "Today, 5/9, Blue agreed to conference call with me & my chiropractor, then me & American Spec. and confirmed to American my deductible had been met.  Blue Cross call ref #[redacted].  Per [redacted] H. at American, she notated her log that my deductible was met.  She said she couldn't update American's system to show my deductible was met.  She would not allow Blue Cross and me to speak with anyone who could fix the issue.  She said I would have to again talk with my chiropractor, then Blue who will take weeks to file a claim then conference call American again which I refused to accept.  She then said she would submit an "eligibility research" claim, ref # [redacted] to fix my deductible." - This is an attempt by ASH to blame BCBS for not giving them the information.On 5/9/17, ASH was notified my deductible was met.  I asked for the following resolution:  "1) Confirm to me via email my eligibility research claim [redacted] has been resolved to where I will not get erroneous statement any longer.  2) Call my chiropractor, Thacker Chiropractic ###-###-####, speak to Melody and resolve the current open billing issues.  My chiropractor has to pay Melody which in turn causes my office visit rates to increase."ASH's response below on 6/14 says " it appears that subsequent research and outreach did result in that information being updated to show that Mr. [redacted] had already met his deductible before the dates of service in question.  As such, ASH has reprocessed the claims without the deductible being a factor.  ASH continues to work with our health plan clients to receive accurate and current information so that such discrepancies are minimized.  ASH apologizes for any inconvenience this may have caused."  I appreciate the apology however, I would more appreciate fixing the issue with my statements and Thacker Chiropractor's open issues.- Again ASH is attempting to blame BCBS for this error they still have not resolved.ASH goes on to say "ASH relies on our health plan partners to provide us the most timely and accurate eligibility and benefits information."  However, they were notified I had met my deductible the several times Thacker Chiropractic called them explaining the issue and when Blue Cross and I called them.  This is the third time ASH tries to blame BCBS when this issue was created by ASH and [redacted] H at ASH did not have the desire to fix my issue.ASH says these following dates have been "reprocessed" meaning a payment was finally made, I received two statements of benefits, one for the wrong charge and one for the corrected charge.  This is confusing and takes time from both Thacker and me to track down.  The dates are:  "(04/06/17, 04/24/17, 05/02/17 and most recently 06/08/17)" - Please note, BCBS and I talked with ASH to resolve this on 5/9, ASH responded to my compliant saying the issues have been resolved on 6/14.  I have since received statements showing my deductible has not been met for 5/11, 6/15, 6/20.My second Revdex.com complaint [redacted] was also closed before I could respond.  The same ASH answer was given. . . it was BCBS' fault and it's been fixed.  It's obviously not fixed and Thacker Chiropractic has not received resolution on their outstanding claims.  I still believe this should be listed as one complaint per error billed.  This would be a total of 7 so far.I've contacted ASH with BCBS.  I've issued two Revdex.com complaints.  I've been told the issue is fixed twice.  Yet, I have three more explanations of benefits showing I have to meet my deductible.  This is a great way for ASH to deny legitimate payments to providers like Thacker keeping cash in the hands of ASH longer.  If it were only me, I could understand it being a one-time issue.  The complaints I've read and the volume of issues Thacker has makes me believe this is the standard process of handling claims to keep high cash on hand.I still want my issue fixed and Thacker's issues resolved.  Thank you for your help. 
Regards,
[redacted]

Good afternoon, 
These concerns were addressed in the initial response and there is no additional information at this time. 
Thank you
[redacted]

ASH has worked directly with the complainant and her provider's office to resolve this complaint. The member's employer group was incorrectly loaded into the ASH system with calendar year benefits rather than benefit year.  This caused denials for maxed benefits that were incorrect. ASH...

has corrected this issue and reprocessed claims.  In addition, ASH has informed the practitioners office who agreed to cease billing the complainant for the claims in question. If the complainant has any additional concerns, she can contact me directly at [redacted].
 
