American Speciality Health Group (ASHG) Denials

Were your health insurance bills denied or reduced by a health insurer based on a Peer Review by American Speciality Health Group (ASHG)?

ASHG is a third party administrator for Cigna and several other health insurers. ASHG basically makes a recommendation to the insurer advising if the the treatment was necessary or if a patient was “over treated” with too much physical therapy/chiropractic. Sometimes ASHG will determine if there is enough documentation regarding whether an MRI was necessary. ASHG cites to medical journals and publications to justify its position.

We all know that insurance companies save a lot of money by not paying bills so it makes financial sense for insurers to hire an “independent” company like ASHG to “review” (ie second guess) the treating physician’s care without ever having to see the patient. ASHG acts as a middleman who allows the insurance companies to claim the reviews are “independent.” In other words, the insurer keeps its hands clean while letting ASHG be the bad guy for recommending denial.

If any of your health insurance bills were denied/reduced as a result of a “review” on one of your patients please call our office for a free consultation over the phone. We represent medical providers whose bills have been improperly denied/reduced by health insurers. We handle these claims on a contingency basis and have been successful in the past in getting these decisions overturned and the medical bills paid.

This blog is not meant to bash ASHG or any health insurers that use their services. Sometimes ASHG is responsible for stopping care that many medical professionals would consider over-utilization. It definitely has its place in the checks and balance system. However, it is my belief that these “independent” third party administrators, in some cases, are not as independent as they claim to be and are often biased in favor of the insurers that keep them in business.


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