Lanl Stance on this Matter

( This stance is open for interruptation but this seem to be the LANL Stance, I would love LANL to provide their stance in writing, until then)


Basically, HR-B is aware of the difficulties with PMC. HR-B (Mr Politio) wants to meet with all "affected" people to discuss the matter. According to Glenn, Polito has convinced his management that this would be a good idea and would like to get as many names as possible for a meeting in the next couple of weeks. WE encourage everyone to contact HR-B with your complaint. This will get you on the invitation list for the meeting. Polito will try to get a gathering place in the "open" so anyone who does not have a badge (e.g. retirees) can attend. Retirees, according to Glenn, hold much less influence than full-time employess in HR but he believes we have an ally in Polito. It could show our good intentions to work within the system and to our benefit if it comes down to legal action.

Glenn also said that we should file a complaint with the NM Health Dept. This department is responsible for the licensng of hospital operations in the state. Our emphasis should be on the fact that PMC represented themselves as an "in-network" provider and UHC says they were not. Apparently, according to Polito via Glenn, Viant, used to secure an agreement between UHC and PMC, is only for "out-of-network" providers requiring preapproval, etc. This is not what was advertised to me. I think it makes sense to file the complaint with the state to get an impartial judgement of the issue. I plan to file my complaint tomorrow. Glenn also asks if we know of any services provided by PMC to anyone on Medicare. The significance of this is that if PMC provided care under Medicare, by default UHC considers them "in-network." Glenn thinks PMC got their Medicare certification in June '07-not soon enough to help me but perhaps it will help some of you.

Glenn repeated his recommendation to write PMC and refusing the charges on the basis that they claimed to be an "in-service" provider and they should be dealing with UHC. Contrary to what I wrote yesterday (I misunderstood this point of our conversation yesterday), Glenn says we should hold back on offering to pay "our share" which is what we would have paid in the normal case (10% of what UHC would have allowed for the service). More paperwork(!) but I will write my letter tomorrow.

Glenn thinks LANL is doing the what they can do and it is no different now than it was under UC. Though I am skeptical, I guess it probably doesn't hurt to go through the motions - again, to show good intentions. Glenn again emphasized the advantage the weight of numbers can have on getting attention and, hopefully, satisfactory resolution of the matter - both with the Lab and with the state.

Also, you should know that HR is aware that there is a blog out there somewhere. They have attempted to find it but have been unsuccessful. Recognizing that blogs often contain assertions that are not founded in fact, they would like to be able to access it and address any issues they feel that they might be able to help us with. I do not believe the blog fits such a description and I told Glenn that I was not the owner and I doubted that you would want to give them the address and access. Glenn plans to write an e-mail to his HR contact (he told me the name but I cannot remember it) telling them that we are unwilling to give them the address. He would be happy to write back if you should change your minds. For myself, I think it best to not give them access at this time - at least until after we meet with them.

Glenn also advised me to write a second letter of appeal to UHC for payment of benefit to my anesthesia provider. I was first billed by them and I was denied the appeal. Apparently, there is a "second level" appeal that is available to us and Polito told Glenn that he thought there was a good chance that the appeal would be granted (based upon what I do not know). I have not yet heard back on my appeal to UHC for PMC payment but, based on your experiences, I don't expect to be successful. I assume Glenn would recommend a second letter in that case, as well. I pass this along to you in case it might fit any of your situations.