Is Cigna the same as American Specialty Health?
No, Cigna and American Specialty Health (ASH) are separate corporate entities, but they have a long-standing business relationship.
The Relationship Between Cigna and ASH
- Third-Party Manager: Cigna Healthcare contracts with ASH as an external benefit management contractor and ancillary provider.
- Delegated Services: ASH manages specific specialty care networks and administrative tasks for Cigna. This includes network management, credentialing, claims processing, and medical necessity reviews for certain services.
- Covered Services: ASH typically handles specialized care lines for Cigna members, such as physical therapy, occupational therapy, chiropractic care, and acupuncture.
When ASH handles these services for Cigna plans, patients and providers may interact directly with ASH portals (like ASHLink) for authorizations and claims, even though the underlying health insurance plan is issued by Cigna.
Why are doctors dropping Cigna insurance?
Doctors and medical groups are dropping or considering dropping Cigna Healthcare primarily due to its controversial automatic downcoding policy for office visits and ongoing reimbursement and contract disputes.
Automatic Downcoding Policy
- Lower Payments: Cigna implemented a policy that automatically "downcodes" higher-level Evaluation and Management (E/M) office visits (such as levels 4 and 5) to lower levels without reviewing the actual medical records.
- Administrative Burden: Instead of getting paid appropriately by default, physicians are forced to file tedious, time-consuming written appeals with full documentation to reverse the downcoding, taking time away from patient care.
- Regulatory Pushback: Medical associations and state regulators—such as the Maryland Insurance Administration—have pushed back or ordered halts on these types of automated underpayment practices, citing legality and fairness concerns.
Contract and Reimbursement Disputes
- Profit Pressures: Major for-profit insurers face pressure to improve margins, leading to aggressive utilization of automated claims adjustments, strict prior authorizations, and low reimbursement rates.
- Network Terminations: Health systems and independent physician groups frequently clash with Cigna during annual contract renewals over fair compensation, resulting in some regional networks dropping Cigna coverage entirely.
What is Cigna health now called?
Cigna's Medicare business is now called HealthSpring.
Key Details of the Change
- The Buyer: Health Care Service Corporation (HCSC) bought Cigna’s Medicare Advantage, Medicare Part D, supplemental benefits, and CareAllies businesses.
- The New Name: HCSC rebranded these Medicare products under the HealthSpring name.
- Main Cigna: The broader commercial Cigna Healthcare company still exists and operates under the Cigna name; only the Medicare-related division changed.
Who owns American Specialty Health?
American Specialty Health (ASH) is a privately held, independent company owned primarily by its co-founder, chairman, president, and CEO, George DeVries III.
Company Overview
- Type: Privately owned and independent
- Founder & CEO: George DeVries III
- Founded: 1987 in Southern California
- Headquarters: Carmel, Indiana, and San Diego, California
What is American Specialty Health insurance?
American Specialty Health (ASH) is a national specialty health organization that manages and administers benefits for musculoskeletal care, physical therapy, and wellness programs.
🔎 What ASH Provides
- Musculoskeletal Networks: Manages care for chiropractic, acupuncture, physical therapy, and occupational therapy.
- Fitness Programs: Offers fitness center memberships and home exercise tools like Silver&Fit.
- Health Plan Support: Partners with major insurance carriers and Medicare Advantage plans to administer specialized care.
📊 Key Program Features
- Coverage Reach: Serves tens of millions of members nationwide.
- Cost Control: Uses targeted site-of-care options to lower therapy expenses.
- Digital Tools: Provides virtual physical therapy and self-care recovery platforms.
Episode 20: Keeping Your Therapy Clinic In Network with Cigna and ASH
Is Cigna considered the worst health insurance company?
No, Cigna is not universally considered the worst health insurance company, though it receives mixed reviews and heavy criticism from individual consumers online.
Industry Rankings and Professional Perceptions
- Employer and B2B Praise: Industry groups often rank Cigna well. For example, The Leapfrog Group ranked Cigna high among national health plans for focusing on healthcare quality and value from an employer perspective. Medical and hospital system surveys also rate Cigna as relatively trustworthy compared to some peers.
