Conference rocks::weight_control

Something seems to have changed with JH since DEC took over more of the 
direction from JH (my impression).  JH reimbursed me for 80% of everything
except the 45/week liquid "stuff".  Since the end of March, they've not
paid the 80% of the counseling sessions (80% of $20.00).  The other $25.00
(doctor and lab stuff) is still being reimbursed at 80%.  I've called JH
SEVERAL times (with each non-payment) and been told they'll check on it and
call me if there's a problem.  I'm assuming there's no problem, since they
never called back, and I'm ASSUMING my "check is in the mail".  Of course,
I'll take my head out of the sand in another few weeks if I don't see it!!!

The issue, to me, is a change of policy in mid-stream.  If this had been
the policy from day one, I might have been able to live with it!!!

(Week 18 of Opti-fast and down 55 pounds!!),
Debbie

    Debbie,
    I called JH last friday and was told that they do not have a record
    of my last two submissions. I sent them copies of Feb and March
    Opti bills specifically addressed to the person I talked with.
    Something has indeed happened and it smell rotten.
    
    They did say that reimbursement for Opti is based upon your medical
    history at the time of entering the program. Seems that you have
    to be really fat and have high blood pressure and all that good
    stuff to be reimbursed. 

I have been considering joining the Medi-fast program at Health Stop in
Leominster.  So I called John Hancock to see just how much would be 
covered if I did decide to join.  They said first they would need a
letter from a doctor stating a medical need for the program, I would 
have to be either 20% or 100 lbs overweight, and they would need a letter
from the Medi-fast doctor stating my height and weight and my ideal goal
weight.  And then they would consider the claim.  If they decided to cover
it, they would reimburse 80% of the tests and meetings after the deductible
was met, and they would not cover any of the cost of the food supplement which
makes sense.

Health Stop has a contract with John Hancock through Digital so they would
submit everything directly to JH and send me bills for the balance.  So I
guess I wouldn't have to bother with submitting all the receipts myself.
It's sounding better and better.

Susan

    Be aware that John Hancock is going through a change in their computer
    application that apparently has them in total chaos up there.  I've
    submitted claims for some things that have no relation to weight
    loss, and they seem to go into a black hole.  I've talked to them
    many times, and finally worked my way up to a supervisor.  She told
    me that while they're switching over to the new system, many claims
    were sent out to branch offices for handling.  They have absolutely
    no record of which claims went where, so there's no way to check
    the status or to even verify that they were received.  In addition,
    JH apparently took over the entire office area for a massive training
    class, 'cause I was told by at least two employees that they had
    been forbidden to go into the area where their desks are for the
    entire month of April.  I've been seriously considering escalating
    within Digital since they are holding quite a bit of money back,
    for which I've already paid the bills and should be reimbursed
    directly.
    
    Anyway, your inability to get the claims paid might have nothing
    to do with Optifast.
    
    							Pat

    Pat,
    If you decide to escalate the issue, why not include me and make
    it a class action grievance. Perhaps there are others - afterall,
    there is strength in numbers.

    I have been esculating.  I have bills [other than medifast] that
    haven't been paid sence FEBUARY.  They have 'lost' bills, started
    our deductables from zero AGAIN.  They pay the provider even when
    the bill says its paid and money to due to me.
    Please let digital benifits know about your problems also.  It will
    help us all in the long run if someone from digital puts some pressure
    on.
    thanks,ed
    

    I talked with them again yesterday, since May 1 was the magic date
    when everything would be OK again.  They finally show me in their
    computer as insured (since February I've been shown as terminated).
    They have paid two claims out of, oh maybe 10 or 12 that I've
    submitted.  They have no record of ever having received any of the
    others.  They have requested that I re-submit everything -- thank
    goodness I kept copies!  Anyway, I'm going to mail everything back
    to them this week and hopefully get some results.
    
RE: .-1
    The only reason I haven't escalated already is I haven't had time
    to research who I should complain to in Digital.  Can you give me
    a name and node or DTN?
    
    							Pat

    ask your local personal rep who to talk with.  I'm at DECUS and
    the name is at my desk.  I had to resubmit claims.  No excuss
    for it.  They are *supposed* to be professional.
    ed
    

    
    I am hoping someone has an update for me on this. I am going to
    the Dr.'s tonight to start on Medi-fast. I just talked to John
    Hancock (I sent in two dr. notes) and they said that they will
    pay for the Dr. visits but not the suppliment which is what I wa
    hoping for.
    
    The questions is now...are they really going to do this or am
    I going to be stuck with the bills..
    
    
    So the bottom line is, has anything improved since this last entry in
    this note?
    
    
    thanks ....Rothel
    

Rothel, I am in my 12th week on Medifast and have not had any problems with 
John Hancock reimbursing me.  I have gotten 80% of all lab and office visits 
back within about 10 days of sending in the receipts.  They do not cover the 
weekly meeting fee or the supplements because that would be like paying for 
your groceries.  

Good luck with your medifast and keep us posted on your progress.  

susan    

    I called J. Hancock before I went for my Dr. appt. They said they
    would pay so lets hope!
    
    I start Wed the 18th. Also get lab tests, EKG and all.
    
    I have lost weigh but never got all my weight off that I gained
    from having my son..he is almost 7 now. I am a touch nervous.
    
    I pray this time I do.
    
    Rothel