Effective 9/1/25 Most Providence Health Plan claims processing and payments will be transferred to American Specialty Health (ASH)

exception: any state employees including Public employees benefit board (pebb) and university of oregon

What this means for existing clients:

Your "benefits" are technically the same, but the following will change because ASH's rules now apply: 

1. I am in-network with ASH, but ASH only covers a maximum of 30 minutes of acupuncture, so there will be a $120 surcharge ($60 per 15 minute unit x 2 units = $120) for a 60 minute treatment in addition to your normal copay/coinsurance/deductible. You can choose to pay my cash rate $150 per 60 minutes instead because this is probably cheaper for you. 

2. ASH requires medical necessity review after five treatments and only acute injuries/conditions are generally approved under medical necessity guidelines. This means that if you are coming to see me for any chronic conditions, prevention or maintenance you will only get to use five visits of your benefit max regardless of how many treatments you have available on your plan. 

ASH says this applies to all Oregon Providence plans, but I've been receiving conflicting information from Providence, so I strongly recommend that you contact your human resources department/union representative to confirm whether this applies to you/your plan. 

I understand that this may make it unfeasible for you to keep your appointments past 9/1/25, so if you would like to cancel any future appointments, please use your patient portal www.onpatient.com or text the clinic mobile #: 541-972-2837. Let me know if you would like to see me prior to 9/1/25, as I will likely extend my hours during the remainder of July and August to accommodate you if there is demand.

I am furious with Providence for doing this midterm when you don't have the opportunity to change insurance plans like you could during open enrollment, so here is the link to file a complaint with the Oregon State Insurance Commission if you share my sentiment: https://sbs.naic.org/solar-web/pages/public/onlineComplaintForm/onlineComplaintForm.jsf?state=or&dsw... Below is a template script of what to tell the commission that you can modify based on your situation:

"Providence's decision to transfer claims processing to American Specialty Health (ASH) midterm effective 9/1/25 is dramatically increasing my healthcare costs because ASH only covers a maximum of 30 minutes of acupuncture per day compared to 60 minutes with Providence, and is limiting access to my benefits because medical necessity requirements will no longer cover my chronic condition and/or preventative care. I think this is an insurance company abuse of power because I am subject to these changes with no recourse and no ability to change healthcare plans like I could during open enrollment. I implore you to force Providence to wait to make these changes until 1/1/26 when I have an opportunity to compare my current insurance with other plans and choose what best fits my needs."

I wish there was more I could do, but ultimately patients have the most power to create change, so let me know if there is anything I can do to support you. Please feel free to contact me if you have any questions, my clinic mobile #: 541-972-2837.