.....Advertisement.....
.....Advertisement.....

LANL employees protest insurance lapse

-A A +A
By Roger Snodgrass

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.