Employees: Physicians Medical Center said services would be covered by insuranceAnne Constable | The New Mexican
David Anderson's son, Collin, tore up his knee while skiing in Los Alamos last year. The surgery to repair his anterior cruciate ligament was successful, but Anderson has been fighting since December to get his insurance carrier to pay up.
The surgeon, Dr. Wayne Auge, recommended the operation take place at Physicians Medical Center, a new hospital in Santa Fe where he is a part owner. Auge was a member of the physician network for United Healthcare, Anderson's insurance carrier, but the hospital was not yet in the network.
Anderson, an information technology team leader at Los Alamos National Laboratory, is among as many as 70 lab employees referred to PMC by Auge and other doctors who were assured the services would be covered under their insurance policies. Now they are being told they are financially responsible for the bills. Amounts range from just over $3,000 to $20,000. The claims total about $450,000, according to a lab employee's blog.
Anderson thought all was well because PMC presented him with a statement saying the hospital would honor his in-network benefits. He expected to pay his deductible plus a 10 percent co-payment, which the hospital estimated would be about $600.
In December, Anderson received a bill from the hospital for $7,535.
United Healthcare refused to pay for the surgery because the hospital was "out of network," and Anderson's policy does not cover out of network costs. PMC told him the bill was his responsibility.
Last week, Lloyd Scarrow stepped down as the hospital's chief executive officer. Jeanne Scheide, vice president of operations for National Surgical Hospitals, a Chicago-based chain that is part owner of PMC, said his resignation was not related to the problems lab employees are having and applauded his "tremendous efforts" in starting the hospital. Scarrow has opened six hospitals in various parts of the country for the company.
Scheide declined to say more, explaining Scarrow "has other opportunities he wants to pursue."
Michelle Vickery, a health care executive from Chicago, will be the interim CEO at the Santa Fe hospital while the company searches for a permanent replacement, Scheide said.
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