Word has just been received that one of the doctors involved in this mess, Dr. Auge, has closed his pratice in Los Alamos. Dr. Auge is part owner of PMC and it really makes me wonder why he would refer us to PMC to have our procedure done if he knew we wouldnt be covered. I still think PMC decieved us LANL employee's into thinking we had coverage for our medical procedures. I still think PMC is ultimately responsible in correcting this issue. However I do feel UHC and the Lab should help its people understand what's occuring instead of not getting involved or helping.
My guess: LANL legal has told LANL mangement to not get involved. Why?
Why would UHC recently sign a contract with PMC knowing this has occured?
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What email address can other employees use to contact you?
I had the same experience nearly 2 years ago with a different surgeon in Santa Fe. I declined treatment until they were contracted with UHC. THEY called ME to say they were contracted. It turned out that they had heard this only over the phone from UHC and did NOT have the written contract until six months later. They gave me the lame excuse that they had been "trained to always do it that way." Furthermore, while the surgery was then contracted, they were not a contracted ultrasound provider. Their billing organization is out of state. They and I had lists of names of UHC reps who told everyone different information. It took about a year to resolve, and UHC never did pay my ultrasound costs. Here are some useful things I learned from the experience: First, never believe anything anyone tells you verbally in person or over the phone. Don't believe any faxes the doctor shows you from UHC unless it specifically states in writing what dollar amount UHC will pay, and then be sure the person who signed is actually authorized to sign. If the doctor's office tells you an amount for your responsibility, make sure it is in writing and signed by 2 witnesses or notarized. I was lied to by both the doctor and UHC. Another thing I learned is to cross out (with one inked line) the part about I agree to pay anything my insurer doesn't pay, and then I initial it. I keep a copy of this document. If they refuse to provide care because I intend to hold them to their word, then I know they were lying. Better Business Bureau has a website where you can register complaints. They will follow up and reply to you. It is yet another way of notifying the provider that others will be aware of what they are doing. I also had the Attorney General's Office contact the doctor. Although the corporation is licensed out of state, the MD must be licensed and accountable in NM for all decisions affecting patient care (like recommending a facility for your procedure). NM Medical Board processes complaints about medical competence. I eventually involved the benefits office and actually got someone who was helpful and concerned. This year, it was harder to get a response from anyone who knew anything or cared. If you have legal insurance, it might not cost you much to at least get some advice.
Throughout all of this, I sent certified letters to the doctor. He left me a voicemail after the first letter but ignored subsequent ones, including some with legal and medical concerns (like the procedure not working, them not following the standard of care because UHC had not paid). That doctor had his business manager pose as a scub tech during the procedure. Since nobody was wearing identification, I didn't know till later. The fake scrub tech did not follow standard procedure but reassured me it was no problem.
My email address is rp4643@hotmail.com
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