Conference 7.286::digital

    I don't know about y'all, but if I'm forced to go to an HMO, I'll
    have to drop medical altogether or leave DEC.  My family was on
    the HMO in Atlanta in '86 and the negligence & lack of communication
    between their "doctors" was largely responsible for my wife miscarrying
    at 5 months -- I know we could sue the pants off of them, but we're
    not willing to put ourselves thru the pain of that process.  However
    we'll NEVER use an HMO again!  We've since relocated to the Gulf
    Coast and are on 'classic insurance' - John Hancock, and DEC doesn't
    offer the HMO here, so hopefully we won't have to make that choice.

    Getting tired of cutbacks w/no visible benefit - David Silvers.
    

I doubt that the new Massachusetts mandatory health insurance law would allow
DEC to switch to only HMOs for Massachusetts employees.

I also think there would be a backlash worse than any we've seen before if
families were forced to leave their family physicians.

/john

    Frankly, I'm surprised that DEC continues to stay with John
    Hancock for "traditional" medical insurance, as there are better
    companies around.
    
    In '85 I left DEC for two years and the company I went to
    had New York Life as the supplier of standard medical insurance.
    I was surprised how much lower my medical bills were, from
    all aspects.  Apparently it was also a good price for my
    employer as well.  When I rejoined in May of 87 it was back to
    JH and higher bills.

    Were the coverages the same?

My understanding is that DECs health plan is self-insured. JH just handles
the paperwork. DECs costs are real not inflated by anyones profit.

                 Alfred

    The other problem with HMO's is the extremely high cost of the plan
    if only a husband and wife join.  The "familiy plan" is for a fixed
    amount of dependents, more than just one.  If I have no kids, I
    have to pay the same as someone with 4 kids.  In effect, my HMO
    cost goes to subsidize the people who have children on the plan.
    I would rather pay for just the dependents I actually have.
    

    Re  .6
    
    It is also my understanding that DEC has "hired" John Hancock to
    administer their own plan; J.H. is, essentially, just a paper-pusher.
    Therefore, what we get for an insurance plan is what DEC has determined
    that it will give us.  It could be better, but it could also be
    a lot worse.
    
    My family belongs to the Matthew Thornton Health Plan in New Hampshire.
    They could also be a lot better; quicker waiting periods for check-ups,
    provision of eye care, etc.  To my knowledge, the best around is
    the Harvard; if it becomes available in Manchester, NH, we will
    switch.
    
    Cost-wise, HMO's are better for a family, even for a married couple
    without kids.  The deductible with J.H. has gotten outrageously
    high; so one seldom meets that level to collect any benefits.  On
    the other hand, there are no deductibles with HMO's.  
    
    As for the care one receives from an HMO, I feel that if you feel
    that you are not getting the right referals (to specialists) you
    have to raise holy hell with your primary doctor, making no bones
    about what you feel that your needs are.  He'll refer you just to
    get you off of his back.  My wife ran into problems like that, and
    I called her doctor at home early Sunday AM, and read him the riot
    act about the poor care that he and his assistants were providing
    her.  She now only has to suggest to her doctor that she thinks
    that she should be referred, and he does so with little discussion.
    
    Personnel has told me that DEC has little say in how the HMO's
    administer their care, and that is unfortunate.  DEC should negotiate
    to have more influence with their HMO's.  They should also have
    common provisions with all of their HMO's; i.e. the provision of
    eye care, and other things of the sort.

    RE .7
    
    That is my point.  The cost is the same for 2 or many, many, many.
    Obviously, the person with only 2 is somehow subsidizing the person
    with many.  The HMO's cost for 2 is much lower than for a family
    with many children.
    
    

    Going back to .1 I just received my little packet in the mail
    and like several other publications to wander across my desk it
    looked like another "smoothed over slick marketing attempt" to
    tell us how hard things are. Left me with the impression to bend
    over and get ready for something else.
    Left_with_a_sour_taste_from_our_New_Flexible_Car_Plan
    

    We've been in an HMO for the past year, and have been extremely
    dissatisfied with it.  As someone else said, I've also gotten the
    impression that Digital has little or no leverage with the HMO
    regarding the way they run their operation.  We've been waiting with
    eager anticipation for the opportunity to switch back to Hancock in
    January, and were not exactly thrilled to learn that we're now stuck
    with the HMO till March. 
    
    However distasteful it is, Digital is not the only company cutting
    back on health care.  I read recently that many large companies
    are moving toward eliminating private health care plans altogether
    and forcing employees to use HMO's.  Furthermore, the article stated
    that once these companies get their people into HMO's, the cost
    of HMO membership is going to skyrocket.  Many HMO's are on the
    verge of bankruptcy now, so that latter statement makes perfect
    sense.
    
    							Pat

    re .8
    
    The deductible for JH is currently $125/person/year.  I don't
    know how this works for families (whether there is a family 
    maximum or similar).  $125 is not unusual for this type of 
    insurance.  Also, I have never had JH refuse to pay whatever the
    doctor billed, minus 20% in some cases.  Admittedly, with a HMO
    I would wind up paying a bit less, but I have known too many people
    who had problems with HMOs being too stingy - in one case, the
    person almost died of a brain disorder.

	Don't know if it's related to future services or not, but JH has 
gotten very slow and sloppy in paying off this summer.  They have sent several 
check to the provider when it was clear on the form that I paid up front.  
They have never done that with the regularity I have seen the last few months.

	Could be they are going to "require" that all payments be made 
directly to the provider, and since most private doctors don't even want to
talk to insurance companies for amounts less than a couple of grand, this puts
the casual patient in a real cash flow bind.  Therefore HMO's may look more
attractive? 

    I've dealt with both JH and an HMO in Mass., and frankly I'll take
    the HMO's.  Regardless of the source of payment, you always have
    to keep an eye on what the medical profession is doing to you...I've
    never noticed any tendency for HMO's to decrease (or improve) the
    quality of medical care.  Having three kids, though, the HMO's
    definitely cost less.
    
    As for JH, I find them most frustrating.  Their service is terrible
    (I wait ten minutes on hold for their 800 number).  They claim to
    pay based on 'reasonable and customary', which often appears to
    be 'random and arbitrary', and they take forever to pay for major
    claims.  I recently had to call them up and, after waiting ten minutes
    on hold, blast them for ignoring a claim that our physician mailed
    five weeks previously.  Obviously, they are measured by DEC's HR
    people based on how little money they dole out.  Since health insurance
    is a part of the compensation package, just like a pay check, it's
    irritating to have to heckle with them over payment of an emergency
    room bill!  So now we can expect JH to go from bad to worse.
    
