Out of ZIP health plan

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By The Staff

This letter is intended for Los Alamos National Laboratory retirees and current LANL employees living in Bernalillo, Sandoval, Torrance or Valencia counties.

If you are seeing a doctor who belongs exclusively to the Presbyterian Health Group (including Presbyterian Hospital), you should check to see if insurance benefits are available to you under the new LANL healthcare insurance plan provided through Blue Cross Blue Shield New Mexico as you may not be entitled to benefits from BCBSNM.

As far as I have been able to determine this is caused by Presbyterian Medical Group restricting coverage to the BCBSNM insured in these counties even if the entity providing the group policy is in a different county.

If you live in any other county in New Mexico (including Santa Fe and Los Alamos), I believe you will find that you don’t have this issue. I have called the LANL benefits office, Hewitt Associates and BCBSNM and I was informed by all three that it is Presbyterian that has placed this restriction. I am waiting for a return call from Presbyterian.

It seems like blatant discrimination that covered access to doctors whom I have been seeing for years is denied based on my ZIP code, while others with the same insurance plan are allowed these benefits. Of course we could always pay an additional $263.95 per month for the Preferred Provider Organization (PPO) option and 40 percent co-insurance and see these doctors as “out of network,” but that cost seems a little excessive to me.

Larry M. Barrick

Bosque Farms, N.M.