ABQ Journal North Article

(Posted in ABQ Journal North March 14 2008)

Friday, March 14, 2008 LANL Insurance Provider to Cover Disputed Bills By Kiera Hay Journal Staff Writer More than 60 Los Alamos National Laboratory employees caught in a fight over medical bills incurred at a Santa Fe hospital were breathing easier Thursday after being told their medical plan provider has agreed to pay the disputed expenses. "I'm very happy with the outcome. It was the hard work of the people in the group," said Rob Vitek, a systems engineer who helped rally workers billed some $450,000 in what they considered unfair charges. "It was a grassroots effort, and it paid off," he added. The dispute began when LANL employees who received care at the recently opened Physicians Medical Center in Santa Fe were told they owed all or most of the cost of their treatment at the hospital because Physicians Medical Center was not part of the network approved by United Healthcare, the company that administers medical plans for LANL workers. Employees said it was represented to them by Physicians Medical Center that care at the hospital, located on Rodeo Park East, was covered under their plan, and they were only responsible for a nominal co-pay. Several workers said they feared that if their bills were sent to collection agencies, they could lose important security clearances. LANL said in a news release issued Thursday evening that United Healthcare, with LANL concurrence, and Physicians Medical Center have negotiated an agreement under which all care at the hospital retroactive to April 25, 2007, is considered in-network. Vitek said employees have been told to expect notification within 10 days that their bills have been paid. LANL spokesman Steve Sandoval said the lab had no comment beyond what was written in the release. "It is important that Laboratory employees always ensure that both their physicians and the facilities in which they practice are part of the United Healthcare medical network before services are provided," LANL human resource employee said Lou Polito in the statement. "Ensuring that your physician or facility is in the UHC network is important because physicians and facilities are constantly entering and leaving the UHC network," he said. Vitek said the good news he and others received Thursday was tempered upon learning that another group of LANL employees was told that care provided after Oct. 29, 2007, by Dr. W. Auge— a doctor who is part owner of Physicians Medical Center and who initially referred Vitek and others to the hospital— would not be covered by United Healthcare. Vitek said Auge falsely represented to clients that he was still part of the United Healthcare network. Auge could not be reached Thursday. "I think Physicians Medical Center got off the hook. I think they represented themselves as being carriers, and they weren't," Vitek said. A message left for Jeanne Scheide, vice president of operations for National Surgical Hospitals, part owner of Physicians Medical Center, was not returned late Thursday. "I think it (the resolution) was the goodwill of LANL and LANL pushing United Healthcare to get this resolved," Vitek said.