Los Alamos Monitor Article

Jilted claimants medical costs will be covered
By ROGER SNODGRASS, Monitor Editor
The Los Alamos National Laboratory employees who found themselves liable for medical services that they thought were covered under the laboratory health plan learned Thursday that their costs would be covered by the plan after all.
Some 35 of the claimants attended a meeting with officials of the lab’s Human Resources Division Thursday where they learned an agreement between LANL and United Health Care (UHC), the administrator of its medical plan, was “99.9 percent” done, said Rob Vitek, a spokesperson for the group.
The laboratory has acknowledged that “more than 60 employees” were facing unexpected medical bills related to problems with Physicians Medical Center of Santa Fe (PMC), which was for a period of time “out of network” for the UHC plan.
The laboratory issued a statement announcing that UHC had agreed to “retroactively treat PMC as an in-network facility.”
“This move allows all claims for services done at PMC from April 25, 2007, forward to be covered as in-network claims, paid at in-network rates with the usual deductibles and co-pays,” the laboratory said.
Claims for services provided by PMC had been rejected by UHC under terms of the medical plan. Laboratory employees who discovered there were a large number of people in the same situation began to discover they shared a common problem and organized a broad effort to have the decision reversed.
Some have said they were misled by PMC into believing that their medical services would be treated as in-network, but later began receiving bills from PMC saying they were responsible for payments of thousands to tens of thousands of dollars.
Vitek, who set up a website on behalf of the group and coordinated an intense e-mail correspondence with the others, said Thursday a planned meeting with a lawyer had now been postponed, but he said complaints had been forwarded to the New Mexico Attorney General, the state insurance board and the Public Regulation Commission.
“It is important that laboratory employees always ensure that both their physicians and the facilities in which they practice are part of the UHC medical network before services are provided,” said Lou Polito of the LANL Human Resources Division in a prepared statement.
“My lesson learned,” said Vitek, “is get everything in writing.”