Blue Cross Blue Shield (BCBS), Aetna, and Cigna all use a third party administrator called American Specialty Heath Network (ASHN).  This company, based out of San Diego, California, acts as the coordinator of all Chiropractic and physical therapy benefits for these insurance companies.  ASHN determines the number of visits a patient is allowed to utilize.  That number starts at 5.  After the 5th visit, all subsequent visits must be pre-approved.  The problem is that ASHN rarely approves any additional visits.  Additionally, ASHN never approves a radiological study.  In simple terms, If your insurance plan utilizes ASHN, you, the insured, are paying for therapy visits that you will NEVER be allowed to use. If you have 20 visits on your plan, you are allowed to use 5.  If you have 60 visits on your plan, you are allowed to use 5, etc.  If you call your insurance company and ask them, they will state repeatedly that you are allowed to use the full number of visits on your plan, never revealing that they use a third party administrator.  If you specifically mention ASHN, only then will they reveal that they use them for "review of claims."  If you call ASHN, they will tell you that you need to direct all questions to your health plan. 

ASHN does a lot more than just "review" claims.  ASHN approves and denies visits, approves and denies claims,  ASHN processes the claims from the doctor's office,  and ASHN pays the Doctors directly (at a much lowered fee).   ASHN is operating as an insurance company while hiding behind the actual insurance provider.  These insurance companies are selling plans, with benefit levels, that the insured will never be allowed to utilize.  There are thousands of complaints online concerning ASHN, yet they are still allowed to operate.  Patients are paying high premiums to get a certain benefit level.  They should be allowed to use them.