Conference 7.286::digital

    The newsletter also makes numerous references to VTX BENEFITS_US
    but the infobase hasn't been updated since late 1994.
    
    Dave

    
    I called HR on Thursday to ask if my wife was covered and what I am
    covered for, I was told through an error on "someones" part ( mine or
    theirs ) she was not....

    So I said OK add her, to which the person to whom I was speaking said
    the cover was changing on Monday and I was better off waiting until
    then as I could enrol for additional cover.

    Make of it what you will...


    \_spike_/

I got the "more details" letter (dated October 10) a couple of days AFTER the
Benefits Today. It reiterates what was in BT, that DMP 1 & 2 will be discontinued
in areas that have HMO Elect beginning in 1997. In other words, calendar year
1996 will be the last when it will be available.

The rest was a sales pitch for HMO's and HMO elect, with charts and survey
results proporting to show that you would pay less under HMO elect and be
happier.

Your basic spin doctor stuff!

    Be VERY careful with a straight HMO!!!  More so as you age!!!
    Make sure you have some handle with which to hang onto your
    own decision making or you will be warehoused in some dumping
    grounds unless you are healthy ALL THE TIME!!  Managed care
    patients are treated differently, remember that!!!  

    From,
    someone who is watching someone real close to her being pushed
    and shoved from pillar to post for being a senior HMOer!

    The entire idea of going to a doctor whose job may depend on how well
    he controls expenses this month seems insane! There are too many horror
    stories out there about patients that have undergone tremendous
    suffering, just becuase the test to diagnose their real illness was too
    expensive. I prefer my doctor be focused on my health, not the bottom
    line. :-(
    
    Harry
    

Perhaps that's why you may be better off with a non-clinic-based HMO (one which
uses independent practicioners.)  I've had nothing but pleasant experiences
(and lower costs) with an HMO (Healthsource NH) over the past five years.

					Steve

Harry:

> -< How did such a screwy idea take over? >-

  I've been told that the answer to that was discussed in
  BACK40::SOAPBOX last year, when some folks were trying to
  bring about real medical reform in this country.

  We're getting reform now, but it's not going to benefit
  the same folks as the last batch would have.

                                   Atlant

    I also noticed that COBRA has been cut.  When I moved my daughter
    over to cobra when she reached 23 the total was 36 months, now
    it's 18 months.  

    	I do see a difference in care between the Digital plan and the HMO.
    A while back I had pinched a nerve in my neck resulting in extreme pain
    over an 8 week period and approx. 90% loss of strength in my left arm.
    Scary would be an understatement of the situation.
    
    	With the Digital plan I'd have been in for an MRI in a heartbeat,
    but with the HMO I never did get one. I was submitted for less expensive 
    and more intrusive/painfull tests in lieu of the MRI. 
    
    	The obvious difference in coverage is that the Digital plan puts more 
    money in the doctors pocket if they submit you for an MRI test while the 
    HMO plans take money out of the doctors pocket for the same thing.
    	
    	The reason for not submitting me for an MRI was that it is an
    expensive test which would not result in any change in treatment, or so
    I was told. It's too bad that there isn't a reliable happy medium, but
    there doesn't appear to be any such option.
    
    	Granted, my out of pocket expenses are less for the HMO vs. the
    Digital plan, but then so is the quality of service (IMHO).
    
    	Ray

    > How did such a screwy idea take over?
    
    Because the people getting the care were not the people paying for it. 
    The people paying for it (in this case Digital) want to cut their cost.
    If you don't like the health care that Digital provides for you,
    nothing is preventing you from going to the doctors you desire and
    paying them with your own money.  All Digital is telling you is that if
    you are going to spend Digital's money on health care, you have to do
    it a certain way.
                                                    
                                    August G. Reinig

    
    	re: -1
    
    	There is a large degree of truth in this one. My advice is to put
    the full $40/wk in your HCRA account for the "private" care needs
    during each year. You get some small tax savings, a deduction each
    year on your taxes for using the full amount as out-of-pocket medical
    expenses (and the HCRA can be used for both dental and medical), and
    you have supplimented the HMO.
    
    	And unfortunately, for now, that is about your only other option.
    People with chronic illness have a different type of medical problem
    belonging in SOAPBOX.
    
    	Hopefully, Congress will fix this problem for the better.
    
    		the Greyhawk

    
    Do HMO's really save Digital money?  From my perspective having been on
    both sides of the fence I have found that when I was ill under an HMO I
    tended to remain ill longer and took more sick days recovering and I'm
    not one prone to dogging it. 
    
    If you have a close relationship with your doctor they will tell you
    privately about the restrictions HMO's place upon delivery of 
    healthcare services. My doctor said the only reason he joined the plan
    was so that he could continue to offer health care to many of his long
    term patients who were being forced into HMO's. 
    
    I was happy that I was able to opt out and be covered by my wife's 
    employer which was equal to the old Digital plan at one-fourth the cost. 
    Digital's opt out dollars more than offset cost of their equivalent to the 
    old Digital Plan 1 with the same level of benefits.
    
    I know of fellow employees who had long waiting periods when they got
    sick, made even longer when they had a referral to a lab, etc. They got
    sicker and sicker while they waited. Not fun when you have a high
    fever, aches, pains etc.  
    
    Someone in Digital might want to compare the per capita sick time rate
    of HMO covered employees to employees covered by other plans. Lost
    productivity and payment of sick pay might add up to more than what
    HMO's save in premiums. Not to be morbid but a check of the death rates
    in those two categories might also be of interest although it's less of
    a productivity and sick pay issue to Digital. A while back U.S. News today
    published an article about some group that had done an analysis of the
    death rates under HMOs' versus other plans showing a rate higher than
    could be explained by some slight variations in data. Indeed, there are
    some significant law suits being pursued by individuals and families
    where their HMO had refused to allow treatments/tests that were medically 
    sound and wherein the patient had now progressed into a terminal state
    or is deceased. The standard HMO tactic is to drag out those suits
    forever...clearly their cash is unlimited when it comes to lawyers. If
    the plaintiff died waiting for a judgement then the suit had to be
    re-started by survivors if any.
    
    In fairness, I have found what appears to be a significant difference in 
    the quality of HMO's offered closer to the Boston area than in other
    areas. In addition, we are offered only one HMO choice in an area where
    there are at least 15 available. In a rating of HMO's the one we were
    offered was at the bottom of the list and was also the cheapest.
    Despite many complaints about poor services no other choice has been
    offered in three years. I would love to have one of the better HMO's
    offered as a health care choice even if cost more in premiums.
    
    JLB 

    re: .11
    
    <<You get some small tax savings, a deduction each year on your taxes for
     using the full amount as out-of-pocket medical expenses>>
    
    I don't believe that this describes the way it works; i.e., the tax
    savings come from the fact that taxes are not withheld on your HCRA
    deduction each week, in fact, the HCRA amount is specifically excluded
    from your 1040 tax deductions because you have not been taxed on them.
    
    I do agree with the idea of HCRA plus the use of HMO Elect because the
    HCRA reimbursement account covers your deductibles on the (non-HMO)Elect
    activities. Deductible is $ 300 per person versus $ 250 per person on the
    Digital plans... A N D... most importantly, an out-of-pocket limit of
    $ 3000 after which (non-HMO)Elect pays 100% of hospitalization and doctors'
    bills.  Use the HMO when it makes sense and you can use (non-HMO)Elect
    when it makes sense.
    
    The biggest negative with this idea is keeping track of insurance
    records and contacts... and it is almost impossible to explain to your
    spouse and dependents, especially when you are under the pressure of a
    medical emergency.
    
    When my son was hospitalized this year I spent an entire day on the
    phone with Prudential and John Hancock trying to figure out how to
    handle his medical costs... I found the (non-HMO)Elect more flexible
    and not that much more costly because of the HCRA and the out-of-pocket
    limit.
    
                                                               

    The main problem with HMO plans, in my opinion, is that they are not
    the coverage anyone who is seriously ill should have.  HMOs have a
    track record of skimping on tests, xrays, etc. which can impede(sp?)
    accurate diagnoses.  They are less likely to cover state of the art
    treatment for cancer, instead classifying it as experimental and
    therefore not covered.  The last thing anyone who is seriously ill
    needs is worrying that they can't get treatment that they need.
    This is leaving aside the whole issue that people are more likely to
    become seriously ill under an HMO because of the lack of proper initial
    treatment.
    
                            

    never mind the "because", what source do you cite for the assertion that
    "people are more likely to become seriously ill under an HMO"?
    
    Mark

    Re: .15
    
    There was a study quoted on the ABC Evening News within the past few
    weeks, to the effect that people covered by HMOs were on average sicker
    longer and the death rate was higher than for people covered by non-HMO
    plans.
     

re: .15

>                    -< do germs know what plan you choose? >-

That wasn't her point.  She was saying that the germs got to grow 'cause
they weren't stamped out by proper initial treatment.

I'm not taking either side in the argument (although I lean towards the
anti-HMO camp), but I *hate* when out-of-context or irrelevant or otherwise
inaccurate sound bites are used in the debate.  I already am exposed to too
much of that garbage in the newspaper now that Newt's strutting his stuff
on Capitol hill.

