On August 1st, Horizon announced a contractual arrangement with American Specialty Health Group (ASH) to administer their Chiropractic & Physical Medicine Services Program.
ASH is a vendor (network administrator) that utilizes their own "peer Clinical Quality Evaluation Manager" as a gatekeeper for chiropractic, physical therapy, occupation therapy, and acupuncture services.
This means there could be a steep increase in improper claim denials as we have learned from recent litigation filed against ASH.
This is bad news if you are a patient with Horizon, or if you treat patients insured with Horizon plans, as cutting benefits appears to be the business model of ASH.
TO STOP THIS, YOU MUST ACT NOW!
PLEASE SEND AN EMAIL TO NJ LEGISLATORS AND REGULATORS urging DOBI to say NO to the Horizon/ASH contract.
In addition, please also forward this email and/or link to any friends and family who might have Horizon insurance.
This added layer of network bureaucracy will likely have the following consequences:
- Out-of-network (OON) providers will be subject to medical necessity review after the 5th visit, therefore potentially cutting a patient's Horizon's OON benefit by up to 83% (from the previous-allowed 30 visits).
- In-network providers will be forced to sign a network contract with ASH at their rates, and if they chose not to, "will be subject to Horizon BCBSNJ’s termination process".
- In-network providers will ALSO be subject to medical necessity review after "a certain number of visits and/or services”.
- Patients will be subject to significant out-of-pocket expenses to pay for treatment in situations where their care is substantially denied.
- Reduced access to these conservative care services like chiropractic and PT will likely have a negative effect on the efforts in New Jersey to combat the opioid crisis.
Please see what is in the public domain about ASH, here.