    I read the 'benefits bulletin'.  Once again, it sounds like Personnel
    is using it to prepare us for the impending reduction in benefits.
    Just another indication of the move from a focus on the employee
    to a focus on the stockholder.  How subtle.
    

RE: .13 >They have sent several 
>check to the provider when it was clear on the form that I paid up front.  

funny - they have sent me several checks that should have gone 
directly to the doctor


RE: .15  I think the choice between JH (e.g., traditional insurance)
and HMO is dependant on what you want to optimize between cost,
service, and quality of care.  HMO's try to optimize quality per cost,
and often optimize service as well.  T.I optimizes one thing - quality
of care - often at the expense of cost and service.   Both are O.K in
my book.   For those of you out there who are blessed with being real
healthy - HMO's make the best choice, because they are less expensive,
and the chances of your needing ccare beyond their scope is very
small.  However, for some of the rest of us, who want to be able to
make our own choice about who will supply the best or most appropiate
care in a critical situation, and/or may already have long-term strong
relationships with doctors in specialties not normally covered by
HMOs,  the traditional choice is the only one. 

re: .13

>                         since most private doctors don't even want to
>   talk to insurance companies for amounts less than a couple of grand

    Really? Gosh - it would seem to me as though they'd be a lot more
    willing to talk to an insurance company than to the patient. Better
    chance of payment, etc. (Most doctors/ER's, etc don't seem too
    concerned if you can provide proof of coverage, without which they'll
    happily take a lein on your house/car.

re: .several

    Who can enlighten us further as to how JH simply administers/pushes
    paper for DEC as a provider. When payments get made, JH issues the
    check. Do they bill DEC regularly for services rendered and bills
    paid?

    -Jack

    Jack, DIGITAL is self-insured as regards JH.  Indeed, JH is only
    the paper-pusher.
    
    Marge

    regarding the noter who thought the doctors would rather deal with
    JH, than deal with us:
    
     It has been my experience that the doctors put severe pressure
    on you to pay up now. What have they to lose? If you pay up, and
    the check doesn't bounce, they get theri money now. If the check
    bounces, they still have the insurance company in their back pocket.
    
    		Gregg

RE: .-1

	Indeed they want their money NOW!  And even the OB/GYN who did all 
three kids wanted an upfront accounting of what JH would pay.  The balance was 
due from me before the 7th month!

    Some of us have had very good experience with HMO's.  I for one
    like the HMO doctor that I go to now instead of the private practice
    GP I used to go to.
    
    It seems to me that it's all in the luck of the draw, just like
    computer companies.  Unfortunately we are all human, including doctors.
    Even in HMO's though, there are plenty of doctors who really do care.
    
    There is one item in the latest Benefits Bulletin that bothers me,
    and one that I like.  The item that bothers me is that those
    people who planned on changing plans at the beginning of the year
    just had their plans blown out of the water.
    
    The nice thing about this bulletin is that, unlike our car plan
    notice, we have been given a clearer picture of a problem, and we
    have been given a little time to think about it, discuss it with
    the proper people, and just generally all-around prepare.
    
    Doug

        A word from a co-moderator (other co-moderators may disagree):
        
        Please don't let this topic degenerate into yet another HMO vs. JH
        shouting match.  It is not productive, and it is a very deep
        rat-hole.  There is *at least* one such topic in this conference
        already, and there's really no point (in my humble opinion) in
        re-hashing yet again the opinions expressed there. (To summarize:
        Some people are happy with HMOs, haven't had any bad experiences,
        and wouldn't change to JH; others swear by JH, and think that HMOs
        are all incompetent health care providers; neither group is able
        to convince the other, because both merely report anecdotal
        personal experiences.)  Perhaps the SOAPBOX would welcome this,
        but it's not productive here, in my humble opinion. 
        
        On the other hand, analysis of the memo that was recently sent
        to all employees and speculation on what it really means (or,
        better yet, *informed* analysis of what it really means, which
        is not likely to show up in this forum) is relevant to *this*
        topic, and is welcome.
        
        Thank you for your cooperation and support..
        
        Tom

Tom - I'm sorry if this is not material you feel is appropriate.  But
I feel very strongly that the choice of traditional vs. HMO should be
maintained, that employees shouldn't be forced to accept one or the
other.  I believe this is the point that people are making, and its a
point that hopefully the powers-that-be will hear loud and clear.  I
accept your concern with this view, and that, as moderator, your
opinion carries significant weight on how this point can be discussed.
I hope that you will continue to permit dissenting views a place in
this file. 

			/j 

    Here's a nit - why should I *HAVE* to choose either?  Both my wife
    and I work for DEC, and she (and our daughter) is covered under
    my policy.  Because she wants LTD, she is FORCED into having JH
    Medical coverage.  If they want to save a few $'s, why not let those
    people, who are paying *NOTHING* into the JH plan, stay off it?
    BTW, it would save us a bunch of hassle in having her covered by
    2 insurance companies...
    

        RE: .22 -- I have no problem with the assertion that there
        should be a choice -- in fact, I agree very strongly with that
        position.  HOWEVER, I don't believe that it is productive for
        people who prefer HMOs to try to persuade people who prefer
        JH to switch, or vice versa.  That particular horse has been
        bloodied and left fatally wounded already, and I'm sure none
        of us wants to be accused of beating a dead horse.  So, let's
        discuss why it's good to have a choice, if that's useful, but
        let's not try to convince one another that either alternative
        is the preferred one.  (At least, not in this conference.  It 
        might be an appropriate topic for SOAPBOX.)
        
        RE: .23 -- Is your wife required to have John Hancock coverage to
        have LTD, or is she required to have medical coverage of some kind
        in her own name?  These are two different situations. I don't have
        John Hancock, but I do have LTD.  If she and your daughter are
        already covered by your HMO coverage, then you are right that it
        makes no sense that she should need to be explicitly covered under
        either John Hancock or an HMO to have LTD.  It's possible that her
        PSA is confused, you know.  Since the rules to cover situations
        like yours are relatively new, they might not be well understood.
        She should contact her PSA, carefully explain the situation, and
        ask for a clarification.  If she doesn't get a satisfactory
        answer, she should escalate the question within the Personnel
        organization until she *does* get a satisfactory answer. 
        
