Conference 7.286::digital

Good Luck, and please let us know what happens.  

Angeline

    I don't think I understand.  You say that starting on Jan1, JH covers
    TMJ, but prior to this they only covered it if it were corrected
    surgically.  That implies that now they cover it non-surgically?
    Then what is the problem?  If not, what changed on Jan1?
    
    Burns

    Prior to Jan 1 (87) JH *only* covered TMJ if it was corrected via
    surgery.  What changed on Jan 1 is that now TMJ is covered (up to
    a lifetime max of $1K) whether via surgery or via other methods.
    The problem I'm facing is that these new techniques to correct the
    problem have been in place for at least a couple of years, where
    surgery is not necessary.  It is only as of Jan 1 that JH is now
    apparently "blessing" these new techniques.  In other words, all
    work done on a TMJ problem prior to Jan 1 that was *not* done in
    preparation for surgery is covered at 0%.
    
    Jon

    	JH is slowly (at DEC's wishes, of course) cutting back on coverage.
    They have to...it's too expensive.  Kinda like steak in the package
    at the supermarket...you keep the price about the same as much as
    possible, and cut the quality & quanity back.  
    
    KMP
    
    

    re: "they have to...it's too expensive".
    
    That's exactly my point, and if they would be willing to get on
    the ball, they could save some money.  Take a given condition, say
    TMJ in this case.  It can be corrected in two ways: one via surgery
    (which they'll cover) and one via no surgery, which they didn't
    cover until 01-Jan-1987.
    
    As the comics section of the newspaper say:
    
    What's wrong with this picture??
    
    Jon

Around 4-5 years ago, we brought our infant son to a neurologist at the 
pediatrician's recommendation just to make sure things were developing 
ok which fortunately they were.  The examination basically consisted of 
bending a couple of limbs, looking into eyes, measuring skull and one or 
two superficial types of checks.  The entire procedure took 10 minutes.

When our bill arrived it said "Extensive Neurological Exam - $150"!  I
called JH and told them this Dr was ripping them off and if they wanted 
to make a case of it I'd me more than happy to help out.  Silence...

Obviously they are only interested in taking the easy way out.  I would 
think the possibility of raising hell with this Dr and all her past 
bills would be exciting.  They might even get on 60 minutes  8-)

-mark

    like .6, I have on several occasions pointed out to JH about medical
    priactics were ripping DEC off. No comment,NO correction.  they
    pay their share, I pay mine.  I tried.
    
    ed badger
    

    Briefly, surgeon charged 30% more than the "normal and customary".
    Since he was Very Good and removed my son's appendix, I paid my
    share and 15% more.  Then I asked JOhn Hancock to write to the Doctor
    and request he waive the remainder.  They (the Dr's office) stopped 
    billing me for the balance.  
    
    I feel that John Hancock is doing all they can to help us reduce
    the cost of medical insurance.  BUT it is up to YOU and I to request
    that JH request that excess costs be waived for "hardship" reasons.
    
    	Rick
    	Merrill
    

    re .8: the charges for the TMJ work done in 86 were within "normal
    & customary" charges.  I'm protesting on the *principal* involved,
    not for "hardship" reasons, although the few hundred bucks I'd be
    saving would certainly come in handy.
    
    In talking with the local Benefits Admin folks, they have presented
    my case (as well as several others also involving TMJ) to JH and
    are waiting for a response.  My dentist has been very good about
    it; not pressuring for payment until this thing is resolved, and
    also offering to do anything he can to help, short of sitting on
    a Supreme Court panel.
    
    The dentist also told me that the work he did in 86 for TMJ was
    *identical* to what would have had to have been done if my wife
    was being prepped for surgical correction of the problem.  As a
    result, the "activity codes" for what he did could fall into about
    20+ different categories.  Maybe he just picked the wrong one? 
    This was also explained to the BA folks, who in turn will be bringing
    it up to JH.
    
    Will post final results here.
    Jon

Back 3-4 years ago, John Hancock reimbursed 80% of all perscriptions, and
100% of generics.  This contained costs 2 ways: 

   1. The employee saw the cost of the perscription, and actually had to 
      carry it for a while.  This gave him incentive to keep the cost down,
      and to question increases.

   2. The employee was encouraged to buy generics (often at less then 1/2 
      the cost of the name brand drug).

Currently, employees pay the first $4 of each perscription, employees
usually do not see the total cost of the perscription, and JH pays a
handling charge of $3-4 per perscription on top of the full cost of each
perscription. 

Could someone explain the cost-containment advantages of the new system to
me?  Thank you. 

    Re: .10
    
    I've occasionally noticed that the prescription cost charged to
    the insurance is significantly higher than what I'd pay if I didn't
    present the PCS card.  This scam seems to be widespread in industries
    that are paid by insurance companies (doctors, auto glass repair,
    etc.)
    					Steve

    I once visited a dentist (different dentist, different city, different
    circumstances than .0, still Digital & JH) where the receptionist
    asked before I left if I had dental health care coverage.  I told
    her yes, then asked why she wanted to know.  It was because the
    dentist had one rate for patients covered by health insurance, and
    another rate (lower) for folks who were paying out of their own
    pocket.
    
    Jon

You shouldn't be suprised that doctors have different rates for
people paying directly vs people paying via insurance: the doctor
has to deal with the insurance bureacuracy, which takes time, which
has to be covered by fees.

Martin.

    re .12&13
    
    That's right, the dentist told us flat out that their would be an
    extra charge if we elected direct payment from the insurance co.
    That charge would be eliminated if we paid the bill and sent in
    the forms ourselves. The companies, often, take a while to pay
    and, if they don't pay the full amount, they have to bill you
    again.
    
    Bob Mc
    

    Can you pay a dentist the lower rate "cash" up front ,then turn
    in the claim form for reimbursement? It seems like this would save
    everyone a few bucks.   BOB

My dentist in Maynard only gives the discount to people not even having her
fill out the insurance forms.

/john

>    Can you pay a dentist the lower rate "cash" up front ,then turn
>    in the claim form for reimbursement?

Of course you can.  Of course *you* would be paying (in time and
effort) during the negotiation period, and in interest costs while you
don't have the use of your money, and would be assuming the risk that
John Hancock would reject your claim.  How much is that worth to you? 

Once upon a time I broke a filling in Tokyo.  The (competent) Japanese
dentist charged about $60 for a replacement.  It took about 4 months
to get that straight with J.H.  It seems they couldn't read the
invoice and sent a letter (in English, of course) and were waiting for
a reply. 

I said the magic word "small claims court" and was paid the next day.

Ps: the dentist's office is in the same building as Dec Tokyo.  Highly
recommended if you're in the neighbourhood.

Martin.

    Is preventive dentistry covered under this new JH plan?
     
    the reason I ask is I had to have a mouth guard made up due to
    grinding of my teeth at night. This cost about $150.00. I know 
    that if not corrected I could have TMJ. My dentist is very good
    and I trust him, but I can't see why JH won't pay for this but
    they will pay for what's in store for me if I don't correct this
    problem now....any suggestions out there?

    As part of my wife's TMJ treatment, our dentist also made a mouth
    guard for her to wear at night to prevent grinding of her teeth.
    Effective Jan 1 87, this is covered as part of the new TMJ benefit
    (up to a lifetime max of $1K).  From what our dentist told me, it
    would be covered *if* he is willing to code it on the JH insurance
    form you provide him as being part of TMJ treatment.  Apparently
    if it's not coded as such, JH views it as "elective and not truly
    necessary".
    
    Bottom line: discuss it with your dentist, then double check it
    with your local Benefits Admin folks.
    
    Jon

    
    I was having TMJ problems back in 1982-1983.  My dentist filed
    a claim for a bite-guard he'd made to help me stop grinding my
    teeth at night, too.  I think it was something like $175.00
    (The bite-guard was almost 100% effective, too).
        
    JH wasted no time reminding us that they didn't cover treat-
    ment of TMJ problems.  

    My dentist kept on them.  He sent them a letter stating that if 
    I <didn't> wear the bite-guard, I ran the risk of destroying my 
    bite, which had been corrected through orthodonture as a teen.  
    
    He reminded JH that if I destroyed my bite, JH would end up
    paying for treating a condition that <resulted> from TMJ prob-
    lems anyways, since they were willing to pay up to $1k in ortho-
    donture.
    
    He also pointed out the dollar diff. between $1k and $175.00.
    His final question was something like, 'how can you deny paying
    $175.00 to PREVENT orthodonture problems, but, at the same time,
    be willing to shell out $1k for orthodonture problems???'
   
    Pardon the pun, but JH didn't bite...
    
