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Please Take the Cigna / ASH Insurance Survey – All Acupuncturists – Any State

Date/Time
03/29/21 - 04/01/21
All Day United States Eastern Time Zone


 

Acupuncturists in Maryland and other states on the East Coast have received letters from Cigna Health Insurance regarding their partnership with American Specialty Health (ASH) to deliver acupuncture services to their members.  Acupuncturists who are interested in providing in-network and out-of-network acupuncture services to Cigna members have been requested to enroll with ASH as a provider or terminate your contract with ASH by April 1, 2021.  Acupuncture services being administered by ASH will be effective on June 1, 2021.

The MAS Insurance Committee has been investigating this matter.  The Committee has found that many acupuncturists are struggling with this news and want to know what they can do about this situation. MAS is committed to keeping acupuncturists informed so that our patients may continue to receive our services.  MAS cannot tell you to not join or to opt-out of Cigna/ASH network.  MAS is providing you with information which is available to all acupuncture providers so that you may make an informed decision. Currently, MAS is working with our lobbyists to meet with Cigna to discuss the impact of their new partnership on the delivery of acupuncture services to their members.

Please complete the Cigna/ASH Survey so that we may collect data about your position on the Cigna/ASH partnership. The deadline to participate in the survey is March 31, 2021.

Below is a list of FAQs and concerns from acupuncturists received by MAS over the last several weeks.  This information may provide you with a few answers and help you to communicate with others about this new plan. We hope that this information is helpful. We will continue to monitor the situation. Please contact us if you have questions.

Sincerely,
Dr. Denise C Tyson, MBA, DOM, L.Ac.
President, Maryland Acupuncture Society

 
What does the Cigna/ASH partnership mean for acupuncture providers who accept Cigna patients? 
Cigna will no longer credential acupuncturists to provide services to their members as of June 1, 2021.  Cigna will not accept or process claims for acupuncture services, and all claims will be submitted to ASH for processing and payment.  If you are currently enrolled with ASH, you must terminate your contract by April 1, 2021 (90 days before start of new network) so that patients are notified.

Who is ASH?

As promoted on their website, American Specialty Health was started by building a chiropractic network with a brand focused on promoting musculoskeletal services.  There is a contradiction with including acupuncturists in this model which is built using their limited knowledge of East Asian Medicine. This is 2021 and the U.S. Health System has expanded to include the full scope of East Asian Medicine.  ASH delivers a plan for acupuncture services which does not consider up-to-date research, clinical evidence, and CPT coding policy and fee structures utilized by CMS and other payers.  ASH continues to use the word “Oriental” on their website which demonstrates their outdated and biased view of East Asian Medicine (1).  It is not beneficial to Cigna members to have their acupuncture benefits managed by a company who has shown a disregard and lack of knowledge of East Asian Medicine.

Acupuncturists are not exclusively musculoskeletal providers such as chiropractors, physical therapists, massage therapist, and fitness trainers. We practice a comprehensive medicine which goes beyond the musculoskeletal system and includes clinical evaluation and treatment of involving all the human physiological systems.   Misrepresenting the practice of East Asian Medicine to health insurance consumers violates the right of patients to receive the full benefits of acupuncture and other treatment methods as it is intended under the scope of practice in our state.  Furthermore, Maryland licensed acupuncturists are independent medical providers who do not require supervision from other types of health providers or a third-party administrator.  

Am I obligated to join Cigna’s third-party administrator, ASH?

No. Acupuncturists are not obligated to join the ASH network.  Cigna is ending all contracts with acupuncturists so if you wish to opt-out of your existing ASH network agreement or decide not to join the ASH network, you have a right to do so.  If you decide to opt-out or not join the new Cigna/ASH network, you may consider informing the Cigna Network Administrator listed on your letter with your reasons for not participating.

I do not wish to participate in this new plan, what do I tell my patients?