On the other hand, perhaps you just misunderstood .14, in which case I 
apologize for my tirade.

-Hal

So when the DMP is dead, what happens to people on LTD who
are effectively frozen forever in whatever medical plan
they were in the day they went out on disability, and that
plan was the DMP? 

Or perhaps my understanding is incorrect, if one is on
long term disability, can you ever (while on disability) 
change your medical plan under any circumstances?

For comparison's sake, are many other large companies 
deleting their medical plans and making employees choose
from a (sometimes unbelievably short) list of HMO's?

   erik

    re: .10

    Is medical coverage (and other benefits and services) not part of one's
    overall compensation?

    Is a cut in benefits (or reduction in services) not a cut in one's
    compensation?

    Should one expect a higher salary if given no other benefits?

        AJ

    re: .14
    
    Maybe some testimonials to drive home the HMO incompetency to save
    money:
    
    1- Skimping on more tests and or a referal to a specialists cost my
    then 1 1/2 year old a 3 day stay in hospital. HMO doctor: "Call us in
    the morning if he is not better, 103 degree temps can last for 5+ days,
    that's typical"
    
    2- Before knowing we had a miscarraige (sp): HMO OB doctor: "come to my
    office, I have an ultrasound machine". No kidding the guy didn't even
    know how to turn it on, had to call for the nurse to come in and get it
    set-up for him. Then he identifies the emrionic sac: "there it is, so
    there may still be hope, let's see you again in 4 days". Finally my
    wife and I insisted we get ultrasound at the hospital and come to find
    his embrionic sac was hemmoraged blood pool.
    
    I am convinced (for the most part) that HMO's are just another
    business. The term "Managed Health Care" means "I'll manage to get
    paid, who cares about your health". They are reluctant to prescribe
    antibiotics, order more diagnostic tests, etc.... while your condition
    goes undetected and gets worse. Most are butchers in my book.
    
    Say no to national health care folks!
    
    rick

    
    
        I hear so many horror stories in here about HMO's.  I had a family
        plan at Fallon about 5 years back and I went thru something of 
        the affect of not being able to get him an MRI.  So we went out
        of the plan to a pediatric specialist at UMASS and he called Fallon
        and talked them into doing an MRI.  Again, this is a case of a
        clinical based HMO..  
    
        I then switched over to Tufts and have never had that problem.
        You pay a little more, but you I don't get into any bad situations
        anymore with them.  Of course, it is not as flexible as DMP is.
        
        But, I would think that anyone is really limiting themselves if
        they go to a Fallon or Harvard.  At least pick an HMO that offers
        the largest set of doctors affiliated with several hospitals, if
        possible, than going to one that confines you to a clinic.
    
        Mike

    
    I have to say that I am very pleased with the HMO that I have been
    using for several years now (17 years with a few gaps).  It is not one
    of those clinic type HMO's.  I do go to a doctor's office that has 6 or
    7 doctors and can see any one of them when the need arises.  I have had
    numerous illnesses and problems throughout the years and have never had
    a problem getting referrals for specialists or lab work.  I recently
    spent one full week visiting labs/hospitals/specialists because of a
    multiple health problem.  In fact, most of the visits were to verify
    what my primary doctor had diagnosed.  I have been in hospitals for
    surgery and even the emergency room over the years with no issues.  I
    currently get allergy shots ever 2 weeks and was sent to an allergist
    for testing and serum (the actual shots are given by the lab at my
    doctor's office). 
    
    My only complaint is that Digital cheapened on the premiums and my co-pay
    went up to $5 for prescriptions (from $2.50) and the vision rebate
    dropped to $35.00; while raising my weekly cost.
    
    I do know folks in the same HMO that have had numerous problems getting
    referrals and tests.  It REALLY depends on whether the office has
    several doctors or if the costs of test and specialists affect the
    Doctor's personal profit.
    
    btw, I have US Healthcare (previously called HMO-PA) if it matters
    
    cheryl
                                                    

    Okay Karen, I'm just trying to clarify things regarding "serious
    illness".  My family has personal experience with serious illness and I
    find it hard to believe that HMOs approach the diagnosis and initial
    treatment of serious illnesses any differently than other health plans.
    
    Mark

    The major reason I stay with the Digital plan is: it's the only plan
    that provides any sort of long-term mental health co-payment.  *NO*
    HMO seems to pay for more than 6 or 8 therapy appointments; I've been
    seeing my therapist for a year now.  If I have to move to an HMO, I
    simply will not be able to continue therapy.  That sucks.

    Elect in HMO Elect pays 70% after $ 300 deductible up to $ 2,000;
    after that 40%.  It pays 70% of psychiactric hospitalization costs up
    to an out-of-pocket limit (I think it's $ 3,000) then it pays 100%.
    
    The elect portion of HMO Elect is administered by John Hancock, not
    Prudential.

    >Elect in HMO Elect pays 70% after $ 300 deductible up to $ 2,000;
    >after that 40%.  It pays 70% of psychiactric hospitalization costs up
    >to an out-of-pocket limit (I think it's $ 3,000) then it pays 100%.
    
    Digital's Plan pays 80% -- my therapy cost in the last year was $6500
    dollars -- the Digital plan paid about $5000; I paid the $1500 balance.
    On the plan described above, I'd pay about $3500.
    
    HMOs do not handle long-term care at all well; to HMOs, long-term means
    more than six weeks.
    					andrew

    <<Digital's Plan pays 80% -- my therapy cost in the last year was $6500
      dollars -- the Digital plan paid about $5000; I paid the $1500 balance.
      On the plan described above, I'd pay about $3500.>>
    
    I would have to pay over between $ 6,800 and $ 7,800 per year for Plan
    1 or 2.  The combination of HMO Elect and HCRA maximum costs less than
    $ 3,700 per year.
    
    		Digital Plan			HCRA plus Pru HMO Elect
    annual cost 6,800-7,800			3,700
    med exp	1,500				3,500
    		------------			-----
    total cost	8,300-9,300			7,200
    
    So, your mileage may vary... obviously, but I still think that HMO
    Elect is a good deal... at least much better than HMO without the
    elect.
     
    

    re:.9
    
    	I should clarify that I had no problems getting other referrals.
    I'm in NH and have Healthsource. I saw 7 different doctors in 8 weeks. 
    Some of them wanted to do tests to "try to find the cause" of the problem. 
    
    	In one case, an orthepedic surgeon wanted to inject dye into my
    shoulder socket to rule out the possibility of a rotator cup tear. It
    (and he) didn't explain a few things, like why the pain started in my
    neck and then went to my shoulder, so I declined the test and
    respectfully asked for another opinion.
    
    	A neurologist performed a test where he stuck a needle into the nerve 
    running from my neck to my left arm, at various points. Then he tells me 
    I had a virus which my body attacked and my immune system mistook a 
    particular nerve for the virus. When I asked if he was sure, he said
    that was his prognosis. Come to find out, the test he did is not
    accurate and many times provides misleading results.
    
    	The last doctor I saw (also a neurologist) explained the potential
    problems with the test done by the other neurologist and said, that
    since I was recovering at this point, there was no need for an MRI
    now.
    
    	So, at this point, there is no conclusive evidence as to what
    exactly happened and the most likely test to show what was going on (an
    MRI) was never done. The last neurologist said that had one been done
    right away, it may have been worthwhile, but not 8 weeks later when I
    was nearly healed.
    
    	The only plus in all of this is that when/if this happens again, I
    know who to go to right away. Again, the point being is if I was on the
    Digital plan, I would have most likely gotten the MRI right away.
    
    	Ray

    ><<Digital's Plan pays 80% -- my therapy cost in the last year was $6500
    >  dollars -- the Digital plan paid about $5000; I paid the $1500 balance.
    >  On the plan described above, I'd pay about $3500.>>
    >
    >I would have to pay over between $ 6,800 and $ 7,800 per year for Plan
    >1 or 2.  The combination of HMO Elect and HCRA maximum costs less than
    >$ 3,700 per year.
    >
    >		Digital Plan			HCRA plus Pru HMO Elect
    >annual cost 6,800-7,800			3,700
    >med exp	1,500				3,500
    >		------------			-----
    >total cost	8,300-9,300			7,200
    
    My annual cost for the Digital plan is about $1850.  My total cost
    is $3300 -- less than what my therapy co-payment would be.

    Re: My annual cost for the Digital plan is about $1850.
    Re: I would have to pay over between $ 6,800 and $ 7,800 per year
    
    Mine is about $3500 (I'm calculating this from the "medical"
    item on my paycheck.)  Why is there such a significant variation in
    the employee costs of the DMP?
    

    re: .30
    
    The cost of DMP varies depending upon the other health care choices
    available in your local area.  I've forgotten the exact details, but
    it's something like:
    
    	HMO Availability		DMP Cost
    	----------------		--------
    	None				Low
    	HMO 				High
    	HMO & HMO Elect			Incredibly high
    
    Digital has been making a conscious effort to force people off the DMPs
    for several years now.  They will drop the DMPs completely beginning in
    1997.
    
    Bob

    re .19
    
    Yes, medical coverage is part of one's overall compensation.  
    
