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.
United Healthcare is the medical plan provider for Los Alamos National Security, LLC Laboratory employees.
Physicians Medical Center began providing services to Laboratory employees in April 2007. When PMC filed insurance claims with UHC for services provided to Laboratory employees from April 2007 through mid-February 2008, UHC correctly processed those claims as out of network. Under the terms of the Los Alamos medical plans, services performed out of the UHC network are either not covered at all or are covered at a reduced percentage. Several Laboratory employees treated at PMC stated PMC convinced them the PMC services would be treated as in network by UHC. More than 60 Laboratory employees faced unexpected medical bills. These employees were forced to deal individually with PMC to resolve the medical bill issues.
To alleviate this burden, UHC, with Laboratory concurrence, approached PMC about a possible solution. Ultimately, UHC contracted with PMC to be in network from April 25, 2007, forward and the claims for PMC services from that date forward will be paid as in network.
“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 Los Alamos’s Human Resources Division. This can be done easily by either consulting the UHC Web site, http://www.myuhc.com, or calling the UHC Customer Service Line at 1-800-603-3816 or the Laboratory’s Benefits Department at 667-1806.
“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,” Polito said.
Following is a list of physicians and facilities that have either left or entered the network since October 1, 2007, through March 3, 2008.
No longer in Network
Dr. W. Auge Los Alamos
McGee Therapy Santa Fe
Prompt Institute Santa Fe
Joined the Network
Tatiana Canning Los Alamos
H Taylor Los Alamos
Frances Chavez Santa Fe
Herbert Gonzales Santa Fe
Michael Katz Santa Fe
Jenny Laden Santa Fe
William Lesson Santa Fe
Maria Rodriguez Santa Fe
Murray Sokoloff Santa Fe
Deborah Werenko Santa Fe
Physicians Medical Center Santa Fe
Los Alamos National Laboratory, a multidisciplinary research institution engaged in strategic science on behalf of national security, is operated by Los Alamos National Security, LLC, a team composed of Bechtel National, the University of California, The Babcock & Wilcox Company, and the Washington Division of URS for the Department of Energy's National Nuclear Security Administration.
Los Alamos enhances national security by ensuring the safety and reliability of the U.S. nuclear stockpile, developing technologies to reduce threats from weapons of mass destruction, and solving problems related to energy, environment, infrastructure, health, and global security concerns.