Letter Received From PMC

(I'm sure most if not all will get the same type of letter in the mail from PMC)

PHYSICIANS MEDICAL CENTER

February 19, 2008
Robin Vitek
Rio Rancho, NM 87144

Dear Mr. Vitek,
This letter is being sent to you for two reasons. First, to convey sincere appreciation to you for choosing PMC as the hospital to provide your surgical care. PMC staff work very hard to provide the highest quality medical care in Northern New Mexico. It is our sincere hope that you had a positive, clinical experience.

Second, we want to address the concerns that have been raised about outstanding payment for your services. For some time, there has been some confusion about who is financially responsible for the services that you received at Physicians Medical Center.Due to communication errors by your health plan, we rendered services to you believing in good faith that the services would be covered. In fact, Viant, a company employed byUnited Healthcare to negotiate Out of Network claims, negotiated a discounted rate forthe services you received. Unfortunately, subsequent to receiving these documented discounts, your employer made a decision NOT to pay your claim.
We contacted your health plan when we discovered that our claims were not being paid.We did not receive denials on claims submitted, rather, we were simply not paid. When we inquired as to why we had not received denial of payment, we were told in late October that your Employer Health Plan (EPO) coverage did not include out of network benefits in spite of documentation to the contrary. We stopped seeing patients with EPO plans at that time. Non-coverage information was not communicated by the pre-certification staff at UHC or by Viant.
UHC and your benefits department have informed us that your claim will not be honored and that you are individually financially responsible for these services. We have been indiscussions for some time to attempt to reconcile this issue but have been unsuccessful.For this reason, we are obligated to bill you. We understand your concerns about this process especially because, as a covered health plan member, you expect coverage for services rendered. You should contact your benefits department with any questions.
We deeply regret the negative impact that this has caused you, our cherished patient,and our hospital.

Sincerely,
Physicians Medical Center of Santa Fe