The following suggestion was shared with MAS and we are passing it along to you:
If you choose not to contract with Cigna/ASH, each provider needs to contact their Cigna patients and explain why they will no longer be in the network, and/or why they will not join the network. Sharing the reimbursement amount with patients may drive the point home. Patients need to complain to Cigna AND their Human Resources department, if their insurance is self-funded, or complain directly to Cigna if they purchase it directly.

We have been advised that Cigna WILL listen to patients, and of course, their employer will as well.  


Please note: This information cannot come directly from the State Association, it must come from Cigna’s members, your patients. A phone call is always more powerful if they can make the time. Below is the phone information we have been given along with a phone script to share with your patients, so they do not have to re-invent the wheel. 

Here is the information we were given: 
Phone: 1 (800) 244-6224

Include the following information:

  • Provider Name
  • Tax ID/NPI
  • Service address
  • Reason for termination
  • Effective Date

Sample Phone Script For Patients To Use

To (Cigna),

Because of the integration of Cigna with American Specialty Health for acupuncture services and the implementation of ASH’s significantly lower reimbursement rates, my acupuncturist of (X years) is terminating his/her contract with Cigna.  ASH reimbursement rates are so low that my acupuncturist cannot accept the rates and sustain his/her practice.  ASH severely limits the amount of time spent with patients to 1 unit which is just 15 minutes equaling around $40 per treatment.  A typical acupuncture treatment is 45-60 minutes, so this is not nearly enough time to give appropriate quality care. This change will end up costing my acupuncture practitioner, which is not sustainable for his/her practice.  For this reason, I will not be able to receive acupuncture treatments which I rely on for (conditions you get treated for). Please reconsider this drastic move on behalf of the best interest of your members and reinstate Cigna’s previous reimbursement rates.

Sincerely,
(Patient name).

What other information can my patients add to their letter to Cigna?

Your patients may also add information about how they were helped by their acupuncturist. We code for our time so your patient can describe their experience with the visits and how they have improved from each encounter to the next.  Writing from the heart with the truth is best.

Will the reimbursement for claims change?
Yes.  The acupuncture CPT codes for the 1st 15 minutes of needling (non-stimulated and stimulated) will be bundled with 1 unit of an additional 15 minutes of needling (non-stimulated and stimulated) and discounted to a flat rate with disregard to the actual procedure time.  This fixed pricing will result in approximately $40 to $50 per treatment.  Acupuncture providers complete SOAP notes, functional outcome assessments, physical examination, history, review lab reports, imaging reports, diagnose, and treat within the scope of practice of East Asian medicine.  Acupuncture is only one procedure within the entire body of this medicine, and it requires assessment and diagnostic expertise to form a treatment plan.  

This flat rate of $40 to $50 will not cover the provider’s patient care expense to deliver services.  The cost of delivering services during this COVID-19 pandemic has risen as providers purchase PPE and modify office spaces.  Acupuncture practices are primarily small businesses and will be negative impacted by this 70% reduction in the reimbursement rates.  Unfortunately, this change can lead to the unsustainability of many acupuncture practices.

Will acupuncturists be paid for Evaluation & Management codes?

Yes.  The E&M CPT codes will be discounted approximately 70% of the average reimbursed rate.  The formula does not account for the new 2021 E&M policy which includes non-face to face patient time and allows for coding for time or complexity.

Will acupuncturists be paid as out-of-network providers by the Cigna/ASH network?

In reviewing the agreements, it appears that providers may be paid out-of-network with the patient responsible for the outstanding balance if out-of-network benefits exists in the member’s health plan.  Providers should check with Cigna or ASH to verify.

The ASH Medical Necessity Review Form (MNR) appears outdated and includes the word “oriental” which has been deemed offensive by the Federal Government, is this form required?

