Mar 12, 2008

LANL workers dispute bills from new hospital

Employees: Physicians Medical Center said services would be covered by insurance

Anne 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.

[Read the full story here.]


Anonymous said...

For more on this see

Anonymous said...

too pissed to comment, but unacceptable.

Anonymous said...

You mean to tell me that LANS HR still hasn't fixed this problem? I'm shocked!

Anonymous said...

Why in the world would any hard working, young, bright technical person want to move to Los Alamos and work for LANL and accept the treatment they would receive? Nice deal for Auge though, part owner and being able to refer your own patients to your little profit center.

Anonymous said...

would you start a new topic?

I was one of the 400 plus employees who left on the SSP on January 10. We were advised that we would receive information regarding payment of our March medical insurance payments by mid-February. When nothing arrived by February 25, I called LANL HR and found out that there had been a "delay" in transmitting the file to UHC but not to worry, I would not lose coverage. Sure enough, on March 1, I received a bill from UHC which I paid on line. However, the week of March 10, I have been trying to have UHC pay a bill for services for March to no avail. UHC shows me as not eligible for services. Needless to say, I have spent hours with UHC and no one can figure out what the problem is.

Anonymous said...

I'm sure Mike Anastasio knows about this growing problem and will get right on it. He wouldn't want to take a chance of losing any of the "best and brightest" who work here, right?

Anonymous said...

3/13/08 10:33 AM : The insurance premium for March has to be paid no later than COB 02/29. If you did not make a payment in February, Hewitt's software may think you've voluntarily dropped medical coverage and automatically deleted you from the file they send to UHC. You should be contacting LANS/HR and Hewitt, not UHC, to resolve this problem and be careful here - Hewitt's software may think your 3/01 payment is for April, not March. FYI, LANS/HR mis-coded my retirement as a termination in their weekly file to Hewitt and I only found out ~2 weeks before my medical covereage would have lapsed.