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My Turn: Patients should be able to file electronic claims

A level playing field is needed

Posted: Wednesday, August 22, 2007

I haven't seen Michael Moore's "Sicko" yet, but I do have a health care horror story to share. It should send a little shiver through all those insured through the state of Alaska retirement system.

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There are a lot of us. In fact, there are so many of us that we stand a real good chance of making a difference if we want to. Read on and see if you want to lobby for a change that will give you - the patient - the same chance to get paid as your doctor.

On May 10, I went to the doctor. The doctor said I had to pay at the time of service. The service was expensive, so I was given the third-degree regarding payment. Could I pay? Would I pay? Yes and yes. I wanted the consultation, and I am insured by the state. I knew I would be reimbursed, so I handed over my credit card.

My mistake. Sometime after running my credit card, the doctor's office submitted a claim to my insurance company. This triggered a long chain of events that to date, some two months later, are not yet resolved.

Here's what happened. I mailed in my claim, marked paid, on or about May 20. The doctor's office filed a claim for the same services electronically on May 23. Doctors can file electronically; patients can't. Patients' claims must travel via U.S. mail.

According to the insurance company representatives, the claim that arrives first gets paid. My claim was in the insurance company system when the check was cut to satisfy the doctor's claim. The evidence of the discrepant claims was there, but the doctor's claim got paid because it arrived first. That's all. And it arrived first because it was shot through electronically, not because it was filed first. I filed first. The postmark says so.

To say I was astounded is to understate the depth of my depression at this turn of events. Being done out of nearly $400 is no small thing for a retiree.

Weeks of phone calls and letter writing go by. I still haven't been paid. As far as I know, the doctor has been paid twice. I have my credit card receipt as proof, and the insurance company reports the insurance check has been cashed. As of July 25, the insurance company reports that it is taking action through its fraud department. By my way of thinking, the insurance company owes me $380. I don't particularly care how they get it.

But now I want more than money, and here's where you, the public, the insured, come in.

I want insurance companies to let patients file their claims electronically so that the system eliminates its bias in favor of providers. If the policy is going to be that he who gets there first gets paid, then we should all have access to the same racetrack. I'd be content if the policy required everyone to use snail mail for their claims, not just the patients. One or the other, but not the dual system now in place.

What do you think? Let's get together and ask our insurance providers to give us - the patient patients - the same deal as the doctors. Let us file electronically too or level the playing field and require snail mail submission for everyone.

• Stephanie K. Scott is a retired special education teacher and Haines resident.



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