Thanks

Date Sent: 6/14/2017 3:27:59 PMMr. [redacted]’s complaint indicates that his chiropractor is receiving incorrect benefit information related to Mr. [redacted]’s financial responsibility, i.e. his copay and deductible obligations.  The complaint states that Mr. [redacted] believed he had met his deductible before receiving treatment from his chiropractor.  However, when the claims for his chiropractic dates of service (04/06/17, 04/24/17, 05/02/17 and most recently 06/08/17) were processed, a deductible was applied.   American Specialty Health (ASH) has reviewed the concerns and would like to clarify that ASH partners with multiple health plans to administer chiropractic benefits including Mr. [redacted]’s health plan.  Providers, like Mr. [redacted]’s chiropractic provider, who are contracted with ASH, will contact ASH to verify eligibility and ASH responds to those inquiries based on the information available to ASH from the member’s health plan at the time of the inquiry.  While health plan clients update benefit information with ASH on a routine basis, the information may not always be the most current and discrepancies can arise.  In such circumstances, ASH will conduct outreach to our health plan clients to confirm the applicable benefit information to resolve the situation. ASH has reviewed the claims for Mr. [redacted] involving dates of service 04/06/17, 04/24/17 and 05/02/17.  While information available to ASH at the time the claims were processed indicated that the benefit amounts were to be applied to Mr. [redacted]’s deductible,    it appears that subsequent research and outreach did result in that information being updated to show that Mr. [redacted] had already met his deductible before the dates of service in question.  As such, ASH has reprocessed the claims without the deductible being a factor.  ASH continues to work with our health plan clients to receive accurate and current information so that such discrepancies are minimized.  ASH apologizes for any inconvenience this may have caused. The dates of service affected were reprocessed as follows: 04/06/17 was reprocessed with no deductible on 04/25/17 under claim number [redacted].  The amount paid on this claim is $42.28. 04/24/17 was reprocessed under claim number [redacted] with no deductible on 05/04/17. The resulting payment on this claim was $42.28. ·  05/02/17 reprocessed under claim number [redacted] with no deductible applied on 05/09/17.  A payment was issued in the amount of $42.28.  06/08/17 reprocessed under claim number 68535904 with no deductible applied on 06/14/17.  A payment was issued in the amount of $42.28. As stated above, ASH relies on our health plan partners to provide us the most timely and accurate eligibility and benefits information.  We continue to work with our health plan clients to ensure we receive accurate and current information.    ASH apologizes for any inconvenience this may have caused.   If there are any additional questions or concerns you may contact [redacted] ###-###-####.

ASH apologizes for the confusion on the issue. We were not aware that [redacted] had paid the claims.  ASH does not pay these particular claims directly and is not made aware when they are paid.  If you have further issues, you are welcome to contact me at [redacted] ext [redacted].  Thanks [redacted]Senior Manager, Operations

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.  I will...

wait for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
[redacted]

March 4, 2015  [redacted]...

[redacted]                                   ...⇄  RE:      Response to ComplaintFiled with the Revdex.com (Complaint ID [redacted]) American Specialty Health Group (ASH Group) received your complaintfrom the Revdex.com (Revdex.com) related to your concerns regarding claimsthat have been denied due to an address issue. ASH Group has researched your complaint and found that there was anerror made on ASH Group’s part that caused the incorrect denial of claims.  ASH Group’s records show that you submittedthe proper documentation in a timely manner in order to add a new addresslocation.  Unfortunately, there was amanual error that caused your primary address to be deleted from the ASH Groupsystem.  Your address has now beenaccurately updated in ASH Group’s system and is reflecting on the websitecorrectly as well.  ASH Group hasidentified all of the claims that denied in error and has reprocessed thoseclaims for payment.  Applicable interesthas been applied to claims that required interest to be paid.  All payments were processed as of 2/27/15 andpaid to you electronically through Electronic Funds Transfer.     ASH Group apologizes for the inconvenience this error has caused youand that we were unable to resolve it sooner. ASH Group appreciates you provding this feedback as we use this type ofinformation and feedback to improve processes to better serve ourcustomers.   Should you have any questions, please contact me directly at800-972-4226 extension ####. Sincerely,  [redacted]Senior Manager, OperationsAmerican Specialty Health

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be mostly satisfactory to me.  I will wait for the business to perform this action and, if it does, will consider this complaint resolved.I appreciate the company responding and acknowledging their delays. What is missing in this response is a commitment to (1) hire more staff or take other action to avoid future delays and (2) improve communication with patients and providers so then know when (or if) medical necessity reviews will be completed. I cannot fully accept the resolution until I see the company has indeed committed to such actions.
Regards,
[redacted]