        Tom

Re: .12:
    
>    Also, I have never had JH refuse to pay whatever the
>    doctor billed, minus 20% in some cases.  

My experience is different.  On several occasions, JH has disqualified
portions of my medical bills as being in excess of "reasonable and customary", 
then paid out 80% of the balance.

In these cases, the doctors involved claimed that their fees for the services
rendered were not higher than usual, but JH still refused to cover significant
portions of these fees.  I'm not sure that the JH bean-counters have a
realistic idea of what doctors charge; my coverage is often substantially
less than 80%.  I shudder to contemplate how the pending changes in our 
medical coverage will affect this.

re .25

Are you confusing the medical and dental plans?

/john

    
    
    Question:  For those of you with JH, is there a limit on
    "out-of-pocket" expenses - as in total costs?  Or does JH only count
    the 20% of the "reasonable and customary costs" when calculating
    your "out-of-pocket" expenses?
    
    BTW, Digital is not the only company revisiting the cost of health
    coverage.  My husband works and GE/RCA, and one of the added benefits
    of that merger is the downsizing of the health benefits.  Employees
    are now required to contribute on a weekly basis to the health
    insurance pot -- to the tune of several hundred dollars/year.  And
    the previous health plan was no bonus either...we called it the
    RCA Scam for Health...in general the plan covered 85% of the
    "reasonable and customary costs", which was fine as long as you
    did not require the services of a top flight specialist.  We picked
    up the IEEE Health Insurance to cover the gaps...

Re: .26:

> Are you confusing the medical and dental plans?

I wish I were.  Parts of my medical bills on _both_ the JH medical and the
dental plans were excluded from coverage because the fees were judged too
high by the benefit plan administrative rules.  Try to convince a doctor
or dentist to lower the fees to a level considered "reasonable and customary"
by the insurance plan!

David

    I tossed out the health plan mailing as "oh, more of the usual DEC
    benefits propaganda" (I get LOTS of junk mail; I must be on everybody's
    mailing list) without even opening it.  From the discussion here, I
    guess it said something important (for a change) - what DID it actually
    say?
    
    If it is going to make a difference to me, I use JH - I seldom get
    sick, and when I do, I go to the same couple of doctors I have been
    going to for many years, and have no intention of tracking down a new
    bunch of doctors if I can avoid it.  Ditto on my dentist.  The only
    complaint I've had (other than that sometimes a charge will get
    rejected as being "more than usual") is that JH takes two months to pay
    off, while the doctors tend to bill me monthly, so usually I have just
    paid, and then gotten a check back later when the insurance finally
    paid off.  My dentist never does this, so last time I was there I asked
    why - turns out they only bill monthly anyhow, so the insurance payment
    usually arrives before the next billing cycle (also, they have a lot of
    DEC patients and are used to this).

        My dentist bills John Hancock directly.  I don't even have to get
        in the loop.  Also, my dentist has been willing to get a statement
        from John Hancock, up front, of what share of the bill for a given
        procedure JH will pick up, so there aren't any nasty surprises.  I
        expect the same can be done for medical procedures; after all, JH
        knows what charges they consider "reasonable and customary", and
        what percentage of the charges are covered. 
        
        If your doctor or dentist isn't this well organized and helpful,
        then perhaps you should shop for another doctor or dentist.
        
        Tom

	re: .-2

	I read the bulletin a week ago, and maybe I missed 
	some points...but here's what I remember.

	- Health costs are going up quickly.  Employee contribution
	  has been increasing, but not as quickly.  The corporation
	  picks up the difference.
	- The recent (3 years ago?) changes in the JH plan, including
	  the review board, pre-notification requirement, second
	  opinion, etc etc have done the job they were intended to
	  do.  However, the cost bulge is now being driven by other
	  classes of service:
	  - Especially, a dramatic increase in the use of out-patient
	    services.
	- Although most of the data was specifically JH stuff, the 
	  memo repeated stated that HMOs were undergoing similar
	  cost and usage growth curves.  Either the HMO data wasn't 
	  available, or would have overcomplicated the memo.  
	- Digital is going to modify its health care benefit, in some
	  fashion.  The specifics are not finished, but they will be
	  finished and announced in January? Feb?  As a result of this
	  slip (don't you love it when personnel "slips" their projects?)
	  the annual "health care choice days" window will be postponed
	  from December until April.  

	Reading between the lines, my guess (pure, uninformed speculation!!!)
	is that the benefits of the JH plan will be modified in such
	a way as to "discourage" the casual use of out-patient facilities
	such as the emergency room or primary-care facilities.  The
	mechanism could be, for instance, lower rate-of-benefit for this
	type of service; or, a different algorithm for determining the
	contribution toward the deductible; or even, an annual per-person
	maximum;  I really don't know, but these are possibilities.  They
	will probably also raise the cost to the employee; in particular
	I bet that they raise the dependent-coverage cost because it
	turns out that "dependents" use primary-care much more often
	then employees (in other words, your kids go to the doctor more
	than you do).

	The result of these changes COULD be to make HMO's look more
	attractive; or at least, many people will want to reevaluate
	their selections.  Hence, the postponement of "choice days".

hmmm - some specialists ONLY see patients in out-patient - i.e., they 
have no out-of-hospital office.....

    I guess throwing this thing out was the right theng to do - sounds like
    it didn't actually list any changes anyhow, except in the time period
    when you can change your coverage if you want to!  I don't have any
    dependents, anyhow.
    
    I'd much rather go to a doctor's office than to the hospital; I wonder
    if that counts as "out-patient" stuff, or if they mean the emergency
    room (can't recall the last time I was there - probably the last time I
    needed stitches).  The only doctor I visit frequently is the allergist
    (every ten weeks to get more serum for my allergy desensitizations - a
    nuisance, but it is working, thank goodness - I used to have to go
    there twice a week, which was a major nuisance), and the gynecologist
    (every six months).  As I said, I hardly ever get sick.
    
    

.15>healthy - HMO's make the best choice, because they are less expensive,
                                                           ^^^^^^^^^^^^^^
    
    My HMO (Lifeguard) costs more per week than any other option.

