By Thomas Vincz, Public Relations Manager

Recent studies have shown that up to 30 percent of health care costs have been linked to tests, procedures, and treatments that provide no real benefit to a patient. While these services do not improve health, they do lead to higher health insurance premiums and out-of-pocket costs.

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) has, for more than ten years, been working with providers who want to improve health care quality, affordability, and experience. From primary care doctors to specialists to New Jersey’s hospital systems, we are partnering to deliver better care, not just more care.

On August 1, 2019, we took another step toward improving quality, cost and experience for our members. We announced our plans to launch a new collaboration with American Specialty Health (ASH), one of the nation’s leading providers of value-based programs and care platforms for acupuncture, chiropractic, occupational therapy and physical therapy services.

ASH is an industry leader in collaborating with thousands of providers in New Jersey and across the country to drive care for patients that is based on peer-reviewed clinical evidence, individual patient history and independently established best practices. ASH’s member satisfaction surveys indicate that more than 98 percent of patients treated by a provider who participates in ASH’s network are satisfied with their care.

Here are Six Things to Know about Horizon’s new collaboration with ASH and Four Facts To Set The Record Straight for our members who use these specialty services.

Six Things to Know:

1. This new network strategy is good news for our members who utilize acupuncture, chiropractic, occupational therapy and physical therapy services. It helps better ensure that your providers’ treatment plans are safe and effective. The program integrates evidence-based treatment guidelines with clinical best practices, specialized peer-to-peer engagement and advanced reporting and analytics to promote the overall health of members who use these services.
2. There are no changes to a member’s cost-sharing responsibilities (deductible, co-pay, or coinsurance) for acupuncture, chiropractic, occupational therapy and physical therapy services.
3. The number of visits covered by members’ plans to their chiropractic, physical therapy, occupational therapy, and acupuncture services remains the same.  Nothing about the collaboration with ASH changes in any way those benefits.
4. Every provider who is in-network with Horizon BCBSNJ is being invited to join the ASH network so unless a provider declines to join ASH’s network, there should be no disruption in your choice of provider. ASH will also be recruiting non-participating providers too, to ensure that our members have broad access and choice of in-network providers and are able to maximize their in-network benefits.
5. Through ASH’s evidenced-based Clinical Performance System (CPS), your chiropractor may be asked to document that your treatment plan is meeting peer-reviewed, evidence-based standards after a certain number of visits.  This will occur through a review process known as “Medical Necessity Determination” (MND) review; this process will occur between the provider and ASH and will be transparent to our members.
6. This program is familiar to your provider, as many health insurance carriers operating in New Jersey already have some form of MND review required for these types of services.  In fact, Horizon BCBSNJ is the last major carrier in New Jersey to institute this process.

Four Facts to Set the Record Straight:

1. Horizon BCBSNJ is imposing NO new pre-authorization requirements impacting our member’s benefits with this new ASH collaboration.
2. Medical necessity review is done promptly and efficiently. This program is familiar to your provider, and many health insurance carriers operating in New Jersey already have some form of MND review required for these types of services. ASH takes 24 hours or less on average to complete its review.
3. Patients are not required to have services or visits pre-approved. Providers have the responsibility to interact with ASH to provide information supporting medical necessity. 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.
4. 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.

ASH has a proven track record of working collaboratively with providers in New Jersey and across the nation.  We are confident that this collaboration will further promote quality care and affordable coverage that Horizon members deserve.

Disclaimer: ASH is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in the administration of acupuncture, chiropractic, occupational therapy and physical therapy benefits. ASH is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey. Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross Blue Shield Association.