Conference 7.286::digital

    This is discussed in a number of earlier notes.  Basically, the prices
    of all the plans are relative to the lowest-cost plan offered in your
    area.  If a new, cheap HMO comes into play, DMP prices skyrocket.
    
    				Steve

	The next step is for HR to claim that the HMO's are so successful
that Digital will no longer offer any John Hancock.  Next they'll raise the price of 
HMO/ELECT till all the people are off it also, then cancel it as a choice.
I loved it when local HR person sent a memo stating that most employees had made the
switch  from JH to an HMO and this was a success measurement.  See all the people must
like HMOs they're all enrolled and off JH as a carrier.

still_bitter_since_JH went from 20 to 60 to 80, to 120?, to 150 PER WEEK~!!!!@#

moo

    but it's pre-tax $$ so your fed tax bite will go down.  :-)
    
    ed

    
>>    If a new, cheap HMO comes into play, DMP prices skyrocket.
      
    I don't believe that's the case in the area where I live (Concord, MA).
    HMO and HMO elect have not changed significantly (they were available
    here previously), but DMP Plan 2 has gone up *over* 40% ! It's now
    around $8,000 for aq family plan. :-o
    
    -Ross     

    Well I live in a HMO area and our weekly deduction (cost) went up 30+%,
    so I wonder what is going on also.  We were just given the new rates
    with no explanation on the rate increase....like we really have a
    choice.
    
    <><><><><><>

    Individual	 $4.47/week <--- +14.62%  <---- $3.90/week
    Family	$17.31/week                      ?.??
    
    The next lowest provider in this area is $13.19/week for individual
    and $40.85/week for family. The highest (Digital plan 2) is
    $67.16/week for individual and $152.17/week for family.
    
    regards,
    mpr

    
    Should get yourselves a National Health Service. Us backward Brits
    get the basics right.
    
    AW

    Re .7  Tell us again what your income tax rates are. :-)
    
    Harry
    

As DMP rates go up, more people will realize that getting HMO Elect and always
going out of plan is cheaper in almost all cases.  Subsequently HMO Elect rates
will go up significantly.

>                 -< You're paying for it one way or another! >-

Of course they are.  But any sober scrutiny of reality will show
they're spending far less than we are for better coverage.
That's the point.

Which do you think is capable of providing better coverage at lower cost:

- The health care and insurance industries as driven by profit motives?

- A plan designed by the peoples representatives to serve the public interest?

In the U.S., we place more faith in the profit motive than public service.
Many americans are not convinced this can solve the problem of escalating
health care costs in the long run, but many more have not thought that
much about the problem and are easily manipulated by FUD to resist change.

- Peter

FUD = Fear, Uncertainty, and Doubt

    ...don't know what you're complaining about  :-)
    
    My weekly  "contribution" is going from $8.00 to $68.00 and since I'm
    on disability, and can't change to anything lower.
    
    Sigh
    
    Bob

    re 10.
    
    Thank you - couldn't put it better.
    
    I read somewhere that the US spends the most per capita on health
    care of any western nation, and also has the largest proportion of
    population without viable cover.  Seems daft to me.
    
    I don't pretend the UK system is perfect, and, certainly for a lot
    of non-urgent stuff it's not good at all. But for the real life
    threateners and urgent stuff (like my wife's emergency section when my
    daughter was born), I know where I would prefer to get ill.
    
    Oh, and we'll even treat any US types who get knocked down or taken
    seriously ill when they are here, and worry about the details (like
    money) later.
    
    As for tax rates, my marginal rate is 40%. You need to add up the
    total of your state tax, sales taxes, and federal stuff, then add
    on what you have to pay out for that I don't have to - like
    basic health care. I'll guess the final figure won't be too far
    away.
    
    AW

re Note 3522.10 by HANNAH::SICHEL:

> In the U.S., we place more faith in the profit motive than public service.

        Actually, what we are placing more faith in is multiple
        providers/multiple plans/multiple options vs. having fewer or
        no choices in any one or more of those areas.

        Obviously, sometimes these multiple choices are more
        theoretical than practical (e.g., you may have to change your
        job) or the choices belong to another entity who chooses on
        your behalf (e.g., Digital).

        (Some of the providers are non-profits.)