< Note 636.31 by CEOSRV::CROWLEY "David Crowley, Chief Engr's Office" >
                      -< Some uninformed speculation... >-

>    	is that the benefits of the JH plan will be modified in such
>	a way as to "discourage" the casual use of out-patient facilities
>	such as the emergency room or primary-care facilities.  The
>	mechanism could be, for instance, lower rate-of-benefit for this
>	type of service; or, a different algorithm for determining the
>	contribution toward the deductible; or even, an annual per-person
>	maximum;  I really don't know, but these are possibilities.  
>    

    Gee, what an innovative approach.  So last month when that dog bit
    my son's face, and it took $1200 in plastic surgury in the emergency
    room to repair it -- that sort of treatment isn't as important as
    treating some single Yuppie's chronic obesity, for example.  How
    about simply having ALL employees contribute to the plan?
    
    I certainly hope a bit more thought goes into these decisions.
    
    

    My wife is an RN in the emergency room of a local hospital. Based
    upon the experiences she tells me, I get the impression that the
    ER could be shut down if it were not for the drunks and drug overdoses.
    There was even one call where a guy asked if he could bring his
    girlfriend in for an AIDS test (she slept with another mate). Of
    course, this is the night shift.
    
    Generally speaking though, MOST of these people don't even have
    insurance. So who offsets the cost of this care? We (taxes) and
    JH most likely. Reduce benefit and the burden of costs will simply
    be shifted (taxes).

    I thought that HMO's were supposed to be structured to encourage
    good HEALTH MAINTENANCE...and thereby reduce costs.  The one we
    had in New England did -- and it worked quite nicely.
    
    JH is another story altogether, though.  I wasn't kidding about
    the dog bite -- 15 stitches, local anesthetic and all, a really
    traumatic event.  Somehow I suspect that those who want to reduce
    ER benefits might waiver if they were to be hit by a truck.  It's
    just a dumb idea to reduce benefits when the costs of medical care
    are rising -- what's wrong with this picture, kids?
    
    More focus is needed to maintain health (coverage for 'well' visits
    for kids, for example) and share the premium load across the board.
    If you don't like the health plan, don't participate.  Just don't
    go out and play in traffic.
    
    

    My wife is a QA/UR (Quality Assurance/Utilization Review) Nurse
    for an insurance company.  She reviews both traditional insurance
    claims (indemnity) and HMO claims.
    
    It is no joke about the cost of out-patient services going thru
    the roof.  What is happening, is that as the costs of doctor office
    visits get higher and higher and deductables get higher, people
    are using the emergency room as a doctors office.  People get sick
    and go to the ER after work, rather than taking a day off work and
    seeing a doctor.
    
    As people are encouraged to use out-patient services, i.e., get
    the vasectomy done in the doctors office, rather than the hospital,
    etc., the costs are going up.
    
    Also, as concurrent review cuts down on the number of days people
    spend in the hospital, they are discovering that the incrementally
    least expensive days are being eliminated and that the hospitals
    are raising the costs for the other days, to make up for the income
    not generated by the longer stays, to cover their fixed costs.
    
    I'm not saying what is right, I'm just trying to let you know how
    things are from another perspective.
    
    Bob

    I WONDER IF ANYONE HAS ANY INFORMED OPINION OF WHAT THE MAILING
    ACTUALLY MEANT.
    
    I HAVE LOTS OF "WAR STORIES" ABOUT JH, ALSO, BUT I WANT TO STAY
    WITH THE FLEXIBILITY OF TRADITIONAL INSURANCE.
    
    
    DOEAS ANYONE HAVE ANY REAL INFO??
    

    re .41:

    	$35 for a walk-in?  $75 for a regular office visit?  $100 for an
    emergency room just to walk in?

    	Am I the only one who smells something funny?  Why are these costs
    out of control?  The most recent figures I have seen say that median
    (to remove the effect of high-priced specialists) *net* incomes for
    physicians in Massachusetts are near $90K/year, and that's well below
    the national average which is getting close to $110K/year.  And these
    guys are crying poor about those numbers!  If they can't realize that
    they're making such way-above-average livings themselves, and they're
    the ones running the medical business, then it's no wonder that they
    have neither the incentive nor the ability to keep costs anywhere
    within reasonable bounds.

    	Another reason for these inflated figures is that, with many poor
    people lacking any health insurance, the costs are just being passed on
    to those of us who do have it.

    	HMOs have some obvious cost-containment advantages here.  They have
    their medical staff on salary and not on outrageous per-visit charges,
    and they don't have to deal with uninsured people.  (Well, if an HMO
    doesn't run its own hospitals, it does wind up subisdizing some of the
    indigient care at hospitals, but that's a second-order effect balanced
    out by the wholesale way that HMOs can purchase use of hospital space.)

    			David

       Let's not turn this in to a debate of Doctors pay, malpractice
       insurance, and why medical bills in general are so high. OK?
       There are medical related conferences for that kind of thing.

                         Alfred

    
    
    There still are things EACH dec emplyee could do to help.{JH ones}
    
    1. keep accurate accounting of bills accounts paid by JH. I've found
       many times JH has paid the same bill a couple times.
    
    2. In Nashua, NH area there is a seedy scheme by NE Radiology. 
    After the hospital takes an x-ray, and the doctor reads it, THE
    XRAY *MUST* BE READ BY THIS FIRM.  An extra $19xray.  This is added
    to reduce liability to the doctor and hospital.  YOU CAN REFUSE
    THIS.   I no longer allow my xrays to be seen other than by the
    attending MD.
    
    These ideaz and other comments sent to personal last week .
    ed
    

    When you say (a previous note) that the average income of a doctor
    is 110k/year.  Is this net income (meaning after paying up all the
    insurance, and other expenses), or is this gross income (meaning
    have to pay all those expenses out of 110k/year)?
    Eugene

        The author of the previous note to which you refer made it
        very clear (through emphasis) that he was talking about *NET*
        income.  However, the definition of "NET" was not made clear.
        
        Tom

    
    RE. .45 
    
    This is noet a seedy plan at your hospital. It is a seedy, sleazy
    plan at most hospitals.  There are even hospitals that will bill
    you thus:
    
    Emerg. rm. 1st 15 min. == $35.00 (this is for the privilege of cooling
    your heels and bleeding on the floor of the waiting room for 2 hours.
    
    attending phys. ==  $35.00 ( this is for some guy who may or may
    not want to be there and who may or may not be awake when you see
    him. 
    
    consulting phys. == $XX.xx ( this is for some guy who happened to
    walk thruough while you were htere and looked at your chart. he
    needed tha extra bucks to make this months porsche payment.)
    