      - Donna
    
    

    Today I talked with JH and found out that preventive dentistry such
    as mouth guards are covered. How much I don't know , but its a step
    in the right direction. In order for you to get benefits, you must
    give your dentist a "health claim" form and not the usual dentist
    statement. When the dentist fills out this form, make sure that
    the mouth guard is to treat TMJ. I'll keep posted on how much is
    covered when the bills are sent out.
    
    If you have specific questions regarding your coverage, you can
    call DTN 223-3300.
    
     Happy smiling!
     Mike Lefebvre
    

    Notice on bottom of recent bill:
    
    As you were probably notified, Digital purchased a new insurance
    benefit package 1/87 affecting benefits paid.  They used to pay
    by a schedule.  They now pay according to percentages and for basic
    dentistry, the benefits have been lowered.
    
    				Thank you
    
    Why are we receiving lower benefits but not costs?  I'd rather
    pay more for the benefit than to have increase dental costs.  I
    gave up on JH for medical after 10 years because I was still paying
    out over $500 a year for just 2 people.  Seems nothing I was been
    treated for was covered.

    
    This is an interesting and frustrating topic.  There also are some
    areas of dealing with an insurance company, (even if that company
    is only doing claims-processing) which I believe verge on violating
    your civil liberties.  I know this sounds overreactive, but think
    about it. . . women are not paid for ob/gyn care, even though if
    it is ignored as preventative treatment, it often leads to very
    serious problems later on.  Now we have hospital preadmissions review,
    as well as a mandatory second surgical opinion on many procedures.
    Now, I know hospitals and some physicians are not doing their part
    in overall cost containment, but now the situation arises where
    these people have to do much more paperwork prior to routine
    admissions, and you have to get involved in the diplomacy loop if
    a problem arises with a second surgical opinion.  All this when
    you're primary concern is one of getting better, and correcting
    a medical problem.  Now, I agree that with some surgical procedures 
    you would be crazy not to get a second opinion, but *at your option*.
    In fact, most good doctors won't perform questionable surgery without
    getting a fellow practicioner to review your records.  So the bottom
    line here is many hospital admissions are delayed, more anxiety
    is added to an already tense situation, and your financial
    reimbursement is decided on by some doctor (or review board in the
    case of the hospital preadmissions review) who is working for the
    insurance company, doesn't know you or your condition, and probably
    doesn't give a damn.  Or in the case of lets say, an emergency 
    hospitalization, is your next-of-kins first though going to be "geez
    I've got to call John Hancock ...."
    
    Has this policy been around long enough (either here or in other
    circles) to create the formation of a group and a class-action? 

Re:.23 by TALLIS::GALLAGHER 

>    Has this policy been around long enough (either here or in other
>    circles) to create the formation of a group and a class-action? 

If so, I'd sure like to know about it!

Signed,

An Un-happy JH user

    I get my teeth looked worked on (Cleaning and a couple of cavities filled)
    and I get a bill from my dentist stating that I owe $70. It also says that
    JH paid $110 of the total. Does DEC know that it's employees have to shell
    out some 39% to cover their teeth?  Seems to me that if DEC is going to 
    choose the insurance company that is covering its' employees teeth, it
    should choose one that won't break its' employees.

						Dave

    On the other hand, over the last five years of regular, competent
    dental care, I have not as much as seen a bill from my dentist.
    I must assume that he either works for free, or that he is satisfied
    with the payments from my JH dental *assistance* plan and has graciously
    decided not to squeeze his patients further to pay for the cabin
    cruiser.

    My wife goes to another, much more expensive dentist, from whom
    we regularly receive after-insurance bills that approach our yearly
    heating budget. She always gripes about the cost. I always tell
    her, in my most loving tone, "Honey, shop around for a less expensive
    dentist, or shut up and pay the bill!"

>    I get my teeth looked worked on (Cleaning and a couple of cavities filled)
>    and I get a bill from my dentist stating that I owe $70. It also says that
>    JH paid $110 of the total. 
        
        Now let me get this straight, you paid $180 for two
        fillings and a cleaning? 
        
        -kHk-

    One interesting aspect of the JH vs. HMO issue is those, like myself,
    who are divorced parents and MUST provide medical insurance for
    children (by court order) who live in other geographic areas.
    
    I don't have a choice, since the HMOs are limited to the locale.
    
    	-Barry-
    

    RE .25
    
    Since I've been with DEC I've had my teeth cleaned and checked
    yearly, and so far there's been no charge. However this year, I
    had them cleaned by a different dentist, and I got a notice
    back from JH stating that they pay only 80% of the standard
    rate. I realize that the dentist may charge more than this
    standard rate, but is this 80% thing new??
    
                                      Jim L

It is fairly common for a dentist to not bill the patient for the
percentage that is not covered by insurance.
  John Hancock dental insurance used to pay 80%. Two weeks ago I
got a statement and I noticed that they only paid 60%. Nothing else
has changed; same procedures and ballpark cost of treatment; same
dentist. I don't recall seeing anything in the DEC benefits flyers
about JH reducing the percentage on its dental insurance.

    re: .30--``It is fairly common for a dentist to not bill the patient
    for the percentage that is not covered by insurance.''
    
    That doesn't seem right to me.  John Hancock is only supposed to
    pay 80%.  By not billing the patient for what John Hancock doesn't
    pay, John Hancock is effectively paying 100%.
    
    I'd like to learn more about the 60% incident.  Has John Hancock
    caught on to your dentist's trick, and reduced its compensation
    to 80% of the amount the dentist is actually charging?
        John Sauter

    re. payment
    
    
    
    Alot of doctors will do the same thing on medical payments.
    They charge their normal rate, and if you are having high medical
    bills, will accept the Insurance payments and forget about what
    you owe.
    
    
    My wife had a lenghthy and costly illness several years back, and
    even after JH paid up, I still owed the doctor and hospital some
    cash. When I asked the doctor for the sum total that I owed him
    he just said forget about it. I don't think JH was over charged,
    because it was the normal billing charge he always got. Its just
    that the doctor took what the insurance company would pay and 
    he dropped the remaining balance. It sure helped, especialy with
    three kids, one a newborn, and another only 1 1/2 in the house.

     re .31:
     
     Hancock pays exactly the same amount to any dentist for the same
     procedure; before Jan 1st, it was 80% of the "reasonable and customary
     charge."  So, if your dentist wanted to charge you only $16 for a
     procedure for which other dentists would charge $20, then you wouldn't
     have any out-of-pocket expenses.  
     
     --Don

    re:  .30
    
    Bob,
    
    I remember getting one of those "Highlights of Benefits" booklets
    sometime in December.  It stated that JH was planning on revising
    their dental benefits based on geographical locations.  Like many
    other people, I postponed some expen$ive dental work, thinking they
    were going to raise their benefit.
    
    $ SET FLAME_LEVEL/EXTREME
    
    My dentist charged $575.00 for a procedure.  JH felt that $450.00
    was reasonable and customary.  They then paid 60% of the $450.00.
    
    I hate JH.  I used to say, "Thank goodness for dental insurance...
    it takes the bite out of the bill."
    
    I don't say that anymore...     :-(
    
    d

    From the 1982 benefits booklet, "If You Need Dental Care":
    
         The Plan pays a fixed amount for specified dental services....
         
         You'll notice that the Dental Assitance Plan pays a higher
         percent of the total bill for preventive care, such as teeth
         clearning, than it does for restorative care, such as root
         canals.  The Plan is designed to encourage you to get regular
         checkups by the dentist.
         
    Thus, the old plan (upto Dec 31, 1986) was not expected to pay 100%,
    nor the same percentage of the bill for all procedures.  However,
    under the old plan, if your dentist billed you for less than Hancock's
    official amount, Hancock would still use their official amount to
    determine your maximum reimbursement.  Under the new plan, they
    compute a percentage of the actual bill, up to some maximum.
    
    For example, let's assume that the old plan used the same percentages
    as the new plan (my guess is that this is true, although the old
    plan doesn't publish the actual percentages).  Thus, under the old
    plan, the most Hancok would pay for a silver filling involving
    one surface was $15 (from the table in the booklet); if we assume
    that this was 60% of Hancock's estimated proper charge, then we
    see that they believed that the maximum reasonable and proper charge
    for such a procedure was $25.  And, under the old plan, whether
    your dentist charged you $20 or $40, Hancock would pay the
    same $15.  (I assume that if your dentist only charged $10, then
    they would only pay $10.)
    
    Under the new plan, you'd be reimbursed 60% of the bill, up to the
    maximum.  If your dentist only charges $20, then Hancock will only
    pay $12.  Thus, in this situation, Hancock is now paying less than
    they were before.
    
    On the other hand, if your dentist charges $40, you should get at
    least the same amount as you would have before, namely $15.  However,
    when they switched to the new plan, they also reevaluated the normal
    charges for the procedures; my guess is that many of the simple
    procedures went up, at least for the Boston area.  (I recently had some
    fillings replaced; I'll have to check my statement from John Hancock
    to see what they actually paid, but I wasn't disappointed.)  Thus,
    in these situations, which is probably the majority of common
    situations, Hancock should be paying more than they were.
    
