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Benefits » Health Insurance » Healthcare Facilitator

Your Health Care Facilitator

About Your Health Care Facilitator

The LANL Health Care Facilitator (HCF) is in the Lab's Benefit's Office to help you understand and obtain the full benefits and services available from your LANS-sponsored health plans. The HCF provides you with two primary services:

  • Information to help you understand your LANS health plan coverage and patient rights.
  • Education on the use of plan benefits and how they coordinate with Medicare benefits.

All information discussed with and services provided by the HCF are In Confidence, unless you give your permission to share it.

The LANL HCF assists members by

  • intervening to resolve problems of coverage, access, and administrative processes; and
  • referring problems concerning contract interpretation and coverage disputes to LANS's Office of the President.

The HCF also serves the future needs of members by collecting aggregate data that can be used to improve health plan coverage, processes, and communications.

Eligibility

All active and retired LANL employees and their enrolled family members, as well as eligible surviving spouses and beneficiaries, are welcome to use this free service.

HCF Help

Contact the HCF when you

  • have a question about your LANS health plan coverage and patient rights.
  • need help resolving a complex problem with your medical plan, and/or
  • need assistance in understanding how Medicare benefits coordinate with LANS-sponsored medical plans.

Your LANL HCF Contacts

Please call the Benefits Office for assistance with these issues at 505-667-1806.

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Self-help

Call your health plan. A customer service representative there can explain the plan's policies and procedures. Issues can often be resolved if you work with your health plan member services. Member services contact information is provided on your insurance ID card or the following Web sites:

The following list includes actions you can take to properly manage your health care:

  • Contact your doctor's office. Your most important relationship is the one you have with your doctor or other health professionals.
  • Assess your needs, review your health plan, conduct interviews, and review your resources when selecting a doctor.
  • Take the initiative to manage your health care before you need to access care and/or are in a crisis situation.
  • Appeal a decision rendered by your health plan if you aren’t satisfied with it. Most plans provide information in the benefits booklet about the appeal process.
  • Review the benefits booklet for detailed information about what is and is not covered under your plan. Be sure to also call your plan before receiving a service to ensure you have coverage.

Medicare Secondary Payer Coverage

If you or your family members are covered by Medicare and you become eligible for employee medical coverage because of your rehired appointment, federal law requires that Medicare no longer be your primary payer. You are required to cancel your retiree medical coverage and enroll as an employee with Medicare as the secondary payer, or opt-out of LANS-sponsored medical coverage and have Medicare coverage only.

If you have received a letter to this effect or have questions, please contact the Lab's Benefits Office at 505-667-1806. For more information, refer to the Medicare Factsheet for LANL Employees and Retirees.

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