    Xray == $XX.xx this is for xrays BUT does not include having them
    checked by the radiologist who is not associated with the hospital.
    
    medical supplies. == $48.50 Tis is for a $00.03 band aid nad a $01.95
    ace bandage and 2 $00.15 alchohol wipes.
    
    Then you will get a separate bill from the radiologist and one from
    your family physician.
    
    It is concievable that the total cost for a sprained ankle to be
    as high as $500 of which JH pays the first $300 and then 80% of
    the remaining $200.
    
    Talk about sleazy practices. And all perfectly legal.

    re .46 and .47

    	"Net" means after all expenses.  It means the same as the "gross
    earnings" on your paycheck, after all expenses but before taxes and
    voluntary deductions.

    re .44

    	I think it's appropriate here to remind people how the medical
    system has no internal cost controls worth mentioning, and that the
    out-of-control costs are just being passed on through insurance costs.

    			David

    The Nov 14 issue of INSIGHT magazine (a new newsweekly that seems
    to be sent free to a wide list) has an article titled "Likely Ills
    from Health Benefits Tax" The summary line says:
    
    "Worries accompany the arrival of Section 89, part of tax reform
    legislation that kicks in Jan.1, The law sets penalties for employer
    health insurance plans that favor higher-paid workers. It could
    mean taxed benefits, less coverage, even fewer part-time jobs."
    
    The details of the article make it sound like most companies are
    going to have to strip their health plans down to a least common
    denominator.

    I heard they were phasing out the "key employee" physicals
    and now I wonder if this was the reason.  Leave it to the
    IRS to want it's cut of everybody's pie ...

    Regarding uncontrolled health industry expenses:  Anyone ever heard
    of a monopoly operating differently?  It might not seem like a monopoly
    in this case, but lots of the time - because of the timeliness of
    your requirements, etc. - it really is.
    
    Wouldn't we like to have a hold on the CPU market that IBM had 20 years
    ago?  Are we trying to get it?
    
    Why? - or better yet - Why not?  At least for as long as you can
    make it last!  Basic human nature just doesn't change very fast.
    
    Fred

    Re: .51
    
>    I heard they were phasing out the "key employee" physicals
>    and now I wonder if this was the reason.
    
    The reason I'd seen stated was that routine physicals are supposedly
    now covered by all health care contracts which Digital negotiates.  So
    there was no longer any need for a specific program to cover the same
    thing.
    
    -  David 

RE: .-1

	Consider also that the reimbursment under JH's "routine physical" 
allowance is $100 every three years or so, not $250 per year!

    HMO ____ NO
    
    I would be a drug addict if I had stayed with the HMO in Atlanta.
    I wish there would have been some guidence for some one who realy
    didn't know what HMO's were all about before I put myself threw
    such pain and frustration with the HMO. I'll take JH any day and
    pay 125 deduct. It is frightning that a RN had the power to determine
    what care I would receive, she was the head of the comitty that
    determind what would or would not be otherized. I am for ever greatfull
    that I could convert to JH last Jan. and get the care I needed.

Re .55:

	I have been using the HMO here in Atlanta since '81.  I have had a
    little trouble from time to time but nothing like what you describe.  One
    thing that you probably did NOT do was talk to your Personnel Rep. about the
    problem.  There are power mad people wherever you go and you have to learn
    to get along with them and get around them.  The people in Personnel have
    the contacts and the power to help with this type of problem when dealing
    with a HMO.  They have considerably less power when it comes to private
    doctors. 

	Also, while the RN makes the initial decision for external references,
    those decisions can be and are reviewed by M.D.s if you ask.  The
    bureaucracy is sometimes difficult to deal with, especially when you are in
    pain, but not impossible.  (I have dealt with them in painful situations and
    it did take some time for them to make up their mind to let me go to a
    near-by emergency room, not the one they wanted me to go to, but a simple
    statement that I didn't think I could make it to that one persuaded them.) 

Source: Management Memo, December 1988

"UPCOMING CHANGES IN BENEFIT PROGRAMS"

"In response to increasing health care costs and to provide employees 
with more choices for access to quality care, Digital is making a number 
of changes to the medical plans offered to employees.  Employees will 
now have three choices:  Health Maintenance Organizations (HMOs) and two 
Digital Medical Plans.

"Digital Medical Plan 1, with weekly premiums of zero for a person with 
single coverage and $7 for dependent coverage, pays 80% of reasonable 
and customary in-hospital and surgical expenses and 80% for outpatient 
services.

"Digital Medical Plan 2, with weekly premiums of $3 for single coverage 
and $16 for family coverage (including the employee), pays 100% of 
in-hospital and surgical expenses and 80% for outpatient services.

"Plans 1 and 2 both require the employee to pay a deductible before the 
Plan begins to pay. Under both Plans, the deductible will be increased 
from $125 to $150 per person per year for single coverage and from $375 
to $450 for family coverage.

"The various HMOs have not yet determined what benefit or rate changes 
they may wish to make to their individual plans.  Details on all these 
changes will be mailed to all employees in the U.S. in February so they 
can make their choices before April 1, 1989.

"At the same time, Digital is enabling employees to benefit from U.S. tax 
laws.  Medical and dental insurance premiums will automatically be 
deducted from employees' paychecks before federal and most state and 
local taxes are calculated.  Depending on income, the tax savings could 
range from about $200 to $500 per year.

"Digital will also offer another program allowed by U.S. tax law that 
enables employees with dependent care expenses (such as child care and 
elder care) to set aside a portion of their income (pre-tax) in an 
account earmarked for payment of such expenses.  A number of government 
restrictions apply to this program; so carefully read all the plan 
details when they are published.

"Information on the medical changes and dependent care programs will be 
available soon through many channels, including newsletters and group 
meetings.  The level of detail will range froma  short video to a 
complete enrollment kit containing detailed plan provisions as well as 
an individualized comparison of the HMOs that are available to each 
employee."