American Specialty Health received a Revdex.com (Revdex.com) complaint from member [redacted]. She stated she has two claims on file that have been denied due to a lack of referral from her primary care physician (PCP) to the chiropractor from whom she sought treatment. Ms. [redacted]’s complaint...

indicates that her chiropractic and radiologist faxed the referral to ASH multiple times. Her attempts to contact American Specialty Health resulted in an inability to locate the referral and a commitment from the agent to follow-up with her after researching further. Ms. [redacted] did not receive the follow-up she requested and would like to have her two claims approved/paid.   ASH administers an in-network chiropractic benefit for [redacted] members, including Ms. [redacted], but a referral from a PCP must be on file in order to approve claims. ASH researched to confirm if a referral was on file for Ms. [redacted]. It was not. The ASH Supervisor mentioned in the complaint reached out to [redacted]’s Outside Referrals Department on 7/1/16 and confirmed [redacted] did not have the PCP referral on file. She then reached out to Ms. [redacted]’s PCP, Dr. [redacted], and left a message requesting she forward the member’s referral to [redacted]’s Outside Referrals Department. [redacted] followed up with [redacted]’s Outside Referrals Department for a second time on 7/20/16 and was again advised the referral was not on file.   ASH escalated the member’s concern to [redacted]’s Pain Management Coordinator on 7/20/16. It was identified that [redacted] received follow-up from the member’s PCP on 7/11/16 and the referral was granted. [redacted]’s Outside Referrals Department sent the referral to ASH on 7/22/16. ASH loaded the referral and reprocessed both claims on file to pay. The member will receive payment next week.   The Sr. Director of Claims outreached to the member to apologize for the inconvenience and to advise both claims would be paid to her next week.

American Specialty Health has incorrectly processed and mailed my reimbursement for Chiropractic services. Their systems are archaic, their staff incompetent and not helpful. For the last 5 months, I've had to follow up on my own claims with 19 seperated calls. I am still owed over $800 and the issues do not look anywhere near settled, as the internal mistakes continue to pile up. I will never again choose a provider that contracts through ASH.

Review: I have spent several hours on the phone with American Specialty Health. Calls that were only necessary because of the incompetency of this company. I sent in several claims that went ignored for over a month. When I followed up via the telephone, they said they had no record of me or my claims. I then had to call Anthem Blue Cross (my healthcare provider) and they had to intervene since (once again) ASH was clearly incompetent and irresponsible with my records. It turns out they lost my claims. As a result, I had to return to my doctor and ask her to re-print all of the initial claims. I then had to scan and email them to the Anthem Blue Cross representative who in turn faxed them over to ASH. Several weeks later I finally received a letter from ASH stating that my claims were received and approved. However, I have yet to receive my reimbursement for any of them. This process has now been going on since at least November.

Today, I called ASH again and have been on the phone for over 45 minutes. The representative told me that they have no claims on my record. After several more minutes of being on hold I was then told that they did not have all of the necessary information from me to process the claim - which is FALSE since I already received a letter from them over a week ago saying that they had received and approved all of my claims.

This company is refusing to reimburse me for these services which is criminal and unethical. What's worse is I now have a few more claims from recent doctor visits that I dread having to send in since I know I will likely go through all of this again. Something needs to be done and this company needs to be held accountable for their actions. And I need my reimbursement IMMEDIATELY. I also want assurance that this will never happen again with future claims.Desired Settlement: My deserved reimbursement. Immediately. And an effective process moving forward.