In some of the insurance plans, this form is required after a few treatments to obtain authorization to deliver further treatment regardless of the number of annual authorized treatments.  ASH has a treatment authorization policy based on a limited and biased view of the practice of East Asian medicine.  Acupuncturists, which are how practitioners of East Asian medicine are typically referred, are educated in the U.S. and other countries in accredited master’s and doctoral level programs.  The study of acupuncture and herbal medicine includes a rigorous study of biomedicine, anatomy and physiology, pathophysiology, pharmacology, and various sciences along with a comprehensive study of acupuncture, herbal medicine, and other modalities.  Acupuncturists are trained to thoroughly document each patient encounter and routinely prepare comprehensive SOAP notes, evaluate medical necessity, create appropriate treatment plans, and report functional outcomes. 

The ASH Medical Necessity Review form and other required forms are a duplication of the acupuncturist’s routine documentation and is redundant since we primarily use the latest Electronic Health Record applications to create clinical documentation.  Consequently, the MNR form creates an unnecessary task using outdated paper forms compromising patient care time.  Completing this MRN form constitutes non-face to face time as described in the AMA CPT codes for the 2021 E&M for which we will not reimbursed appropriately under the Cigna/ASH plan.

Footnote:
1) East Asian Medicine refers to the practice of non-Western medicine usually associated with East Asian countries.  This term was adopted by MAS in 2019 in response to the national removal of the word “oriental” in public documents.  This medicine has a long, well documented history and may be referred to in many ways such as Asian Medicine, Acupuncture Medicine, Acupuncture and Herbal Medicine and Eastern Medicine without referring to “Oriental Medicine”.

Important Registration Instructions: Everyone – MAS Members and Non-MAS Members must LOG IN to the MAS website in order to register for live MAS events.
If you are an MAS member, you can login with the email where you receive MAS email communications.
If you are not an MAS member, but you receive MAS emails (or have attended MAS seminars in the past), then you may ALREADY be a subscriber and you can login with the email where you receive MAS email communications.
If you are not a member or a subscriber, you may register (for free) as a subscriber HERE(scroll down to the blue middle button that says register now)

Members and Subscribers who don't remember or have not yet set up their passwords can set/reset them HERE.





Please Take the Cigna / ASH Insurance Survey – All Acupuncturists – Any State

Date/Time
03/29/21 - 04/01/21
All Day United States Eastern Time Zone


 

Acupuncturists in Maryland and other states on the East Coast have received letters from Cigna Health Insurance regarding their partnership with American Specialty Health (ASH) to deliver acupuncture services to their members.  Acupuncturists who are interested in providing in-network and out-of-network acupuncture services to Cigna members have been requested to enroll with ASH as a provider or terminate your contract with ASH by April 1, 2021.  Acupuncture services being administered by ASH will be effective on June 1, 2021.

The MAS Insurance Committee has been investigating this matter.  The Committee has found that many acupuncturists are struggling with this news and want to know what they can do about this situation. MAS is committed to keeping acupuncturists informed so that our patients may continue to receive our services.  MAS cannot tell you to not join or to opt-out of Cigna/ASH network.  MAS is providing you with information which is available to all acupuncture providers so that you may make an informed decision. Currently, MAS is working with our lobbyists to meet with Cigna to discuss the impact of their new partnership on the delivery of acupuncture services to their members.

Please complete the Cigna/ASH Survey so that we may collect data about your position on the Cigna/ASH partnership. The deadline to participate in the survey is March 31, 2021.

Below is a list of FAQs and concerns from acupuncturists received by MAS over the last several weeks.  This information may provide you with a few answers and help you to communicate with others about this new plan. We hope that this information is helpful. We will continue to monitor the situation. Please contact us if you have questions.

Sincerely,
Dr. Denise C Tyson, MBA, DOM, L.Ac.
President, Maryland Acupuncture Society

 
What does the Cigna/ASH partnership mean for acupuncture providers who accept Cigna patients? 
Cigna will no longer credential acupuncturists to provide services to their members as of June 1, 2021.  Cigna will not accept or process claims for acupuncture services, and all claims will be submitted to ASH for processing and payment.  If you are currently enrolled with ASH, you must terminate your contract by April 1, 2021 (90 days before start of new network) so that patients are notified.