    No, a cut in benefits is not necessarily a cut in ones compensation. 
    If you consider cost of the benefits your compensation (instead of the
    benefit itself), then if Digital continues to pay the same money toward
    your benefit, there is no cut even if the benefits cost more, and there
    fore you get less.  However, not many of us think of it this way so
    YES, a cut in benefits is a very real cut in our overall compenation.
    
    Should one expect a higher salary?  Get real.  Digital still thinks the
    dental costs from 10 years ago are customary and reasonable.
    
    Just because I understand what Digital is doing and why they are doing
    it doesn't mean I like it.  I don't like having my health care
    insurance plans dictated by Digital.  But, we have to live with the
    consequences of the silly idea that your employer pays for your medical
    insurance (but not your car insurance or your house insurance).  One of
    those consequences is that the payer for the benefits and the receiver
    of the benefits are not the same and therefore do not have a common
    goal.  
    
                                        August

    Re. 23.
    
    >>illness".  My family has personal experience with serious illness 
    I find it hard to believe that HMOs approach the diagnosis and
    initial treatment of serious illnesses any differently than other health
    plans.<<
    
    You'd better believe it.  My daughter was unable to get any treatment
    at all for an endocrinal problem because the her HMO "expert" said
    there was nothing wrong with her.  No tests were taken.  This was just
    his opinion.  I took a second job and saved enough to send her to
    another doctor at Woman and Brigs.  
    
    There was something very wrong, and the W&B doctors recommendation was
    to let the HMO investigate the deeper problem that was causing her
    symptoms.  Only after that doctor sent the HMO a report did they 
    acknowledge the problem.  Now, they rewrite prescriptions for the same 
    drugs the W&B doctor prescribed with no tests to see if there is any 
    change, or any kind of investigation of the deeper problem.
    
    It took me 7 years to get my HMO to take a health problem seriously,
    and even now they haven't done a proper diagnosis.  It seem like they
    treat symptoms only.  Although, I would have thought they would have
    been at least curious as to why one of their patients had pneumonia
    three times in one winter.
    
    The decision of the Digital Health Plan and HMO Elect was taken out of
    my hands by Digital when it cost more than my pay could manage.
    

    I have had very poor results with the HMO that I chose several years
    ago when my premiums *tripled*.  The most obvious change is that
    when I notice a problem that I think I should go directly to a
    gynocologist or dermatologist for, I am required to first go to the
    general practicioner first (read: time off work) and then wait for
    the review board to approve the referral.  I then make another
    appointment and take more time off of work for that visit.  
    
    I had a situation where my son had a cyst on his head (he was 6 at the
    time).  I called the doctor, described the lump and said I thought
    I needed to go to a dermatologist.  He replied that it was probably a
    "boil" and to use warm compresses. When this didn't work I made a visit
    to him where he confirmed that it wasn't a boil, but didn't really
    know what it was.  He would not refer me to a dermatologist, wouldn't
    do any tests.  In the meantime I wanted to know what this "cyst" was -
    so I went to a dermatologist under the HMO-Elect portion and paid
    for it myself.  It turned out to be a sebaceous cyst - nothing to worry
    about, but what if it had been something serious?  I have found that
    I am using the HMO-Elect portion more and more because I simply don't
    want the run-around.  I also recently discovered that not *one* of the
    15 or so doctors in my practice was trained in the U.S.
    (Bolivia,Ecuador,Granada,Cuba etc....).  That didn't set well with me
    either.  I am now looking to change practices and see if that makes
    any difference.
    
    My attitude now is that with an HMO you better be ready to fight
    like a junk-yard dog if you want quality healthcare.
    
    Elizabeth

    Once again. You'd better believe that HMO's diagnose differently than fee
    for service providers.

    I call them High Mortality Organizations (HMO) since Health Maintenance
    Organization is an apparent oxymoron.  A HMO IS an Insurance Company.
    They happen to have some employees that have some training in Medicine.
    It seems that the way that they avoid the expensive tests is by
    statistical diagnosis.  Statistical diagnosis is what they use even
    when the tests are cheap.    All an insurance company cares
    about is the profit.  Statistically they feel that they can satisfy
    most of their customers and those that die are outliers.  They count on
    people being self centered and only caring about themselves and their
    premiums.

    We would be in an uproar if the government decided what health care we
    were rationed.  We would call it crazy to let a psychic be our physician.
    But we seem (on average) to be happy to have psychic insurance company      
    employees ration our health care, if it is called an HMO.

    I will remain in the HMO-elect plan until I can purchase an 80/20 plan
    outside the company for the same kind of cost.  It was getting close than
    you would think last year.  I expect it to be even closer this year.

>    Once again. You'd better believe that HMO's diagnose differently than fee
>    for service providers.
    
    It probably depends on the HMO.  For non-clinic HMOs (like Tufts, which
    I've been very pleased with), the doctors that are affiliated with them
    take patients with other insurance plans as well as Tufts patients, and
    I've seen no evidence that either of the two practices I have used
    under Tufts modify their treatment or diagnostic methods based on which
    HMO or insurance company I use.
    
    Actually, that's not quite true.  When (while at my previous doctor) I
    changed from DMP2 to Tufts, they recommended I have a full physical (as
    Tufts covered that).  
    
    John

Re. .33
>>  Re. 23.
>>    >>illness".  My family has personal experience with serious illness
>>    >>I find it hard to believe that HMOs approach the diagnosis and
>>    >>initial treatment of serious illnesses any differently than
>>    >>other health
>>    >>plans.
>>                    
>>  You'd better believe it.....

Indeed you should.

A member of my family was recently diagnosed with an acute case of a dreaded
disease.  The particular combination of symptoms, which in retrospect were an
obvious and unmistakeable hint to any doctor that was paying any attention,
went on for about 3 months. 

During this 3 months (being reasonably smart about medical issues ourselves) ,
we kept requesting a CBC (Comprehensive Blood Count). The HMO doctor, besides
missing the significance of the symptoms, refused to do a CBC.

When an outside doctor finally authorized a CBC (due to an accelerating
decline), we were ordered to get to Dartmouth University / Hitchock Medical
Center NOW.  Not tomorrow;  not this afternoon;  NOW. 

We were informed at Dartmouth that it was the worst blood counts they had ever
seen -- a medical record for them -- and that collapse and death were probably
a couple of hours away when we got there (since the counts were crashing on
an accelerating curve).

The Chairman of the Department at Dartmough U. Medical Center was so horrified
at the conduct of the HMO doctor that he actually worked with us to draft a
letter to the President of the Matthew Thornton Health Plan.

(That letter has never been acknowleged, let alone answered).

On the OTHER hand, life is GREAT in an HMO when they finally let you crash and
you need expensive treatment.  The bill for the JUST the first (of many) visits
was over $101,000, and ran to about 50 single-spaced 8x11 pages;  maybe
3000 line items.  And this was ONLY the hospital bill, not physician and
specialist fees.  

Such encylcopeadic bills just get paid by the HMO:  no submitting 50 page
bills, no hasseling over individual charges, no trying to keep track of
everything and ride herd on the hospital's billing office.  No deductable, 20%
co-pay, etc. etc. etc.

We're way into the hundreds of thousands of $$$'s now.
And it just gets taken care of, like magic......

The bottom line is that HMO's are not good for "maintaining" health and 
catching problems early (which is the opposite of what they mid-lead you to
believe).

They are bad for "maintaining" health because the physicians that you normally
see are just Employees.  As employees, they are goaled and measured by
managers, who focus on rationing health care in order to meet the expectations
of the owners of the HMO.

This is the Veterinary Ethic of Medicine:  when the ultimate loyality is to
whomever is financing the health care (just like when you take your pet bird
to the Vet).

Just stop and think for a minute about the Veterinary Ethic of Medicine as
applied to you and your family......

Bottom line:  HMO's are terrible for staying well and getting problems
diagnosed and treated early.  They are GREAT when you finally crash, and are
put into the hands of non-HMO doctors in a hospital, with all the billing
and costs handled by the HMO.

All of which means that you need to be a very informed and assertive consumer
of medical care.  Don't be passive and let the HMO doctor call all the shots.
Take responsibility to take care of yourself and your own treatment.  Go
outside the HMO system for diagnosis when necessary.

When you are in an HMO, you need to treat them as just a "convenient part" of
your total health care.  They won't be a "crutch", like a traditional caring,
fee-for-service doctor who follows the Hippocratic Oath.  The HMO doctors are
there to help the HMO earn a profit for it's owners.

You need to think of yourself as the "owner" for your health care, and the
HMO doctors as just "subcontractors".

    Last year at this time, I was presented with a $120 per week increase
    in the DMP or a series of 2 HMOs. Only one of the 2 was in the HMO
    Elect program. I asked for a listing of all the doctors available in
    each of the plans. While both claimed to service my corner of the state
    of Conn [actully the northeastern sixth of the state] they had few
    service providers. I am 7 miles from a hospital that neither plan
    recognizes. This is where we send all ambulance based cases when we are
    called out on Rescue call [I'm with the Fire Dept too]. 
    
    I did a study and sizable write-up of the plans available [including
    the apparent 'red lining of services available by Zip Code] as well as
    the plans available in my area but not offered. The response I got from
    Corporate was that the plans available were the only ones recommended
    by the frim contracted to do the research. 
    