    If a claim has been denied, you can appeal.  I don't know whether
    or not you can appeal Hancock's assessment of "reasonable and customary
    charges".
    
       Gary

.27>        Now let me get this straight, you paid $180 for two
.27>        fillings and a cleaning? 
        
        That's it!! He did take a couple of X-Rays, but according to the
        bill they were a total of $12.

        Re:-.1,
              If that's the case, then why doesn't DEC do us all a favor
        and get a new Dental Plan?

       							Dave
        Sorry I took so long to reply, but I don't always get a chance to
        read notes. I'm too busy working and making money to pay what JH
        won't.
           

    Here are some numbers, based on a recent (1987) visit to the dentist,
    and the table in the 1982 dental benefits booklet.  I have no idea
    as to whether or not the numbers listed in the 1982 booklet were
    changed between then and the switch to the new program in 1987,
    so it is possible that those numbers may not represent the true
    1986 situation (can someone who's been here longer than me help
    with this particular point?).
    
    Prophylaxis (cleaning)
    	Old plan: the most they would pay was $20
    	New plan: they paid 80% of my dentist's bill.  He charged $32,
    		  so they paid $25.60, which is $5.60 more than the
    		  old plan.
    
    Filling (amalgam, two surfaces)
    	Old plan: the most they would pay was $21
    	New plan: they paid 60% of my dentist's bill.  He charged $47,
    		  so they paid $28.20, which is $7.20 more than the
    		  old plan.
    
    Seems to me my benefits have gone up.  I can understand how people
    who go to inexpensive dentists may wind up with less, though I'm
    not sure that's totally unfair.  The dental plan has a deliberate
    policy of requiring the employee to pay part of the bill.
    
    Dental plans are very expensive, which is why many companies don't
    provide any dental insurance.  Dental health is also far more related
    to personal hygiene than treatment covered by regular health insurance
    (although there are many exceptions each way).  Thus, it makes sense
    to provide an economic incentive for employees to maintain good
    hygiene; this is done by paying a greater percentage for preventative
    work (80%) than for restorative work (60%).
    
    I'd be interested in details on other companies' dental plans, to
    see how they compare.  However, I'm sure the bottom line is how
    much DEC is willing to spend for employee benefits.
    
       Gary

    What bugs me about the new dental plan is that the changes were
    made without notice. (Or did I miss it?)  All I got was a notice
    in the November Benefits Bulletin that the covered charges would
    be adjusted UP in some areas beginning in 1987.  As far as I saw
    it said nothing about only paying 60-80% of these new maxima.
    
    Well, they fooled me.  I postponed a $175 procedure until January.
    In fact I had the first appointment of the new year!  When the dentist
    submitted the claim, JH only covered 60% - $105, even though on the
    pre-treatment estimate JH said they would cover all $175.  A protest
    got them to cough up the extra $70 since they had committed to it
    on the pre-estimate.  They were very surprised that we weren't notified
    about the details of the new plan.
    
    When I got out of college I worked for Johnson & Johnson.  About
    a year after I started, they instituted an interesting dental plan.
    The first year you were in the plan, they would pay 60% of your
    reasonable and customary dental bills.  If you had at least one
    prophylaxis during the year, for which I think they paid 80%, then
    the next year your benefit went up to 70%.  The following year you
    reached the maximum 80%.  If you missed having a cleaning/checkup
    in any year, you dropped back to 60% and had to start all over.

    Re.18
    I got 3 night guards over the past few years and from two different
    dentists. The cost is about $40.00. I think your dentist ripped
    you off. I even got one free because I had to have a mold of my
    mouth taken when I had a partial bridge made. 

    Here's some new information, at least it was news to me.  In pursuing
    this with JH, I finally got thru to somebody within JH who had a
    certain level of responsibility and gave the following statement:
    
    Choice A: Cover the couple hundred dollars worth of TMJ work done
    last fall (as discussed here in previous replies).
    
    or
    
    Choice B: My wife will have the problem corrected by surgery, which
    will cost JH at least 20 times more money, and you *will* end up
    covering last fall's work anyway under the rules of "preparation
    for surgery".
    
    The choice seems obvious.  But the JH person admonished me in that
    JH is only the *administrator* of the policy, and therefore they
    follow it to the letter of the law.  If an exception is to be made,
    Digital will have to make the exception, since the funds to pay
    for *either* method come directly out of Digital's coffers.  JH
    makes no payments out of their own funds for *anything* -- it all
    gets paid by Digital to JH.
    
    So *why* is personnel & my benefits admin person telling me that
    it's something I've got to duke out with JH???
    
    Jon

    My wife, who has paid claims and administered insurance plans as
    an employee of an insurance company insists:
    
    1.  Digital buys the coverage they choose from the insurance company.
    If they want better coverage JH will be happy to sell it to them.
    
    2.  If a dentist is charging more than "reasonable and customary"
    they may be charging too much.  The "reasonable and customary" is from
    the 90th percentile of statistical analysis of an entire area.
    
    3.  Rising medical and dental costs are directly related to the
    lack of questioning by people using the services.
    
    Etc.
    
    Dave    

    re:.41
    
    If she believes that crap, tell your wife that I've got a bridge
    to sell her too.
    
           Dr. Orin Scrivello, DDS

    re:  .41  :  I agree that part of the problem is what DEC chooses
    to have covered.  When I was at orientation, I asked about eye
    (glasses, contact lens) coverage.  The person doing my orientation
    said that it wasn't available because John Hancock didn't provide
    that type of coverage.  I then noted that my previous employer
    also had J.H. administering their group health plan - and my
    understanding was that the plan was defined by the company purchasing
    the benefits - and that eye care was covered there.  I was then
    brushed aside with some side comment suggesting that I didn't know
    what I was talking about (???).
    
    -peg

    My dentist and family doctor won't even accept payment from
    John Hancock, they take so long to process payment and always
    seem to come up with a problem on simple bills.
    We're required to pay the full amount at the time of each visit
    (no billing allowed), and get reimbursed from John Hancock.
    I've been going to the same dr./dentist for over 19 years.
    
    Payment usually takes about 1 1/2 - 2 months to come back, now
    I can understand the doctors/dentists frustrations at dealing with
    them.
    
    But this means have to have the $ up front each time I visit the
    dentist/doctor knowing I have to pay before i can leave....
    

    RE:  .44
    
    I too, have recently received the same notification from my dentist
    and physician, that due to extremely long reimbursement times from
    JH, that payment in full (or other prearranged payment schedule) would be
    required.  As in .44 1.5-2 months seems to be the norm.
    
    
       
    
    

    I "thought" that was the norm with John Hancock...
    
    Any doctor that I or my children have seen have "never" taken John
    Hancock....  I have ALWAYS had to submit a receipt to them for
    reimbursement. ..
    
    GLK

I pay my doctor 20% on the spot and then send the bill into John Hancock, who
pay in their own sweet time -- too long.  And sometimes the idjits send me the
check -- even though our plan provides direct payment to the doctor unless
you specifically ask for payment to the patient.

Emerson Hospital bill JH directly, as does another one of my doctors.

/john

Every doctor or dentist I have been to always had a sign on the desk,
"payment is expected at the time services are rendered".  The simplest
mechanism for all concerned is for me to pay with a check, they send in
the form, and JH pays me.  Two stamps required.  Any time the money
goes to the doctor, the doctor then has to bill me the difference (2 more
stamps).  Or if I pay in advance and the dr signs the JH check over to
me, it is one more stamp.

Number of stamps is how I am measuring the amount of paperwork involved.

Why shouldn't the doctor get his money up front?

       So why does everyone stay with JH? I switched to an HMO and the
    price stayed the same. You just pay $3 a visit and $3 or $4 per
    prescription. This seems to be better than paying 20% for some things
    JH doesn't completely cover.
                                                      Denny

    Because SOME (read that as very little, but..) of John Hancock's
    benefits are better... and IF you happen to be using that benefit,
    or someone in your family is, then it is better to stay with John
    Hancock...
    
    GLK

    I've been using DIGITAL's dental insurance for nigh onto 10 years
    now, and never once, NOT EVEN ONCE, have they correctly reimbursed
    me when I had already paid the dentist.  They invariably send the
    money to the dentist, no matter what is noted on the form or what
    additional information is included in the claim on a note.  The
    dentist then has to reimburse me when he receives the check.
    
    I also had two claims refused recently.  One was for a dental check-up
    which JH said was at less than a 6-month interval.  In fact, it had
    been 8 months since my last dental claim.  The other was a medical
    claim which was rejected for the stated reason that I was not a DIGITAL
    employee when the medical care was received (my 10-year anniversary is
    coming up). 
    
