Conference 7.286::digital

        Some of my friends and I have been satisfied with the care we
        have received through Fallon.
        
        I do know of one administrative mixup---a newborn child was
        entered into their records three times (before the birth as
        `Baby Xyz', once under the correct name, and once with the last
        name messed-up).  My friends received a couple of extra bills,
        but it was humorous and easy to convince Fallon to drop the
        extra kids and the bills. 
        
        Note that I don't know of anyone with Fallon who has had needed
        out-of-area or emergency care.  These are the areas where the
        most HMO-related problems seem to occur. 
        
        					B.J.

    Fallon is pretty good.  I've been with them for 2 years.
    Of course it depends on the primary care doctor you have and
    most of the better ones are located in Worcester.  In fact most
    of  their  tests  are  located in WOrcester so you may find yourself
    travelling to Plantation Street more often than you thought.  Still
    though, it's the best in your area as far as I'm concerned.


    

     I've had Fallon for a couple of years now. I've had no complaints.
    The major difference from JH is you can't 'choose' your doctor.
    But, you are new to the area so this won't matter as much.
      My wife works for an OB/GYN who will be going to work there in
    June. She is going with him and can't wait.
                                               denny

    We've been with Fallon for six years+. I am quite satisfied with
    the quality of medical care, with the price, and with the level
    of care. The doctors have dealt with me fairly and seem genuinely
    concerned with our health.
    
    The restrictions of having to go to one of their facilities did mean
    that my son had to go to St. Vincent Hospital in Worcester instead of
    Holden Hospital (where we live). Given all the pain we've avoided from
    having a good hmo program, I think it's worth it. (But, then, it was my
    son's arm that was broken.) At any rate, you'd run into that with any
    clinic. 

    
    I'm not in an HMO, I went with John Hancock.  I don't have my benefits
    book handy, so I can't tell you exactly why I chose to take the
    insurance coverage rather than a health maintenance organisation,
    but the one reason that sticks out for me is: no change from the
    usual way of doing business.  Since you're new to this country both
    options are new and both require a change in the way you get health
    care.
    
    I like not being restricted in my choice of physician and/or
    specialist.  I like knowing that if I'm away from home, on vacation,
    and need medical care, I can just walk into any hosptal and tell
    them who to bill.  (I don't really know how this is handled with
    an HMO -- it's different, but certainly medical care would be provided 
    in an emergency, so the result is the same.)  I was also interested
    in the way counselling services were covered, and JH seemed to be
    the better deal.
    
    I think I took JH primarily because it allows me freedom of choice.
    You'll probably get more knowledgable answers from other noters.
    But, since medical care is handled so differently here, haven't
    you been provided with assistance from personnel in understanding
    the system?
    
    CQ 

    re: 490.5
    
>    I like not being restricted in my choice of physician and/or
>    specialist.  I like knowing that if I'm away from home, on vacation,
>    and need medical care, I can just walk into any hosptal and tell
>    them who to bill.  (I don't really know how this is handled with
>    an HMO -- it's different, but certainly medical care would be provided 
>    in an emergency, so the result is the same.)  I was also interested
>    in the way counselling services were covered, and JH seemed to be
>    the better deal.
    
 When my husband and I were honeymooning in the Virgin Islands 2 years ago, 
he had to have emergency medical care for an ear infection -- 2:00 o'clock
in the morning we drove over the windy, winding roads -- we showed them
our card and Fallon was billed directly -- we didn't pay a cent except we
had to pay out of our pocket for the prescription from drug store -- we sent
this bill into Fallon and they paid it.

As to preference of doctors, you do have a choice -- within their clinic --

The only difference I have found has been psychiatric care -- the number
visits you are limited to per year, whereas in John Hancock you have to
first fulfill the deductible, then pay what JH doesn't pay.

       JH only pays 85% on MANY services. Fallon pays 100%
                                                     Denny

    My family were Fallon members for about 7 yrs before we moved up
    to NH.  We were very satisfied.  During this time, we had one baby
    born, one major car accident, one ear-infection-away-from-home,
    and innumerable cuts, scrapes, and general odds-and-ends.  No problem.
    
