Anthem Blue Cross of California
Helping members save on acupuncture care
As our valued partner, we want you to know about a change we’re making to our acupuncture care claims review process. This change will help members keep their share of the costs as low as possible, while also making sure they get the care they need.
What’s changing?
Starting October 1, 2016, American Specialty Health (ASH) will process all acupuncture claims, in and out of the network, for our California fully insured large and small group PPO (Preferred Provider Organization) plans. ASH also will review claims for acupuncture care to make sure the services members get are medically necessary.
A logical decision
ASH’s new role will bring greater efficiency and consistency to our processes. In turn, this will help streamline health care delivery and lower costs. ASH has a long history of trusted service to us and our members. For more than a decade, ASH has performed a similar role for Anthem members in other states across the country. We are confident that ASH’s expertise in acupuncture claims and excellence in service will continue to benefit us and our California members.
About American Specialty Health
ASH is a national health services organization. The organization provides fitness and exercise programs, population health solutions and specialty health care programs for health plans, Medicare Advantage plans and employer groups. ASH has more than 1,000 employees and serves more than 32 million members nationwide.
Learn more
This month, we will send this sample letter to affected members to explain the new arrangement with ASH. In that letter, we’ll include a list of frequently asked questions (FAQs) about the claims review process and tips on how members can save money on acupuncture care. Here’s a similar version of those FAQs.
Blue Cross Acupuncture Member Letter
A new way to get acupuncture care at the right cost
Dear <Member Name>:
When it comes to your health, we’ve got you covered. And that means more than just covering costs. We want to make sure you get the right care, and keep your share of the costs as low as possible. That’s why we’re changing the way we review acupuncture claims, starting October 1, 2016.
American Specialty Health (ASH) will review acupuncture claims
ASH is a leading specialty health plan with a national network of credentialed acupuncturists. All Anthem Blue Cross acupuncturists are in ASH’s acupuncture network. Starting October 1, 2016 ASH will review acupuncture claims to help make sure the services members get are medically necessary. This means making sure services are medically necessary to prevent, diagnose or treat an illness or condition while meeting accepted standards of care.
Your benefits will stay the same. Only the way acupuncture claims are reviewed will change. And it may help lower your costs for acupuncture care in the future.
How ASH works:
When a claim for acupuncture care comes in, ASH will review it and decide if your treatments are medically necessary.
- If ASH decides the services are medically necessary, you may need to pay for part or all of the cost depending on your plan’s deductible, copays or benefit limits.
- If ASH determines the services are not medically necessary and the acupuncturist is not in your plan (out of network), you may be responsible for 100% of the costs.
Here’s what you should do
If you plan to get acupuncture care after October 1, 2016, find out if your acupuncturist is in your plan. If so, you don’t need to do anything else.
If your acupuncturist is not in the plan, ask him or her to call ASH at 1-800-972-4226 and ask for a medical necessity review. ASH will review your proposed treatment and decide if Anthem Blue Cross will cover it. This will help you know what your costs may be.
Staying in the plan saves money
In some cases, acupuncturists in your plan have agreed to accept discounted fees. This helps make sure you pay less out of your own pocket than you would if you visited an acupuncturist who’s not in your plan. So it makes sense to find an acupuncturist in your plan. Just visit anthem.com/ca and choose Find a Doctor.
If you have questions
We’ve enclosed some frequently asked questions about the new claims review process and how you can save money on acupuncture care. If you have more questions or need help finding an acupuncturist in the plan, call Customer Service. That number is on the back of your member ID card.
Wishing you the best of health,
Anthem Blue Cross