    I have neither the time nor the inclination to have to fight them
    for my money each and every time I file a legitimate claim.  What's
    their problem anyway?
    
    						Pat

    JH is indeed a pain for dental.
    
    I recently started going for cleanings 3 times a year rather than
    twice, due to heavy buildup on my teeth.  I *know* what is going
    to happen.  I will only get reimbursed for every other visit because
    of the 6-month rule, rather than 2-out-of-3, which would be more
    sensible.
    
    Burns
    

    re all:  so with all this trouble with JH, is anybody (besides me)
    letting their PSA or benefits administrator know about what kind
    of organization JH is turning into??  I would think that if a company
    like JH had an account as large as Digital, and Digital told them
    to "shape up", there might be a flurry of activity within that company.
    
    Jon

After all, we change travel agents regularly.  Maybe JH has had our
contract long enough?

    My doctor informed me that JH was one of the best they deal with
    for response time.  Dental has been confusing though.
    		--- Karen ---

    I've never had a problem out here (Arizona) either. Either the
    doctor's are patient (punny, isn't it?) or JH is satisfactory
    to them.
    
    							Warren
    

    Funny, my dentist never complains about how long it takes JH to
    get him his money; he just sends me bills once every six months
    for the difference.  (He even keeps the forms in his office, in case
    I forget.)  However, JH really doesn't seem to get along well with
    my allergy clinic.  They take so long to pay (more than 2 months)
    that I start getting letters from the accounting firm that does
    the clinic's bills that go "apparently your insurance company isn't
    going to pay this old bill, so you owe us $$$$$$".  Since going
    through the allergy desensitization program has really improved
    my health a great deal, I feel like they shouldn't have to keep
    waiting for months for their money (anyhow, they might report the
    late payments into MY credit record or something - who knows what
    the accounting place might do?), so I pay them (assuming I have
    the money!).  Then a couple of months later the clinic gets paid
    and signs the check over to me, or credits my account (since I go
    there every ten weeks now to pick up more allergy solution, they
    have usually just gotten paid for the previous visit by the time
    I come in for the next one).  Why is this such a slow process??
    I can see why they might take a long time to figure out and process
    the paperwork for something complex or controversial, like experimental
    surgery (they REFUSED to pay to have my ugly birthmark removed,
    several years ago - luckily I managed to scrounge up the money myself),
    but the allergy clinic ought to be pretty routine.  Especially now
    that I have been going there and sending them the same paperwork
    every ten weeks like clockwork for the last 3+ years.

    
    I had a dentist appointment just this morning. He is actually glad
    to see JH (he says). He told me that all his problems with held-up
    payments and approvals are with Blue Cross-Blue Shield and that
    JH is usually very fast.
    

    While on a business trip in California, I had to have emergency
    dental work done.  The dental clinic offered to bill Hancok for
    the covered portion, and they just had me pay the difference.
    I didn't even have a form!
    
    				Steve

    
RE: Note 254.49 by BEOWLF::RIEU >

>       So why does everyone stay with JH? I switched to an HMO and the
>    price stayed the same. You just pay $3 a visit and $3 or $4 per
>    prescription. This seems to be better than paying 20% for some things
>    JH doesn't completely cover.
                               
Which HMO costs the same as JH?
           
Having just received the flyer for this year, I don't see how anyone can
compare the cost of JH to the HMO's. I have been with Lahey HMO for 2
years, but I can't see paying $420/yr for HMO coverage when all I usually
need is a physical and maybe one other trip. 
           
While I am philosophically inclined to stay with Lahey, I just can't afford
it! JH is insurance for the big bills, and now pays for some physicals. 

       I have Fallon Clinic as my HMO, family coverage is $8.09 a week.
    Which is, I believe, LESS than I used to pay for JH 2 years ago.
    I don't know how they compare if you're single.
                                                    Denny

>       I have Fallon Clinic as my HMO, family coverage is $8.09 a week.
>    Which is, I believe, LESS than I used to pay for JH 2 years ago.
>    I don't know how they compare if you're single.

JH is fully paid by DEC if you're single.  It costs me 8.94 / week for family
coverage.

/john

          <<< HUMAN::DISK$HUMAN_WRKD:[NOTES$LIBRARY]DIGITAL.NOTE;1 >>>
                          -< The DEC way of working >-
================================================================================
Note XXX.0                   Medical Insurance Alert                   7 replies
POBOX::LEVIN "My kind of town, Chicago is"           27 lines  26-JUN-1989 11:21
--------------------------------------------------------------------------------

    WARNING TO ANYONE DEALING WITH JOHN HANCOCK AS THE ADMINISTRATORS
    OF OUR NEW DIGITAL MEDICAL COVERAGE.....  (Yes, I'm SHOUTING.)
    
    I just received a claim where the new $150.00 deductible was taken
    in full, even though the old $125 was taken earlier in the year
    (under the old J.H. plan).  In a memo from personnel, it has been
    stated that
    	"If the $125 deductible has already been met, you will only
    	need to satisfy $25 more.  Copayments for October, November,
    	December, January, February and March count toward the current
    	year's deductible."

    Now, I've just got off the phone with J.H., who will correct my
    record and process a corrective $125 at 80%.  I was told that the
    problem is the result of their having to manually process carry-overs
    from one system to the other. Their calculations for amount remaining
    to out-of-pocket limit was also wrong.  (This should be
    	$1200	base individual limit
    	 -150	less deductible
    	 -nnn	less any payments paid out of pocket so far this year, 
    		typically the 20% balance when they pay a bill at 80%.)

    Bottom line: check your claims carefully to see if you, too, were
    affected. (I won't include my opinion of the administrative expertise
    of J.H. here, since I'd have to set the flame quite high.)
    
    	/Marvin    	
================================================================================
Note xxx.1                   Medical Insurance Alert                      1 of 7
TOOK::TWARREN "Stand in the place where you work..."  8 lines  26-JUN-1989 16:52
                      -< same thing just happened to me >-
--------------------------------------------------------------------------------

This happened to me too.  I just got a bill from the
Health Stop that was to be covered my medical, and
the insurance paid *none* of it.  Starting my deductable
all over again.  I will be getting on the phone very
soon.

Terri

================================================================================
Note xxx.2                   Medical Insurance Alert                      2 of 7
YUPPIE::SILVERS                                      11 lines  26-JUN-1989 19:09
                        -< this is getting pathetic... >-
--------------------------------------------------------------------------------

    I have a daughter who is very sick, & I expect problems dealing with
    JH (I had alot of problems dealing with them when she was born 1/2/89),
    
    I there  anyone within DIGITAL who is responsible for
    seeing that they do their jobs correctly?  After all, its DEC's money
    now, and if DEC can freeze my salary, the benefits should at least be
    administered professionally and courteously (not the case in the past,
    or, it appears, now).
    
    				Ds.
    
================================================================================
Note xxx.3                   Medical Insurance Alert                      3 of 7
ADVLSI::N_FIELD                                      13 lines  27-JUN-1989 08:19
                         -< DEC resolution of issues >-
--------------------------------------------------------------------------------

    If you have major problems with JH, (as, they refuse to pay something
    you believe the rules say they should), and you have tried to work
    it with JH, refer to the book you should have received entitled
    "YOUR BENEFITS BOOKLET". It is a rather thick 8 1/2  x 11 glossy
    book with rainbow stripes on the cover.  Section 12 at the rear
    of the manual clearly tells who to contact in writing in 
    DEC to get the problem looked into. I have used them, and they were
    fair, responsive, enforced the rules, and were reasonable.
    
                                                 Norm
    
    PS- I believe they work with major issues, and policy, and not
        efficiency problems or correctable errors.
================================================================================
Note xxx.4                   Medical Insurance Alert                      4 of 7
SPGOGO::HSCOTT "Lynn"                                14 lines  27-JUN-1989 08:34
                     -< Benefits Specialist in Personnel >-
--------------------------------------------------------------------------------

    Digital Personnel will get involved for major JH issues, whether
    benefit related or administrative. Check your Personnel office for the
    Benefits Specialist.  I've used mine in PK a number of times (JH had
    difficulty with my hyphenated last name, among other things) and she's
    been very helpful.
    
    It's also important to get Personnel involved since DEC has
    representatives meet with JH quarterly (if not more often) to discuss
    problems and they can raise general issues there.  I wouldn't be
    surprised to see the increased deductible raised as an issue, after
    reading here about people getting a double hit.
    
    --Lynn
    
================================================================================
Note xxx.5                   Medical Insurance Alert                      5 of 7
BMT::COLVARD                                          9 lines  27-JUN-1989 10:00
                                  -< THANKS! >-
--------------------------------------------------------------------------------

    
    re .0
    
    Thanks for the warning!  I have had problems with JH recently and it
    never occurred to me that they were screwing us on the deductible.
    
