Medical Billing Forum

General Category => General Questions => Topic started by: cardinal on June 08, 2009, 02:51:45 PM

Title: American Specialty Health Network
Post by: cardinal on June 08, 2009, 02:51:45 PM
Hello all,

I have just signed a Chiro and her previous biller encouraged her to no longer be contracted with American Specialty Health.  The doctor has become frustrated with little or no payment from Anthem CA due to not being enrolled with American Specialty.  Does anyone have any input and or experience with Amercian Specialty?  I have heard good and bad.

I would like to have as much info as possible as the doctor is asking me to help her decide about re-enrolling.

Thanks much
Title: Re: American Specialty Health Network
Post by: PMRNC on June 08, 2009, 03:07:12 PM
What I do in that situation is pull reports showing adjustments and claims by carrier so that I can analyze whether or not it is beneficial to the provider to stay participating. This is why it is so important to keep a good database in your PM software. You really can't go by whether it's a good carrier or not, you have to take in all the circumstances of that particular practice.
Title: Re: American Specialty Health Network
Post by: Pay_My_Claims on June 16, 2009, 11:00:49 AM
I have a similar situation with my provider Linda. We are non-par with Aetna, and almost became a network provider. It took us a long time to come out of network with them the first time since the reimbursements are low. We spent month's on a client to provide her with the chair she needs, but she changed insurance mid stream, and her Aetna has no OON benefits. We wanted to get non par provider approval, but they found someone that was within the area that could provide her the chair. We explained to him what the reimbursement would be, but he apparently got some special consideration from Aetna and has negotiated a larger amount. Well now my provider wants to be in network so he can negotiate. I said WTF??? Don't let one case make you sign your life away. The benefits of one case will not make this practice. We would not be able to negotiate on all cases especially being a network provider. The reports you speak of are very vital to show relevance in situations such as mentioned by the poster.