Instant analysis (FWIW):  Digital Plan 2 is essentially the existing 
JH plan.  Digital plan 1 is a "we save/you save" plan".  I suspect the 
rationale is that we consumers will spend our (and DECs) medical 
dollars more carefully if we have to pay 20%, and in return, DEC will 
thank us (or cut us in on the savings) with lower premiums.  I have a 
feeling if Plan 1 is successful, Plan 2 will fade over time (perhaps 
new employees will not be eligible for Plan 2).  Its possible that 
most DEC employees will not be expecting big hospital (in-patient) 
expenses, and thus Plan 1 will become the more popular one (on the 
other hand, if I was thinking of starting a family in the near 
future...)

Anyway, I wonder if perscriptions are treated the same way on both
plans? 

The pre-tax deduction for premium contributions and child care sounds 
like an unusual application of the 'cafeteria plan' approach, maybe a
tax loophole waiting to be closed?   

        I think your analysis of "plan 1" is fairly accurate.  It gives
        people the choice of self-insuring certain medical expenses,
        or at least, part thereof, and accepting a higher "deductible"
        usually results in a lower insurance premium.
        
        I'm not sure whether "loophole" is the right term to use to
        describe the provision for using "pre-tax" dollars to pay for
        various services.  Like all Federal regulations, the IRS code is
        subject to change on relatively short notice, and it's up to
        employers to decide which programs that are allowed within the IRS
        rules they want to implement.  The idea of allowing people to
        avoid "double taxation" on service income (you pay income tax,
        then use the already-taxed dollars to buy medical or dental
        services, or elder or child care, which gets taxed again) is
        somewhat popular, especially as the amount of many people's income
        that goes for such expenses increases. 
        
        Tom

I believe an important number was missing from .57, that is the $3000
maximum out-of-pocket expense if you go with Plan 1.  So to me, it seems
like a person with dependent coverage would be betting ($16 - $9) * 52 weeks
= $364 savings versus the possible $3000 maximum.

    Plan 1 can also be help for those of use with spouses who are employed.
    I already use my wifes' plan to pick up the 20% that JH doesn't pay for
    under the current plan.  One the face of it, it doesn't seem to make
    sense to pay extra to get the last 20% of in-hospital stays covered
    under JH, when my spouse's plan will already pick it up.
    
    I wonder if one can go from plan 1 to plan 2 at a later date without
    some kind of evidence of insurability, etc.  If my wife were to
    change jobs or something, it would probably be desirable to switch
    to plan 2 until her new insurance would kick in.
    
    I guess we will just have to wait and see.
    
    Bob

>I believe an important number was missing from .57, that is the $3000
>maximum out-of-pocket expense if you go with Plan 1.  So to me, it seems
>like a person with dependent coverage would be betting ($16 - $9) * 52 weeks
>= $364 savings versus the possible $3000 maximum.

I'm sure Plan 2 has a stopgap as well, I think the current stopgap is 
$5K.

    Does dental change under either?  How about psychotherapy benefits?

    RE:.60,.62
    
    The way I read it there is no change in the out-of-pocket maximum
    expense.  The quote below is from "The Digital Medical Plans and
    Dependent Care Reeimbursement Account Program" dated December 1988.
    
    	/s/	Roger
    
    
    "Plan 1 requires a lower payroll deduction than Plan 2, but it also
    reimburses less (80% versus 100%) of inpatient hospital or surgical
    expenses.  
    
    Under either plan, the most an employee would be required to pay
    out of their own pocket for covered expenses would be $1,200 per
    person per year ($3,600 for three family members).  After this
    out-of-pocket maximum is reached, the plan pays 100% of the reasonable
    and customary charges for all remaining eligible charges for the
    rest of the plan year (with some exceptions)."

    It seems to me that the cost for dependent coverage should be based
    on the number of dependents.  Why not?

    Are there changes to the current "Unlimited Major Medical"? do we
    expect to see a cap of say $1,000,000?????
    
    

        Regarding these many questions:  to the best of my knowledge,
        no one from Personnel follows this conference, so any reply
        to any of these questions is *unofficial*.
        
        I've received *some* official communications (because I once
        had "manager" in my job title, so I'm on the mailing list),
        and the plan is to distribute updated information to EVERY
        employee, spelling out all the details, in late February and
        early March, with small group meetings coordinated by your
        Personnel Services Administrator.
        
        Your manager should have received the same booklet I received. Go
        to your manager or PSA and ask to see it.  It isn't secret.  It
        contains the paragraph: 
        
        "As a member of Personnel and/or Management, it is important
        for you to understand these changes.  Read this report carefully.
        It will help you explain these changes to employees."
        
        Specifically:
        
        Dental plan -- no changes.  Open enrollment planned for April,
        1989.
        
        HMOs -- some will be changing their rates (no news, not under
        Digital's control).  Personalized bulletins will go out prior
        to the open enrollment period, same as before.
        
        "Unlimited Major Medical" -- the booklet I got doesn't mention
        any cap.  I believe it is not a goal of the program to limit
        the total expenses, but rather to shift payment for the "little"
        stuff.  (Most of the expense probably comes from lots of little
        claims, and administering them is itself expensive.)
        
        Why doesn't "dependent coverage" cost depend on the number of
        dependents?  Good question.  It doesn't.  That's just the way it
        is.  It would probably make sense if it did, but that would make
        it harder to administer.  If you care enough about this to try to
        get it changed, you could start with the Corporate Compensation
        and Benefits Manager @CFO, DTN 251-1335. 
        
        Tom
        not in Personnel, just a recipient of the "background report"

>
>    Are there changes to the current "Unlimited Major Medical"? do we
>    expect to see a cap of say $1,000,000?????
>
I've seen some plans with this, as opposed to "unlimited"

does it really make a difference?

I wonder what happens when the $1,000,000 runs out (maybe you just 
change to an HMO?)
    

re: dependent coverage based on family size

It was explained to me by an insurance plan administrator at one time that
large families tend to spend less per person on routine medical care
than small families do.  Above some small number of children (probably 2)
family medical spending tends to level out, so insurance plans reflect this.

- tom]

        RE: .69 -- I wonder whether that's been true because large
        families can't AFFORD the same amount per person as small 
        families, rather than because there's something about the 
        dynamics of large families that means they don't need as much
        medical care, per person, as small families.
        
        This is still relevant where deductibles or copayments apply,
        but would not be relevant in a plan where 100% of all expenses
        were paid.
        
        Tom

    The "unlimited major medical" issue is that until we have some sort
    of catostrophic health program nationally, Digital is one of the
    VERY few companies offering us this level of protection. What it
    means is you don't have to worry about being wiped out financailly
    after your major medical gets used up. A typical cancer expense
    can get into the millions!
    
