Conference 7.286::digital

    
    Sounds like somebody is trying to screw you. I don't think you need to
    raise the issue to the Benefits Manager. Just point people at Digital's
    Policies and Procedures section 4.09. I reproduce the relevent section
    below. You can get it yourself by saying:
    
    VTX ORANGEBOOK
    
    Good luck.
    
    Dave
    
    PS Not sure a DIRECTORY would have helped you but the speed of the line
       makes no difference to how long the DIR takes. It's all done on the
       server and just the results (ie found listing) returned to your
       system.
    
 |     If CMI and the attending physician are not in agreement
 |     on the employee's medical fitness for work, CMI will
 |     schedule an Independent Medical Exam (IME).  The
 |     decision of the IME will conclusively resolve any
 |     dispute as to the employee's medical status.  In rare
 |     instances however, (e.g. where there have been threats
 |     of violence) Digital's Health Service Organization may
 |     overrule the IME's determination.  IME's will be
 |     scheduled as quickly as possible and the employee's
 |     claim will be considered to be pending during this
 |     period.  However, the employee's pay will continue
 |     until CMI reaches its decision on the claim.

 |     If an employee does not keep his or her IME
 |     appointment, another will be scheduled and pay will
 |     immediately stop until the results of the IME are
 |     available, and confirm the employee's need to be
 |     absent.  If the IME evaluation confirms the disability,
 |     the employee will be paid retroactively and will
 |     continue until the disability or entitlement to
 |     benefits ends.  If an employee fails to keep the second
 |     appointment, the employee will be subject to Corrective
 |     Action and Discipline up to and including termination.

 |     When CMI denies a claim for disability status, the
 |     Company will immediately stop disability income
 |     protection benefits until the employee returns to work.

 |     Employees whose disability claims have been denied are
 |     required to return to work within three work days of
 |     the notification of the denial.

RE     <<< Note 2006.1 by SMAUG::GARROD "Floating on a wooden DECk chair" >>>
                          -< Policy is on your side >-

    
>    Sounds like somebody is trying to screw you. I don't think you need to
>    raise the issue to the Benefits Manager. Just point people at Digital's
>    Policies and Procedures section 4.09. I reproduce the relevent section
>    below. You can get it yourself by saying:
    
   Dave
 
   Thanks for the quick reply and the pointer to section 4.09, it will come in
handy when I call CMI tomorrow.  It looks like CMI operates according to SOP for
the insurance industry, Reject claims for whatever reason, whenever possible and
hope the claimant will roll over to the might of authority. If the claimant 
presses the issue, you only pay what you should have anyway, if you succeed in
intimitating them, than you save a buck.  I felt a lot better when the STD
program wasn't run by "Professionals".

Regards
Barry   

    
    
    Hi, Barry 
    
    Be sure and talk to Earny Glen. He knows the policy.  
    
    					Your 'old pal' 
    
    					Kelly Poshusta
    

    Back a few months ago I was having a conversation with one of the
    company nurses and she brought up the CMI issue.  She said that there
    were terminally ill DECCIEs that were receiving threating letters
    from CMI to return to work.  She said that DEC was working the issue.

    >Is CMI and/or Digital willing to accept financial  responsibility for
    >any accidents I might get into attempting to drive with a cast on my foot. 
    
    I understand they make a distinction as to whether it's a right or left
    leg.  If it's a right leg you can't work the pedals, whereas the left
    leg is just along for the ride.
    

    re .5
    
    	*sigh*  I guess they've forgotten all about that silly pedal called
    the clutch.
    
    	Peter

Does your job require you to wear safety shoes as a result of:

1) Law or OSHA requirements

2) Digital Policy

3) Other

If #1, I would inform CMI that Digital and CMI would be violating the law by
forcing you to return to work at this time.

If #2, get your plant safety person or plant manager involved in the issue.

If #3, I have no idea what to do.

HTH,

Bob

    Hi
    Digital paying millions of dollar a year in std,ltd and worker's
    compenstion insurance premium,CMI and IME are organisations that 
    getting payed by the insurace company and they will try to fight
    you to get you off their back if they don't pay you and your
    doctor say to stay home hire a lawyer because,your doctor word
    is against their doctor word.
    CMI AND IME doctors not better than any doctor you see ,IME TRIED
    this tactic with me i went to 5 doctors and all they said the same
    thing about my condition only the insurance company doctor said
    different even digital send me to their own doctor and he said
    what my doctor said. so I prevailed.
    
    REGARDS,
    ALI

                                                 
    Dear Barry, 
    
    Core Management is a way for DEC to intimidate employees back into
    work. The STD process, once handled by your PSA or local nurse, 
    is now depersonalized to be handled by a computer that demands
    you come back into work according to preset rules. I'm positive 
    there a switch in the computer that says "broken ankle - 2 weeks". 
    
    Quite frankly, CMI could care less how you feel. Their contracted 
    job is to get you back in here as soon as possible. Please have
    your current doctor impress upon them, that your health and 
    well being is in jeopardy, should you be forced into returning
    to work before healthy enough to do so.  
    
    Not to sound so horribly jaded, but I had a rotten experience
    (before CMI) with Health Services and Personnel.( Corporate Personnel 
    which should be to their disgrace.) I was told I had had more than enough 
    time off, (by a nurse) and then told by a supervisor my illness 
    was not his problem. To my dismay, I had to fight dirty and 
    mention the a magic word associated with the law profession. It 
    did eliminate the harrassment I incurred.  
    
