Friday, February 29, 2008

Another SAD Story of Someone Being Mislead by PMC

(Sent to me Feb 29th- She wanted it posted.This is just another example of what PMC did to a LANL employee who has insurance from LANL) Its criminal!!!

I had a total of seven visits to PMC starting 5/30/07. My Dr. ( Dr.Theresa Elliott of the Spine and Pain Institute) has been trying to determine what is causing my back pain.
On my first visit to PMC, I was assured that even though they were presently out-of-network, all I would be responsible for was the $20.00 co-pay "regardless of the outcome of the out-of-network status". In fact, before my first visit I called PMC to verify what I told by my Dr., and it was. My next five visits were a repeat of the first. My husband was witness to all that was said to me. On my last visit in November, I was told about possibly having to pay 10%, but they also they took my $20.00 co-pay.

I received my first bill earlier this month showing my account was 120+ days past due. I called PMC and talked to Lynn wanting an explanation. What Lynn told me is that they originally wanted to bill UHC for "office visits", however, in October UHC said this was not negotiable, so now PMC wants to charge me for "out patient procedures". Lynn also told me that all I am responsible for is the 10% I would have been charged for the out-patient procedure and the remaining 90% has been written as a "bad debt write-off physician's request". Whether this was negotiated for Dr. Elliott's other patients in the same position - I do not know.
(I also learned from this phone call that as of 2/11/08 PMC is now in-network but they can't backtrack to procedures that have already been performed)
I discussed all of this with Dr. Elliott on my last visit, who has since stopped using PMC. She also told me not to pay PMC because she feels she was also misled.
I feel since they required me to, and I paid, the co-pay, I owe nothing but possibly the 10% for my last visit.
I relayed all this to Mathew Shivadecker from UHC and he agrees that even though my situation is different, I still fall into this mess. Matt also told me to exhaust all appeals, which I am in the process of doing. I was also told I was misled by PMC first by saying all I was responsible for was the co-pay and they were going to treat each treatment as an "office visit".

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