Business

Response:

Good afternoon,

Review: We were notified by this company that we would be removed from their contracted businesses (which we wanted to be) in December of 2013. Our chiropractic office indicated to American Specialty Health that we wanted to be removed so that we could bill certain other insurance companies directly without having to go through them. They originally gave us a deadline of December 6th. They then ignored our request to be removed and kept extending the deadline. We contacted Aetna insurance and inquired why we weren't receiving any payments from services rendered. They told us that unless they received the paperwork from American Specialty Health we were considered to still be a part of their network. American Specialty Health ignored our request to be removed and after continually extending the deadline for an additional 2 months, told us they would take up to 180 days to send out the paperwork stating we were no longer affiliated with them. Currently, we are unable to bill certain insurance companies for services rendered until they send over the paperwork (we aren't getting paid for services done on patients with certain insurances and won't until they send the paperwork). Lastly, the woman ([redacted] or [redacted] is her name) from American Specialty Health my staff has talked to has been very rude and condescending. They are a greedy company and are preventing our office from collecting insurance payments from patients.Desired Settlement: This paperwork should have been sent over in December like we requested. I want the paperwork sent over stating that we are no longer affiliated with American Specialty Health so that we can get insurance payments from Aetna and Cigna for services rendered. Basically, I'd like to not work for free.

Business

Response:

RE: Response to Complaint Filed with the Revdex.com (Complaint ID [redacted])

American Specialty Health (ASH) received your complaint from the Revdex.com (Revdex.com) related to

your concerns about your participation status with ASH. Your complaint states that you were notified in

December 2013 that you would be removed from contracted business and that you were given a deadline of

12/6/13. You also state that ASH ignored your request and kept extending the deadline.

ASH researched your concerns and found that ASH contacted you on 11/20/13 to follow up on a letter sent to

your office regarding your malpractice insurance. At that time, ASH was told that you were still determining if

you wanted to continue participating with ASH. The ASH representative advised that if ASH did not receive the

malpractice declarations page, you would be terminated from participation. On 12/18/13, ASH again

outreached to your office regarding the same issue. Your office manager indicated that claims had been denied

for an address issue. The ASH representative offered to transfer the office manager to Customer Service but

the office manager declined. The representative advised that ASH still needed the malpractice information.

On 1/8/14, ASH contacted the office again and spoke to you directly. According to the call notes, you indicated

that it was not a good time and would call back. On 1/10/14, your office contacted ASH and indicated you were

going to resign from participation by submitting a letter. The representative advised that written notice was

required and a letter would be sufficient. . On 2/13/14, your office contacted ASH in response to a notice of

termination sent to your office for failure to submit the malpractice information. At that time, the ASH

representative advised that because the office had been terminated by ASH, the actual termination would be

pended with the office being considered participating until after your right to appeal the termination (60 days)

had expired. The representative also noted that processing a termination could take up to 30 days in order

forthe contracted health plans to update their systems in response to the notice. This information is consistent

with the termination provision of your contract with ASH that was in effect at the time. At this point, ASH had

not received any conforming notice of your resignation from the network.

On 2/18/14, your office manager contacted ASH again and indicated that she did not want to have to wait for 30

days for Aetna and Cigna to be notified and she wanted a letter that she could send to them. The

representative advised that ASH is unable to provide such a letter within that timeframe. On 2/21/14, ASH

contacted your office and your office manager indicated that you were upset with the process. She indicated

that she would call ASH back on 2/24/14. On 2/26/14, ASH called your office again and spoke to your office

manager. She was advised that your termination date with ASH would be 3/11/14 based on the failure to

provide malpractice information. Your record in ASH’s system does reflect the termination date of 3/11/14,

which is correct based on the contractual process by which ASH can terminate your participation with ASH.

regarding the malpractice information concern. At this point and since then, ASH does not have any record of

you submitting a conforming request to resign from the network. Written notice of termination is required per

section 7.01 of your Practitioner Services Agreement with ASH.

This company is beyond difficult to deal with. They routinely deny payment of claims, refuse to understand that I have dual insurance and have no copayment, and can not even decided exactly what my copayment is (either $15 or $40, it changes daily with them). I have called monthly, my provider calls monthly, [redacted] has called and they still can not figure out how to do their job. They sent me 9 denial letters in one day!!!! I wish so deeply that [redacted] would stop doing business with them.