    Thanks again.
    
    Shawn
================================================================================
Note xxx.6                   Medical Insurance Alert                      6 of 7
ICESK8::KLEINBERGER "Welcome to *my* fantasy..."     10 lines  27-JUN-1989 11:39
--------------------------------------------------------------------------------

    RE: expect to have problems...
    
    A person once told me, if you go looking for problems, you'll be
    sure to find them.  Don't ssume you'll have problems, and go to
    personnel, etc, unless you really do.
    
    I used John Hancock for 5 full years without a single problem,
    ever...
    
    g
================================================================================
Note xxx.7                   Medical Insurance Alert                      7 of 7
ARGUS::BISSELL                                       18 lines  27-JUN-1989 11:46
                           -< Overpay and Underpay >-
--------------------------------------------------------------------------------

I suggest that you look at EVERY slip you get from JH.  I recently discovered 
an $800.00 + error that they made which they fixed when I brought it to their 
attention.   My wife and I started about six years ago looking at ALL the 
forms we get from JH.  We have found many errors both in our favor and against 
us and have brought all of them to the attention of JH.

The only problem that we had that took a bit of time was a double billing of a 
$600 (approx) charge by a hospital.  The hospital sends the bill directly to 
JH and we never see the bill and JH trusts and pays the hospital directly.  
This bill stood out as the service date was over two years old and I knew it 
had already been paid once.  

Another problem you can run into is that the DRs office does not make clear 
what proceedure/time was done/used.  You may have to take the bull by the horn 
and get the Office staff to resubmit the claim.

Please look out for DEC and check the bills to see that they are not overpaid 
as well

    re "Digital personnel will get involved for major issues..."
    
    How do you define "major issue"?  I finally got thru to JH this
    morning, after numerous repeated attempts to get past the telephone
    busy signal.  (Never was able to get even this far all day yesterday).
    Then I was on HOLD for 27 minutes (yes, I timed it) before I got thru
    to a person.  Almost had forgotten what I called about.
    
    I was inquiring about a dental claim that I had submitted about 6 to 8
    weeks ago that I hadn't seen reimbursement for yet.  They told me that
    since they were working with a "new system", that I should only be
    concerned if the claim was OVER 8 WEEKS OLD and still not paid.
    
    New system or not, it would seem that they could better plan for the
    introduction of a new system (training, bugs, etc) without letting
    their previously-nothing-to-write-home-about service go TOTALLY down
    the tubes!
    
    Jon

    re .-1, almost forgot.  The JH rep couldn't find my claims in the
    computer and advised me to resubmit them.  Resubmit?  And get one of
    their nasty-grams in the mail about my devious attempts to collect
    twice on the same claim?  She explained that "because the claims can't
    be found in the computer currently, there is a good chance that they
    have gotten lost".
    
    This is getting to be more trouble than its worth...
    
    Jon

Re: Note 254.63
    Note XXX.0                   Medical Insurance Alert                   

  So you'll all know what's happening...
    
    Following some oft-stated advice, after I posted the above note,
    I then send a mail message to Ed Brady @CFO, stating the facts (without
    the emotion) in my note and suggesting that Digital as a corporation
    should work with John Hancock to ensure all records are properly
    updated, not just those of us notice the problem.  I received a
    reply from him thanking me for pointing out the problem and indicating
    that some correction action will be taken.
    
    re: Note xxx.6
    
    <<  A person once told me, if you go looking for problems, you'll be
    <<  sure to find them.  Don't ssume you'll have problems, and go to
    <<	personnel, etc, unless you really do.
    
    <<	I used John Hancock for 5 full years without a single problem,
    <<  ever...

    Well, I guess you've been rather lucky.  I've used Hancock for more
    than 15 years and have always kept close track on payments, etc. On
    several occasions, there have been errors on their part. They're very
    nice about correcting things when I've called, but the bottom line is
    that I've decided to watch out for myself. That's not the same as
    "looking for problems". I've only had to go through personnel a
    couple of times.
    
    --- flame on simmer
    
    	Once, when Hancock sent a check to the wrong doctor because they had
   	mixed my claim with someone else, they tried to tell me that they
   	wouldn't pay my doctor until they recovered the money from the other
   	doctor. Needless to say, I yelled at them about that, and they agreed
   	to pay my doctor immediately.
    
    --- flame off

    
    		/Marvin    

    The so-called New System has at least one benefit I'm aware of: In the
    past, if you sent a bill to JH and you were still under the deductible,
    JH wouldn't telling the concern who submitted the bill. Now, they're
    supposed to notify the people owed the money that the deductible hasn't
    been reached. In my case, a blood analysis company that our doctor used
    tried for a bit less than 6 months to get $$ from JH before billing us
    directly. I wish my mortgage company was that patient! :-)
    
    						Trace

    re .67
    
    While that particular example is 'good' for the consumer, it's a real
    rip-off for the doctor, forcing him to endure pains that he shouldn't
    have to bear.  And I think it puts more emphasis on a practice that
    more and more doctors/dentists are starting to use; ie, YOU pay up
    front and YOU duke it out with the insurance company.  Doctors
    shouldn't have to work that issue if the health insurance company
    doesn't have its act together, as appears to be the case with JH.
    
    Jon

    I had no problem getting through to JH on the phone the other day.
    Of course, their computer was down, so they couldn't do anything for me.

re .70: -< Try 8-800-DEC-2060 >-

and prepare to be put on hold for a l-o-n-g time.

That's the standard JH number (equivalent to DTN 223-3300, but presumably
costs Digital more $).

    
    My problems have been so severe this year that I am dealing directly
    with the manager at JH, Patty Lee Haugh.  Since they instituted
    this policy [with me], I am having no problems.
    
    You ask what problems did I have?
    
    1. with all my dependants, deductable on EACH one started at zero
       after the switch over.
    
    2. bills took 6-8 weeks to get paid.
    
    3. bills were LOST.  I had to send many duplicates.  this also extended
       the time it took to pay them.
    
    4. in most cases, I paid the doctors and the bills submited were
       marked paid.  However, that did not stop JH from sending MY money
       to the doctor instead of me.
    
    5. it became increasingly impossible to get through to any of the
       workers.  they were fustrated [not a fact, just my impression]
    
    6. return statement could not be compared to bills mailed to JH.
       statements were very confussing lumping many dates of service
       into one line.
    
    7. When asked to straignten out situation, send me a statement that
       *I* could understand, it took them one month to get one together
       because *they* couldn't figure out the mess.
    
    I did take my problems to the benifts specialist in MK02.
    
    My advice is to elevate the problem above the current workers and
    supervisors and go straight to Patti.
    
    There are over 50K people using JH and few problems.  But when those
    problems happen, they are bad one.
    I also understand why some people don't have problems. I've experience
    two methods, 1. no claims submitted.  for the first 10 years with
    DEC, I never used health insurance.  so, no problmes seen.
    2. bills submitted to JH, no personal records kept.  I *used* to
    do that.  At least you don't know you have problems.  Of course
    it they mess something up, you don't know about it.
    
    ed
    

    We've had a similar situation to .-1.  In dealing with the people who
    answer the phone at JH, I can't help but sympathize with them.  They do
    not seem to be very happy campers, and I can understand why.
    
    As best I've been able to figure out, they've got one h**l of a mess
    with their computer system.  They switched over to a totally new
    application a month or so ago, and it appears to have been screwed up
    every way it could possibly could have been.
    
    First of all, JH conducted training on the new system *after* it was
    installed in production.  They set up the training courses in the
    office area normally used by the people who process claims, and
    threatened those people with their jobs if they entered the area during
    the three-week training period.  They had to pack up what they thought
    they'd need out of their desks, and if they forgot something ... well,
    it just had to wait three weeks.  Virtually no claims got processed
    while the training was going on, so they started on the new, unfamiliar
    computer system with a tremendous backlog.
    
    The system itself is a nightmare.  They are unable to bring up a
    complete claim/payment history on the screen, even for the current
    year.  And the thing I found most appalling is that the system
    constantly *recalculates* your standing for the *entire year* and comes
    up with apparently random numbers each time which *MAY OR MAY NOT* be
    applied to the bottom line of your claim.
    
    I got a statement with a note on it that read "A recalculation of all
    the claims submitted by you or your family during this plan year
    resulted in an additional $20.00 payable for this claim."  No further
    explanation.  And the $20.00 was *not* added to the amount paid.
    
    Then the next one I got had the following note: "Benefit reduced by
    $64.00 due to a previous overpayment."  Again, no further explanation. 
    And again, the amount paid was *not* reduced by $64.00.
    
