How the Cigna and American Specialty Health Provider Updates Are Impacting Acupuncture Practices

The acupuncture industry has seen many significant changes since the start of 2021. Recent changes in policies are impacting how acupuncturists provide services for Cigna members. 

Let’s review what you need to know about the Cigna-ASH policy changes. 

What Changed With Cigna and American Specialty Health (ASH)?

American Specialty Health Provider is taking over processing and payment for Cigna members for many states. Cigna is no longer credentialing acupuncturists to provide services to members or accepting or processing any claims. They decided to partner with ASH to facilitate all claims for various specialty services, including acupuncture. 

If acupuncturists wanted to stay in-network for Cigna members, they needed to join ASH by September 1, 2021. If they did not join ASH, they opted to provide out of network services for Cigna members moving forward.

The Cigna and the American Specialty Health Provider | Timeline

Acupuncturists are facing some hurdles when it comes to servicing Cigna members. Here’s a brief overview of what happened with the American Specialty Health Provider taking over claims for acupuncture services within the Cigna network.

• January 2021 — Cigna announced that claims for acupuncture services will no longer be processed by Cigna and will be managed by the American Specialty Health Provider (ASH), effective in June 2021. This update doesn’t impact California, Oregon, Washington, and Tennessee.
• May 2021 — Cigna and the American Specialty Health Provider announced an extension of the deadline for joining to the American Specialty Health Provider, moved from June 1 to September 1. 
• September 1, 2021 — The deadline for maintaining an in-network status passed on this day. 

Now that the deadline has passed, any provider who did not join ASH is no longer considered in-network for Cigna members. 

How This Cigna ASH Update Will Impact Your Acupuncture Business

As noted, if you wanted to stay in network for Cigna members, you needed to join to the American Specialty Health Provider before the deadline in early September. But remember, there are a lot of considerations to assess when looking at whether or not joining ASH suits your business needs. 

By joining to the American Specialty Health Provider, you’re able to service Cigna members as an in-network provider. This often means you’ll get a lot more patients.

But remember, just staying in network doesn’t mean joining ASH is necessarily valuable for your business. You should review your client base to determine how many patients are coming to you from Cigna. 

How are they finding your practice? Are they coming to you because you’re in the network? Or are they simply coming to your practice without any regard for the network?

If joining ASH will get you access to more patients, this decision seems to be pretty simple to make. But you need to remember that ASH rates are impacting how much money you’re going to make for each patient. 

In-Network and Out-of-Network Benefits 

If you stay within the network for Cigna members, you are held to the amount you can charge. For example, here’s a breakdown of in-network billing:

• $250 total charge
• Fees discounted $75 to $175 for patients using in-network providers
• The plan pays $140, and the patient pays $35. 

On the other hand, if you decide to not join ASH, you’re going to be out of network. Here’s a breakdown of billing for out of network:

• $250 total charge
• No discounts for practices that are out of network
• The plan pays $140, and the patient pays the remaining balance of $110. 

As you can see, there are pros and cons to both decisions for acupuncturists. 

What’s Next for Acupuncture Services for Cigna Members?

Practitioners are either joining ASH or terminating their contacts with Cigna. In fact, many acupuncturists are encouraging their patients who are Cigna members to directly contact Cigna to express their disapproval. 

Unfortunately, a lot of small business owners in specialty practices are being put in a difficult situation — either accept ASH’s lowered reimbursement rates to continue providing services for Cigna members or terminate their Cigna contract to opt out-of-network. 

So while staying in-network can attract more patients who are Cigna members, you’re making less money per patient at ASH’s current reimbursement rates. And out of network providers can make more per patient, but they likely lose patients who are looking for in-network providers. 

Streamline Acupuncture Billing With HBS

Make sure you’re maximizing your acupuncture billing so you can increase your revenue and grow your business. 

Holistic Billing Services is an experienced acupuncture billing provider. Our team can help your practice navigate the intricacies of insurance billing claims to help you hit your revenue goals and reduce the amount of denials. 
To learn more about Holistic Billing Services’ acupuncture billing services, talk to one of our billing and coding experts today.

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