    I was asked if I would be interested in an HMO in Southern Worcester
    county Mass [area next to my home area]. As I drive thru the area to
    get to work and most everything we do, I said YES!. the offer was later
    revoked [it was verbal].
    
    My doctor at the time would have nothing to do with either of the
    plans. While I was skeptical of the message from that practice,
    everything they told me has been verified by my HMO doctor.
    
    You must go to the primary first. If you get a referral you must wait
    to go to the referral and you must take the approval paperwork with
    you. You must always have your card. If the referral wants to do
    anything that is not on the approval paperwork, you must go back to the
    primary, convience them it is needed, get the new paperwork and then go
    back for the other work. My time, day time.
    
    1 month perscription fill/refill, six month max script. I'm lucky
    because the co-pay is only $5. With Synthroid, I pay ~$12.00 retail, on
    the plan I pay $5.00 and the HMO pays ~$3.16. If I had a $10 co-pay the
    pharmacist said to go retail because it would onlt cost me $29.75 for a
    3 month supply. Meanwhile we drive 7 mile to get scripts filled once a
    month.
    
    My HMO Elect plan only raised my weekly cost by 125%.
    
    Howard   

    Re: .37
    
    That would be okay if every layperson knew enough about medicine
    so that they'd know when a doctor was omitting a test or ignoring
    a symptom of a serious disease in an early, perhaps curable
    stage.  Make a mistake in a situation like that, and you or a
    family member are toast. 
    

    Re: .39
    
>>    That would be okay if every layperson knew enough about medicine
>>    so that they'd know when a doctor was omitting a test or ignoring
>>    a symptom of a serious disease in an early, perhaps curable
>>    stage.  Make a mistake in a situation like that, and you or a
>>    family member are toast. 
    
    For sure.  Absolute truth.  Which is just about what happened to us.
    
    (And the really scary thing about our experience is:  my wife *IS* a
     clinical medical professional......)
    
    The HMO elect is a really good deal for people who don't feel comfortable
    with their knowledge of medicine, because then you can affordably call
    on an outside doctor who isn't rationing visits and diagnostics.
    
    By the way, I mis-spoke about something in .37.  It was NOT the
    President of Matthew Thornton who the Chairman at Dartmouth-Hitchcock
    took to task;  it was the President of the Hitchcock Clinics (for whom
    the doctor worked).
    
    Matthew Thornton's been real good about all this....
    
    

    As this string points out, you had better learn to differentiate
    appropriate from non-appropriate medical care if you deal with HMOs. 
    One way to understand the situation is to look at where the money goes,
    and what the reward system is for some of these plans.  Of course
    different organizations have different ways of working, so one size does
    not fit all here.
    
    Let me tell you my understanding of how some of this works.  I'm sure
    that there are other knowledgable prople out there that will correct me
    if I get some of this wrong.
    
    If we take HealthSource as an example, the head of the organization was
    reported in the newspapers to have received $5.6 million last year -
    that's a lot of health care dollars into one man's pocket!  Now why on
    earth should he receive that much compensation?  Simple.  It's for the
    same reason as other CEOs receive big bucks - the organizations return
    on its investors investments.  I heard that if you put in $25,000
    dollars at the biginning, you would now have $250,000.  Also, what do
    the other top administrators make - probably pretty good salaries, too.
    
    And by the way, Healthsource actually is a PHO (Physicians Health
    Organization).
                                                   
    Now, what is the reward system for the PHO doctor/investors?  My
    understanding is that if you are a doctor and have as an example 100
    patients, that you would have a goal of some number, say 20, referrals
    to specialists.  Now if you only do 10 referrals you and your peers get
    a big bonus for the money saved.  Can anyone tell me what would happen
    to that particular doctor if he did 30 referrals?   Might there be some
    subtle, or not so subtle, pressure to shape up and not do so many?
                                 
    As the physician you could be in a troublesome situation.  With
    patients being hearded into HMOs, you might not have much success in
    private practive unless you had a contract, or were part of the
    organization - again a need to conform to the rules of the
    organization.
    
    There are also other things going on.  One issue is called Capitation. 
    I think this means that there are $X to treat a patient for a
    particular problem and someone - maybe the hospital - eats the rest if
    they spend more on the treatment.  Another way to limit the cost of
    treatment - possibly at the expense of the patient's health.
    
    So, to understand the behavior you must understand where the money
    goes and what the measurement system is.   We have for profit
    health organizations and their doctors and investors making big bucks.
    
    If you feel uncomfortable with the way things are going what can you do
    about it?  I think on an individual basis you have to be very agressive
    about finding out what is the appropriate, accepted treatment for the
    health problems that you or your family are having and be sure your HMO
    is measuring up to those standards.
    
    If we follow the news we would also see some other things that are
    happening to change the balance of power somewhat.  The first is
    legislation.  For example, some states are starting to pass laws
    mandating minumum standards for length of hospital stay for childbirth. 
    I think Massachusetts just did this.  Another is legal action.  I've
    seen news recently of lawsuits filed for wrongful death agains health
    organizations for late or negligent treatments.  I suspect that people
    are going to figure out what is going on and the courts will be
    overflowing with this type of stuff until the decline in care is
    reversed.
                                     
                                                      

Without commenting on the quality of care of HMOs, I offer this observation:

We recently had a vacation aborted by a SERIOUS problem resulting in an 
emergency room to 4 day hospital stay well out of the coverage area (God 
bless Resurrection Medical Center in Chicago). 
 
Matthew HMO covered the whole tab, over 11K; paid the bill within 7 days of 
reciept.  Now before we spread kudos about how prompt and forthright they 
were, understand that they actually only paid a tad over $3K.  This is the 
result of a "negotiated contract" with a third party.  HMO pays promptly and
gets a STEEEEP discount (when the hospital's accounts payable clerk told me
what they had paid I almost choked figuring that MY COPAY was going to be $7K).

On the one hand, I think it is great that my HMO is finding ways to keep costs
down.  On the other hand, there ain't no such thing as a free lunch.  That 
other $7K is floating around in the "system" someplace; call it a medical 
insurance system overhead charge, if you will.  We ALL pay for it and other 
discounts through our contirubtions/deductions/copays.

Since insurance companies (and banks, brokers, etc) NEVER lose money, they just 
charge higher fees, I think I am impressed by the elegance of a system that 
lets them gather in substantial profits (my "health care" investments are doing 
VERY well) at the same time making it look like they are saving us money.

Yup, I think it is a slick system.

Dave

Re 4188.41:

> ... you had better learn to differentiate appropriate from
> non-appropriate medical care if you deal with HMOs.

You'd better learn that anyway.  As my father remarked to me, before his
retirement from being professor and head of a well-respected medical school
department, there is virtually no quality control on private practitioners.
You can't differentiate on price -- he had plenty of stories about the
horrible medical care available to people who can afford to pay for it --
and you probably have no idea about the market pressures on practitioners.
If you had a good picture of it you'd be disgusted.  Or should I say "more
disgusted"?

Compound this with the superstitious attitude most people have toward
medical care, and you have a prescription for expensive disaster, which is
exactly what the USA has right now.

My advice: (a) invest in the insurance industry.  At least they're the ones
making the money from the disaster.  And (b) however you do it, get your
medical and dental care from people who are on the faculty of professional
schools.  They'll be better educated, more up to date, and somewhat better
oriented than the general run.  It's no guarantee, but it's your best bet.

___Pete

Re: .42

The system is actually more insidious. In some states, with 
your 11K bill and an indemnity plan paying 80%, you would have
ended up paying 20% of 11K while the insurance company 
ends up paying 80% of 11K less a 50% discount.

I do not know if this is the case with Digital or not. 

Gim

    re:44
    
    	The Digital plan used to (and probably still does) pay based on their 
    version of *reasonable and customary rates*. They can, and have, said that 
    their R+C rate was much less than what was charged. This would leave you 
    with whatever percentage you were obligated to pay, plus the amount over 
    and above what Digital's R+C rate was.
    
    	This was one of the biggest things that forced me into an HMO. My
    out of pocket expenses almost always maxed out each year, and on a
    family plan with a few kids, it's a decent amount of change.
    
    re: the system in general
    
    	The HMO's/insurance companies neither consume nor provide for health 
    care. They are nothing but middlemen. They make a profit that adds, in 
    reality, to nothing but the bottom line. 
    
    	Unfortunately, the insurance industry is second only to the US
    government. So, guess how quick any of this will change ?
    
    	Ray

    
    We should be sending all of this discussion to our CEO and his
    lieutenants.
    
    We should be able to choose our health care from menu of choices and
    not be forced into an HMO.  I personally would like to see Digital go
    with a menu of benefits, as some companies have, and let us have the
    option of what we want and we don't want.  
    
    I plan to send my comments on the demise of DMP1 and DMP2 to our CEO
    and hope that many others will do the same...
    
    Maybe our action can influence what the choices will be...
    
    Mimi

    Dittos on using University facilities when you can.  My son has a
    condition called hypoplasy which means that he has poorly formed
    tooth enamel.  Needless to say he has had to have alot of dental
    work done for an 8 year old.  When I saw some of the bills I was
    getting (and how utterly ridiculous John Hancock's "reasonable and
    customary" quotes were) I started taking my son to the dental school
    at Loma Linda University.  He gets much better treatment and care
    than he did before (professors of Pediatric Dentistry monitor every
    procedure the student dentists are performing as well doing examinations
    before and after the procedure) and the prices are very reasonable.
    The only drawback is that the University is about 20 miles from me -
    but it is more than worth it.
    
