Many thanks to the reader who sent us this:
Check out the lead story over at the LA Monitor today. Seems LANS and UHC are trying to stiff some employees on paying for their medical bills.
The employees have started up a blog ( vmans.blogspot.com ) that details their problems with LANL HR and UHC.
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LANL Employees Protest Insurance Lapse
By Roger Snodgrass, MONITOR EDITOR
A group of employees at Los Alamos National Laboratory believe they are victims of an insurance runaround.
Rob Vitek, one of the people receiving bills for surgery that he thought the laboratory insurance provider, United Health Care (UHC), would pay, has put up a website at vmans.blogspot.com, claiming 70 LANL employees have been "stiffed".
One of the group's first priorities has been to try to find out how many people are in the same boat. So, far it is in contact with about 25 people who are engaged in a busy network of e-mail communication. But the group is hoping to be joined by as many others as the case may be.
While there is much information still missing, which the group and the individuals in the group have not been able to get, Vitek said the number - 70 employees - caught up in the problem has been confirmed by the laboratory and the surgery provider, Physicians Medical Center (PMC).
PMC is a subsidiary of National Surgical Hospitals and is located on Rodeo Park Drive East in Santa Fe.
The details of individual stories vary. But the bottom line is that patients were referred to PMC by their physicians and received medical treatment with the understanding that the services would be covered under their laboratory health insurance, with the exception of their co-pay responsibilities.
Several testimonials on the website state that the employees specifically asked and received written and verbal assurances that their claims would be covered by UHC.
While the employees have information that PMC was considered an "in-network" provider both before and after they received treatment, some commented that they were told by the provider that that the company was "out of network" at the time of their visit, but that their treatment would be handled as an "in network" service.
Vitek said he was told verbally that PMC was in process of renewing its contract with UHC and that he had "nothing to worry about."
Sometime later, when they began to receive bills personally for the treatment, employees were advised by PMC to appeal the insurance company's decision.
The blog contains a letter Vitek indicates was received in response to his complaints to the surgical hospital PMC.
The letter acknowledges confusion about who is responsible for payment.
"Due to communication errors by your health plan, we rendered services to you believing in good faith that the services would be covered," the letter states. Noting that discounted "out of network" claims for the services Vitek received were negotiated by a company employed by UHC, the letter continues, "Unfortunately, subsequent to receiving these documented discounts, your employer made a decision NOT to pay your claim."
LANL spokesman Steve Sandoval said he spoke to lab officials in the Human Resources office Tuesday about the matter.
"The laboratory is aware of the situation involving PMC and lab employees," he said in a prepared statement. "We believe that there are a few dozen laboratory employees that are affected by this matter. The laboratory is overseeing what the employees and PMC are doing to resolve this matter. Should the laboratory have reason to believe that UHC incorrectly administered the lab's health care plan, the laboratory will take action."
Some members of the group have bills that are more than three or four months overdue and feel they are in danger of having their accounts turned over to a collector.
Employees with Q clearances share concerns that a collection process might be weighed against them when their security status is renewed, although the Employee Retirement Income Security Act protects claimants from being fired or discriminated against for attempting to obtain a benefit or exercising their rights under the act.
Lloyd Scarrow, CEO of PMC, said, "I've been instructed by my corporate interface that I cannot comment."
Scarrow cited provisions under the Health Insurance Portability and Accountability Act (HIPAA) that protect patients' private information.
He said he would ask another person, who might be able to speak more generally about the situation, to return the call.
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Below is from the vmans.blogspot.com web site:
...Now all these people are being billed from PMC for the total amount due of the sugery. PMC is threating to take us to collections. That's a issue for most since we are cleared professionals. This amount ranges from $3,400 to $20,000 dollars. PMC is blaming UHC and LANL for the problem. UHC will not pay even after appealing and LANL is being quiet about the matter and quite frankly, is NOT helping it's employees.
34 comments:
It is disturbing once again to see that LANS, LLC abuse its employees (≈70).
(//vmans.blogspot.com, important blog.)
LANL not helping its employees? Puh-lease! The top brass is just busy counting their bonuses each time they f*ck us over and get rewarded!
Is this the type of insurance nightmares that we are going to have to look forward to at LANL?
You all realize, don't you, that LANL ala LANS, LLC is self-insured, right?
In other words, UHC only administrates over the LANL-funded plan according to the policies LANS has put in place for UHC to follow. So, if UHC refuses to pay these bills, it's a sure bet that they deny payment at the direction of LANS, LLC.
8:01 PM - shocker! Like 7:38 PM, LANL/LANS top brass is f-ing us over and enjoying it. Perhaps this way they can get rid of a few more workers before the next RIF.
Those Pu-sodden whiners are all used up anyway. Get me some fresh meat.