        Bob

    But let us not forget that "non-profit" does not necessarily mean they
    do it for fun!!!   Non-profit organizations are a legal technicality. 
    They have no bottom line to focus on, or stockholders, or Wall Street
    to worry about, but their motive is still to make some kind of margin
    which will allow them to pay their executives fat salaries and perks.
    Like any bureaucracy they still strive for self-perpetuation, so they
    spend their "surpluses"  (think 'profits') on things like lobbying,
    advertising, etc.  Show me the big difference!!
    
                                           

National health care?!? My god, man, do you know what you're saying?

The "S" word!

Derived from the "C" word!

As long as freedom fighters around the world struggle, we will never permit it! 

Can someone get Jesse Helms on line here to defend our rights?

    re 15
    
    for 15 years in the Uk we have had a definitely non-'S' conservative
    govt. NHS survives, as it is seen to be valuable this last 50 yrs.
    Changes, reforms, of course, but still there.
    
    Do not confuse with Bill C's attempts to get 'managed care' in US.
    Rather different emphasis.
    
    Oh, and I have Private Medical Insurance as well - to cope with the
    non-urgent stuff that the NHS isn't designed to cope with too well.
    
    
    Freedom fighters better make sure that if they get shot, this happens
    in the UK, not US, unless you are covered by 'Freedom Fighter Health
    Care Inc (Not for Profit, of course)'.       :-)
    
    AW

    re:  DMP 1 & 2 -  when DMP got it's first huge jump in cost, Digital
    exposed to us employees that they were doing it on purpose, and would
    continue to raise the price annually in an attempt to incent employees
    to select the lower cost/more "efficient" HMO plans offered.  Remember,
    John Hancock only administers DMP; Digital actually pays the medical
    claims, as Digital is self-risk-managed in the 80/20 medical plan. 
    
    Also, as a medical plan group shrinks, the premium rises
    proportionately, because admin. costs lose the economies of scale
    achieved in larger groups.  Plus, the smaller group has a higher risk 
    of claims risk.  In that respect, it makes sense that DMP plan 
    rates are rising.  
    
    M.
    

    Re: .17-
    
    >Also, as a medical plan group shrinks, the premium rises
    >proportionately, because admin. costs lose the economies of scale
    >achieved in larger groups.  Plus, the smaller group has a higher risk 
    >of claims risk.  In that respect, it makes sense that DMP plan 
    >rates are rising.  
    
    	So, if all of us in forced HMO areas had "bitten the bullet" and
    elected DMP we could have actually held the DMP rates in check....
    Interesting. Too late now I'm afraid. 
    
    	I'd like to know what percentage of HMO elect members DO NOT use
    the HMO but rather "eat" the increased cost of DMP to retain their own
    doctors. I know we do for our son's pediatrician.
    
    Phil

    re: .14
    
    If I remember correctly the President of United Way makes
      $2,000,000.00/year - that is definitely "NON-PROFIT" paying
    	his salary...
    

re Note 3522.19 by CSEXP2::TIMA_MGR:

>     re: .14
>     
>     If I remember correctly the President of United Way makes
>       $2,000,000.00/year - that is definitely "NON-PROFIT" paying
>     	his salary...
  
        You are off by about an order of magnitude.

        Bob

    
    	"an order of magnitude?"
    
    	You mean your president is paid $20,000,000.00 a year?
    
    				Malcolm.

    The former Pres of the United Way -- the guy who was fired --
    was making big bucks.  I think it was well over 1 mill maybe two
    plus he had lots of buddy-buddy relationships where it looked
    like he was getting kickbacks from subcontractors.
    
    After that the UW cut the salary for the position to about
    $500K and found a new director.
    
    ed

        THe Prez's salary is about $ 200,000  per year. At least the legal 
    	reported salary...
    
    
    	Only professional athletes, rock "musicians" and some CEOs
        make  20 mill per year.
    
    

re Note 3522.23 by CSSREG::BROWN:

>         THe Prez's salary is about $ 200,000  per year. At least the legal 
>     	reported salary...
  
        I think we both misread the $2M posting -- upon re-reading, I
        note that it said "President of United Way" (not "States").

        I have no idea what the President of United Way makes, and I
        don't care -- I haven't donated to them for decades.  (I also
        don't think of the United Way as a healthcare provider,
        except in very indirect ways!  On the other hand, the recent
        discussion included government as healthcare provider.)