Review: I currently have health insurance with [redacted], and they use American Specialty Health to process their chiropractic claims. My [redacted] policy states that I receive 20 visits per contract year. My contract year is from 7/1/15 - 6/30/16. ASH keeps denying my claims due to Ref. Code 21: Services rendered in excess of visits or benefit maximums. I have spoken with [redacted] on 3 different occasions, trying to resolve this issue. The 1st time I was told that ASH had been notified of the correct policy and that my Dr should resubmit for payment. The re-submissions were denied for same reason. I called [redacted] again in October 2015, spoke with [redacted] at [redacted] and was told that he spoke with a supervisor at ASH named [redacted], and that it was straightened out and that my Dr should resubmit for payment. The re-submissions were denied for same reason. I called [redacted] again on 1/14/16 and spoke with [redacted] who spoke with [redacted] at ASH. He responded that my Dr should receive an approval notice and then submit, once again. I called my dr and was told that they had spoken with ASH on 1/15/16, and that ASH was denying the claims for the same reason as above. Ref # from 1/14/16 - ASH [redacted] / [redacted]. Ref from 1/15/16 ASH [redacted] / [redacted]. I called [redacted] today 1/18/16, and was told they would reach out to ASH, once again, and resolve the issue. This is a horrible process of denying claims repeatedly, even after being informed by [redacted] to approve for payment.Desired Settlement: ASH needs to approve payment for the visits I am entitled to. In addition, to a review of their business practices.

Business

Response:

ASH has worked directly with the complainant and her provider's office to resolve this complaint. The member's employer group was incorrectly loaded into the ASH system with calendar year benefits rather than benefit year. This caused denials for maxed benefits that were incorrect. ASH has corrected this issue and reprocessed claims. In addition, ASH has informed the practitioners office who agreed to cease billing the complainant for the claims in question. If the complainant has any additional concerns, she can contact me directly at [redacted].

Thanks

Review: I added a clinic using the correct form. ASH cancelled my contract, something that they admitted was their mistake, and I am continuing to get denials on my claims. Also, the address online is incorrect, I have corrected this issue before manually and it is not continues to be incorrect. Also, I am not visible as a provider for my location. Every time we call it is something else that you. This is costing me thousands of dollars! Completely unacceptable and causing me severe financial distress.Desired Settlement: FIX IT NOW! I believe that I should be elevated to the highest tier provider, something that I am close enough to be anyway, and not be bothered with denials again!

Business

Response:

March 4, 2015 [redacted], [redacted] RE: Response to ComplaintFiled with the Revdex.com (Complaint ID [redacted]) American Specialty Health Group (ASH Group) received your complaintfrom the Revdex.com (Revdex.com) related to your concerns regarding claimsthat have been denied due to an address issue. ASH Group has researched your complaint and found that there was anerror made on ASH Group’s part that caused the incorrect denial of claims. ASH Group’s records show that you submittedthe proper documentation in a timely manner in order to add a new addresslocation. Unfortunately, there was amanual error that caused your primary address to be deleted from the ASH Groupsystem. Your address has now beenaccurately updated in ASH Group’s system and is reflecting on the websitecorrectly as well. ASH Group hasidentified all of the claims that denied in error and has reprocessed thoseclaims for payment. Applicable interesthas been applied to claims that required interest to be paid. All payments were processed as of 2/27/15 andpaid to you electronically through Electronic Funds Transfer. ASH Group apologizes for the inconvenience this error has caused youand that we were unable to resolve it sooner. ASH Group appreciates you provding this feedback as we use this type ofinformation and feedback to improve processes to better serve ourcustomers. Should you have any questions, please contact me directly at800-972-4226 extension ####. Sincerely, [redacted]Senior Manager, OperationsAmerican Specialty Health

Review: I have [redacted] Open Access Plus - Choice or high end option health insurance through my employer. Unfortunately they only offer [redacted]. For 2014 my Benefit Plan provides unlimited chiropractic visits per year. My Chiropractor has been reimbursed for all my visits until October 2014. In December 2014, I received 2 letters from American Specialty Health telling me that claims for chiropractic visits on 10/10/2014 and 11/10/2014, as well as all future claims needed to be reviewed for 'medical necessity' in order to be eligible for reimbursement. And since my Chiropractor is 'out of network', I had to fill out their Out of Network Medical Records Cover Sheet and supply my medical records with diagnosis and treatment codes. I gave this paperwork to my chiropractor and she forwarded the requested information to American Specialty Health. I have since received more letters from American Specialty Health (in January and now in February) requesting the same information for these 2 chiropractor visits from 2014. Why do they keep harassing me? My Health Benefit for 2014 provides for UNLIMITED Chiropractic visits. And oh by the way, my Health Benefit costs me about $340 per month in 2014. Why am I paying for benefits that American Specialty Health is trying to deny? My chiropractor chooses NOT to be part of their network and she has forwarded the requested information to them. And they are harassing me about claims for $60 - really???!!! I am attaching the scanned in document regarding the 10/10/2014 claim as well as page 1 of the 11/10/2014 claim.Desired Settlement: American Specialty Health needs to honor the benefits that I am paying for and reimburse my chiropractor and above all STOP HARASSING ME!!!!!!