Who is ASH?

As promoted on their website, American Specialty Health was started by building a chiropractic network with a brand focused on promoting musculoskeletal services.  There is a contradiction with including acupuncturists in this model which is built using their limited knowledge of East Asian Medicine. This is 2021 and the U.S. Health System has expanded to include the full scope of East Asian Medicine.  ASH delivers a plan for acupuncture services which does not consider up-to-date research, clinical evidence, and CPT coding policy and fee structures utilized by CMS and other payers.  ASH continues to use the word “Oriental” on their website which demonstrates their outdated and biased view of East Asian Medicine (1).  It is not beneficial to Cigna members to have their acupuncture benefits managed by a company who has shown a disregard and lack of knowledge of East Asian Medicine.

Acupuncturists are not exclusively musculoskeletal providers such as chiropractors, physical therapists, massage therapist, and fitness trainers. We practice a comprehensive medicine which goes beyond the musculoskeletal system and includes clinical evaluation and treatment of involving all the human physiological systems.   Misrepresenting the practice of East Asian Medicine to health insurance consumers violates the right of patients to receive the full benefits of acupuncture and other treatment methods as it is intended under the scope of practice in our state.  Furthermore, Maryland licensed acupuncturists are independent medical providers who do not require supervision from other types of health providers or a third-party administrator.  

Am I obligated to join Cigna’s third-party administrator, ASH?

No. Acupuncturists are not obligated to join the ASH network.  Cigna is ending all contracts with acupuncturists so if you wish to opt-out of your existing ASH network agreement or decide not to join the ASH network, you have a right to do so.  If you decide to opt-out or not join the new Cigna/ASH network, you may consider informing the Cigna Network Administrator listed on your letter with your reasons for not participating.

I do not wish to participate in this new plan, what do I tell my patients?

The following suggestion was shared with MAS and we are passing it along to you:
If you choose not to contract with Cigna/ASH, each provider needs to contact their Cigna patients and explain why they will no longer be in the network, and/or why they will not join the network. Sharing the reimbursement amount with patients may drive the point home. Patients need to complain to Cigna AND their Human Resources department, if their insurance is self-funded, or complain directly to Cigna if they purchase it directly.

We have been advised that Cigna WILL listen to patients, and of course, their employer will as well.  


Please note: This information cannot come directly from the State Association, it must come from Cigna’s members, your patients. A phone call is always more powerful if they can make the time. Below is the phone information we have been given along with a phone script to share with your patients, so they do not have to re-invent the wheel. 

Here is the information we were given: 
Phone: 1 (800) 244-6224

Include the following information:

  • Provider Name
  • Tax ID/NPI
  • Service address
  • Reason for termination
  • Effective Date

Sample Phone Script For Patients To Use

To (Cigna),

Because of the integration of Cigna with American Specialty Health for acupuncture services and the implementation of ASH’s significantly lower reimbursement rates, my acupuncturist of (X years) is terminating his/her contract with Cigna.  ASH reimbursement rates are so low that my acupuncturist cannot accept the rates and sustain his/her practice.  ASH severely limits the amount of time spent with patients to 1 unit which is just 15 minutes equaling around $40 per treatment.  A typical acupuncture treatment is 45-60 minutes, so this is not nearly enough time to give appropriate quality care. This change will end up costing my acupuncture practitioner, which is not sustainable for his/her practice.  For this reason, I will not be able to receive acupuncture treatments which I rely on for (conditions you get treated for). Please reconsider this drastic move on behalf of the best interest of your members and reinstate Cigna’s previous reimbursement rates.

Sincerely,
(Patient name).

What other information can my patients add to their letter to Cigna?

Your patients may also add information about how they were helped by their acupuncturist. We code for our time so your patient can describe their experience with the visits and how they have improved from each encounter to the next.  Writing from the heart with the truth is best.