    I then got a claim with $25.00 deductible shown as being taken out,
    even though I had already satisfied the $150.00 deductible several
    claims back.  But the $25.00 was *not* deducted from the amount paid.
    
    And, lastly, the paid one claim twice:  once to the doctor and once to
    me.  They then wrote to the doctor asking that the money be returned,
    but in the meantime the doctor had sent me a check for the overpayment.
    
    Over a three week period I tried to get someone at JH who could begin
    to explain to me what was going on.  After threatening to begin
    escalation procedures within Digital, I finally spent most of a morning
    on the phone with a nice person who was *extremely* frustrated with the
    entire situation.  She was never able to answer my questions, but she
    did total up my claims, total up what I had been paid, and total up
    what I should have been paid.  We came up with an $80.00 error in JH's
    favor.  That is right, I can't argue it, since the total numbers make
    sense to me.  But the message I got was that what the computer did to
    my account is not understood by anyone there.
    
    The JH office seems to be in total chaos.  No one knows what's going
    on, and no one seems to understand this new computer system, which, by
    the way, appears to have been designed by a life form somewhat less
    intelligent than my dog.  I have heard nothing that leads me to believe
    the situation is going to get any better anytime soon.
    
    Moral:  Check everything they send you with a fine-tooth comb.  And
    follow up on discrepancies!  And prepare to spend a *lot* of time on
    it.
    
    							Pat

    Always make COPIES of what you send in. *N*E*V*E*R* send in originals
    unless you've made a copy.
    
    I use the pre-paid envelope with the flap for indicating who these
    bills are for. I've make copies of the flap, then stapled together all
    the bills for each individual in the family along with the flap. I then
    list the amounts submitted on the flap itself. If I've already paid, I
    mark in GREAT BIG LETTERS "Doctor has already been paid". Then I fold
    each packet to fit and put them all in one envelope. Since I started
    doing this, I've had no problem with payments sent to the wrong place.

    It's also a good idea not to include dental and medical in the same
    envelope. They go to different groups and it only confuses things
    if you send them in together.
        
    	/Marvin 

re: .73

Well Pat, at least you haven't been sent to a collection agency.  I haven't
either, but that is only because my wife works for an insurance company
and deals with the hospital business office on an almost daily basis.  When
things started getting absurd, my wife offered to pay the hospital and fight
it out with JH on our own.  Since the hospital knew my wife, they told her
not to worry about it but that normally the account would have been sent to
a collection agency a month ago.  This was for surgery done in March.

I think we should give them 6 months to get their act together and if things
aren't in order, DIGITAL should find another 3rd party claims processor and
invoke whatever escape clause we have in our contract with JH.  (We were
smart enough to get an escape clause in our contract, weren't we?)

Bob

    They just did it to me.  We had a whole bunch of claims rejected.
    (They sumarily reject anything from an opthamologist, even if it is
    a medical problem.)  We resubmitted the claims, with a letter
    explaining the medical nature.  They applied most of them to a NEW 
    deductible.

    Small claims court would be the place to go.  However ...
    
    JH is acting as an adminstrator for DEC.  Do you really want to take
    DEC to court?

    After some thought (and a bit of prodding), I've set .77 hidden.  It
    may or may not belong in a public conference, but I'm [typically] not
    one to write borderline-policy-acceptable notes.  If the moderators
    feel that it's OK, then by all means set it unhidden.
    
    I wonder if it would open any eyes with the Digital people who deal
    with JH if employees who have trouble with JH (I understand there are
    *some* that don't!) would calculate how many hours they spend on the
    phone with JH trying to straighten out a claim, plus the time involved
    to write them notes attached to duplicates of already-submitted claims
    that got lost in their 'new system', then multiplied by their hourly
    salary rate.  (I'll do the *first* claim on my own time; subsequent
    duplicate claims and time on the phone to straighten it out, however,
    is NOT on my own time).
    
    Perhaps this note belongs under the 'waste watch' topic...
    
    Jon

    Jon, I suggest you call Patti Lee.  She's head cheese at JH for
    Digital.  I can supply you her number via personal mail if you
    want.  She is working my claims personally.  I found another claim
    they 'lost'.  Instead of requireing me to send a duplicate, she's
    calling the doctor's office for conformation of the bill then
    sending payment to me.
    btw, Patti's number is straight in, no waiting on hold.
    equiv to customer going through KO's office.
    ed
    

    Previous note regarding JH and pregnancy/obstetrics bills reminded
    me of this.  Several years ago (about 15), my wife was not responding
    to some medication in the way her doctor expected her to respond.
    To rule out the possibility that she might be pregnant (which he
    felt might explain the reaction), he asked her to take a pregnancy
    test.
    
    She did - the bill was submitted to JH - they rejected it since
    at that time, laboratory work "due to or resulting from pregnancy"
    was specifically excluded. I explained that this test had nothing
    to do with the usual pregnancy cases, but that it was a specific
    test to determine reaction to medication. JH still said "No". Then
    I pointed out that the wording in the policy actually said that
    they were obligated to pay for ANY negative-result pregnancy test.
    
    1 - They paid.
    2 - The policy was reworded the next time it came out!
    :
    :....... and fortunately today there's no such limitation.
    
    	/Marvin (who started this latest batch of notes)
    
    P.S. I just received my check to correct the double deductibles.
    As I said earlier, my experience has been that JH is very cooperative
    in making corrections. Maybe it's because they've had so much practice.

    For what it's worth, I too have had trouble with Hancock over the
    years (10 of them).  They routinely 'lose' claims, allegedly in
    the mail room, so they say.  I've gotten the impression that they
    are legally bound to respond to a claim within 60 days of receipt,
    which appears to be when the mail magically reappears.  I recall
    hearing about the legal responsibility, but I can't quote a source.
    It may have been Hancock themselves, but it was probably personnel.
    
    Last Labor Day my 6-year-old son was bitten on the face by a
    neighbor's dog.  It took 15 stitches (at $100 each) to fix him up,
    and the claims were sent in on the same day.  Just before Halloween
    I called Hancock because the hospital was getting nervous.  Hancock
    couldn't find the claim.  I wanted to know how much they were going
    to cover (of the 'reasonable and customary' fees), so I told them
    I'd call them the next morning, so they could find the claim.

    I also told them that I expected them to pay 100% by the end of
    the week, and it would be very disappointing to hear otherwise.
    I explained the nature of the incident, and that I would be happy
    to call the DEC V.P. in charge of the Hancock relationship if that
    would help expedite the situation.  I had retained an attorney to
    deal with the neighbor, so I explained that after the end of the
    week, I would turn the whole claim over to him to handle.  None
    of this was presented as a threat, but as a congenial, matter-of-fact
    statement of where they could expect to be by friday.
    
    I called the next day, the claim had been found, and paid 100%.
    The hospital and the doctor had the check the following day.
    I'm not advocating the use of threats, but keep in mind that Hancock
    is not there to serve YOUR best interests.  You are.
    
    

    Hancock seems to have come up with a new "reason" for not processing
    claims.  I had several sizeable claims that were not getting any
    response from JH.  I started getting letters from the hospital,
    doctors, etc. demanding payment...
    I called JH to see what the problem was, and was told "I don't see
    any claims here, they probably got delivered to the Hartford instead"
    In a pre-printed envelope???  They were actually claiming that the
    postal service was routinely delivering mail correctly addressed
    to Hancock, to the Hartford!
    
    From now on, ANY correspondance sent to JH will be sent via registered
    mail, so that I can PROVE that it was delivered to them and when.
    From that point on, it is their responsibility to handle it, and
    to pay the claim.  
    
    Kevin

    I have a problem with the way the insurance changes were handled this
    year and was wondering what other people thought.  Having been dinged
    by JH last year, I decided to switch to an HMO during the annual 
    December grace period.  Then DEC comes along and delays the grace 
    period until April 1, 1989.  For all my kids doctor visits between
    January 1 and March 31, I had to pay all out of pocket to make my
    deductable for JH for 1989 (about $230).  Had I been in the HMO,
    it would have been around $24 for office visits and an additional
    $7 a week for a total of $115.   Wouldn't it have been more fair to
    people in this position to proportionalize the deductable to a quarter
    the total yearly amount??  I paid deductables as if I were in the JH
    plan for the whole year when in reality, I was only in for three
    months.
    
    Brad.

    This is beginning to sound like a broken record.
    
    I recently switched my wife over as a dependent for JH dental coverage.
    She went for an office visit the first week in April and submitted
    the appropriate paperwork to the dentist, similar to what I've been
    doing for years.
    
    I've received 2 notices for the same bill since then, the second
    of which I paid in full.  I inquired to the dentist's office of
    the status of the insurance claim, and they said that they hadn't
    heard from JH.
    