    Elizabeth
    

    
    I would refer many of you read-only NOTERS who are concerned about this
    topic to Newsweek Magazine , October 23, 1995 issue.
    
    	The article is Healthcare:Beware Your HMO on page 54.
    
    	The key to success or failure in your relationship with an HMO
    is how the practioners get paid. Know that, and you will always be
    ahead. 
    
    	Get the rag (has the FAB 4 circa 1970 on the cover), and read the
    article. It could very well save someones life.
    
    
    		the Greyhawk

	Has anyone explored how the Matthew Thorton sale from Hitchcock 
	Clinics to ???? will effect those of use who have Hitchcock Clinic 
	doctors as primary care?  Anyone have a contact to get answers 
	from before we have to make our decisions in mid-November?  

	Dave

    Matthew Thorton was not owned by Hitchcock Clinc, they are two seperate
    entities.  One an insurer, MTHP and one a service provider, Hitchcock. 
    So for those of use who have Hitchcock doctors no change.
    
    PJ

>     	Get the rag (has the FAB 4 circa 1970 on the cover), 

        I don't think we had a FAB 4 in 1970.

        Bob

    Now for another voice:
    
    	I've been in Fallon for 17 years, had 6 kids with them.  We have had
    multiple hospital stays, surgeries, specialists of local fame, etc.  I
    have seen medical bills of over $80,000 for which I paid $0.
    
    	I have only the best words of praise for Fallon and my family has
    tested this system almost to the max.  From physical/therapy to the
    psychological needs, they are great.
    
    	I would not go to anyone else.

RE:52

	I am glad your experience with Fallon has been so positive.  Mine has
been such that I wouldn't trust them for acne advise.  It is because of Fallon
that I call HMO's High Mortality Organizations.  My complaints have been
discussed through the entire chain of complaint structure and to the board of
directors of Fallon.  I can assure you that they do not care one bit about their
patients or the quality of the health care they provide.

Jim

    VTX BENEFITS_US has been updated; they put a text version of the
    Benefits Today newsletter in it. So now you can read a BENEFITS_US
    update that directs you to BENEFITS_US for more info... :-(
    
    Dave

    If you want to "start your heart", or possibly stop it, check out the
    new medical insurance rates at VTX HCCZ_US
    
    WOW !

Is it my poor memory, or are some of these options up over 100%?  I guess
I'm lucky.  Tufts is only going up for me by 18%.

j.

    Well, they aren't all going up.  Harvard HMO Elect is actually going
    down $.66/week for family.
    
    I can live with that.  :-)
    
    John

    Matthew Thornton straight HMO is going up $.02/week.  That makes me
    feel good.
    
    Irene
    

    Bay state health care is up 61% and that does not make me #$@$# happy
    at all.

	Well, according to my most recent paystub and VTX, HealthSource is
going down $3.41 for the family plan.

			1995	30.77
			1996	27.36

    Re. 48
    
    I just read that article yesterday.  Can someone tell me how Matthew
    Thornton Dr's are paid?  Months ago I asked my Dr. if she has refused
    requests for tests and she said no and that MT has never restricted her
    either.  I chose them because they are affiliated with Mary Hitchcock
    in Hanover, but after reading that article I wonder if I would ever be
    referred up there if there was a serious problem.  Wouldn't it be
    cheaper for them to let me die?
    
    The other question I had with the article is on how the Drs are paid so
    they don't offer tests if it is coming out of their own pocket.  How
    does this work with surgeons and OB Drs in the program.  A normal baby
    delivery is about 3K or so, so how does the Dr. get compensated for
    that?  Never mind anything complicated.  What about appendicitis?
    
    Tina
    
    

    Re .61
    
    When Hitchcock Clinic moved down and took over the Matthew Thornton
    business, I asked directly if I HAD to go to Memorial or would I have
    access to Mary Hitchcock in Hanover (now Lebanon) if I needed Hospital
    care.  The answer was (then) "You may go to Mary Hitchcock if you
    choose".  Being as our family has done all of their hospital things
    there, excepr once, when we had a hitch surgeon who had relocated to
    memorial, that would be my choice also.   (The surgeon and patient were
    preped, he looked at the latest set of xrays, consulted the patient and
    spouse and decided not to operate in fact. He was right)
    
    Sooo, unless I ask again and get a differnt answer, I think it's yes.
    
    Bill
    

    There's a pertinent article in a recent (the current?) issue
    of Good Housekeeping on particularly-HMO practices.  The main
    focus of the article is the "dump the mother and new baby out the
    hospital door within 24 hours" policy, but it does touch on
    doctors being told they'll be dropped from plans if they don't
    meet cost goals, etc.
    

> Message-ID: <Pine.3.89.9510231146.A130169-0100000@acs.bu.edu>
> MIME-Version: 1.0
> Content-Type: TEXT/PLAIN; charset=US-ASCII
> 
> 
> The Managed Caring Plan(tm)
> 
> by Richard Liebmann-Smith (an editor of American Health Magazine)
> 
> Welcome to Managed Caring(tm), a whole new way of thinking about
> friendship.  The Managed Caring Plan(tm) combines all the advantages of a
> xtraditionalx friendship network with important cost-saving features.
> 
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> Under the Plan, you choose your friends from a network of pre-screened
> accredited Friendship Providers.  All your friendship needs are met by
> members of your Managed Caring(tm) panel.
> 
> WHATxS WRONG WITH MY FRIENDS?
> If youxre like most people, youxre probably receiving Friendship Services
> from a network of Providers haphazardly patched together based on where
> youxve lived, worked, or gone to school.  The result is costly
> duplication, inefficiency and conflict.  Some Providers may not meet
> national standards, responding to your needs with inappropriate, outmoded
> or experimental behavior.  Under Managed Caring(tm), your friendship needs
> are coordinated by a designated Best Friend, who Cares(tm) about the
> quality of all your Friendships.
> 
> HOW DO I KNOW THESE ARENxT JUST A BUNCH OF LOSERS WHO CANxT MAKE FRIENDS
> ON THEIR OWN?
> Many of todayxs most dedicated and highly trained Friendship Providers are
> as concerned as we are about delivering quality Caring(tm) in a
> cost-effective way.  They have joined our network because they want to
> focus on Caring(tm) for you rather than devoting their resources to the
> paperwork and high Bad Friendship premiums that have sent the cost of
> traditional Friendship Delivery systems skyrocketing.  Our Friendship
> providers have met our rigorous standards of loyalty.
> 
> WHAT IF I NEED A SPECIAL FRIEND, SAY FOR POKER OR FISHING?
> Special Friends are responsible for most of the unnecessary Friendship
> Procedures that have sent the cost of the traditional Friendship Delivery
> system skyrocketing.  By training, experience, and by virtue of knowing
> you for what you really are, your Best Friend is qualified to refer you to
> a Special Friend within the Managed Caring(tm) network should your needs
> fall outside the scope of his or her excellent training.
> 
> SUPPOSE I WANT TO SEE FRIENDS OUTSIDE THE MANAGED CARING(tm) NETWORK?  CAN
> MY BEST FRIEND EVER REFER ME TO THEM?
> No.  The only time you can see a Friendship Provider without first
> consulting your Best Friend is in the event of a Friendship Emergency.
> 
> WHATxS THAT?
> The Managed Caring(tm) Plan covers your friendship needs 24 hours a day,
> 365 days a year anywhere in the world, even if you need a friend out of
> town, after business hours, or when your Best Friend is Caring(tm) for
> someone else.  You may be on a business trip and find yourself lonely.  In
> such a case, you may make a New Friend, and all appropriate Friendship
> Procedures delivered in this Emergency Friendship will be covered under
> the plan, provided you notify us within two business days.
> 
> WHAT FRIENDSHIP PROCEDURES ARE COVERED UNDER THE PLAN?
> Typical Friendship Procedures covered include (but are not limited to): 
> Chewing the fat, slinging the bull, shooting the breeze, hanging out,
> checking in, cheering up, kidding around, dropping over, partying,
> moaning, gossiping, joshing, ribbing, holding your hand, patting your
> back.
> 
> ARE ANY FRIENDSHIP PROCEDURES NOT COVERED UNDER THE PLAN?
> Yes.  Ineligible services include (but are not limited to): drinking in
> excess of six ounces of alcoholic beverages, lending sums in excess of $5,
> going the extra mile, exchanging ethnic or dirty jokes, and sex.
> 
> HOW CAN I FIND OUT IF THE FRIENDSHIP PROCEDURE I NEED IS COVERED?
> If you need a Friendship Procedure, call the toll-free number on your
> Managed Caring(tm) I.D. card to arrange for precertification of the
> proposed Procedure.  All appropriate Procedures will be approved for
> coverage within 24 business hours.
> 
> BUT WHO DECIDES WHATxS APPROPRIATE FOR ME?
> We do.  Isnxt that what friends are for?
> 
> __________________________________________________________________________
> Changing the world, one diaper at a time.

