American Specialty Health

The overall program in connection with Kaiser Permanente is a great idea and a financial help to retired folks.
However the service and financial billing of A&F Direct leaves a lot to be desired and boarders on
purposely scaming customers.
I signed up on 11/30 (my invoice from A&F states 11/30 through 12/30) and I paid $75.
$25 for enrollment, $25 for Dec and $25 prepayment for a future month.
However A&F said the $25 was for 11/30 (one day)!!!!!
They are unwilling to correct this charge and insist there is nothing wrong with it.
Subsequent emails either got not answered at all, or it took 2 weeks to get a replay.

If I could put zero stars I would. American Specialty Health has partnered with CIGNA to review claims. Since they have started as the third party reviewer of claims, all of the medically necessary doctors, therapies and services that my severely autistic son receives are now be denied. I have letters from both his regular pediatrician and his developmental pediatrician noting these medically necessary claims. The reason for one of the denials is the submitted information does not clearly explain and support your need of more treatment. Let me tell you the severity of his needs. My 7 years old son , his motor planning, fine motor, oral motor and gross motor skills are that of a 3 year old. He needs hand over hand assistance with daily self care and self help activities including dressing, feeding, and hygiene. He still wears diapers because he does not understand the motor planning for potty training. I have to help him with baths and brushing his teeth. Only in the last month after several years of trying and practicing was he able to drink out of a an open cup. I never once had a problem getting his claims paid for his medically necessary doctors, therapies and services. I am trying to comprehend what makes ASH an expert on determining this. Additionally, because I did not receive notification of this new claims review process, CIGNA was going to allow the claims be paid out as previously done as a pay and educate opportunity. Apparently American Specialty Health decided that it was not allowed. Now tell me how is this third party reviewer allowed to tell the payer of the claim, CIGNA, not to do something.
I am disappointed in CIGNA for partnering with this company. If you ever see your health insurance plan say that they partnered with American Specialty Health, please change providers immediately. ASH is only there to inundate you with paperwork to wear you down until you give up so they don't have to pay out your claims. Then you end up unable to pay for the services and have to give them up.

I need physical therapy for my second or revision surgery. I would like to continue physical therapy for two reasons: I want to return to work, and I want to avoid a third surgery which is likely to be shoulder replacement surgery. I can only have five visits before I must undergo a review.
This is is reckless and withholding accepted post-surgical revision protocol.

ASH is a total scam and the insurance companies that contract with them are getting ripped off. I've been billing insurance for 6 years and when I encounter ASH it's always a problem. The most current encounter goes like this: We have a new patient. I call her insurance company and ASH to get eligibility info. I'm told the annual deductible is met. So I collect the co payment from the patient for three visits in December and submit the rest to ASH. I received EOBs from ASH showing that all three visits applied to the patient's annual deductible. This was incorrect. The patient's deductible had already been satisfied in February 2018. I've now called ASH three times to get the claims reprocessed. I also spoke with a representative from the insurance company who confirmed that the annual deductible had been satisfied in February 2018. This rep called ASH while I was on the phone with her and told the ASH rep that the deductible had already been satisfied. But ASH sat on the claims for another two weeks. I called today to follow up and they had just reassigned the claims to another department. I spoke to the Supervisor Anthony H who clearly did not care. He specifically said that ASH doesn't have any timeline for processing these claims and they get done when they get done. I tried to explain to this man that he should be concerned for the patient who is held financially responsible for services that fall to the deductible. The fact that ASH improperly processed three claims, reporting that the amount due was the patient's responsibility is WRONG. ASH should be investigated for the mishandling of claims and then failure to correct the mishandling when it is clear that the claim was handled improperly.

This company does not take a NO for an answer: constantly harassing me with their marketing material: called them up and asked to stop: and it goes on and on..I am an MD I do not need a DC harassment: very unprofessional!!

I agree with all of the reviewers below, zero stars. How in the world can they have an A+ rating with 42 one star reviews and nothing higher than 2 stars (1 reviewer) ?????

Prior to having Anthem Blue Cross PPO we had their HMO plan, which was actually FAR easier to deal with than the PPO because of ASH, even though the provider was out of network with the HMO! With the HMO the provider was paid by the medical group with a referral from the MD. But now since the switch to the much more expensive PPO plan, ASH has stepped in and denied all claims for PT, 20 of them to be exact.

ASH's whole purpose for being is to police and deny claims, and they have ZERO interest in the patient's health. I have spent countless hours on three way phone calls with ASH and Blue Shield, and they tend to put all of the blame on the provider for not doing their paperwork. It is a TON of paperwork, not streamlined or up to date with this century.

Actually, it only makes sense that medical providers would choose to opt out of dealing with insurance companies who use ASH because it makes life hell for them to simply get paid for their work. This company creates a break in the relationship between the provider and patient by deliberately withholding payment when it is medically necessary. They are trying to be the judge and jury in which you prove medical necessity when in fact they are not as knowledgeable as a physician.

How can we fight back? Insurance board? Legal action? They seem to hold all the cards. Who will investigate this further?

I am not affiliated or contracted with this company: however this company keeps sending me contract related information, sometimes under fake names but to my office address: after receiving one yesterday, called them up to ask them not to send me any material any more: Mr ***, whom I happened to talk to, was extremely rude, not helpful at all. Well, I am going to return their "stuff" from now on. Yes, this company is very shady in their practices. (an MD)

As a practitioner in a low margin specialty of acupuncture it is inconceivable how many times I need to submit proof of treatment for the same patient only to not receive any answers.
This company is a complete fraud from the word GO. They do not pay claims, continually 'lose paperwork' that is faxed to them, and then ask for more details that are for the same treatment dates.
In short the patients suffer because they will not go through the billing process and the acupuncture field is driven into the lowest levels of health care provider.

American Specialty Health, ashlink.com is a horrible company to whom Kaiser P has granted gatekeeper authority to acupuncture services for it's patients. Kaiser dropped the ball, left the arena, and no one is home. No one answers the phone at American Specialty Health. The only option is to leave voicemail (unless you have the name of an employee, which tells me I would get through if I was your friend). They have the power to deny my treatment, but I can't call and tell them that the questionnaire they gave my provider never asked the right questions. THEIR assessment had nothing to do with the reason I am seeking acupuncture!! SHAME ON KAISER FOR GRANTING AMERICAN SPECIALTY HEALTH THE RIGHT TO DENY MY TREATMENT, AND NOT GIVING ME THE OPPORTUNITY TO DISCUSS MY ACTUAL MEDICAL TREATMENT NEEDS, CURRENT HEALTH, OR WELLBEING.

Horrible service. Never answers the phones - seldom pays claims and when they do, it's after a ridiculous amount of paperwork and the payment is grossly below average for services rendered. Seems to be a way to NOT pay for services for patients/policy holders.
Terrible company to attempt to work with -- AVOID At ALL Cost!