    Last week I called JH and waited the obligatory 30 minutes (with
    the recording being repeated every 30 seconds :*().  Finally, when
    I reached a person, she looked up my account and acknowledged that
    my wife had indeed been added as a dependendent, but that there
    was no record of a claim being submitted.  She then said that they
    are about 2 months behind data entry for claims, and that a check
    should be mailed to me within 2 weeks.  
    
    I politely told her that I sincerely hoped so.
    
    Mark.

    Yea maybe we should have a JH notesfile with more moderators than
    Lipton has teabags.  Give it a rest, will ya.
    
    

    Andy,
    Why do you feel uncomfortable reading tales of woe with regard
    to John Hancock? If this isn't the place for these tales than perhaps
    you could put in a "pointer" to a more appropriate one?
    
    Barry_who_has_never_had_any_trouble_with_John_Hancock_claims

Andy, I understand that you would rather see folks do something
    constructive than to just whine and bitch here.  Unfortunately,
    I for one can't find anywhere constructive to voice my problems.
    Personnel doesn't seem to want to get involved, and I don't know
    where else to turn.  Thats why I put my story here.  Maybe somebody
    can come up with a way to fix the more global issues.  If there
    is a corporate benefits-type person who cares what kind of service
    Digital gets from its vendors (ie Hancock), maybe we could collect
    these stories (with authors' permission, of course) to document
    the fact that things are NOT acceptable in regard to Hancock's
    benefits.
    
    So, anybody know who we SHOULD be sending this stuff to?
    
    Kevin Farlee

    I've esculated thought personal here in Merrimack.  I got the story
    that rarely problems occure.  Looks like that just isn't so?
    I'd also like to know where this belongs.  This is a Digital problem,
    isn't it.  I know I've tried the 'right' route.  There is strength
    in numbers?  Mybe someone who has the power will have reason to
    read this note.  
    
    Haven't posted my note, I've got private mail requesting 'the number'.
    Hope its helped those that got it. I can't imagine how a top level
    manager will have time to personally handle the claims hderself before
    she straightens out the mess.
    
    but maybe this is the wrong notesfile, maybe we should start a digital
    notesfile where we can discuss problems?
    ed
    

re .90:

The appropriate executive in the corporation who can handle mishandled 
claims from John Hancock is:

Edward J. Brady
U.S. Employee Benefits Manager
Digital Equipment Corporation
150 Coulter Drive
Concord, Massachusetts 01742-2191
Tel 508.264-1337

I've escalated a problem on a JH claim *in a professional manner* 
and in writing, together with all the backup materials and had very good
results. 

Marge

	I've added the Keywork JOHN_HANCOCK_HELP to this note to point
	to the previous reply by Marge.  PLEASE, and this is only MY
	opinion, use that route BEFORE bitching about JH.

	Let's put the ownus (sp?) on the right people. (and if they do a
	good job, then GREAT!)

						mike

    My 'concern' over the deductable isn't claim specific, but rather a
    policy matter within Digital, and probably affects many employees.

    Mr. Brady should be able to address your concerns.

    Having found this topic write-locked this morning, I called my Benefits
    Specialist, Bev Robbins (PKO Site) and asked her where employees should
    direct their problems/complaints/issues of JH.
    
    Bev explained that the first step is to go to your Site Benefits
    Specialist if there is one. If not, find out from Personnel who is the
    Functional/Organization Benefits Manager (there are 5 total; one for
    each organization; who form a review committee).
    
    Or, you can forward/contact Fran Bastien in West Concord, who is the JH
    liason manager for John Hancock.  Ed Brady is also fine, but more the
    Corp. Benefits manager.
    
    --Lynn
     

    
    As a former PSA, I think the notes that have been written
    are totally appropriate for this conference. They may
    contain a lot of griping - lord knows the problems I
    had dealing with Hancock on behalf of others are too
    numerous to mention - but these siuations TEACH others
    how to maintain proper records.
    
    The responsibility of the employee is to make sure the
    doctor submits a "complete" and descriptive bill to
    Hancock. They cannot pay things that say "office visit", 
    or other generic terms. Submit ALL you bills so they 
    can be applied to your deductible - many doctors will
    do this, but you may want to, ensuring it gets
    there. Keep receipts if you pay your doctor up front, and
    make sure they note you have paid.
    Write across the receipt you name and badge number. Keep
    every statement Hancock sends you so you can compare
    this with your records.  Keep a benefits book at 
    home so you and your spouse have a reference guide. 
    
    
    This can turn into a major project at times, In know. Since I 
    contracted colitis (too many years as a PSA) I have 
    many bills, and by year end I have a very thick 
    folder. BUT, I have encountered no problems by following these 
    guidelines.
    
    The cost of medical care has forced people to actually
    shop for doctors, surgical procedures, etc., but this
    is a reflection of the times. We as employees must
    monitor how we use our medical benefits closely. 
                                   
    I hope people will LEARN from the horror stories of others
    in this note. 
    

From:	NAME: HECTOR CONTRERAS @MLO         
	FUNC: MEM COMP/BEN/RELO               
	TEL: 223-4419                         <CONTRERAS.HECTOR AT A1 at EMASA2 at MLO>
To:	See Below


Attached please find an explanation of the problems we are having at our J.H. 
claims office. 

Please distribute to personnel and management within your operating groups. We 
are putting a shorter version on LIVEWIRE next week.





Author:	Ed Brady @CFO                 
Date:	13-Jul-1989
Posted-date: 13-Jul-1989






The Hancock Claim Office in Braintree, MA is currently experiencing 
problems which have caused delays in the processing of our employees' 
claims.

This message should provide you with an understanding of what the 
problems are and how Digital and Hancock are responding to them to 
re-establish the high level of claims service to which employees are 
accustomed.  It should also help you respond to questions and concerns 
in your organizations.

Background

A series of major events for John Hancock occurred due to Digital's 
April 1, 1989 change from our "John Hancock Medical Plan" to the 
Digital Medical Plan.  As a result Hancock had to:

   .  Change from one John Hancock Medical Plan to two Digital
      Medical Plans

   .  Convert to a new claim processing system throughout the 
      Braintree office

   .  Change plan details such as increased deductible, expanded 
      benefits for physical therapy, medical equipment, speech 
      therapy, GYN visits, Pap tests, mammograms, etc.

   .  Draw a new contract for Digital changing our relationship to one 
      in which the Company would hire Hancock as "only" the 
      Administrator of our Insurance Plans rather than as an Insurance 
      Company

The Impact

All of these changes are positive for Digital, however, they have 
caused some problems.

The most obvious, and the one which you probably have heard concerns 
expressed by employees, is the fall off in claims office service.  
There is no denying that Hancock claims processing service has 
declined.  Simply stated, the reason is that these simultaneous 
changes have added a significant amount of time to the processing of 
individual claims.

One area not well planned for was telephone calls to Hancock.  
Telephone usage increased dramatically (by 45%) from 3100 per week in 
January 1989 to 4500 by the middle of June - usage that went beyond 
the Hancock's customer service unit's capacity.  Compounding this 
problem was the use of claims processors to assist in telephone 
service.






The Solutions

The claims problem is currently a major priority for both Digital and 
John Hancock.  While services can be expected to falter somewhat in 
times of change the current service is no longer acceptable.

Digital is closely monitoring Hancock's corrective measures which 
include:

   .  Hiring a permanent experienced claims administration staff on
      July 12 for evening work

   .  Increasing customer service hours, particularly for the 
      West Coast population

   .  Processing claims through seven other claims offices around
      the country in addition to Braintree

These actions will have an immediate affect on reducing the backlog of 
claims awaiting processing.  The goal is that by August 15, Hancock 
claim administration will return to an overall level of efficiency 
that both Digital and its employees expect.

Hopefully this information will help you respond to employees' 
dissatisfaction with Hancock's service, and make it clear that 
corrective action is underway.  




