A New Battle Facing a Different Group.

( As a stated in my blog under 99.9 % below -IN RED) Well its happened and here is an example.There seems to be a pattern and the same name appears. Im sure it will not effect as many people but it hurts to see anyone having to go through a mess like we just went through. Can LANL HR post a message on the LANL Web site that Dr Auge is not a UHC provider?

I'm one of the people who is going to be hit by the next phase of this mess. My wife was injured skiing on Feb. 2nd and we went to Auge shortly after that. My wife contacted Dr. Auge's office and believed, from their responses, that he was in-network. The staff at Dr. Auge's office made a photocopy of my insurance card, could see that we were not covered, but made no effort to inform us of that fact. My wife had surgery on Feb 20th at PMC and the PMC charges are going to be covered (I believe), but Dr. Auge was the surgeon, and his bill of about $5300 is not covered (according to UHC). HR told me that it will be difficult to get UHC to cover the expenses since Dr. Auge was dropped from the network, unlike PMC which had not yet been added to the network.

We were not patients of Dr. Auge's at the time when he was dropped from the network, so we didn't get any message warning us of the fact. LANL HR told me that UHC sent Dr. Auge certified mail telling him that he was no longer in-network, and that he shouldn't pass himself off as such, back in October.

LANL HR told me that I was the first case of this kind that she had heard of (where PMC is covered but Auge not), but that more people are is the same boat.

I called his office today. I told them that I understood that they weren't in-network service providers for UHC and the woman who answered the phone (Ruth) said "We are, but Dr. Auge isn't". When asked if it was their policy to inform people that they aren't in-network, they ignored the question and asked about my wife. They told me that she would be covered under her "global period" -- her 90 day period after surgery. When I pointed out that Dr. Auge wasn't covered during the surgery, she said that she would have Sarah get back to me. From what Ruth said, I guess it is Sarah's job to deal with these problems.

I expect I will have to do something akin to what all of you have already done, but I doubt that the same solution can be applied.

I sure didn't need this.