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AHCCCS slow to pay out-of-state claims for HIV and AIDS patients

KINGMAN – Scott Blankenship was diagnosed positive 22 years ago with HIV, a virus in the blood that often later turns into Acquired Immune Deficiency System and is fatal.

In mid-March, Blankenship received a letter from Dr. Michael Karagiozis, an HIV and AIDS specialist practicing in Henderson, Nev. Karagiozis informed Blankenship that he was ending their physician/patient relationship due to non-payment of claims for care submitted to Arizona Physician’s IPA, one of two insurance carriers (along with Health Choice) for the Arizona Health Care Cost Containment System.

AHCCCS is the state equivalent to Medicaid.

“I’ve been seeing Dr. Karagiozis for more than seven months and just found out he has not been paid by AHCCCS for more than 18 months for Mohave County patients he sees with HIV or AIDS,” Blankenship said.

Blankenship said Karagiozis is the closest HIV and AIDS specialist and now those Mohave County patients face the unwelcome prospect of longer duration travel to Flagstaff or Phoenix for treatment and to receive prescriptions they need.

“What AHCCCS doesn’t seem to understand is people with HIV or AIDS are not supposed to be stressed out over where their medical providers are,” Blankenship said.

Blankenship receives assistance from Housing Opportunities for People Living with Aids and HIV (HOPWA) in Clark County, Nev. HOPWA provides him with financial help in paying for rent, utilities and food vouchers. But the agency can only help with payment to doctors for care when funding is available, which it presently is not.

He was in Virginia dealing with a death in the family March 15 when he learned of the non-payment of APIPA claims, Blankenship said. He contacted Karagiozis’ office and was told his appointment for March 20 was cancelled.

Several additional phone calls to AHCCCS and Karagiozis’ office managed to get him one last appointment that he kept March 24.

Richard Sgaglio, office manager for Karagiozis, said AHCCCS has made a few smaller payments of past claims. But it has an outstanding debt of about $6,000 with Karagiozis for treatment of HIV and AIDS patients from Mohave County.

“Our billing company has had issues with them for over a year,” Sgaglio said. “We’ve tried everything to get them to pay, but I’m afraid it’s bureaucracy.

“We’re out-of-state and evidently they don’t want to pay for patients they came to us and asked to treat in the first place. The claims sent to them have always been a problem as far as payment.”

Sgaglio estimated Karagiozis was seeing 25-30 patients from Mohave County at the time the “patient termination letter” was mailed out.

A portion of that letter reads as follows:

“The simple reality of the situation is that the program administrators for Arizona Medicaid have deliberately withheld the medical payments that are your legal right. There is no legitimate explanation for this refusal to pay for your medical care, except that the program administrators have obviously decided to keep the money legally assigned to you through the federal government for other purposes.

“Although the state of Arizona contracted my office to provide services to HIV patients in the Mohave County area over the past 18 months, they have refused to honor their financial obligations to pay for your healthcare. We have tried countless times to rectify the situation, but Arizona will not cooperate.”

Sgaglio went on to say Karagiozis would again schedule appointments with Mohave County HIV and AIDS patients if AHCCCS would pay 50 percent of the outstanding bill now and promise to make good on the remainder of the debt in a reasonable amount of time.

According to information on the APIPA Web site, providers should allow 45 days for processing of claims following submission of the member’s ID number, date of service, procedure code, amount billed, provider ID number and claim number (if known).

A representative of APIPA was contacted and said no information about any patient could be given out due to federal Health Insurance Portability and Privacy Act laws, unless the patient first contacted them and said it was OK.

Blankenship was re-contacted. He called APIPA and spoke with a supervisor who would only give her first name of “Linda.” She told him his claim had been paid in full as of March 22 and added she would not speak to any reporters.

However, Blankenship said he also contacted the office of Karagiozis and was granted an appointment for April 21.