Vmans Perspective

First and foremost the comments I make in this perspective are mine and no one else contributed in any manner. Maybe by entering this letter and opening this blog site up, people will get involved and start communicating to get the matter resolved. That is my intention.

As of today, this issue is still without any sort of resolution despite all the letters written to PMC, UHC, LANL, AG Office, Insurance Commission, etc. At this time I would like to tell you my perspective as to what I think has occurred and what is occurring with this matter.

We know that close to 70 LANL Employee’s ( retired and working) are being billed by PMC (Physicians Medical Center of Santa Fe) for using their facility to conduct surgical repairs primarily from DR. Auge (Northern New Mexico Orthopedic) - a United Health Care Provider and part owner of PMC. By the way, Dr. Auge has been paid by UHC. The balance outstanding from these employees totals about $450,000.
PMC stance is of little substance and does not hold any merit to these employees but they want their $450,000 and say they will take us to collections. These employees, including myself , were basically mislead into thinking our surgery would be fully covered by our insurance carrier (UHC). We pay UHC each month fee’s(premiums) to cover us when we have to have these surgeries. In fact, if any of us had gone to Santa Fe Medical Center for the procedure we wouldn’t be in this mess, but we were referred by our good doctor to use PMC and were made to believe our insurance carrier (UHC) would cover the procedure. PMC told us verbally and via a written document that was given to us at the time we checked in we were covered.

I think PMC knowingly and with deliberate cause told these people what they wanted to hear so the procedure would be done at their facility. This meant money in PMC’s pocket. PMC is a newly constructed surgical center owned by National Surgical Hospital and they need patients to keep the doors open. The letter from PMC that I received at check-in is key and it can be interpreted to mean several different things. This letter was constructed in such a way that a regular Joe without any background in law would read it at face value and it would mean to them as it meant to me, my procedure was covered by UHC as IN-Network meaning, I would only pay 10% of the bill. 10% is even written on this letter. I would call this Intentional or negligent misrepresentation. I guess we should of known better and brought an attorney with us that day to review the paper work.

LANL soon received word of what was going on by UHC and some LANL employee’s asked for LANL ‘s help in solving this matter. Because LANL is under contract with UHC, they are not at liberty to take a stance either for or against the employee’s whose lives are being affected, even if we do work here. So these employees who asked for help , including myself, were told in so many words that it’s your fight not ours, and we have to follow the LAB’s legal staffs direction.
Too many of you readers, this may not seem like a big issue, but when you are Q cleared and your credit is scrutinized very closely by the DOE, any finicial negativity can have an effect as to you getting or not getting your clearance. This issue is not only about the money PMC say’s we owe it’s about our employment with LANL

Where do we go from here? Personally I would love to get this all behind me but it doesn’t seem it will just go away on its own. I believe an attorney will have to get involved to protect the interests of these good LANL employees and this will cost everyone more money. Possibly a Class action law suite will need to be filled against all parties. I also believe a criminal investigation needs to be conducted by a State of New Mexico agency and the New Mexico Insurance commission needs to investigate UHC and its contract with PMC.

On a personal note we could all just roll-over and pay PMC. That is if we all had the money. The matter would be resolved and we could all go our ways, right? I know some of you people reading this would do that. I’m not the type of person who just does something to avoid confrontation when I know I’m right. I will fight this even if it cost me more than my outstanding bill of $3600.00. You may ask, “why would you do that”? Because this is happening to all of us whether you think so or not. It’s a trend occurring in America and its why many people think we need Universal health care. Being honest and doing what’s right is what this is all about. Integrity has been lost! If we don’t start taking a stance against this sort of un-lawful, deceitful behavior, then shame on us all. We all need to do what’s right for all of us and if you feel you have been cheated out of your hard earned money, stand up and make it loud and clear you will not stand for it.