Urge DOBI to oppose Horizon partnering with American Specialty Health Network (ASH)

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Horizon Blue Cross Blue Shield of NJ has decided to partner with a utilization review company called
American Specialty Health Network (ASH) to manage claims for acupuncture, chiropractic, occupational
therapy, physical therapy and speech therapy. The potential union of Horizon and ASH is scheduled to
begin January 1, 2020, pending approval by the New Jersey Department of Insurance (DOBI).

Why is this bad for patients – the nearly 3.8 million insured by Horizon?

Based upon information received from multiple credible sources, it is our opinion that the following
improper practices will carry over to Horizon insureds:

  • Routinely denies medically necessary care with unreasonable standards that are out of line with
    widely accepted standards of care, often after just 5 visits, which leaves the remainder of the 30
    visits most Horizon plans allow unused for which patients have paid premiums for.
  • Requires documentation to be reviewed after pre-determined amount of visits based on the doctor’s claim history, not the patient’s condition or history
  • Has a history of administrative delays in processing requests for care and issuing payments
  • Has a history of cost-shifting administrative costs of their services into medical costs to the patient
  • Coerces patients into paying for their own care entirely out of pocket by denying reasonable and medically necessary care and encouraging providers and patients to sign waivers acknowledging the care is not medically necessary and paying for it themselves.

Our concern is with our patients having access to the care outlined in their Horizon health plans. In our
opinion, ASH has a history of inhibiting access to care as evidenced by it being the subject of at least
three large class action lawsuits in the past year alone. Below is a summary of those lawsuits:

Cigna Corp. and American Specialty Health Group, Inc. in May of this year reached an $11.75
million settlement in a class action lawsuit brought on behalf of all out-of-network chiropractors
who had claims improperly denied. According to the lawsuit:

  • ASH used improper and inconsistent practices to routinely deny services that were medically
    necessary, failed to take into account the individual conditions and needs of each patient, and
    used rigid internal guidelines that conflicted with generally accepted standards of care within the
    chiropractic profession, as well as Cigna’s own policies.
  • ASH’s utilization review process led to arbitrary and capricious denials of coverage and restrictions on patient care.

Class-action lawsuit accuses Cigna of cost-shifting scheme to divert administrative charges

  • The lawsuit filed in April 2018 in Pennsylvania accused Cigna of falsifying Explanation of Benefits
    (EOB) forms to misrepresent charges from American Specialty Health.
  • The suit further argued that the scheme could mean Cigna is reporting inaccurate Medical Loss
    Ratios, used to calculate the percentage of premium income versus medical expenses.

Law suit against ASH and CIGNA for cost-shifting in California

  • The lawsuit filed on May 23, 2018, in the Southern District of California for charging members for
    what appeared to be medical expenses for therapy services but were actually charges for ASH’s
    administrative services.
  • Plaintiffs assert that ASH and CIGNA breach the Employee Retirement Income Security Act by
    concealing material information about ASH’s charges on the patient EOBs.

All you have to do is click this link: STOP Horizon/ASH!

The link will bring you to a form to fill in your name, address and email. A pre-written email is ready to go to your own representatives as soon as you click "Send Email."

This is so easy to do, just click on the link and it will send it all for you. We need your help to stop this change!

Thanks and Be Well,

Dr. Mary