To Distribution List:

ALBRIGHT @MEMIT@VAXMAIL,
JAMES BAHRNES @MLO,
BETTY BAILEY @WJO,
BEATRICE @BOXTOP@VAXMAIL,
FJOHNSON @WJO@VAXMAIL,
DAWN GREELEY @MLO,
GREENFIELD @SSGVAX@VAXMAIL,
JOHNSON @HEIDI@VAXMAIL,
KELLYP @MEMIT@VAXMAIL,
LATHAN @DELNI@VAXMAIL,
MILNE @MEMIT@VAXMAIL,
PLEE @MVPS@VAXMAIL,
PRICKETT @OBSESS@VAXMAIL,
RUDDEN @HAVOC@VAXMAIL,
STCLAIR @MEMIT@VAXMAIL,
THISTLE @BRUTUS@VAXMAIL,
WATSON @RDVAX@VAXMAIL,
DAVE WELIVER @ICO,
NAME: DREW WOODHOUSE <WOODHOUSE.DREW AT A1 at EMASA2 at MLO>,
MARK ABBETT @MRO,
CHRISTENSEN @MSBCS@VAXMAIL,
ED COTTER @MLO,
DICK FARRAHAR @CORE,
DAWN GREELEY @MLO,
LEE HAYES @MLO,
KOCH @VALUES@VAXMAIL,
LOAN @TYFOON@VAXMAIL,
L_ABERDALE @DELNI@VAXMAIL,
BOB MULKEY @MLO,
CHIP PARISI @BPO,
PICARDI @MSBCS@VAXMAIL,
LARRY ROSSINI @CORE,
WILLOW SHIRE @MRO,
STADECKER @SHARE@VAXMAIL,
LINDA STCLAIR @MLO,
DONNA TAYLOR @MLO,
MAURICE VANDERPOT @MLO,
WATSON @RDVAX@VAXMAIL,
AMBROSE @ABLEJR@VAXMAIL,
BENINCASA @DELNI@VAXMAIL,
BOOTH @BAYDEC@VAXMAIL,
BORRERO @PLANET@VAXMAIL,
B_SMITH @VALUES@VAXMAIL,
DALTON @SHARE@VAXMAIL,
DEBORAH @BAYDEC@VAXMAIL,
DOLMAT @SHARE@VAXMAIL,
DWAGNER @WLDWST@VAXMAIL,
FORRESTER @HAVOC@VAXMAIL,
GRAVELLE @UCOUNT@VAXMAIL,
HANNON @NUGGET@VAXMAIL,
HEINTZ @SACMAN@VAXMAIL,
HUTCHINSON @PARITY@VAXMAIL,
J_KELLY @DELNI@VAXMAIL,
KALITA @CURIE@VAXMAIL,
KEARNS @BOXTOP@VAXMAIL,
LAGERQUIST @CURIE@VAXMAIL,
MANN @BETTER@VAXMAIL,
MARSHALL @NUGGET@VAXMAIL,
BEVERLY MATTERA @MKO,
MOORE @DECWET@VAXMAIL,
PLAVALLEE @HYEND@VAXMAIL,
RTAYLER @HYEND@VAXMAIL,
SASCHUK @HBO@VAXMAIL,
YOUNG @AIPERS@VAXMAIL,
BORRERO @PLANET@VAXMAIL,
DJAKAITIS @NRADM@VAXMAIL,
DOLMAT @SHARE@VAXMAIL,
FLEMING @CADSE@VAXMAIL,
HANNON @NUGGET@VAXMAIL,
KNIGHTC @FACVAX@VAXMAIL,
LAMSA @WJO@VAXMAIL,
LEONARD @GIAMEM@VAXMAIL,
LYNCH @HAVOC@VAXMAIL,
MACDONALD @SHARE@VAXMAIL,
MALLOY @RAVEN1@VAXMAIL,
MANGUS @HAVOC@VAXMAIL,
SUE MILNE @MLO,
SASCHUK @HBO@VAXMAIL,
SCHIPANI @RAVEN1@VAXMAIL,
WONG @HBO@VAXMAIL,
NAME: Kathleen Acierno <ACIERNO.KATHLEEN AT A1 at EMASA2 at MLO>,
NAME: EDWARD COTTER @MLO <COTTER.EDWARD AT A1 at EMASA2 at MLO>,
NAME: CLAIRE GILPATRIC <GILPATRIC.CLAIRE AT A1 at EMASA2 at MLO>,
NAME: Kathy Gossett <GOSSETT.KATHY AT A1 at EMASA2 at MLO>,
NAME: RONALD GREEN <GREEN.RONALD AT A1 at EMASA2 at MLO>,
NAME: Maryann Hart @MLO <HART.MARYANN AT A1 at EMASA2 at MLO>,
NAME: Barbara Kendrick <KENDRICK.BARBARA AT A1 at EMASA2 at MLO>,
NAME: Debbie LeBlanc @MLO <LEBLANC.DEBBIE AT A1 at EMASA2 at MLO>,
NAME: CAROL LEGER <LEGER.CAROL AT A1 at EMASA2 at MLO>,
NAME: BOB MULKEY <MULKEY.BOB AT A1 at EMASA2 at MLO>,
NAME: Larry Plutnicki @MLO <PLUTNICKI.LARRY AT A1 at EMASA2 at MLO>,
RAK @HAVOC@VAXMAIL,
VOLLMUTH.GARY AT A1 at EMASA2 at MLO,
NAME: DREW WOODHOUSE <WOODHOUSE.DREW AT A1 at EMASA2 at MLO>,
NAME: DIANE MARSDEN@MLO <MARSDEN.DIANE AT A1 at EMASA2 at MLO>

    Appropriateness?  JH was one of the things I missed most about DEC
    while I was away and was also one of the reasons I felt good about
    coming back.  There are worse insurance plans, much worse.

    Of course, there are also better plans.  I know of one that has a limit
    one million dollars a year in health care.

>    Of course, there are also better plans.  I know of one that has a limit
>    one million dollars a year in health care.

I thought JH has *no* limit.

    My wife just spent 45 minutes on hold Friday to talk to a JOHN
    HANCOCK rep to figure out why our medical reimbursements have
    not been paid - not counting follow-up phone conversations with
    DOCTORS complaining about lack of PAYMENT. This is not a way to
    run a "COMPANY". Maybe we - DIGITAL - should RE-evaluate the
    COMPANIES we deal with. Surely there is a better way !!
    
    FLAME OFF.
    
    Dan

          <<< HUMAN::DISK$HUMAN_WRKD:[NOTES$LIBRARY]DIGITAL.NOTE;2 >>>
                          -< The DEC way of working >-
================================================================================
Note XXX.0               JOHN HANDCOCK INSURANCE ADVISOR               2 replies
FOOZLE::SHELDON "LOCK&LOAD GO ROCK&ROLL"             16 lines   2-AUG-1989 14:57
--------------------------------------------------------------------------------
    Does anyone know if there is such a thing as an in-plant medical
    insurance advisor or counsler. I have a large stack of hosp. bills and
    insurance forms and clames and paid bills (around maybe $100,000.00).
    Some of it has been paid and some of it hasn't been paid. I recieved a
    letter from my primary care hosp. telling me that I was in the rear in
    payments. As far as I know I have full coverage under the old and the
    new John Handcock plan. I just sent (today) John Handcock the latest
    stack of bills and signed insurance forms, but I dont know if this will
    cut any slack whith the hosp. collection dept or not or if we will be
    able to recieve continuation of the required treatment which ran these
    bills up.
    
    Thank you in advance
    
    Jan
    
================================================================================
Note xxx.1               JOHN HANDCOCK INSURANCE ADVISOR                  1 of 2
STAR::MFOLEY "Rebel without a Clue"                   6 lines   2-AUG-1989 15:05
--------------------------------------------------------------------------------


	Type SHOW KEYWORDS and you'll see something with John Hancock.
	Do a DIR/KEYWORD=whatever that keyword is.

						mike
================================================================================
Note xxx.2               JOHN HANDCOCK INSURANCE ADVISOR                  2 of 2
MSCSSE::LENNARD                                       7 lines   2-AUG-1989 15:08
                              -< A Known Problem >-
--------------------------------------------------------------------------------
    There are benefits coordinators or something like that within our
    Personnel organization.  Howsomeever, I have seen a least two pieces
    of mail in the last week discussing the almost complete breakdown
    in the claims process.  I'm with an HMO so I don't know the specifics
    but apparently John Hancock is buried in claims and will be for
    several more months.  Personnel should be able to illuminate you
    (or is that eliminate?).

You are going to have to do a good bit of homework before anyone can help you.

Each claim that has been submitted should have a statement from JH that shows 
when it was paid and how much they paid as well as why they did not pay all of
it.  

There are several reasons why you may not have "full coverage". 

first the "full coverage" only covers the "reasonable and Proper" charge for 
procedure and your service provider may charge more than that and you are 
liable for the difference.

second, many things are only covered at 80% and again of the "reasonable and
proper charge"

If surgical procedures are required and you did not get a second surgical 
opinion then the full amount is not paid and you are liable for the rest and 
again it it the "reasonable and proper" charges

Also JH may pay yhe wrong amount because of the way the bill was submitted or 
for some other reason.

    I believe the phrase is "Reasonable and Customary".  It's an insurance
    industry euphemism for 'Arbitrary and Random'.  Or maybe 'Too little
    and Too Late'.
    
    Good luck.
    
    

    If you have had a case where John Hancock has refused a family members
    hospitalization, against the doctors orders, can you please send me
    mail.

    I am in urgent need of this type of information, as this has JUST
    happened to my daughter, and I need some information on what you did,
    and if you fought it past the appeal stage, how.

    Many thanks,

    Gale Kleinberger
    BIGRED::GALE