Will the reimbursement for claims change?
Yes.  The acupuncture CPT codes for the 1st 15 minutes of needling (non-stimulated and stimulated) will be bundled with 1 unit of an additional 15 minutes of needling (non-stimulated and stimulated) and discounted to a flat rate with disregard to the actual procedure time.  This fixed pricing will result in approximately $40 to $50 per treatment.  Acupuncture providers complete SOAP notes, functional outcome assessments, physical examination, history, review lab reports, imaging reports, diagnose, and treat within the scope of practice of East Asian medicine.  Acupuncture is only one procedure within the entire body of this medicine, and it requires assessment and diagnostic expertise to form a treatment plan.  

This flat rate of $40 to $50 will not cover the provider’s patient care expense to deliver services.  The cost of delivering services during this COVID-19 pandemic has risen as providers purchase PPE and modify office spaces.  Acupuncture practices are primarily small businesses and will be negative impacted by this 70% reduction in the reimbursement rates.  Unfortunately, this change can lead to the unsustainability of many acupuncture practices.

Will acupuncturists be paid for Evaluation & Management codes?

Yes.  The E&M CPT codes will be discounted approximately 70% of the average reimbursed rate.  The formula does not account for the new 2021 E&M policy which includes non-face to face patient time and allows for coding for time or complexity.

Will acupuncturists be paid as out-of-network providers by the Cigna/ASH network?

In reviewing the agreements, it appears that providers may be paid out-of-network with the patient responsible for the outstanding balance if out-of-network benefits exists in the member’s health plan.  Providers should check with Cigna or ASH to verify.

The ASH Medical Necessity Review Form (MNR) appears outdated and includes the word “oriental” which has been deemed offensive by the Federal Government, is this form required?

In some of the insurance plans, this form is required after a few treatments to obtain authorization to deliver further treatment regardless of the number of annual authorized treatments.  ASH has a treatment authorization policy based on a limited and biased view of the practice of East Asian medicine.  Acupuncturists, which are how practitioners of East Asian medicine are typically referred, are educated in the U.S. and other countries in accredited master’s and doctoral level programs.  The study of acupuncture and herbal medicine includes a rigorous study of biomedicine, anatomy and physiology, pathophysiology, pharmacology, and various sciences along with a comprehensive study of acupuncture, herbal medicine, and other modalities.  Acupuncturists are trained to thoroughly document each patient encounter and routinely prepare comprehensive SOAP notes, evaluate medical necessity, create appropriate treatment plans, and report functional outcomes. 

The ASH Medical Necessity Review form and other required forms are a duplication of the acupuncturist’s routine documentation and is redundant since we primarily use the latest Electronic Health Record applications to create clinical documentation.  Consequently, the MNR form creates an unnecessary task using outdated paper forms compromising patient care time.  Completing this MRN form constitutes non-face to face time as described in the AMA CPT codes for the 2021 E&M for which we will not reimbursed appropriately under the Cigna/ASH plan.

Footnote:
1) East Asian Medicine refers to the practice of non-Western medicine usually associated with East Asian countries.  This term was adopted by MAS in 2019 in response to the national removal of the word “oriental” in public documents.  This medicine has a long, well documented history and may be referred to in many ways such as Asian Medicine, Acupuncture Medicine, Acupuncture and Herbal Medicine and Eastern Medicine without referring to “Oriental Medicine”.

Important Registration Instructions: Everyone – MAS Members and Non-MAS Members must LOG IN to the MAS website in order to register for live MAS events.
If you are an MAS member, you can login with the email where you receive MAS email communications.
If you are not an MAS member, but you receive MAS emails (or have attended MAS seminars in the past), then you may ALREADY be a subscriber and you can login with the email where you receive MAS email communications.
If you are not a member or a subscriber, you may register (for free) as a subscriber HERE(scroll down to the blue middle button that says register now)

Members and Subscribers who don't remember or have not yet set up their passwords can set/reset them HERE.