    This is probably one of the best benifits we have and very few folks
    realize how significant it is!
    
    Dick

    re .70
    
    I my case, the effect is more; these symptoms mean this trivially
    treatable malady so why bother the doctor.
    
    There is also the effect of 'its too difficult to take the whole
    family to the doctor to get one of them looked at and it is next
    to impossible to arrange, at zero notice, for someone else to
    oversee the rest of the brood.
    
    Financial considerations also apply. The deductable is per person
    so the first effect gets applied as often as possible.
    

    Sounds like plan 2 is for me.  With a 14 year old skate board
    enthusiast and a 4 year old who shows signs for making Evil Knevel
    look like a wimp 100% hospital protection is a must.  
                                       

    
    RE:  Several earlier notes:
    
    >Does dental change under eitehr?  How about psychotherapy benefits?
    
    That's an excellent set of questions which I'm sure the benefits
    people would rather not deal with.  The reasonable and customary
    allowances made for routine dental care are quite unrealistically
    low.. I know few dentists whose charges are in line with what JH
    allows.  My dentists tries to accept insurance as payment in full
    for his services, but told me several years ago that he could not
    do so with his Digital patients, since the allowed schedule was
    so unrealistic...
    
    >How about psychotherapy benefits?
    
    Also a good point.  Depending on the level of the provider used,
    the charges vary widely.  And, 2,000 at 80% and the remainder at
    50% doesn't buy much care in some cases.  And, when you read the
    fine print, charges for psychotherapy are *Not* applied to your
    out of pocket expenses.  Why?   This is legitime care -- why should
    this be treated any differently than any other health service? 
    I mean why not have a limit on chiropractic care too?  Further,
    until this is adjusted legistatively, or otherwise and insurers
    are forced to reimburse this equally -- the limits relect rate
    schedules that are about 10 years-outdated.  And, if for example
    you have a child who say is being treated for something such as
    Attention Deficit Disorder by either a clinical psychologist or
    a psychiatrist that 2K will be gone quickly.
    
    >We are one of the few companies to have unlimited benefits.
    
    I must from my own experience, and having studied a large number
    of plans (offered by other medium to large size companies) disagree
    with you.  Our plan is currently about industry average.  No better
    and no worse.
    

        RE: .74 -- You're offering your opinions, right?  Calling them
        clarifications if they're not based on fact doesn't necessarily
        clarify anything but our understanding of your opinions.
        
        The bulletin that was sent to managers and personnel states
        explicitly that the Dental Plan doesn't change.  I agree with you
        that JH's "reasonable and customary" payments don't seem to match
        actual charges, but that's neither here nor there, and isn't
        relevant to the question of whether the Dental Plan changes.
        
        The bulletin says nothing explicit about psychotherapy benefits,
        at least, nothing I could find in it.  (Have you read a copy?)
        Since these are currently handled as a medical benefit (if I'm not
        mistaken), I strongly suspect the benefit structure is not going
        to change, but until I see more explicit documentation from
        personnel, I'd hesitate to assume either that it will stay the
        same or that it will change.  This is obviously a hot topic for
        you, and you believe that the current benefit structure is not
        fair, but that has no bearing on the question that you claim
        to be clarifying.
        
        As for "unlimited benefits", I think you took that out of context.
        The original assertion made was that Digital is one of the few
        companies to offer major medical coverage with no cap or ceiling
        on the benefits, not that our overall plan was remarkably better
        than the others offered by medium to large companies.  What other
        companies (of any size) offer major medical coverage with no upper
        limit on the total amount paid for a covered illness? 
        
        Tom

    
    RE: .75
    Tom I' certainly not trying to get into a devil's advocate argument
    with you, but given your comments, I'd like to offer the opportunity
    to clarify my opinions and give the factual basis surrounding them.

    First I haven't seen any bulletins sent to managers and/or
    personnel, and I don't think what might or might not be in this
    bulletin is the issue here.
    
    Second, .73 asked how benefits for psychotherapy might or might not
    be changed.  My reply and the question posed in .73 is not "a hot
    topic -- here you are simply offering your opinion.  What fact/
    facts are you basing this on?  I was basing my reply on what I know
    about the current fee structure in this field, and some simple
    arithmetic rearding how much treatment this will buy.  The "hot
    topic" value I have here is that treatment and help in this area
    should be treated no differently than any other insured need.  As
    for the limitations I discused, I've relied on our published materials
    for those facts.

    Unless you know something I don't, (in the way of changes) you are
    wrong in stating that these charges are dealt with in the same manner
    as other medical charges.  ( I've gotten this information from the 
    current edition of "Digital -- Your Benefits Book.", specifically 
    Pg. 3.33.  What this says, (and you might look it up and let us know
    if this has changed) summarizes the psych benefits as coverage at 80%
    of the first $2000.00 (less any deductables) ..... then expenses in excess
    of 2,000 to be covered at 50%.  It goes on to then say that "The
    remaining 50% of charges are not covered expenses and will not be
    applied to your out-of-pocket maximum."  These are not my opinions
    -- they are facts which are published.
    
    Other companies -- as I defined them:  (General Signal Corp, GCA Corp,
    Wang Labs, Merrill Lynch, AT&T, Bank of New England, to name a few)
    which I am familiar with have no coverage ceilings.   Thus, we do
    not treat catastrophic illnesses any differently.
    
    I am not simply pointing these things out to put myself into an
    adversarial position, but I would point out that my opinions have
    their basis in facts.  However linguistically your are correct in
    pointing out that clarifications must/should have their basis in
    fact... However, up until the point of offering opinions of what
    changes we should have -- I believe my opinions are factual.
    

        You're right, psychotherapy benefits aren't currently handled in
        exactly the same way as other medical benefits, but they are
        handled under the general umbrella of medical benefits, rather
        than being handled under some separate plan (as, e.g., the dental
        benefits are).  And you're right that the limits on psychotherapy
        benefits are lower than those for other kinds of medical care.
        (This is not just a problem at Digital, but that's not necessarily
        relevant.) 
        
        Nothing in the materials I've received suggests that there will be
        any changes in the psychotherapy benefits that differ from the
        general changes in the medical benefits.  Since the question posed
        related to the imminent changes in benefits, what is or is not in
        the recent bulletin is very germane to the question.  
        