Business

Response:

The attached letter was mailed to the complainant today. Thanks!February 25, 2015[redacted] RE: Response to Complaint

Filed with the Revdex.com (Complaint ID [redacted])American Specialty Health Group (ASH Group) received your complaint

from the Revdex.com (Revdex.com) related to your concerns about your [redacted]

plan and services you received from your chiropractor, Lori Pinto, D.C. Dr. Pinto is not participating with ASH Group

at this time and is considered an out of network practitioner. [redacted] has

contracted with ASH Group to perform verification of medical necessity for

their customers’ out-of-network chiropractic benefits on behalf of [redacted]. [redacted] benefit plans may require verification

of medical necessity for services to be considered covered services. ASH Group

implements its review process in accordance with the coverage requirements

specified in your [redacted] issued benefit plan.

ASH Group begins verifying medical necessity for claims involving

out-of-network benefits after the first five visits of each calendar year per

unique patient/provider combination. In

this case, [redacted] did pay your first five visits in 2014. For services supported by ASH Group, [redacted]

then forwards related claims that require medical necessity verification to ASH

Group. If documentation that medical

necessity has been verified is not already on file for out-of-network claims,

then ASH Group requests medical records from the customer, with a copy to the

treating practitioner, in order to verify medical necessity. You are responsible for submission of such

records to support the medical necessity of the services; however, some

practitioners will voluntarily do this on behalf of their patient. You can

submit the records directly if your practitioner is not willing to submit

records on your behalf. While your submitted complaint states that your chiropractor has

submitted the records related to dates of service 10/10/14 and 11/10/14, ASH

Group does not have those records on file.

To expedite processing, those records can be sent directly to me by fax

at [redacted] or by email at [redacted]. Should you have any further questions, please contact me directly at

[redacted] extension [redacted].Sincerely,[redacted]Senior Manager, OperationsAmerican Specialty Health

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.

My chiropractor already forwarded the requested information to ASH Group. I guess the ASH people need to look a little harder to locate that communication.

Regards,

Business

Response:

ASH has searched in all possible locations but cannot locate the required documents or confirm that they were submitted. We apologize for any inconvenience it causes but we would need the documentation resubmitted. It can be faxed to [redacted] or emailed to [redacted]. Thanks

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this proposed action would not resolve my complaint. For your reference, details of the offer I reviewed appear below.Well - this just goes to show how [redacted] up the insurance industry is. It is quite sad that the right hand has no idea what the left hand is doing. I received a letter from [redacted] on March 10, 2015, stating that these chiropractor visits from October/November 2014 had been approved. My chiropractor also told me that [redacted] finally reimbursed her for those visits. I guess [redacted] forgot to tell that to American Specialty Health. So technically ASH Group's proposed action doesn't resolve the complaint because [redacted] already resolved it.I'm done dealing with these [redacted]. It's just a waste of time.

Regards,

Business

Response:

ASH apologizes for the confusion on the issue. We were not aware that [redacted] had paid the claims. ASH does not pay these particular claims directly and is not made aware when they are paid. If you have further issues, you are welcome to contact me at [redacted] ext [redacted]. Thanks [redacted]Senior Manager, Operations

Consumer

Response:

]

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. Iwill wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