        Bob

    The Philadelphia Inquirer has been reporting CEO salaries for the
    region over the last several days.  One of the upper, upper echelons is
    the President of U.S. Healthcare who received more than $7,000,000 in
    compensation this year.
    
    So remeber, when they tell you that you have to clear out of that
    hospital room, he's probably gaining a bonus payment.

    
    I too looked into DMP for my family coverage.  I live in an area
    which offers HMO-Elect.  My family uses out of plan specialists
    extensively.  In my research of Digital plans, I found out that
    the out of plan portion of HMO-Elect is administered by John Hancock,
    in the same exact manner (other than 70/30 vs. 80/20) as the DMP.
    
    As I see it, there is no reason to take the DMP if the HMO-Elect
    plan is offered in your area.  I believe the only reason we still
    offer DMP is that there are areas where an HMO-Elect option is
    not available.
    

	I think the way HR handles the whole "choice" process needs our input.
	
	First, thru some improper planning health care costs were unloaded upon
	us with no prior warning.  Remember when HMOs first hit the scene?

	We were told in a very cowardly way, "You have a choice" (with smerk on face)

	In Seattle, we only have one choice outside of JH, and in my opinion is not a
	good one. 

	Every year I ask for additional choice(s) and I get told, "other cities only
	have one choice also" (again with the smerk)

	Blue Cross has this thing about pre-existing conditions but a small effort by
	HR could put us back in the "choice" seat again. ie no block on pre-exist cond.

	All we want is a "REAL CHOICE"

	
death or roo-roo

    	For more reasons as to the incentive to switch, JH is a "fee for
    services" provider. The more services provided, the more fees levied and
    the more money the health care providers make. In todays sue-happy
    society, it is very easy to justify costly, but not always necessary,
    diagnostic tests.
    
    	My understanding of an HMO is that there is essentially a large
    calculated pool of money to pay for the yearly health care provisions
    of all its members. Any surplus of money left in the pool at the years
    end is distributed amongst all of the health care providers. This
    manages cost by placing the incentive on minimizing the amount and type
    of care provided.
    
    	Not too long ago I injured my back. Being that I'm on an HMO, the
    last thing they wanted to do was an expensive MRI. After seeing 7
    different doctors over the course of the 8 weeks that I was in extreme
    pain, it was only the last one that said had it been earlier on in the
    injury he would have ordered an MRI. If I had John Hancock I would have
    been scheduled for an MRI after the first visit.
    
    	The point in all this is that the JH plan rose astronomically
    because it is astronomically more expensive to administer due to the 
    method in which the health care providers derive profit from the system.
    It should come as no surprise that as more economical plans become
    available to employees, Digital would want to create an incentive for
    them to switch. Unfortunately, people on disability or with
    pre-existing conditions can get financially slam dunked in the process.
    
    	Ray

    
    re: .-1, if an HMO-elect option is offered to you, the out-of-plan
    portion of it accepts all pre-existing conditions.  My weekly family
    cost for HMO-Elect is $30.00 vs. $22.00 for the HMO only.
    
    I don't know if it's unique to my geography, but my HMO also accepts
    all pre-existing conditions.  I'm told that all of the HMO's in my
    geography offered by Digital also accept all pre-existing conditions.
    
    I will grant you that using out-of-plan services has both a deductible
    and co-pay to a maximum out of pocket.  I believe all of the HMO-Elect
    plans we offer have a $300.00 deductible, 30% co-pay, and $3,000
    maximum out of pocket.
    
    Are there alot of areas in which an HMO-Elect is not an option and the
    DMP is the only option?  Are there any folks out there selecting DMP
    over an HMO-Elect, and if so, how did you arrive at your decision?

>    I don't know if it's unique to my geography, but my HMO also accepts
>    all pre-existing conditions.  I'm told that all of the HMO's in my
>    geography offered by Digital also accept all pre-existing conditions.

All HMOs that Digital contracts with accept all pre-existing conditions.
Otherwise they wouldn't get Digital's business.

>All HMOs that Digital contracts with accept all pre-existing conditions.
>Otherwise they wouldn't get Digital's business.

Note that these same HMOs may have pre-existing condition exclusions for other
customers.  It's Digital's contract with each one that demands that they
have no such exclusions for customers in Digital's group.

