Blue Shield Coverage–Big Changes for Some in 2020If you might have anything to do with Blue Shield in the new year, please read this
. We hate fine print, but even more than that we hate insurance surprises, so I've tried to outline all the information that could affect you.
The Change: We have been informed that acupuncture benefits for some Blue Shield California PPO plans will be managed by a third party, American Specialty Health (ASH), beginning Jan 1, 2020. Due to this change, we will no longer be in-network providers for Blue Shield California PPO plans that are managed by ASH in the new year.
ASH’s policies prevent us from providing the quality of care that our patients deserve and are crippling to a small business. ASH pays acupuncturists up to $41 per visit, including the patient’s copay. In addition, ASH requires an overwhelming amount of paperwork and claims are often denied. One of the most egregious policies they have is that after 5 treatments, the provider is required to submit a lengthy request for more treatments, which is often denied. Patients are often left wondering why they have 20 visits per year in their policy, but can only use 5. If you are interested in getting a feel for why we do not contract with ASH, we suggest looking at their Yelp page www.yelp.com/biz/american-specialty-health-san-diego.
Which Plans: As of right now there is still a lot of uncertainty as to exactly which Blue Shield of California plans will be affected and how the billing will work, despite the concerted efforts of the California acupuncturist community and billers. As I understand it:
If your insurance is anything other than Blue Shield of California PPO these changes do not affect you.
This change should not affect Federal Employee Blue Shield plans, out of state Blue Shield plans, and “self-funded” Blue Shield plans which are large group plans funded through your employer. These plans do not have a metal in their name.
This change will affect Covered CA Blue Shield PPOs and all “fully-funded” Blue Shield California PPOs such as small business, non-employer individual and family plans. These plans all have a metal in their name.
We’ve been told that Blue Shield will not verify the new year benefits until Jan 1, 2020 and, based on our experience, we expect the information to be inaccurate for some time into the new year. We recommend that you get in touch with your broker or Blue Shield representative to inquire if your plan will be administered through ASH in 2020.
In Our Office: Starting January 1, 2020 at Thrive, patients that have Blue Shield California PPO plans that are managed by ASH will no longer be able to use their insurance benefits at our office. Because of the amount of paperwork and likelihood for denial, will will not be billing out of network for these plans. Normally we can offer out of network patients a superbill for you to submit to your insurance company for reimbursement, but we’ve been told that Blue Shield California PPO plans that are managed by ASH will not accept superbills from patients.
It is my desire to continue serving you and I hope you continue care with us. For those patients the time of service discount rate will apply to visits in our office. This rate includes the following options:
Per Treatment Payment:
Prepayment Plans Terms and Conditions:
This office offers two prepayment plans for patients paying at the time of service. In return for the patient's agreement to prepay for a specific number of visits in advance, the patient is offered free treatment(s).
- $500.00: With the purchase of 5 treatments at $100/treatment, the patient receives one treatment for free, for a total of 6 treatments. ($83.00 per treatment)
- $900.00: With the purchase of 9 treatments at $100/treatment, the patient receives two treatments for free, for a total of 11 treatments. ($81.00 per treatment)
Sad Times For Chinese Medicine (and Chiropractic and Physical Therapy): I am very disappointed that this change represents a step in the wrong direction for patients’ access to Chinese Medicine. I first got enough acupuncture that made a difference to my health in 2000 when my insurance was covering part of my treatments. I love it when insurance pays for a portion of a patient’s treatments. And these changes will be affecting Chiropractic and Physical Therapy providers too. I hate these changes and I hate having to tell you about them.
The California acupuncturist community is in an uproar as we feel we’re being forced to go out of network which means many of our businesses are going to take a hit and our patients will suffer. Many patients will be forced to change the frequency of treatments or give up treatments entirely. It’s heartbreaking to me to think of all the people with less options for their medical care. All the people with less access to life changing acupuncture care and the hope is provides.
Questions: Please don’t hesitate to contact us with your questions and concerns about how this may affect you. We will do our best to help you understand what we know at this point. And don’t forget to use your benefits for the rest of 2019.
Upcoming EventsInterested in feeling more peace of mind? Like to have more energy? Want to reduce your inflammation and improve your immune system? Join us for our October state of mind workshop to learn the inside-out understanding that allows people to thrive regardless of circumstances.
In this uplifting workshop you’ll learn how your mind works, so you can enjoy more peace of mind and:
- Supercharge your performance
- Improve your relationships
- Enter the healing zone
Because less mental stress (worry, rumination, over-analysis, frustration, guilt) isn’t just more enjoyable, it’s correlated with better physical health. And the bonus is that when you understand your state of mind better, it’s easier to make better decisions to support your health.
Seats are limited, so click this link to find a date that works for you and register:
What We’re Treating in the ClinicColder temps mean achey joints for some people. And boy have we had some cold mornings so it's no surprise that patients have been asking for more support for their joints lately. The great news us that acupuncture isn’t just great at reducing joint pain, it also reduces inflammation and supports joint repair. Plus I have lots of great recommendations for herbs and diet to support your joints.
Existing patients can book online here. Make sure you get a confirmation email and click "CONFIRM" in that email. You are always welcome to call or email us if you prefer to schedule that way or you’re not finding any appointments that work for you online.
New patients need to call or email us to set up their first appointment because there is just too much information we need to share with you.
Christina Ness-Hawks, LAc