    I looked at my booklet last night.  I'm with HMO Elect (HCMP) for years
    now, and I could not help but notice that Harvard Community plans were
    CONSIDERABLY less expensive (co payments included) than the rest.  
    
    Why is that?
    
    

Today's Globe (10/25/95) has an article on Blue Cross
of MA being sued for the issues discussed in .44

That practice is being changed as of 1/96. Of course, the
suit had nothing to this change.  Hum....


Gim

    
    Two quick comments
    
    1) Our experience with HCHP has been excellent.  This has included the
    birth of a child (we had a choice of when to leave the hospital) and
    lots of kid care for 2 kids.  We've had tests, medicine, and visits to
    Children's hospital with no evidence of rationing (for example, my son
    being sent to Children'd for a 2 day visit for a strictly precautionary
    reason).
    
    2) Concerns about HMOs and doctors withholding care because it is in
    their financial interest are legit.  It seems people are ignoring the
    financial incentive in a traditional system which is for the doctor to
    over medicate, do extra tests, do extra procedures because that is how
    they make more bucks.  In both cases the integrity and expertise of the
    doctor is what defines quality care from poor care,
    
    IMHO,
    Greg
      
                                                      

>>    I looked at my booklet last night.  I'm with HMO Elect (HCMP) for years
>>    now, and I could not help but notice that Harvard Community plans were
>>    CONSIDERABLY less expensive (co payments included) than the rest.  
>>    
>>    Why is that?

It's always been that way, hasn't it?  The idea is to encourage membership in
the HMO's and discourage use of an indemnity-style plan.  HMO Elect is a mix of
the two, and so is more expensive than the HMO and less expensive than the
straight indemnity plan.

You do pay for the privilege of out-of-plan medical coverage.

						Brian

    Re: .64  Too funny.
    

    I recently lost a family to cancer.. just shy of her 40th birthday..
    I can't / won't get into all the details here.. too frustrating.. but
    the bottom line is that if you are really sick, stay clear of HMO's!
    
    the HMO wasted  precious time deliberating endlessly on whether or not
    to allow a bone marrow transplant procedure that has been proven very
    effective in arresting this particular type of cancer.. they finally
    agreed to pay for it but not until other more traditional methods were
    exhausted..  this even after staff oncologist's argued that it would be
    a waste of time so to speak bothering with traditional treatments..
    
    bottom line is they squandered valuable time here.. who knows what may
    have happened if they would have paid attention to the physicians
    recommendations initially.. she ended up having the transplant but it
    took nearly 4 months for the HMO to approve the procedure...and this
    cancer was one of the most aggressive forms...
    
    not to mention the amount of time it took for them to diagnose
    initially... told her she just had the flu.. over and over again..
    until her husband demanded they do a blood test etc... they didn't feel
    it necessary to perform the blood test since if it were the flu it
    wouldn't be necessary... sigh...
    
    thank goodness for HMO Elect....
    
    
    

    Can anyone answer this one --
    
    	If the medical coverage (HMO Elect) is going up on price, then why
    	are my Opt-out $$$$$ going down??
    
    	Example - My SO (also employed by Digital) carries our family HMO
    	Elect coverage. This cost is increasing by approx. $.70 per week.
        I therefore Opt-Out and my $$$ will decrease by approx. $3.00.
    
    

Opt-out is generally equivalent to what Digital pays the lowest-cost
supplier available to you.

				Steve

    The real question is, why do we have to look in here to find out the
    answers to these obvious questions? I'm looking forward to filling out
    the questionairre...
    
    Doug.
    

re. 70

>                       -< HMO's good if you're not sick >-
>
>    I recently lost a family to cancer.. just shy of her 40th birthday..
>    I can't / won't get into all the details here.. too frustrating.. but
>    the bottom line is that if you are really sick, stay clear of HMO's!
    
I'm really sorry to hear of your loss.  However, please don't make such a 
blanket condemnation of all HMOs.  HMOs are not created equal; some are 
excellent.  I'm alive today because of the doctors and nurses at the Santa
Teresa Kaiser Permanente facility in San Jose.  I've had the same specialist 
for 9 years with excellent results and I only had to change my internist 
because he decided to switch to the emergency room.

Over the past 17 years, I've only had one "turkey" in the system and I just 
never went back to see him.  Before Kaiser, I also saw an occasional private 
doctor who was not so terrific; you find good and bad doctors on both sides.  
When it comes to medical care, "your mileage will vary" is especially true.  

HMOs are not for everyone, but a good one does help keep costs down without 
sacrificing access to the latest and greatest technology.  I personally like 
the willingness of my Kaiser doctors to let me participate in the decisions 
related to my health care.  It's far less frightening than some of the private
doctors I've had in the past who wanted to make all my decisions for me (the 
"don't worry your pretty little head" type).

Just my 2 pennies in favor of my choices.

				SQ

BTW, my husband is also alive thanks to the doctors and nurses in the 
Sacramento Kaiser who patched him back up after a serious auto accident 18 
years ago.  So basically, our family loves them.

re:   <<< Note 4188.72 by QUARK::LIONEL "Free advice is worth every cent" >>>

>>Opt-out is generally equivalent to what Digital pays the lowest-cost
>>supplier available to you.
    
    I don't believe this is correct; Extracted from some old memo's 
    on my area's health plan options from my local Personnel rep...
    
(note: these are weekly figures)
    
				   1992			   1993
			     single	family	     single     family
Name of Plan		    coverage   coverage     coverage  coverage
------------------------    -------------------     -------------------
DEC MEDICAL PLAN #1	     $ 0.00	$ 9.79	     $ 2.52    $15.39
DEC MEDICAL PLAN #2	       5.52      23.92	       8.05     29.73
CHOICE CARE/CYO HMO	       0.00       6.04	       3.17     15.37
WESTERN OHIO/DYO HMO	       0.00       8.53         2.50     13.47
OPT-OUT			     $21.85		     $24.25

(Note: these are *monthly* figures)
    
	    	     DECs		Employee               
	 	 Contribution	      Contribution	    Total Cost
		FAMILY  SINGLE	     FAMILY  SINGLE	  FAMILY   SINGLE
		------  ------	     ------  ------	  ------   ------
1991 Choice C	269.66  105.13	      66.34   12.87	  336.00   118.00
1991 WOHCP      265.40  101.57	      65.60   12.43	  331.00   114.00
1991 DMP 1	634.17  198.00        36.83    -0-	  671.00   198.00
1991 DMP 2      635.17  194.50	      88.83   19.50	  724.00   214.00
    
1992 Choice C	350.04	132.31        26.17    -0-	  376.21   132.31
1992 WOHCP	352.27	134.33	      36.96    -0-	  389.23   134.33
1992 DMP 1	707.58	228.00        42.42    -0-	  750.00   228.00
1992 DMP 2	692.35	217.08	     103.65   23.92	  796.00   241.00
    
1993 Choice C	405.92  152.46	      66.60   13.73	  472.52   166.19
1993 WOHCP	398.59  146.86	      58.37   10.83	  456.96   157.69
(1993 DMP costs not available at the time this data was collected)

    
    If you take the opt-out quoted for 92 and 93 above, multiply by 4 1/3
    and compare to Digital contribution for the cheapest option, you will
    find that the opt-out money is less than Digital's contribution.
    
    I don't have the data handy for more recent years (one way to get it is
    to call John Hancock and ask for the COBRA costs for the various plans)
    but my recollection is that the pattern holds.
    
    BTW, it is also interesting to calculate the contribution ratios...
    
    Dave

    
    
    	I was always under the impression that if you retired from
    	Digital that you got the same coverage as today (just you
    	the employee, not spouse) for as long as you live.  I
    	thought reitirees don't have to go onto COBRA plan???
    	Is this not so?  I know that for retirees the amount
    	Digital pays is getting less over a period of years as
    	they lower the amount.  At least that 's what I thought
    	till I read the mailing.  The confusion was that it
    	was addressed to 'Digital empoyee OR RETIREE!  Anyone
    	know what the scoop is for folks retiring? (I'm not
    	ready to retire, but it does help to know what's ahead
    	so I can plan for it!)
    

  Well, for one thing, Digital significantly changed retirees health
  benefits a few years ago. Whereas they used to cover retiree health
  care 100%, they now base their coverage-of-the-cost on years of ser-
  vice. I *THINK* you now need 25 years of service to qualify for 100%
  company-paid coverage.

  If someone has the details, I'd certainly appreciate if you'd post
  them.

                                   Atlant

    
    
    	Re: 77
    		I also think this is correct.  I think also, that
    	the percentage is going down every year for the next "X"
    	years to a certain percentage Digital wishes to pay. What
    	this means is that the longer you stay the less you get
    	"company paid" on your health benefits when you retire
    	if you do have less than 25 years with the company.  I
    	wish someone who has the facts readily availble would
    	post them here.  Thanks.

    Re .76-.77-.78:
    
    In 1993, Digital reduced the amount of its support for health insurance 
    for retirees with less than 25 years' service by 2% for each year under 
    25.  For example, an employee who retires with 21 years of service will 
    have Digital's portion of his/her medical plan support reduced 8%.  As
    Digital normally pays more than half the total premium, however, the 
    increase in the employee's contribution will be more than 8% when he/she 
    retires.  The maximum reduction in the company's contribution was set at 
    30%, equivalent to that for an employee who retires with 10 years of 
    service (the requirement for retiring at less than age 65).
    
