Important information for members who get acupuncture, chiropractic, occupational therapy and physical therapy services
Beginning January 1, 2020, Horizon BCBSNJ plans to collaborate with American Specialty Health (ASH) to implement and administer our Chiropractic & Physical Medicine Services Program, which will include the following services:
- Occupational Therapy
- Physical Therapy
It has come to our attention that some health care professionals and associations are relaying false information about this program to their patients and the public. We want to make sure you have the correct information.
Any claim that there will be any change to the benefits Horizon BCBSNJ members have for chiropractic, acupuncture, occupational therapy or physical therapy care is absolutely false. There are no changes to a member’s cost sharing responsibilities or to the quantity of services members can receive under their health plan.
No approval required when you need to get care
There are no new pre-authorization requirements being imposed by ASH or Horizon BCBSNJ as part of this program. You will not be required to get any visits or services pre-approved. Any provider who is in-network with ASH is required to hold members harmless of any financial responsibility if they provide services to members and those services are determined by ASH to not have been medically necessary.
Below are answers to questions you may have.
What is American Specialty Health (ASH)?
American Specialty Health (ASH) is a personal health improvement company. Pending regulatory approval, ASH will offer clinical benefits, fitness programs, health coaching and provider network management to improve the overall health of members as part of our Chiropractic & Physical Medicine Services Program. ASH is a recognized leader in collaborating with providers in New Jersey and across the country to manage the network of providers delivering these specialty services. ASH works with two health plans here in New Jersey, more than 20 Blue Cross Blue Shield Plans around the country, and over 100 health plans nationally. More than 40 million Americans are covered by a health plan that relies on ASH’s proven Clinical Performance System for chiropractic, physical therapy, occupational therapy and acupuncture services.
What does ASH do as part of this program?
ASH will oversee the care health care professionals in these specialties to make sure you get the care you need, when you need it. ASH works with health care professionals to ensure that treatment plans reflect clinical best practices and are based on clinical evidence, medical necessity and patient history.
Are my benefits changing?
This program will not impact your covered benefits in any way. There are no changes to the number of visits covered by your plan and no change to your cost sharing responsibility(deductible, copayment or coinsurance) for these services.
Is my health care professional participating?
Many of the providers who are in-network with Horizon BCBSNJ already participate in ASH’s network in New Jersey and participate in ASH’s evidenced-based Clinical Performance System (CPS). Every provider who is in Horizon BCBSNJ’s network is being invited to join ASH’s network. ASH will also be recruiting nonparticipating health care professionals to ensure that our members are able to maximize their in-network benefits.
What if my health care professional is out of network?
You will likely incur higher out-of-pocket costs for visiting an out-of-network provider. If you have coverage for out-of-network services, claims for the out-of-network services will be processed according to your health plan’s out-of-network fee schedule.
You will be notified if your health care professional will not be in-network beginning January 1, 2020 and given information on how you may be able to elect to continue treatment. This treatment may be available for a period of four months from January 1, 2020 through April 30, 2020, or you may select a new health care professional.
Out-of-network providers are also subject to the Medical Necessity Determination review process as with in-network providers. Your provider may have to provide documentation that supports a determination of medical necessary. This typically occurs after the fifth patient visit as part of their reimbursement.
What tools are available to members as part of the ASH program?
Our collaboration with ASH will give you access to new tools and resources to improve your care. You will be able to:
- Use Virtual Physical Therapy services instead of more expensive services in a hospital-based outpatient setting or stand-alone clinics
- Register with EmpoweredDecisions! a self-service care web and mobile platform. EmpoweredDecisions! offers:
- Digital and live coaching services
- Exercise videos
- Educational content and action steps
¹American Specialty Health Group, Inc. is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in the administration of chiropractic and physical medicine services. American Specialty Group, Inc. is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.