Review: This company handles the chiropractic claims for our insurance company. they say that they have a very simple submission process for claims, which our Chiropractor and his staff graciously agreed to submit for us. They precisely followed instructions on the claim form including the instruction to fax the claim to ash. when we contacted a ASH to make sure that they had received the claim, customer service said that they throw away all faxes that come to that number. They provided no explanation as to why they would do this or why this fax number was listed on their instructions. They told us that the claim would have to be mailed. Again, the chiropractic office helped us out and mailed the plane to a ASH. A number of weeks passed, and we called them again only to be told that it can take approximately 6 weeks to process claims and that they could not provide any status updates or even confirm whether or not they had a claim. Then Friday March 13, we called again and they stated that they still had no record of the claim. They also said that they have 2 small offices and that one office could not tell us what the other office may or may not have received and that things can be lost between the two offices. This is completely unacceptable! Our claim represents a substantial amount of money, and it is our belief that they are behaving in a fraudulent and unethical manner in delaying the process for so long, that the submission time frame deadline will expire. at the very least, customer service representatives are rude and unhelpful and they make the claims process impossible.Desired Settlement: I believe that they have this claim since they have received it via fax and mail, and that if they say they do not have it so this is a lie. I want this claim process immediately and without further runaround.

Business

Response:

Attached you will find the response to the complainant that was placed in the mail today. Thanks April 7, 2015[redacted]

[redacted]RE: Response to your

complaint submitted to the Revdex.com (ID[redacted]) [redacted],American Specialty Health has reviewed the complaint you submitted to

the Revdex.com (Revdex.com) related to claims submissions for your

treatment. While we understand that your

provider may have faxed claims to us, unfortunately such a submission is not an

appropriate manner to submit claims to us.

Claims for chiropractic services under your health plan are required to

be submitted to ASH on paper. Research of our records has not revealed that

your claims were recorded as having been received. To help remedy your situation in relation to

these claims, you or your

chiropractor can submit claims directly to me for expedited handling. The claims in issue here can be emailed to me

at [email protected] or mailed to me at: [redacted]. Please make sure to address

the claims to my attention for faster handling. Our records indicate that during a call on 1/23/15 between you and ASH

staff you were advised ASH had no claims on file for your services. At that time, you indicated that your

chiropractor had faxed in the claims. The representative then told you that

claims sent by fax are rejected. During a

subsequent call you made on 2/6/15, an ASH representative also informed you that

the claims were still not on file. The

ASH agent advised that claims can only be mailed or submitted online and that

faxed claims are not accepted. The agent

did indicate that claims are processed in a different location and that if

something had recently been submitted and wasn’t on file yet, then there would

not be a way for the representative to confirm it had been received. Information received via mail or on-line

usually is processed and available in our files within five business days.For clarification on the information you were

provided, ASH does not throw out claims sent via fax. However, ASH does not maintain a fax number

for the receipt of claims. Claims sent

to other unrelated ASH fax numbers may not be received in the correct department. Additionally, the agent that indicated that

claims are processed at a different location than where they are received was

incorrect. In fact, all claims properly

mailed to the designated address are received by ASH in a designated central

location to ensure timely and appropriate handling. Such documents are scanned upon receipt for

processing and tracking. Once scanned,

the documents are available to our staff in various locations to access

electronically in order to expedite processing. ASH apologizes for any incorrect information

provided to you during your calls. We

strive to provide the best customer service and will use your feedback as a

tool for coaching training. Again, to help resolve the current issue, you or

your chiropractor can submit those claims directly to me for expedited

handling. The claims can be emailed to

me at [redacted] or mailed to me at: [redacted]. Please make sure to address

the claims to my attention for faster handling.

Please note that this is an exception to assist you with this current

matter. Should you have any questions, please contact me directly at [redacted]

extension [redacted].Sincerely,[redacted]Senior Manager, Clinical OperationsAmerican Specialty Health? ?

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me, IF it is carried out as promised. One note regarding the handling of faxed claims, the business response from representative [redacted] stated "ASH

does not maintain a fax number for the receipt of claims. Claims sent to other unrelated ASH fax