    Anyone who retired before January 1, 1994, was grandfathered and
    suffered no reduction.
    
    To my knowledge (within the relatively recent past, anyway), Digital
    never paid 100% of the premiums for retiree health insurance.
    
    This is not a lifetime arrangement, by the way.  Upon reaching age 65,
    retirees are automatically transferred to Medicare or HMO retirement
    plans (their choice) with greatly reduced premiums (well, usually).
    
    M. 

    HMO's keep health care costs down? What about Premiums?
    
    Digital (Personel) encouraged the folks in Dallas to join an HMO plan
    in 1993 to get us off the Digital"Private" Medical program (offered to 
    us at $85/week in 1993) and now the HMO premiums have gone though the roof:
    
    Cigna Elect family coverage
    
    1993        1994         1995
    28/week      53/week      85/week
    
    And for the straight CIGNA hmo plan knock off an economical 
    $10/per week from these numbers
    
    Where's the savings?  All these HMO's do is jack up the rate
    until we're forced to the lowest tier HMO.  
    
    Thanks Digital, I have a choice between $10/week at a place that
    looks like a clinic from a Russian prison camp or $85/week for 
    my current HMO.  That's not much of a choice. 
    
    For $85/week + the $26.00/week Opt out money I can buy private 
    insurance and squander as much health care as I want and visit
    the doctor for socializing too..  What are they doing with these
    premiums?
    
    Where's the savings we were promised?  Where's the Economy of 
    61,000 Digital Employees in the marketplace negotiating a group 
    insurance rate from several of the group insurers.
    
    Where's our choice?  
    
    I get better rates by belonging to IEEE, Chamber of Commerce, or 
    a fraternal association than working here at Digital.
    
    What's the problem with OUR PERSONEL depart and the way they negotiate
    healthcare options for Digital Employees?  Someone in PERSONEL is 
    personnally accountable for this and I would like to see an
    explaination and some choices for my $100/week $400/month $5,200/year
    premiums. 
    
    I've called three of my friends in the business and all of them
    have private insurance at their companies with very low cost HMO
    options.  $28 to $45 each weeks gets these folks private insurance
    and they work for companies with less buying power than Digital.
    
    My HMO increase this year is more than some of my friends premiums.
    
    Where's the Beef Personel? IMHO You are not earning your money this 
    year and you're not giving me any choices...

    >    1993        1994         1995
>    28/week      53/week      85/week
>    
>    And for the straight CIGNA hmo plan knock off an economical 
>    $10/per week from these numbers
>    
>    Where's the savings?  All these HMO's do is jack up the rate
>    until we're forced to the lowest tier HMO.  

    Are you sure that's because the HMO jacked up the rates or is a lot of
    that change because Digital lowered the % of the premiums Digital pays? 
    Two effects add up to what we all see in our paycheck ... one entity
    are the providers the other is mother Digital.  Personally I wouldn't
    knock either of the two without doing a little research to see who's
    camp is causing most of the increase.

     
>    I've called three of my friends in the business and all of them
>    have private insurance at their companies with very low cost HMO
>    options.  $28 to $45 each weeks gets these folks private insurance
>    and they work for companies with less buying power than Digital.
>    
>    My HMO increase this year is more than some of my friends premiums.

    Not an excuse but maybe an explanation.  Outside of the GMA in the US
    I'd guess that Digital doesn't have much clout with HMOs.  HMOs tend to
    be local.  How any Digital employees are there in the greater Dallas
    area, or the greater Atlanta area, etc?  These numbers probably make
    Digital a pretty small employer in those areas outside of
    Massachusetts and New Hampshire.

    Greg

                                   

>                     <<< Note 4188.81 by MROA::YANNEKIS >>>
>
>    >    1993        1994         1995
>>    28/week      53/week      85/week
>>    
>>    And for the straight CIGNA hmo plan knock off an economical 
>>    $10/per week from these numbers
>>    
>>    Where's the savings?  All these HMO's do is jack up the rate
>>    until we're forced to the lowest tier HMO.  
>
    
    
>    Are you sure that's because the HMO jacked up the rates or is a lot of
>    that change because Digital lowered the % of the premiums Digital pays? 
>    Two effects add up to what we all see in our paycheck ... one entity
>    are the providers the other is mother Digital.  Personally I wouldn't
>    knock either of the two without doing a little research to see who's
>    camp is causing most of the increase.
    
    It doesn't matter if Digital or the HMO is to blame, Personel is 
    responsible for these matters and looking out for the employees
    best interest.  If I saw a $32/week increase coming I would have 
    tried to find a lower cost alternative rather than leaving it ride...
    
    Who's making these decisions on my behalf and hanging me out to dry?
    
>
>     
>>    I've called three of my friends in the business and all of them
>>    have private insurance at their companies with very low cost HMO
>>    options.  $28 to $45 each weeks gets these folks private insurance
>>    and they work for companies with less buying power than Digital.
>>    
>>    My HMO increase this year is more than some of my friends premiums.
>
>    Not an excuse but maybe an explanation.  Outside of the GMA in the US
>    I'd guess that Digital doesn't have much clout with HMOs.  HMOs tend to
>    be local.  How any Digital employees are there in the greater Dallas
>    area, or the greater Atlanta area, etc?  These numbers probably make
>    Digital a pretty small employer in those areas outside of
>    Massachusetts and New Hampshire.
>
    Digital is a multi-national company with large groups of employees
    outside the GMA.  The GMA is not Digital and Digital is not the GMA.
    
    (I know this is blasphemy to some but it bears to be repeated until
    the truth sinks in)
    
    
>    Greg
>
>   
    Greg,
    
    There's no excuse when you can join an outside group program and spend
    half the premium.  Why even offer healthcare as a benefit? 
    
    
    HMOs are local but we have several hundred employees in Dallas, and 
    Every major city.  100+ people is a pretty good group, but forget 
    this local group nonsense, with 61,000 employees we should have a 
    nationwide private insurance choice in the $20 to $50 per week 
    range, just like other companies.  Digital isn't that unique that 
    our money doesn't spend in the marketplace like everyone else's.
    
    John W.

    That letter that was supposed to come out to people who
    will lose the DMP 1 & 2 options in 1997 because they are in
    HMO Elect areas -- can anyone tell me what it said?  I never
    received a copy, despite asking for one, apparently because
    they neglected to send it to people who are not in HMO Elect
    areas now, but whose areas will have HMO Elect available by
    1997.  (VTX HCCZ_US says we'll have HMO Elect available in 1996.)
    Thanks.
    

    
    John,
    
    It seems I am with you more than you realize.  It seemed to me that the
    original note I responded to blasted the HMOs and my guess would be
    Digital is much more responsible for the bigger bucks we are all paying
    and the even tougher situation folks not in GMA face.
    
    I do not know what industry norms are for health care are these but it
    seems hard to believe we are close to it.  
    
    Greg
                                                 

    When I was hit with $120+ increase last year in CT when Digital
    introduced HMO & HMOElect, I spoke with my current providers about the
    2 HMOs that were offered. All the providers told me to stay away from
    both of the HMOs. Not having the ability to go outside [at the time], I
    pushed to have Digital look at the other 2 HMOs that do service my area
    and most [not all] doctors belong to. No dice including on appeal.
    
    To paraphrase the call I received from Comp & Beni [funny how they
    don't like to write anything down] 'The organization that did the
    survey and made the recommendations, recommended the 2 we selected.'
    When I asked who did the survey, in hopes of being able to reach that
    person, I was told "John Hancock".
    
    The HMOElect still took 4+ months to get my doctor authorized. I chose
    one from the book, but he wasn't 'coded' to accept HMOElect. Some
    computer error.
    
    Also, when I checked the Providers available in VTX HCCZ_US, some of
    our towns have multiple Zip Codes. Some of the selected providers only
    service selected Zip Codes in the town. In one case if you get Post
    office Box mail your choices are limited, but your neighbor that get
    household delivery has more. The Zip codes tended to fall along some
    socio-economic lines. Paraphrase on that one 'well, the service
    provider tells us what Zip Codes they offer, you really need to take it
    up with them.
    
    Howard

    RE: .83
    
    Karen,
    
    As I recall, there wasn't a seperate letter that came out; I think it
    was in the "Benifits Today" newsletter that came out a couple of weeks
    ago.
    
    Deb

    re. 85
    
    When I had a problem with HMO Elect availablity, I requested Personnel
    to provide the same HMO options of an adjoining ZIP code.  They did it
    with no problem and I was able to choose the HMO I wanted.
    
    You might try that approach...  Good luck!

Here's what I received, as best I can transcribe it.

=================================================================================

Important Notice to All Digital Medical Plan (DMP) Participants

As the next step in the evolution of our managed care strategy, Digital is
planning to discontinue DMP 1 and 2 for people who live in an HMO Elect service
area beginning in 1997. Although the DMP will continue to be available in 1996,
we're letting you know about the change now in case you want to enroll in an
HMO or an HMO Elect for 1996 instead of waiting until 1997. We're also
providing this information now because we're concerned tyou may be spending
thousands of dollars more each year than is necessary for your medical
coverage. By changing to an HMO Elect option, for example, it's likely you
could continue to use all your current doctors and pay much less overall for
your care during the year.