    The ear-infection-away-from-home was in Maine, I think.  We called
    Fallon and they just said find someone and go there.  We went to
    a local doctor (as I recall) and gave him the appropriate numbers.
    We never saw a bill.  In fact, the odd thing is, we never saw an
    ambulance bill after the car accident either, even though I don't
    think that is covered.
    
    Burns
    
    

    I would very strongly recommend Fallon.
    
    One of our kids has had a very serious medical condition which was
    diagnosed by Fallon. They immediately transferred him to UMass in
    Worcester as they have the best treatment facilities in the area
    to deal with his illness. They paid 100% of all his medical bills
    - including expenses from further treatment at Childrens and Brigham
    and Womens (all this exceeded $100K!). Most incredibly we asked
    them to pay for a new form of treatment (which was still in the
    experimental stage) and they agreed. The treatment would have been
    done in San Fransisco, and was very expensive (it involved radiation
    implants), but they agreed to it, and made a decision very quickly!
    
    They continue to pay for follow-up care, they have paid for further
    drug treatments, we get expensive prescriptions for $2 - we're
    obviously very happy with them.
    
    Our experience with their day to day treatment has also been good.
    We can pick our primary physicians, and so far they've worked out
    well.
    
    A happy customer,
    
    Tim Horgan
    

There are some specialties that an HMO doesn't cover.   A friend of
mine once needed treatment in a certain, uncovered specialty, and 
found the doctors in the clinic were recommending outdated treatments.
He received far better care by going to a specialist at a Boston
hospital.  The problem with an HMO is that the doctors at the clinic,
who may not be very expert in the type of care you need, are
nevertheless the ones who make the decision about whether you need
specialist care.  For them to make this decision, it means admitting
that they are incapable of taking good care of you, and making a case
to their financially-motivated superiors to spend clinic funds on an
outside specialist.  Now, doctors do have high morals, but I believe
this system prevents patients from getting the best care in many
non-critical situations. 

I'm sure the good HMOs will do well by you in critical situations, but
if you want to simply optimize care, as opposed to care/$, and are
willing to do the legwork to find the really good doctors, I recommend
JH. 

	While Fallon as such does not exist in Atlanta, GA, there is an HMO 
	here and I have been happy with it.

Re .10:

	You obviously have a great respect for specialists and their extra 
	training.  I am not certain that it is as well placed as you believe 
	it is.  While I am not a doctor, I have worked in a medical 
	environment for a while and have seen the fads and heard the horror 
	stories.  You have to remember that doctors are people like everybody 
	else.

	Sometimes wisdom is knowing when to leave well enough alone and doing 
	as little as is needed to fix a problem.  Many medical treatments 
	have side effects that make this a good course of action.  The HMOs 
	are appropriately conservative in this regard but usually do know 
	when a specialist should be called in.

	It is true that there are some things that the HMOs do not cover that 
	JH does and visa versa.  You do have to look at what each provides 
	before you sign up.  If you do that you are not likely to be 
	disappointed or surprised.

RE: -1.

You miss my point.  I don't know how you read my note to suggest that
specialists imply more or excessive or less conservative treatment.  
My experience has been to the contrary,  specialists often result in 
more thoughtful, less intrusive, faddish treatment.  

If I have some non-commonplace ailment, I want to see a specialist,
not a general practitioner or surgeon who sees just a few cases a
year.  I have found that an experienced specialist is a much better
DIAGNOSTICIAN, this is (to me) the most difficult part of practicing
medicine, and where people who deal in a subfield day-in and day-out
have a real edge.  The specialist is often also apt to be more current
on methods of treatment, and the most modern methods tend to be less
intrusive than ones from the 50s and 60s. The result is surer, better
treatment.  Some examples of specialists not often found in clinics: 
Dermatologists, urologists, allergists, proctologists, etc., 

I don't mean to get on a soap box.  For a clinic, Fallon is probably 
quite good, but I felt it was only fair to recognize the advantages of 
the <other> option.

/j

    I belong to the Matthew Thorton HMO and they have never hesitated
    to recommend a specialist if they felt it was needed.  There is not
    defensiveness about it.  My wife was sent to specialists when she
    had skin problems and allergies.  
    
