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Doctors ER group clarifies position

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By The Staff

 The Jemez Mountain Emergency Physicians, which provides services for the emergency department at Los Alamos Medical Center, recently clarified its position regarding the in-network status of the group with New Mexico Blue Cross and Blue Shield.

According to a press release from the Jemez Mountain Physicians, the physician group confirms that although it does not have a direct contract with Blue Shield, it does accept its payment and patients do not receive a remaining balance bill. 

The release said, “patients are responsible for the deductibles or copays under their plan, but there should ultimately be no out of pocket difference to them.”

According to the release, informational handouts are provided to any patient with NMBS that come to the Emergency Department at Los Alamos Medical Center, as well as a dedicated customer service contact for any questions they have.  “The group only receives 2-3 calls from patients monthly relating to our network status, and we try to resolve any patient inquiries within the same day.”

“It is important to us that the community know that they don’t have to drive off the hill for quality care, they can be seen quickly in the Emergency Department by our excellent physicians and hospital staff.  We are very proud of the Emergency Department having the No. 1 patient satisfaction ranking for most of the last year within the hospital system that LAMC is part of,” said Dr. Kristy Ontiveros, the head of the physicans group.

LAMC CEO Feliciano Jiron also released a statement regarding the situation.

“Los Alamos Medical Center (LAMC) acknowledges that the current ER Physician Group is not under the contract with BCBSNM and is actively working to remedy the situation and is working in unison with Blue Cross/Blue Shield of New Mexico (BCBSNM).  In the interim, BCBSNM is sensitive to the issue and is compensating by adjusting claims to the in-network rates if they would otherwise qualify.  If a member has had an ER claim at LAMC processed at the out-of-network rate they should contact BCBSNM customer service, who will review claims and adjust them if appropriate,” Jiron said.

The physicians group said if there were any questions regarding this situation to contact Dawn Sears at 662-1572.

The Los Alamos Monitor previously reported that the ER Physician Group and BCBSNM are currently in negotiations and a contract is expected to be in place by July.

 In the meantime, BCBSNM is adjusting claims to the in-network rate if they would otherwise apply.

Jiron responded to questions about how a provider not contracted with BCBSNM was chosen to staff the emergency room.

“Like anything else, when you partner with an organization, you’re hoping that that organization will do their part in creating partnerships with other organizations that you share that same need to provide services with,” Jiron said.
“Ultimately, since they are a separate corporation, we cannot mandate that they participate. And ultimately it would be the choice of those groups to participate. Our hope is that in partnering with an organization, they would share some of the same ideas that we have in regard to participating with payers, but we can’t force that or drive it.”
Jiron said that to some extent the center can consider whether a provider has the same affiliations as the center, but “ultimately it’s up to that organization to determine how they want to be reimbursed, and whether or not what they’re being offered for that service is something they want to contract for. And it’s their choice.”
Legalities prevent LAMC from being too involved with discussions between BCBSNM and the ER Physician Group, but Jiron confirmed that discussions were ongoing between the two.