99.9% Chance UHC Will Pay

This morning LANL HR held a meeting with the employee’s effected by this insurance fiasco. I would like to say the news is very good and there is a 99.9% chance all of us Lanl and Non-Lanl employee’s who were insured by UHC and had a procedure done at PMC will have their claims paid. I have received word the agreement was signed by Lanl and since its UHC's agreement I can say with a fair amount certainity the problem for us 70-76 employee's is now behind us. This would include those no-LANL employee's as well, I personally asked if non-lanl would be included at the meeting. We should all be getting a letter from UHC within 10 days. Also, be sure to check your EOB's.
I want to thank LANL HR for stepping up to the plate and for helping to get this done, its a huge relief.

Now then and this is very important... There may be people who have seen Dr. Auge after Oct 29th, 2007. You should know that as of that date, Dr. Auge was terminated as a UHC carrier. You may have been lead to beleive he is still in network with UHC but UHC will not pay on this claim because he is not. Your recource is to write to the New Mexcio Medical Board or call them at 1-800-945-5845 or locally at 476-7220 and file a complaint. I'm not preavy to the amount of those effected by this and I sure hope the amount is minimal. Ouch! Maybe another mess.

LANL HR said It was our grass roots effort that made this materialize. The Newspapers (LA Monitor and Santa Fe New Mexican), this blog and contacting State Agencies put this issue in the open. We should all be proud for the hard work we did.

On another note: personally I think PMC and the doctor (Dr, Auge) got left off the hook. I would expect, but I do not know with certainty, that this issue is not over for these parties, I hope not because it has smelled very fishy to me from the start. I would guess the Attorney General’s office and the Public Regulatory Commission may still continue their investigation into this matter. I feel UHC can do a better job in communicating to LANL employee's and LANL retirees. LANL retiree's are really out on their own and there needs to be a way of getting insurance information out to these people. LANL also needs to make sure UHC is doing it's job and providing outstanding service to the employee's. UHC has issues like any other insurance carrier. You need to get the issues into the open and get them fixed. PMC ...I will stick to my guns and say they were ultimately the blame for this mess.

My lesson in all this: Get everything in writing, verbal agreements don’t mean anything these days. If you call to find out if your insurance carrier will cover you for a procedure at least get a case number and make sure the conversation is recorded or please save a huge hassel and get it in writing.