Conference 7.286::digital

It more sounds as if your particular PCP isn't helping you out.  I've found
Healthsource service to be exemplary.  Have you called Healthsource to ask
about the referral?

				Steve

    I agree with Steve.  Sounds like the problem is your primary care
    physician, not Healthsource.  I have had no problems with referrals. 
    And a simple call to Healthsource, early on, lets me know if my PCP has
    taken care of the referral (I don't even check now).  --S

    
    I have HealthSource via my husbands plan at LockHeed. After being on
    Blue Cross/Blue Shield, HealthSource seems a bit limited in what they
    cover and there are alot of deductibles.
    
    The other thing with us, as this is the only plan offered at LockHeed,
    is that we live in Mass, and the listed Dr's in our area is very
    limited and there was not many to choose from.
    
    Haven't had to use it yet, but I hope when we do, all will run
    smoothly.
    
    Mary
    

    Re: .3
    
    You can't do blanket comparisons between two different employer plans -
    each employer negotiates with the HMO to come up with a set of
    coverages and deductibles which they want to offer and pay for.
    
    I have had Healthsource NH for 4-5 years now, and have had NO paperwork
    hassles, NO red tape and have not encountered any of the deductibles. 
    Of course, your situation may vary.  I have received numerous referrals
    to specialists, and my son got an out-of-plan referral for an expensive
    test with no grief whatsoever (his PCP asked for it, we got it).
    
    I have found the Healthsource staff helpful in answering questions and
    resolving issues.
    
    				Steve

I'm with Steve. I've been with Healthsource for over 4 years now 
and have had emergency surgery and physical therapy on myself as 
well as surgury on my son, who was 1 yr at the time. We had a trip 
to the emergency room while at the Cape as well. Never had a 
problem with a referral, even for a 2nd opinion, and never any 
paper work problems. In fact, I can't recall any paperwork at all.

We're pleased.

daryll

    I also had a problem getting a referral when we used Healthsource in
    NH.  (we had to lobby for a referral by writing a letter and
    complaining to the Patient Relations dept.)  We are using Matthew Thornton 
    now and are much happier with the 
    PCPs and the availability of specialists.  MTHP will merge with HCHP,
    which I've heard is excellent also, and this should further benefit
    both.
       
    Laurie

    
    My PCP told us that HealthSource would be merging with CMHC, not sure
    when, but that they will still be treated as separate entities. 

    re .6, Matthew Thornton merging with Harvard...
    I've been a Harvard Community Health Plan subscriber for three years
    now, and it's been very good.  The only thing is, I found HCHP to be
    very stingy with its physical therapy coverage.  I had a bad muscle
    spasm in my neck/shoulders last fall (maybe the year before, I don't
    remember), and was prescribed a muscle relaxant and only 4 visits to
    PT.  The folks at the PT clinic said it really takes 6 to 8 visits
    to work out a problem like the one I had.  But Harvard didn't/wouldn't
    OK more visits.
    
    Also, HCHP will not cover chiropractic (hope that changes before the
    next open enrollment period) -- apparently the plan considers
    chiropractic, acupuncture, acupressure, myotherapy, etc., "alternative
    therapies."  We are out of pocket over $1000 on chiropractic costs
    because my husband injured his back and could not get relief through
    Harvard doctors.  He's fine now...hope the bank account recovers
    soon...

I have not seen anything about Healthsource merging with any other HMO.

			Steve

    
    I have called both Healthsource and CMHC about this about two months
    ago, and both confirm it, but don't say when it will be happening.
    
    My PCP has also had conversations with them about it because the thought
    was that CMHC physicians would be picked up by HealthSource, thus, we
    could use Dr's listed on CMHC, but that is not the case, physicians 
    would would have to apply to HealthSource for approval.
    
    There is no date as to when this will be taking place, as far as I
    know.
    
    Mary
    

    
    Also, I might add, it depends on who you talk to at both places.  The
    normal folks answering questions did not know, I was transferred up to
    people in supervisory levels.

    re: .8 I can't remember if the Elect option which allows John Hancock
    coverage for things outside of your HMO  will cover chiropractors or not, 
    but it does cover osteopathy (alternative healing specializing in
    musculo-skeletal problems). This is what I use to get my monthly back
    adjustment (don't like chiroprators anyway) and JH covers it at 70%
    after the $300 deductible. You might want to consider this option
    during the next open enrollment to avoid any more $1000 out of pocket
    payments.
    
    Debbie
    

    It might vary by HMO but I have used chiropractors for several years
    and have been reimbursed under the HMO Elect option.
    
    Larry
    

The "Elect" part of HMO Elect has exactly the same coverages as the Digital
Medical Plans.  Therefore chiropractors are covered.

I'm a little surprised that HMOs don't cover osteopathy.  I believe the AMA
considers doctors of osteopathy legit.  They certainly don't consider
chiropractors legit.

  <<< Note 3960.14 by NOTIME::SACKS "Gerald Sacks ZKO2-3/N30 DTN:381-2085" >>>

>I'm a little surprised that HMOs don't cover osteopathy. 

	It depends on the HMO. Some will cover D.O.s

Jim

The following might help explain the differences in satisfaction experienced
between Healthsource clients having different PCPs.

I believe the basic method of payment for Healthsource PCPs works like this.
(There may be other elements I am not aware of.)

  o A flat payment for each patient they accept. This payment is fixed and 
    covers all care the PCP provides from 0 to infinity.

  o A lump sum is set aside for each PCP to cover the referals they make. Each 
    time a PCP makes a referal a deduction is made from the lump sum. At the 
    end of the year the PCP receives a check for whatever remains of the referal 
    set aside.

Different PCPs will approach this method of payment differently. You can draw
your own conclusions about how the financial incentives are set up. Certainly,
it would be helpful when evaluating your choice of any managed care program to
know what the financial incentives are for those making the decisions regarding
what care will be provided. Just saying what is "covered" under the contract
doesn't tell the whole story.

Tom,

I guess I would start with the HMO themselves. You may be pleasantly surprised,
but even if they stonewall you, that might be informative in itself.

After that I would try asking participating physicians. When you ask the
physicians you might, as a side effect, get unsolicited comments about how the
HMO treats them like, "They are very hard to get your money from." Or, "They are
a pleasure to do business with." Or, "They don't permit us to disclose that."
All this can be additional input to your decision. Keep in mind that the
physicians comments provide insight into both the HMO and the physician.

					Tom

Another excellent source of input is specialists to whom you have been 
referred.  My wife was informed by one specialist to whom we were referred by 
our then HCHP PCP that he could do more if she had been referred by, for 
example, a Pilgrim PCP.  We heard this type of thing from others also.  We 
switched to Pilgrim at the next open enrollment.

Our understanding was that HCHP (and presumably other HMOs) provide a pool of 
cash to pay for referrals.  What isn't used is shared among the PCPs at the 
end of the year.  The size of the pot and the scheme for disbursing the 
unused funds seems to be a major factor in the difference between the levels 
of care provided/available.

    RE: .14, .15
    
    >>I'm a little surprised that HMOs don't cover osteopathy.
    > It depends on the HMO. Some will cover D.O.s
    
    with HMOs like Tufts (which is a network of participating physicians in
    private practice), basicly, you just need to find a D.O. that is a
    Tufts physican (preferably affiliated with the hospital your PCP is
    affilliated with) and ask for a refferal. Or the easeier case, most
    D.O.s are PCPs; just choose the D.O. as your PCP.
    
    Deb