Letter from Mr. Scarrow -CEO of PMC

( This is the responce to an email sent to Mr. Scarrow - See Below)

Thanks Bob, I understand your take, but it is wrong. United asked us to treat you as "in network" so we promised to do so. Now they say that your "in network benefit" is zero and they are telling us you to seek payment from you. It is rare, but occasionally even a Blue Cross in network, in contract, approved service claim is denied. When that happens the patient is still responsible for the failure of their coverage just like you are responsible for the failure of your coverage. No hospital can know what the "in-network allowable" is until they receive a discount arrangement or an EOB. All we ever received was the discount, which we are honoring per our agreement with you. We gave you forms to sign that said you would be treated as in-network because your insurance said they would cover your charges otherwise you would not even have a discount from billed charges. We are still honoring an in network discount as we promised. Unfortunately, your insurance did not pay their portion. You still owe the discounted portion of the bill, just as you would if they had defaulted on an in-network facility. You hired the insurance company to cover you when you signed up for coverage. In essence, LANL has defaulted on your liability. An attorney will cost you more than what you owe to come to the same conclusion. Pursue as you wish, but if you truly have the support of your co-workers, it might at least be worth a group meeting with your employer. I'll be glad to attend and bring paperwork that you signed and that they signed. We are not hiding from anything we have said or done. Best Wishes, -Lloyd

(Question Sent to Mr. Scarrow, CEO-PMC)

20-Feb-2008 TO: Lloyd Scarrow, CEOPhysicians Medical Center of Santa Fe Hello Mr. Scarrow: I received an email message from you on Feb. 19, explaining some of the circumstances surrounding the "in-network" status of Physicians Medical Center and the disputes that have arisen regarding the substantial difference in payments due for services rendered under "in-network" vs. "out of network" provider status. I wanted to personally thank you for taking the time and effort to communicate this information to me in written form. This is certainly a complex problem and I appreciate your efforts to provide the "background" information. I believe that openly sharing all relevant information can help us to find a just resolution, and I want to assure you that I want to settle this issue in good faith and pay your facility the correct amount for the services that were rendered. In this spirit I would like to articulate my own perspective. I am writing on behalf of my wife who was the patient. The following statements represent my own opinions only; I am speaking only for myself and I am not representing the position of any other person (although I intend to share this email message with other people who are in a similar situation). I would be very interested to hear your response to my position; perhaps we can identify what facts we take as undisputed, and exactly where we disagree. I entered into an agreement with Physician's Medical Center. I acknowledged my agreement by signing certain forms, as well as by my consent. It was on the basis of this agreement that PMC, my surgeon, and (perhaps - I'm not sure) the anesthesiologist performed their services. This agreement is also the fundamental reason that each of these parties can expect me to pay for their services. So lets examine "the agreement" in detail. One of the written terms of my agreement with PMC was a letter signed by Lisa Castellaw stating that PMC was aware that they did not have "in-network" status with United Health Care, but that PMC would honor my in-network benefit. This written statement was a key element of the terms and conditions of the agreement between PMC and myself. I entered into an agreement with PMC based on this written promise from PMC (that is, that PMC would bill me at in-network benefit levels). This promise was, in fact, part of the terms and conditions of my agreement with PMC. I believe that PMC cannot unilaterally change the terms and conditions of our agreement. I do not agree to the new terms and conditions (namely, that I must pay full cost for PMC's services with no in-network benefit). I believe that the evidence supports my position that PMC should charge me for the services rendered at in-network benefit levels. Again, thank you for your email and the opportunity to communicate with each other in a polite and non-confrontational manner.