LANL Insurance Provider to Cover Disputed Bills
By Kiera Hay, Albuquerque Journal Staff WriterMore than 60 Los Alamos National Laboratory employees caught in a fight over medical bills incurred at a Santa Fe hospital were breathing easier Thursday after being told their medical plan provider has agreed to pay the disputed expenses.
"I'm very happy with the outcome. It was the hard work of the people in the group," said Rob Vitek, a systems engineer who helped rally workers billed some $450,000 in what they considered unfair charges.
"It was a grassroots effort, and it paid off," he added.
The dispute began when LANL employees who received care at the recently opened Physicians Medical Center in Santa Fe were told they owed all or most of the cost of their treatment at the hospital because Physicians Medical Center was not part of the network approved by United Healthcare, the company that administers medical plans for LANL workers.
Employees said it was represented to them by Physicians Medical Center that care at the hospital, located on Rodeo Park East, was covered under their plan, and they were only responsible for a nominal co-pay.
Several workers said they feared that if their bills were sent to collection agencies, they could lose important security clearances.
LANL said in a news release issued Thursday evening that United Healthcare, with LANL concurrence, and Physicians Medical Center have negotiated an agreement under which all care at the hospital retroactive to April 25, 2007, is considered in-network. Vitek said employees have been told to expect notification within 10 days that their bills have been paid.
LANL spokesman Steve Sandoval said the lab had no comment beyond what was written in the release.
"It is important that Laboratory employees always ensure that both their physicians and the facilities in which they practice are part of the United Healthcare medical network before services are provided," LANL human resource employee said Lou Polito in the statement.
"Ensuring that your physician or facility is in the UHC network is important because physicians and facilities are constantly entering and leaving the UHC network," he said.
Vitek said the good news he and others received Thursday was tempered upon learning that another group of LANL employees was told that care provided after Oct. 29, 2007, by Dr. W. Auge— a doctor who is part owner of Physicians Medical Center and who initially referred Vitek and others to the hospital— would not be covered by United Healthcare. Vitek said Auge falsely represented to clients that he was still part of the United Healthcare network.
Auge could not be reached Thursday.
"I think Physicians Medical Center got off the hook. I think they represented themselves as being carriers, and they weren't," Vitek said.
A message left for Jeanne Scheide, vice president of operations for National Surgical Hospitals, part owner of Physicians Medical Center, was not returned late Thursday.
"I think it (the resolution) was the goodwill of LANL and LANL pushing United Healthcare to get this resolved," Vitek said.
11 comments:
The UHC plan is self-insured, which means the Lab can direct UHC to pay. It reminds me of a friend whose newborn couldn't be covered under the plan because she hadn't notified UHC of the birth within 30 days. The reason she didn't notify UHC was that she and the newborn were critically ill and UHC refused to pay the newborns considerable expenses. UHC notified her that if the Lab "waived" the 30 day notice, the newborn's expenses would be covered. Once she wrote to her congressman, senator, NNSA, to explain the situation, the Lab directed UHC to cover the newborn. That's how it works folks.
"I think it (the resolution) was the goodwill of LANL and LANL pushing United Healthcare to get this resolved," Vitek said.
Bullshit. It was the fact that a few people dared to organize to FORCE LANL to do the right thing that got this matter resolved. As always, the vast majority of Lab employees (aka sheeple) glanced up in a daze to observe from a safe distance the commotion being created by these few brave souls. But now it's time go back to grazing. Baaaa...baaaaa...
3/15/08 10:45 AM
I agree in your comment in general, but LANL is operated by LANS, LLC, since June 1, 2006, and they are responsible for LANL.
(//vmans.blogspot.com, prevailed, thanks Rob Vitek, et al.)
PMC & Auge should eat the charges. They deliberately misrepresented themselves. That sounds like FRAUD. In addition, Auge is self-referring.. that's a conflict of interest, and also against medicare rules. Where is the Attorney General in all this? LANL/LANS should considering suing to recover the money.
"...the vast majority of Lab employees (aka **sheeple**) glanced up in a daze to observe from a safe distance..."
No, no no! You used a verboten word here on this blog. Next time please use more gentle wording such as "people who act like scared and helpless kittens". It will make the sensitive people who visit this blog feel much better about the LANL workforce.
The recent solution solves the problems of those who were billed by PMC while PMC was not "in network". However, there is another batch of employees who recently had surgery at PMC when it was back "in network" but the surgery was done by Dr. Auge who was kicked out of the UHC network. These employees are being told by LANS that they are out of luck and they are facing medical bills that are in the amount of thousands of dollars.
The saga continues...
It's kinda scary to think this could happen to any of us who are covered under United, glad to hear this is being cleared up.
Be glad you don't have Kaiser Permanente.
Believe it or not, LANS came through on this. The trouble was PMC's doing, but LANS made a big effort to fix this.
Anonymous said...
Be glad you don't have Kaiser Permanente.
3/16/08 7:14 PM
Respectfully, please explain your comment........
My bill finally got settled. We're all sheeple' but it was LANL that told the hopital to negotiate a solution with United. United who gave out of network discounts in writing. LANL that defaulted on the discounts and hid behind United until the hospital administrator told us to go to LANL for resolution. My claim was over five months old and I never got sent to collection by the hospital.
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