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Insurance Frustrations Have Patients Feeling Left Out

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RALEIGH — Lawmakers on Capitol Hill are arguing over the best ways to protect patients' medical rights. A key issue is to keep patients from feeling like the odd ones out as managed health care groups and doctors spar over what is covered and what is not.

If you have ever had trouble getting an insurance claim paid, you know how frustrating it is to be caught in the middle between your doctor and your insurance company.

SomeWake Countydermatologists are putting an end to that frustration by simply resigning from a major HMO, and that leaves their patients out in the cold.

"I'm dreading calling Healthsource and trying to get some information from them," said Sue Sager.

Sager received the bad news at her medical appointment Tuesday. The dermatologist she had been seeing since her last doctor stopped participating with her insurance company was also dropping her.

"I just couldn't believe it. I could not believe that this was happening a second time to me, and that I would have to look for another physician," said Sager.

The doctors at Wake Dermatology Associates say they are droppingCigna-HealthsourceJuly 26 because so many claims have not been paid.

"Many of them are still pending. I've got sheets of claims that they just have not paid properly," said Dr. Mendall Jordan, a dermatologist.

In addition to unpaid claims, Jordan says Healthsource has tried to get refunds on claims it did pay.

Jordan says he is not the only dermatologist who has had problems with Healthsource. The HMO admits it has lost eight dermatologists in Wake County this year.

In a statement, it says the 13 currently on its list "meet nationally accepted standards for accessibility and availability." The stateDepartment of Insuranceaccepts the answer.

"Turnover happens in a network situation, so that in and of itself is not particularly troublesome," said DeAnne Nelson of the Department of Insurance.

But it can be troublesome to patients who now have to start over with doctors they do not know.

"I'm not sure what I'm going to do," said Sager.

Healthsource says it is reviewing its payment policies to see if changes need to be made, but it may not have a choice.

The Department of Insurance will soon be conducting a regular audit to examine how the HMO processes claims and the turnaround of doctors in its network.

In the meantime, if you want to know what your rights are as a patient, you can get an insurance guide by calling1-800-546-5664.