Feed me, Seymour!
8:01 pm: "So, if UHC refuses to pay these bills, it's a sure bet that they deny payment at the direction of LANS, LLC."
Not likely. LANS certainly doesn't review each claim, only sets the general rules under contract that UHC will follow (the terms of coverage). I think this is a UHC mistake that will quickly be remedied. If not, lawsuits may follow, but against UHC, not LANS. The "self-insurance" issue is a red herring for those who seek to use it against LANS. Study your law.
This could be the beginning of what most on the staff will soon be facing when they attempt to secure promised benefits from LANS.
LANS could clear this mess up in a single afternoon if they really wanted to fix it. Thing is, I don't believe they really want to fix it.
Why should they? It easier for LANS to just let the affected workers twist in the wind. Maybe some of these people will even get mad and decide to leave the lab. LANS would probably views that as a "two-fer" -- reduced medical costs plus one less staffer on the payroll.
I'm hearing rumors that the Vision Service Plan is the next item to go up on the chopping block.
From what I have read on that blog, it sure looks to me like this is fraud on the part of Physicians Medical Center (PMC). Unfortunately, any crook can claim to be an in-network provider and not be one. I have experienced some devious providers myself.
It is interesting that Dr. Auge, who made the referrals to PMC, is a part owner of PMC and is abandoning his practice. This is fishy with a very strong smell. It is also very strange that PMC now, after all this, has a contract with UHC, and this seems to be just some interim lapse that the employees are being stiffed for.
Is this shoddy business LANS responsibility? Not necessarily. Before undertaking any costly procedure, the employee / insured owes it to his or herself to check directly with UHC to see if the provider is in-network, as opposed to "takes the insurance". That said, if the provider makes statements that they are in network and they are not, then the provider must be liable for it.
If I had to guess what is going on with all the silence from LANS, it would be that LANS is trying to figure out a way to help without becoming liable themselves.
The patients can always refuse to pay. The main problem with this is the potential damage to one's security clearance. That is one thing that LANS should be proactive about, if nothing else.
I think LANS should provide free legal advice and not drag their feet. The affair is disgraceful on all sides.
I had a few rounds with UHC over treatments received in the Fall. Prior to treatment, I had called to check it the treatment would be covered. I was assured by UHC that the treatment would be covered. BUT, when the bills were submitted, UHC denied the claims. After more than 20 phone calls, UHC finally agreed to pay for the treatment. It turned out that the UHC employee who had told me that the treatment would be covered was correct. But, it appears that UHC has some kind of policy about denying many non-routine claims.
I had a few rounds with UHC over treatments received in the Fall. Prior to treatment, I had called to check it the treatment would be covered. I was assured by UHC that the treatment would be covered. BUT, when the bills were submitted, UHC denied the claims. After more than 20 phone calls, UHC finally agreed to pay for the treatment.
It turned out that the UHC employee who had told me that the treatment would be covered was correct. But, it appears that UHC has some kind of policy about denying many non-routine claims. I suppose that UHC makes out when individuals do not keep records of phone calls including names and dates and are not agressive in pursuing the reimbursement.
Thanks again to Roger and the Monitor, another ugly LANS scandal surfaces.
The letter from PMC states that these claims were denied by the employer. This after UHC confirmed coverage in writing. And LANS is "aware" of the situation but hasn't acted.
What a disgrace.
ALL insurance companies have unofficial policies to deny "non-routine" claims. It's part of doing business because even they wear down half those claimants, insurers save billions of dollars in the long run. Insurance is one of the biggest scams going. Look at New Orleans and how many claims have not been settled since Katrina!
Nothing to worry about. I'm sure if you properly submit your claims into Concur everything will be just fine!
> The letter from PMC states that these
> claims were denied by the employer.
Yeah. Souns like PMC is lying. It's not up to the employer to accept or deny claims against the medical insurance. The employer doesn't run the medical insurance. It's UHC that decides to accept or deny.
I wouldn't think that "not paying" would have too much affect on one's security clearance at this point. It is a disputed charge, after all.
Maybe after lawsuits and going to court and being ORDERED to pay up and still not paying, then there might be some consequences. But not yet.
Yeah, but Vitek is a known whiner.
Stuff like this comes straight from the top, and that means LANS LLC. Be very careful about accepting the explanations that you hear from LANL HR.
They're obviously leaning hard on UHC to reduce medical costs by squeezing beneficiaries and by putting many of the claims under strict medical review. It's a cost saving measure being ordered by LANS LLC.
As others have stated, UHC is done on a cost basis. It's not really "insurance" in the tradition sense. If medical costs go up at LANL this year, LANS will have to find some way to help pay the difference in next year's budget.
