(Employee's perspective after meeting with LANL HR)
1-March-2008
Here is a short summary of a few things I've learned recently that I thought others might be interested in.1) I met with Ben Glover (HR division leader), Lou Polito (HR Benefits group leader), and Maria Russell (HR Benefits Design and Administration group) on Wednesday Feb. 27. This meeting was informative and reassuring. It is very clear to me that HR is "paying attention" to this issue and takes ownership of our healthcare insurance benefits and policies. They are not just "passing me off to UHC" or letting me fend for myself. I learned a bit more about the dispute itself, and I gained an appreciation of the legal constraints HR must operate within. I believe that HR may be our most significant ally, but we need to be patient. HR *cannot communicate* about some things with us; we need to accept that. HR will organize a meeting with all those involved with this dispute, perhaps in two weeks.2) Ben Glover assured me that at this time there is no reason to worry that this billing dispute will have an adverse affect on our clearances. That is also true for those of us in HRP. And we do not need to take any proactive step to inform anyone in the security division.3) It is important that we exercise all of our ERISA rights and exhaust all possible avenues before we try to go to court. And this is true not just for claims against UHC: it is true for claims against PMC (that surprised me). So, what are our ERISA rights? I'm learning about this, but the first and most obvious is that we have the right to receive the reason for denial of a claim "in writing and in a manner you can understand." I have already received a letter in response to my appeal to UHC, but this letter was ambiguous and I did *not* understand it. So I have taken my appeal to "the second level" and asked for a clearer explanation. Going to this second level in the appeal process is important if you are trying to exercise ALL of your ERISA rights.
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3 comments:
Thanks for the information. My take is "action always speaks louder then words." Let see where we are in two weeks. I will keep my hopes up that LANL HR will provide us information and help, but at the same time I won't count on it. Sorry, but I have a bad taste from other situations I have been involved in. HR does a nice job of talking but not walking, So I won't hold my breath.
How do you appeal to a second level and to whom, Send another letter to UHC?
During my meeting about 2 weeks ago with Lou Polito and Ben Glover, of LANL HR, I brought up the issue that: "do you think that 70'some patients / your employees here at LANL could be sooooo dumb that they would have "mis-interpreted" the financials of this deal soooo badly that during (both) the pro-op meeting with the Doctor and then AGAIN during the arrival sign-in at PMC, that they totally mis-construed their financial obligations?" For 70 'some people to mis-understand THAT badly, we all must have been asleep.
I have appealed twice to UHC based on info from Lloyd Scarrow of PMC. Both have been rejected. UHC's rep at LANL, Matt, claims that no appeals have been accepted by UHC which is in contradiction to what Lloyd told me.
Also note that UHC only manages our Health Plan for LANL, we are still self insured.
I had another problem with losing health insurance for my wife and HR was able to get her back on the plan as we spoke on the phone. I believe HR could help us but is not, for some reason or another.
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