        I think you may have interpreted the question in a different way,
        as a question about how the benefits might be changed to make them
        more useful, and in that context, your answer is useful.  I must
        agree with you that the current benefits for psychotherapy appear
        to be oriented toward short-term crisis resolution, not toward
        long-term treatment of a chronic or recurrent problem.  I doubt
        this will change soon, but I agree that it would be a positive
        change.  (I suspect that social policy needs to change first.) 
        
        Of course, we'll learn the details of any changes when the revised
        versions of "Your Benefits Book" come out; in the meantime, let's
        try to distinguish between answers based on the published data and
        our wishes for how things would change. 

        Tom

< Note 636.74 by LDYBUG::GALLAGHER >
>    My dentists tries to accept insurance as payment in full
>    for his services, but told me several years ago that he could not
>    do so with his Digital patients, since the allowed schedule was
>    so unrealistic...
    
    Digital's Dental Assistance Plan pays 80%, 60%, or 50% of established
    amounts, depending on the type of service provided.  (Page 4.2.)
    It's unrealistic to expect that this assistance would cover the entire
    cost of the treatment.
    							Larry

    Re: Dental Plan Notes - it's a Dental ASSISTANCE Plan.  Never was
    designed to pay most/all of dental expenses.  It does, however, pay
    more, percentage-wise, for preventive services (e.g., checkups) than it
    does for remedial services. 

    I haven't read the previous  notes to this topic, so bear with
    me if this has been asked already.
    
    I found out today that we will be expected to pay yet another
    deductible when the new plans go into effect.  Since I've
    already paid the $125 for this year, plus another $125 for
    psychotherapy benefits, plus $125  to cover my daughter's coverage,
    I have already paid $375 in deductibles this year.  In April
    I will have to start this again, and end up paying yet another
    $450 in deductibles.  Say it isn't so!  Surely this must be
    some kind of mistake.   If I had known this, I maybe would
    have been able to delay the at least one of the medical treatments
    until April, but two of these were necessary/emergency situations and
    I needed the medical treatment.  Does anyone have any information
    on this?  I can't believe I have to pay $825 in deductibles alone.
    Arrghhhh.
    
    Thanks,
    maria
    

    If a second deductible were applied to a claim of mine, I would
    follow the procedure on pages 12.6-12.7 of the 1988 "Your Benefits
    Book" by filing an appeal.  I suspect that if second deductibles
    are part of the change, there will be many appeals.

    As I understand it, on 1 April, the deductible will increase on
    each family member and on the family maximum. We will be required
    to pay the difference between the current $125/person and the new
    (either $150 or $175) per person deductible, not an entire new
    deductible. So, the impact will be only slight. Also, the new family
    maximum will be in effect on 1 April, so that will also affect larger
    families. Forgive me for not having the actual values; I'm merely
    attempting to relate the concept of what happens when the deductible
    is raised.
    
    Mike

        RE: .80 -- Your question is definitely one you should ask during
        the "small group meeting" with your personnel representative,
        which should happen in the next few weeks.  I suspect that the
        position will be essentially that expressed in .82, but I don't
        have enough details yet to be certain.  And if you are convinced
        that the handling of your case is wrong, use the appeals process. 
        
        Tom

    I and my family have had several doctor bills so far this year and
    I haven't had to pay any deductable yet.  By practice, we pay the
    doctor's office and then bill John Hancock.  I have already gotten
    three checks from JH.
    
    FWIW
    Irv Waldo

	RE .81

	You will not have to pay a 'double deductable'. Essentually
	Jan thru Mar this year are added on to 1988. Thus, if you
	have satisfied your 1988 deductible in calendar 1988, you were
	not subject to a new deductible starting in Jan 1989. If
	you did not satisfy the deductible in calender 1988, you
	have until 1 Apr 89 to satisfy 1988 deductible. Thus if
	have not satisfied your 1988 deductible yet, then it would
	be wise, if at all possible, to delay expenses until 1 Apr 89.

	Starting 1 Apr we all start the new year (1989) starting
	the new deductibles then.  Now 1989 will be a short year, only
	from 1 Apr to Dec 31 1989.

	Therefore think of 1988 as from 1 Jan 88 to Mar 1989

	and 1989 from 1 Apr to 31 Dec 1989.

	(1990 therefore is planned to start on 1 Jan 90).

RE: .85

	According the latest mailing I just got, with all the forms, your 
deductible "deduction" is NOT right!

	Page 5, paragraph labeled "Annual Deductible" says:


	".... Because of the increase, if you have already satisfied your 
deductible as of April 1, 1989, you will have to pay an additional $25 as an 
individual or up to $75 as a family....."


	That says to me the deductible reset to 0 on 1 Jan, and gets a 
"kicker" in April 1.

    Yes, I can vouch that the deductable began 1-Jan-1989.  Just got a check
    for $2.40 (80% of expenses beyond the deductable).

	The misinformation I gave came from a personnel type.

	What bothers though is that they must have KNOWN about
	it but didn't communicate to US. We have had lots in
	so-called information, largely incomplete except for
	telling ue how much DEC has been paying and we are going
	to charge more.

    I just returned from a "small-group" meeting, which covered pretty
    much the same stuff that was in printed material I already received.
    
    I pointed out that today, JH covers accidents 100% (up to some limit
    I don't recall - and then it goes to the usual 80%) and asked if
    there would be any change to this under Plans 1/2.  Personnel there
    ventured that it would change to the same as illnesses (80% from
    the start, after deductible), but said this was a guess and she
    would check for sure and let me know.  I'll post anything I'm told.
    
    OTHER MISC. TOPICS:
    
    HMO coverage of psychotherapy is very geographic. When I lived in
    Massachusetts, long term care was covered.  I've since moved to
    Illinois and find that all HMO's provide merely short-term crisis
    coverage.  I'm not sure, but I suspect Massachusetts requires HMOs
    there to provide stronger benefits, since all HMO's in Massachusetts
    offered comparable (better thsn Illinois) coverage.
    
    It doesn't affect me since my wife is not a DEC employee, but it
    was pointed out that as of 1989, one person can opt for dependent
    coverage with a weekly cost (such as Plan 2) and the spouse will
    be included. The spouse then can select a no-cost option (read that
    as Plan 1) and still be covered 100% for hospitalization.
    
    	/Marvin