Watch out! The 'biggies' are still to come: elimination of retirement medical, freezing of the TCP1 pension, and reduction of TCP2 employer contributions to 3%. Future Benval studies will assure this course of action.
What executive insurance plan is Mikey covered by?
Just snagging a flu shot at LANL was a major accomplishment for many workers this year.
What do you expect? This place is now run as a "for-profit" managerial operation. The whole idea behind this was to squeeze the workers and, conversely, reward the executives who do the squeezing. Is this too difficult for everyone at LANL to fully grasp? Expect more of the same in the future.
don't you mean socialist Democrats?
Don't you mean self serving Republicans?
Poetic justice comes to mind.
Vitek's reputation as a whiner is pretty well known. I bet LANS is trying to figure out how to settle this, but let him twist for a while. He's pretty pathetic.
As usual some comments to this blog have resorted to personal insults rather than addressing the real issue. Whether or not someone is a "whiner" has nothing to do with over 70 people not having their claims paid. Surely not all those people are "whiners".
Is everyone who writes or talks about a LANL problem now labled a "whiner"? I thought not enough people were speaking up about problems. Is there a way to speak up without someone jumping in and smearing someone else.
Why can't problems be discussed rationally instead of injecting personal comments? Did the whiner comments come from LANL addresses? If so, then perhaps those folks should be concerned about whether or not they are using government computers for government work.
Morevoer, why do some who comment sound like immature teenage boys rather than adults? Surely educated people can make their points without sounding immature.
4:13 pm: "Surely educated people can make their points without sounding immature."
Who are you calling immature?? And stop calling me Shirley!!
Get over yourself.
What do you mean, "Get over yourself?" Do you realize how stupid and obnoxious so many of the comments are on this blog? People write garbage because they can post anonymously!
"Poor me, poor me…we're entitled after all!
--Once the shrill cry of welfare addicts, now the shrill cry of the Republican entitlement addicts of northern New Mexico. To think, this happened under a Republican administration. Ironic, don’t you think?
3/6/08 11:37 AM"
Nope try again Mr Troll.
3/6 11:37 am: "Just snagging a flu shot at LANL was a major accomplishment for many workers this year."
I walked into my doctor's office at LAMC, filled out a single sheet for insurance purposes, and got a free flu shot (back in November) in less than 10 minutes total. Screw LANS.
This is the type of thread I really dislike on this blog (and similar things have appeared on its various ancestors). The reasoning typically goes like this:
1) Something bad happened.
2) It happened at the lab/to lab employees.
3) Therefore it is further evidence of how messed up the lab is and how lab management is out to screw us.
WRONG. The only thing this type of argument shows is that the individual making it has no sense of the world outside the lab. Anyone who has been to the doctor for more than a cold in the past decade knows that these balance billing/ out-of-network snafus are everywhere. United Health is a major insurer and you will find the same thing happening with Aetna, BlueCross, Cigna...you name it. Every year they renegotiate prices with providers and sometimes the negotiations fail. It has NOTHING TO DO WITH THE LAB. You could run into this working for any major U.S. corporation, provided you are lucky enough to be working for a company that actually offers comprehensive health insurance. So stop whining because it shows nothing besides naivete about the reality that exists beyond LANL.
5:39 pm: Please stop posting your insane ideas. Your type of rationality and comon sense is not needed or wanted here.
Sooo.... PMC lied in its initial communications stating that they were going to treat everything as "In Network" but now we're supposed to believe the letter PMC sends to explain it's all UHC and LANL's fault? Sorry. Doesn't pass the sniff test. If you know anything about insurance, you know these guys were trying to play the system and they got caught, and now they're trying to point the finger at big bad insurance company and big bad LANL.
And it looks like at least half the posters here just buy right into it JUST so they can slam the lab, who gives a crap how true it is or how much you might actually know about this stuff.
3/6/08 12:56 AM - congrats, I think you've got the gist of what no-one can tell you. Go get 'em.
I am one of those facing a bill from PMC that is not getting paid by UHC. Before I mouthing off about the whole I (gasp) actually spoke to PMC CEO LLoyd Scarrow personally on the phone and also talked personally to the HR division leader and benefits group leader as well as the UHC representative here at LANL.
If everyone on this blog would actually get all sides of the story before mouthing off, there would be a lot more signal to the noise.
We may never know the full story, but it is pretty clear that PMC new they were out of network and proceeded either maliciously or incompetently. UHC followed the rules in denying the claim, and LANL?HR cannot tell UHN what to pay without violating the laws that allow us all to deduct insurance expenses pre tax.
LANL HR does appear to be trying to help. LANL legal is indeed preventing much of the story being told publicly. Frustrating, but I will accept it if they help.
I am plenty unhappy about things since LANS took over. But this is one is not LANS' fault.
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