Optimizing Value

Before we look at the specifics of why an HMO or HMO Elect may make more
sense for you, let's focus briefly on Digital's managed care strategy and what
it means to you. The strategy has been designed to optimize value for you.
What does getting the best possible value from your medical option mean?
Broadly speaking, three things:

 0 Quality. Digital's managed care strategy allows us to work as partners with
  medical providers to be sure they meet our quality standards and provide
  you with quality care and service.

 0 Satisfaction. Based on the results of the employee health care value survey
   Digital has participated in with other major employers, we know that 81%
   of Digital employees are significantly more stisfied with HMOs than with
   the DMP.

 0 Cost. Allof us are concerned about what we pay for health care. Digital's
   managed care strategy focuses on HMOs, which offer the most cost-effective
   delivery of health care in the country.

Looking at Costs

First, let's consider the issue of cost, an important factor for all of us.
The following chart compares the expected 1996 payroll contributions of
DMP coverage in HMO Elect areas against typical HMO and HMO Elect payroll
contributions.

                    Weekly Costs            Annual Cost
                Individual      Family  Individual      Family
DMP 1           85.64           155.98  4,453           8,111
DMP2            96.04           175.78  4994            9,141
HMO Elect        7.17            28.23  373             1,468
HMO              3.97            17.13  206               891


        Costs for HMOs and HMO Elects are averages of "benchmark" HMOs and
        the HMO Elects offered by Digital in different regions of the
        country; that is, the lowest priced HMOs and HMO Elects in each
        region that meet Digital's quality and performance standards.

We believe the numbers speak for themselves. Clearly, your own annual
payroll contributions through the DMP (which don't include Digital's costs)
are many thousands of dollars more each year than they would be if you
enrolled in an HMO or an HMO Elect. But we realize that cost isn't the
only concern you may have about medical coverage. Flexibility is another
important issue.

The Advantage of HMO Elect

The key to Digital's HMO Elect options is flexibility. If you enroll in an HMO
Elect, you choose how to receive medical treatment each time you need it
during the year.

 0 In-network treatment means you use doctors and hospitals that participate
   in the HMO Elect network. You receive higher benefits, so you pay less
   outo of your own pocket for care during the year.

 0 Out-of-network care means you choose any doctor or hospital you like. You
   still receive benefits, but you'll haee a deductible and coinsurance as
   you do with the DMP. So your costs for out-of-network care are more than
   if you go in-network. But overall, HMO Elect costs can still be
   significantly less than the DMP.

With an HMO Elect you can receive all your care during the year in-network,
some of your care in-network and some out-of-network, or all your care
out-of-network. Regardless you'll still receive plan benefits. However, you
may also be concerned about which doctors you can use.


You Don't Have to Change Doctors

Many of us have important, ongoing relationships with doctors, hospitals, and
other health care provicers. The good news is that today, most doctors and hospi
tals participate in several managed care plans. It is possible that your
providers don't participate in the HMOs or HMO Elect networks available to
you. Understandably, you may not want to give up your curent providers.
However, it's important to be aware that:

 0 You could enroll in an HMO Elect,

 0 Pay thousands of dollars less each year for your coverage,

 0 Continue to see all the same providers you see now by using your HMO Elect
   on an out-of-network basis,

 0 Still pay substantially less overall for your health care for the year,
   again, using the same doctor and hospitals you use now, and

 0 Over time, begin to save even more by using HMO network providers for
   some care, such as routine physicals, allergy shots, and so on.

An Example of Cost Savings

Let's assume you join an HMO Elect with family coverage, but decide to have
all your care out-of-network. That is, you're an HMO Elect member, but you
decide to use doctors and hospitals that don't participate in that HMO network.
Also, let's assume a family member has a serious condition that requires close
attention by the doctor as well as a hospital stay and surgery. Here's a
comparison of your overall costs for the year with DMP 1, DMP 2, and a
typical HMO Elect. THe chart shows HMO Elect costs out-of-network first,
then HMO Elect costs in-network (as though you used HMO Elect participating
providers for your care). You'll see that participating an an HMO Elect
results in big savings, no matter how you use the plan, although the
in-network feature is clearly the most cost effective.


In this example, your total bills for the year are assumed to be as
follows:

 0 Your Annual Expenses: $500 for physicians' office visits (three visits),
   X-rays and laboratory expenses, plus $70 for prescription drugs (two
   separate perscriptions).

 0 Your Dependent's Expenses: $1200 for physician office visits (eight
   visits), X-ray and laboratory expenses, plus an $8,000 hospital stay,
   $2,500 surgery bill, and $250 in prescription drug costs (five
   prescriptions).

Here's how each plan would cover your expenses and the total amount you would
pay for care (assuming all charges fall within reasonable and customary
guidelines).


                                        HMO Elect               HMO Elect
                        DMP 1   DMP 2   Out-of-Network          In-network
Total actual            $12,520 $12,520 $12,520                 $12,520
Expenses

Plan benefits           $10,364 $11,724  $9,139                 $12,375

Your costs               $2,156    $796  $3,381                    $145
(deductibles and
 coinsurance or
 copayments)

Your annual              $8,111  $9,141 $1,468                  $1,468*
coverage costs
(through payroll
 deductions)

Your total
annual costs            $10,267  $9,937 $4,849                  $1,613

      * Assumes $10 copay for physician office visits and $5 copay for
        prescription drugs.

Learning more about HMOs and HMO Elect

Changing to a new type of medical plan can be a big step, and we want to
provide the information you need to make informed decisions:

 0 Our first step is to send you this letter, which begins the discussion
   about the advantages of managed care plans like HMOs and HMO Elect and
   provides what we believe are compelling cost comparisons and examples.

 0 The next step will be open enrollment for 1996. Late in October, you'll
   receive your 1996 open enrollment package, with your personalized
   statement and enrollment book. We encourage you to think carefully about
   your medical coverage, review the options available to you, read the
   section in the enrollment book describing how to choose an HMO or an
   HMO Elect for 1996. Once again, you can stay in the DMP for 1996 if
   you wish, but that option will not be available to you in 1997.

 0 Then throughout 1996, we'll provide additional information about HMO's
   and HMO Elect: how they work, what their advantages are, what
   experiences other Digital employees have had when moving from a DMP to
   an HMO or HMO Elect, and how to find out more about them.

For More Information

If you'd like more information now about how HMOs and HMO elect work, please
read Your Benefits Book on VTX (enter $ VTX Benefits_US). Or check Health
Care Choices by zip code (HCCZ) for an overview of how various plans cover
medical care (enter $ VTX HCCZ_US).

>First, let's consider the issue of cost, an important factor for all of us.
>The following chart compares the expected 1996 payroll contributions of
>DMP coverage in HMO Elect areas against typical HMO and HMO Elect payroll
>contributions.
>
>                    Weekly Costs            Annual Cost
>                Individual      Family  Individual      Family
>DMP 1           85.64           155.98  4,453           8,111
>DMP2            96.04           175.78  4994            9,141
>HMO Elect        7.17            28.23  373             1,468
>HMO              3.97            17.13  206               891

>
>        Costs for HMOs and HMO Elects are averages of "benchmark" HMOs and
>        the HMO Elects offered by Digital in different regions of the
>        country; that is, the lowest priced HMOs and HMO Elects in each
>        region that meet Digital's quality and performance standards.


That's a heck of an average.  HMO elect here in Dallas is $85 a week for
a 2 person family.  Somehow I think the different regions were Marlboro 
and Maynard.

al

    There are at least two HMOs offered in my area but the ELECT option  is
    only available with one of them. 
    
    Does anyone know why the ELECT isn't offered with *all* the HMO
    choices?  
    
    

    Re: .90 which hmo elect is "tied to"
    
    In my area there are two HMOs offered, and the Elect option
    is for the better one.  If I read the info correctly, the
    paperwork, etc. for Elect shouldn't affect the HMO at all,
    and which HMO it is shouldn't affect the Elect stuff, except
    whether or not your physician(s) are in the HMO.  I think
    Benefits has overlooked the herding possibility you mention,
    so far :-) 
    

    Am I the only one who still hasn't received their HMO id cards
    for 1996...
    
    

    Got mine late last week (sheesh)
    
    	Dave

    re: .92
    
    Nope.  I don't  have mine either.  I don't really care as long as their
    computer knows I'm enrolled.
    
    Bob

I got mine by mid-December but it had the wrong subscriber number on it.  
They had used my social security number which I had not authorized.  My old 
subscriber number was a unique number created by the HMO that I had been 
using since January 1991.  So I demanded that the subscriber number be 
changed back to the old unique subscriber number.  To get this done it 
involved many phone calls to the HMO, PSN, and Benefits Express and the 
month of January to get new cards.

Judy

    Re: 94  I don't really care as long as their
        computer knows I'm enrolled.
    
    The HMO's computer didn't know I was enrolled until about the
    third week in January.  I've burned up about $200 of Dec's money on
    the phone getting various things straightened out.  The latest
    number is finding out this morning that the HMO doesn't cover
    FDA-approved medications until six months after they've been approved.