    I am one of those folks that was faced with a $117/per week increase
    with Plan 1. To meet all of the needs of the family and due to the VERY
    limited choices for HMOs I went with the "elect plan".
    
    Here is the update.
    
    U.S.Healthcare couldn't let me use my preferred primary physician
    because he wasn't 'coded' to accept my 'type' of incurance. Remember
    the elect plan is one that over rides the basic plan. All I wanted was
    the ability to go to anothe physicia, if I wanted.
    
    Eye examinations are a $2.00 co-pay. No info in any of the doucuments
    sent in the last 4 months. There are no plan doctors in either my
    county or the one to the south. An hour drive to pay only $2.00. Whata
    deal.
    
    Eyeglass/contact reimbursement $35.00. Pay all up front then call and
    ask where to send the receipt. At least I can buy anywhere I like.
    
    Persciption Drugs: "Outpatient covered 100% after $5 co-payment per
    prescription." Well not quite. My wife is on synthroid and the primary
    physician does one script for a year and marks it in 100 unit
    increments [~90days]. UShealthcare only allows 30 per fill. Cost now
    goes to $5.00 per fill or $60 for the 1 year script. Seems that
    UShealthcare won't allow more than a 5 refill script so the pharmacies
    have to do 'something special' to cover this. If we had $10.00 co-pay
    the 100 would have been cheaper at $29.92 than $30.00 for 90. As it is
    the plan pays $3.06 after I pay $5.00. With Express Pharmacy, my cost
    $8.00 per year.
    
    Both available HMOs in my area have terrible reputations and providers
    are dropping out like flies. Nice choice, DEC.
    
    Howard  

Well ASO went through this pain last year (for this year) and now we're faced 
with even worse choices thanks to the sale of ASO to SCI....you may not 
realize just how nice the Digital plans are

dave

>    U.S.Healthcare couldn't let me use my preferred primary physician
>    because he wasn't 'coded' to accept my 'type' of incurance. Remember
>    the elect plan is one that over rides the basic plan. All I wanted was
>    the ability to go to anothe physicia, if I wanted.

Are you saying that if you had gone for U.S. Healthcare without HMO Elect
they would have let you use a certain primary physician, but because you
went for U.S. Healthcare _with_ HMO Elect they won't?

    Note 3522.35
    >Are you saying that if you had gone for U.S. Healthcare without HMO Elect
    >they would have let you use a certain primary physician, but because you
    >went for U.S. Healthcare _with_ HMO Elect they won't?
    
    That's right, unless they can get the physician "approved" for this
    coverage code. "It's one of those computer problems" said the lady on
    the phone.
    Howard

I think you should discuss this with Digital's liaison with the HMO.
I suspect it violates the contract.

    Here's another gotcha...
    
    Fallon HMO now allows members to choose specialty care providers
    outside the HMO if so desired.  Seems like a great feature, and
    something very similar to HMO elect provisions.  But....
    
    If you opted to pay the additional premiums for HMO elect (because 
    you wanted the flexibility to choose your own specialty care providers
    if needed), the Digital contract with Fallon says you must use Fallon
    specialty care providers, or use the elect portion of the program to go
    outside the HMO (which costs a lot more).  You can't use the flexible
    provisions described above unless you have the less expensive plain
    Fallon HMO.
    
    Wish that were mentioned when this year's choices were considered.
    Bottom line...you pay more for the privilege of getting less!

RE:3522.37
>I think you should discuss this with Digital's liaison with the HMO.
>I suspect it violates the contract.

	You can give it a try bit I do not believe that you will get anywhere. 
An HMO (High Mortality Organization ?) is an insurance company that makes 
money selling insurance, not providing health care.  As far as I can tell, that
is the contract. 

from .29:

"Unfortunately, people on disability or with pre-existing conditions 
can get financially slam dunked in the process"
(of switching to more economical plans)
    
So what is the story on this? Do some HMOs refuse to accept
someone with pre-existing conditions or on disability? charge more?

   erik

At least as of a year ago, if you are on disability your rates will
NOT change, even if everyone else's do change for the same plan.

This was a big help to me as I was placed on disability the day after
open season closed.  A drunk driver put me there, and I thought things
would be a huge mess, but they were not.

Lew

    
    All of the health plans offered in my area (Wash DC) cover
    pre-existing conditions.  I was able to change my health care
    provider during open enrollment to a more generous plan even
    with a significant pre-existing condition.