numbers may not be received in the correct department." However, I would like to point out that the instructions on the ASH website ([redacted]) give two options for submissions of claims. Option A states "Obtain your medical records yourself for the dates of service you want verified as medically necessary and send that information by fax to the fax number below or by mail to ASH Group at the address below." Option B states: "Ask your non-participating practitioner to communicate directly with ASH Group to verify medical necessity. If your practitioner is willing to do this on your behalf, we have developed reporting tools for your practitioner to use. The practitioner can assist you in meeting your obligation to obtain medical necessity verification by: Completing the Medical Records Cover Sheet ([redacted]) ..... He or she may fax the Medical Records Cover Sheet along with the forms to ASH Group at the number below or mail the forms to the address below." If no fax number is maintained for the receipt of claims, why is a cover sheet with fax numbers provided for the appropriate routing of faxed claims, and why is the fax referred to on both options? Further, it is highly questionable that both faxed and mailed copies of the claims both were never received and appropriately processed.In good faith, I will respond to Ms. Matthews offer of personal expedited processing and attempt to obtain a copy of the documentation from my chiropractor (in the hopes that they kept a copy of what they mailed to ASH), and I will submit this claim directly to her. I will wait for the business to perform the promised action and, if it does, will consider this complaint resolved.Regards,[redacted]

Review: on December 15th I renewed my silver and fit membership online through AHS. for some reason my checking account was charged 3 times when it should have been charged only once. one payment was refunded to my checking account on the same day. I went onto their website and it showed that 2 transactions had been cancelled but one was credited them back. I then sent them 3 e-mails and never received a reply. I then proceeded to call them and they told me that the were showing 2 cancellations. I told them that my bank account had only been credited back for one of the cancellations. they said it sometimes takes 7-10 days, although I don't quite understand that as the 1st cancellation was refunded that same day. I then went to my bank to see if there were any pending credits, which there were not. the bank told me to have them send me a letter verifying the 2 cancellations. on December 30, I called them again. after 10 minutes of talking to a customer service rep and not getting anywhere, I asked to speak to a supervisor. she put me on hold and came back and said there were no supervisors available. I then asked her if she would just send me a leeter, verifying the 2 cancellations and was told "we don't do that". I asked for a supervisor to call me back, but based on my dealing so far with this company. I doubt this will happen.Desired Settlement: I would like the $25.00 credited back to my bank account. $25 isn't going to make me rich or put me in the poor house but it's the way I've been treated through this whole thing. terrible, terrible customer service.

Business

Response:

The attached letter to the complainant has been placed in the mail today, 1/16/15. Thanks

Consumer

Response:

I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.

Regards,

American Specialty Health is a blood sucking leech, making profit by denying health care providers proper payment, denying patients their right to get the allotted number of visits they should have been approved for, slowing down the overall process for claim adjustment, payment, and customer/provider care, not to mention illegal business practices by withholding information from providers when representatives give patient eligibility information, and giving false information in Explanation of Reviews/Benefits.

We are a small clinic in Georgia, and we have been marginalized and denied proper payment time and time again because of American Specialty Health. So we decided to terminate our contract with ASHN because it was affecting our relationship with our patients. But now we can't get payment from any of the big insurance companies (i.e. BlueCross BlueShield, Aetna, Cigna...) because they contracted with ASHN to handle chiropractic care.

ASHN is effectively monopolizing the chiropractic and other specialties' programs and forcing other providers to get in contract with ASHN in order to get paid the little to none they pay out.

DON'T DEAL WITH ASHN.

Review: American Specialty Health (ASH) has failed to respond to my healthcare medical provider regarding my eligibility for continuation of treatment. My insurance company, [redacted], has contracted with ASH to service providers and perform medical necessity reviews. According to [redacted], ASH has a significant back-up in the processing of such reviews and is unable to service their providers and, ultimately, patients like me. My calls to ASH have been fruitless as they will only speak with my provider or my insurance company - they refuse to speak to patients and were unapologetic about the resulting delays to my treatment. In fact, they have advised their providers to just continue treatment yet fail to promise that they will cover their costs. This results in providers asking their patients (me) to cover the cost of treatment myself! This related article shows how ASH and [redacted] are failing to provide necessary service to providers and patients: [redacted]Desired Settlement: I expect American Specialty Health (ASH) to immediately respond to my provider and agree to cover the costs of my additional treatment regardless of their ability to complete a medical necessity review. ASH should absorb the cost of their failure to service providers and customers and not pass on the pain to us. At a minimum, ASH should commit to a time frame for completion of the medical necessity review - they were unable to even tell [redacted] that.

Business

Response:

Mr. [redacted]’ complaint indicates that ASH has failed to respond to his practitioner’s request for medical necessity verification. He also states that ASH is refusing to take his calls and will only speak to his practitioner or [redacted].