- General Insurer Scores: Publications like Insure.com place Cigna in the middle or upper-middle tier for customer service and digital tools, though they note that affordability and high deductibles remain drawbacks.
Common Consumer Complaints
On consumer review platforms like ConsumerAffairs, WalletHub, and the Better Business Bureau, individual ratings are heavily negative. Common member frustrations include:
- Claim Denials: Frequent complaints regarding rejected coverage for procedures, MRIs, and specialized prescriptions.
- High Costs: High out-of-pocket expenses, deductibles, and unexpected billing issues.
- Customer Support: Long wait times and difficulties reaching helpful representatives.
What insurance company is taking over Cigna?
Health Care Service Corporation (HCSC)—the parent company of several Blue Cross Blue Shield plans—completed the acquisition of The Cigna Group's Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D, and CareAllies businesses on March 19, 2025.
Key Details of the Transition
- Rebranding: Cigna's Medicare Advantage and Part D plans have transitioned to operate under the HealthSpring brand.
- Medigap Policies: Certain Cigna Supplemental (Medigap) policies are transitioning to subsidiaries like Medco Containment Life Insurance Company (MCLIC), an HCSC subsidiary.
- Operations: Cigna's Evernorth Health Services continues to provide pharmacy benefit management for these plans under a multi-year agreement.
- Core Cigna: Cigna as a whole is not being acquired; Cigna continues to operate its commercial, employer-sponsored, and individual health insurance portfolios.
Is Cigna and Blue Cross Blue Shield the same thing?
No, Cigna and Blue Cross Blue Shield are not the same thing; they are completely separate health insurance companies.
Key Differences
- Company Structure: Cigna operates as a single national corporation. Blue Cross Blue Shield is a federation of 33 independent, locally operated companies and licensees that vary by state.
- Networks and Availability: Both offer large national and global provider networks, but their specific doctor availability, plan options, and pricing depend heavily on your local geographic area.
- Recent Business Changes: Health Care Service Corporation (the parent company of several Blue Cross Blue Shield plans) acquired Cigna's Medicare business, but the core corporate entities for their regular commercial individual and employer health plans remain entirely distinct.
What is the best health insurance company?
Kaiser Permanente is widely ranked as the best overall health insurance company in the U.S. for its high customer satisfaction, integrated care, and affordability, though availability is limited to select states.
Top Health Insurance Providers
- Kaiser Permanente: Best overall and most affordable where available, offering combined insurance and medical care in eight states and Washington, D.C.
- Blue Cross Blue Shield (BCBS): Best for nationwide coverage and PPO plan options, featuring a massive network of doctors and hospitals.
- UnitedHealthcare: Best for large network reach and low complaint rates across 30 states, though average individual premiums can be higher.
- Aetna (CVS Health): Best for customer service and low consumer complaints, with added perks like minute-clinic co-pays.
What changes will Cigna make in 2026?
Cigna is implementing several major operational, branding, and policy updates, highlighted by rebranding its Medicare business to HealthSpring after selling it to Healthcare Service Corp.
Medicare and Brand Changes
- HealthSpring Return: All existing and new Cigna Medicare plans transition to the HealthSpring brand.
- Visual Identity: The new brand features purple as its primary color while keeping benefit consistency.
Customer Experience and Accountability
- Transparency Reports: Cigna publishes its first annual customer transparency report focusing on customer care and resolution stats.
- Executive Pay: Leader compensation is directly tied to customer satisfaction scores.
Prescription Drug and Formulary Updates
- Tier and Rule Shifts: Cigna updates standard and specialty drug lists, moving certain medications to higher or lower tiers and adding new prior authorization rules.
- Coverage Adjustments: Specific policy updates alter coverage for weight management drugs, growth disorders, and pain medications. You can review broader plan details in the Cigna Health Insurance Plans documentation.
Medical and Policy Guidelines
- Prior Authorization: Cigna adds new CPT and HCPCS codes to its pre-certification lists.
- Service Criteria: Updated guidelines adjust coverage criteria for medical devices, musculoskeletal management, and specific surgical procedures.