    If the staff at the HMO are professionals then this should not be
    a problem.
    
    Pierce

    You do *not* have to be an HMO member to use Fallon Clinic.
    They are perfectly happy to accept JohnHancock.  My wife 
    has been a patient there for over 10 years, since before
    DEC recognized the existence of HMOs; I would be also
    if our doctor hadn't been re-organized into strictly an
    allergist  (Me: "I'd like to see Dr. X"  Them: "Do you have
    allergies?"  "Well, no, but I'd still like to see Dr. X."
    "Are you sure you don't have any allergies?"  "No."  "Are
    you *absolutely* certain you don't have *any* allergies?"...)
    
    The Plantation Street clinic is an hour from us by car; it's
    worth the trip.

       Fallon also takes  Blue Cross/Blue Shield.
                                             Denny

    
    I belonged to Fallon for over 4 yrs. I chose them over JH because
    they seemed to cover 100% of everything (except Psychiatric care).
    I was able to seem the same primary care doctor (just ask for an
    appointment with them) everytime. I also had to go to an ER once.
    Overall I was happy with the services. Fallon also happens to be
    a subsidiary of Blue Cross/Blue Shield.
    
    The major disadvantage about HMOs depending on the size of their
    business, is that it may be hard to get an appointment on short
    notice unless it's an emergency.
    
    Re: .7:
    
    Doctors like to prescribe the treatment that they know well and
    feel comfortable with. They can't afford to not keep up with
    sub-specialities either. The AMA requires that doctors keep up to
    date with not just their area in Medicine. They must prove this
    also by attending workshops, etc. in order to get their licensces
    renewed and their licensces must be renewed every 2 or 3 yrs depending
    on the state. 
                         

    My family and I belonged to Fallon Clinic for 2 years (Worcester).
    We had a lot of problems with them.. A few examples:
    
    1. My husband being both diabetic and having high blood pressure
       has to be very careful.  One time he hurt his back and it being
       a Saturday, his regular doctor was unavailable.  The doctor who
       saw his prescribed him do NOT BOTHER to read his chart and 
       prescribed a medication that combined with what he was taking
       could very well have killed him...
    
    2. My son was in a bad car accident and we had to have his medical
       records transferred.  It took two weeks for Fallon to finally
       forward them - and that was only after I went there and physically
       asked (I just about had to beg!!!)
    
    These are only two examples, when I came to DEC I switched to another
    HMO and we go to UMASS.  My husband's doctor said he is so screwed
    up due to the combination of mediations they kept switching him
    to, it's not funny.  I would NEVER RECOMMEND FALLON TO ANYONE...IF
     YOU SIGN UP WITH THEM, SOONER OR LATER, YOU'LL FIND OUT THAT WHEN
    YOU GO, YOU'RE TREATED LIKE CATTLE AND THE DOCTORS GOT CARE LESS
    ABOUT YOU AS LONG AS THEY GET PAID!!
    
    *** ALSO, IF YOU GET PRESCRIPTIONS FROM THEM, CHECK IT BEFORE LEAVING,
        THEY ARE KNOWN FOR GIVING WRONG PRESCRIPTIONS!!   ***
    
    

    I can only speak for the Fallon Clinic in Worcester, but I hate
    it there. I have a doctor that I have been seeing for years who
    transfered to the Fallon clinic from a small private office. 
    In the old office the receptionist, nurses and billing people were
    freindly, organized and made appointments that did not require too
    long a wait (usu 15 min or less). At Fallon clinic they always try
    to make appointments with other doctors, the waits are unbelievable
    even early in the morning and some of the people who work there
    are very rude (others in all fairness can be very nice). All in
    all I wouldn't recommend it.

        As with almost anything, you pays your money and you makes
        your choices.  I was a Fallon subscriber for several years
        before I moved to New Hampshire.  I had NO complaints with
        their service.  
        
        Tom

    Well, thanks for all your comments and advice, both for and against.
    We did consider all of the view expressed to us both here and by
    mail.
    
    In the end decide to go with Fallon, mostly for convenience sake. If we
    actually need to use them at all, we'll be in a better position to make
    our own judgements (and maybe change HMO) in December.

    Thanks again,
    
    Jon