    Please do as other's here have said, and obey your doctor's order's.  
    YOU have done NOTHING wrong. Unfortunately, illness and injury
    now cause employees to become pariahs and marked individuals
    in this company. The days of someone caring are over, and you 
    do need to fight for yourself and your rights. 
    
    Please keep us posted! 
    
      
    
    
    
    
    
     

Update:

  I talked to my doctor last night and got the impression, from him, that the
CMI representative was very hard to reach and when he finally did reach her,
she seemed to only be interested in getting me back to work ASAP without regard
to his wishes or my condition. This AM I called CMI who said, the decision was
based on information provided by my doctors nurse? (Broken foot=two weeks?)
I informed them that this was not in agreement with what my doctor had told me.
The CMI Rep. told me that all I had to do, was have my doctor or his nurse call
them with his diagnosis/prognosis and they would get everything straightened 
out. I called my doctors office this am and told his nurse what CMI had said 
they needed to do. I called CMI a few hours later and they told me that my 
doctors nurse had called and needed to call back later with additional 
information concerning restrictions? I called my doctors office again and was
told that the nurse was waiting for my doctor to provide her with a list of
restrictions to give to CMI (no driving, limited walking on crutches etc.).
I am now waiting for my doctors nurse to call me and let me know what
happened when she called in with the new information.

In the meantime I get a call from a corporate nurse who "understands" from CMI,
that I'm ready to return to work, she's already spoken to my manager about
this! I informed her about the situation, detailed above, and she is to inform
my manager that the STD claim is pending review.

My right foot has a toe to mid calf cast on it, it would be "possible" but very
dangerous to try to drive with it.  
Safety Shoes are required (by OSHA I believe) in my work area.

Thanks to everyone for the replies and input, I'll post the outcome as soon as
I know it.


Regards
Barry 
 

    Barry:
    
    I know only too well the horror of dealing with CMI; I agree with the
    person who indicated CMI's purpose is to harrass people into coming
    back to work!!  I came back weeks ahead of when my doctor anticipated,
    simply because CMI was causing me much more stress than my day to day
    job was (or at least that's how it felt to me).
    
    On Valentine's Day I was sitting at my desk when I was hit with chest
    pains and shortness of breath.  When I was able to move, I made my way to
    Health Services.  The nurse indicated my B/P was 190/115 and I had a
    rapid pulse rate.  The nurse said I probably should go home; silly me
    I drove myself.  My best friend (a former RN) insisted on calling my
    doctor because I have had long term B/P problems and my family has
    a long history of heart disease.  My doctor was appalled that I had
    been allowed to leave the building to drive myself home!!
    
    To make a long story short, I did not have a heart attack, but my
    doctor said until my B/P returned to a more normal state there was no
    way I could work and/or drive my car.  He also changed meds to control
    the runaway heart rate and said it would take a few weeks for all the
    meds to kick in and be effective.  I was to stay home, relax, take it
    easy and AVOID STRESS!!  Right doc!
    
    I processed all the proper paperwork for STD and FED EX'd it out.
    Two weeks must be the norm for CMI to start bugging everyone.  I was
    called at home repeatedly, sent notices that my STD was about to 
    expire.  CMI even contacted DEC corporate to say that my doctor was not
    cooperating with their doctor as far as keeping them advised of my
    condition.  My doctor is in Atlanta, Ga.....the CMI doctor was in
    California!!!!  My doctor's nurse told the CMI doctor repeatedly what
    my doctor's office hours were....CMI always managed to call AFTER
    hours.  When my doctor would call the phone # left by the CMI doctor,
    he would get an answering "machine", not an answering service, thus
    losing any opportunity to speak with a real person!!
    
    When my doctor was finally able to speak with the CMI doctor he was
    infuriated to find this doctor in California recommending that he
    prescribe one of the strongest tranquilizers on the market and send
    me back to work!!  My doctor is also the Workman's Comp doctor for
    General Electric so it's not as though he's unfamiliar with STD pol-
    icies.  My doctor refused to prescribe the drug; he knew it would 
    have an immediate impact, but felt it's highly addictive qualities
    and other side affects would be detrimental to me in the long-run.
    CMI was adamant about it.  My doctor just about blew a fuse and told
    the CMI doctor that in all good conscience he would not do this to a
    patient of 23 years, so if CMI didn't agree with him could they please
    suggest another doctor in the Atlanta area for me to see.  CMI couldn't
    recommend another doctor.
    
    I've outlined the above to personnel and Human Resources.  Both reps
    admitted they were experiencing a few "bugs" in how they understood
    CMI's administration of STD was to be implemented and they would look
    into it.  Obviously, I haven't heard anything back.  I'm appalled, but
    not surprised that CMI would bug terminally ill employees.
    
    I can only speak for myself; I know there has been abuse of the STD
    system, but I resent the implication that everyone who goes out on
    STD is abusing the system.
    
    Karen
    
    
    Because my doctor is aware of what is happening at DEC he reluctantly
    OK'd me to come back, but made it abundantly clear that he would not
    be responsible if something happened to me once I was back on DEC
    premises.  Health Services signed me back in....so I'm here.
    
    One thing I did do was make sure my friend and my sister have copies
    of my doctor's release......I didn't want the only copy of that paper-
    work to reside in my personnel file :-(
    
    

    re.11  I think your case is very different from .0 and I don't think
           they can be compared in terms of ability to return to work. 
           A broken leg is very different than a heart condition. 
           I'd like to mention, in your case, if I had a doctor who didn't
           think I was able to return to work and simply sent me back to
           work because he/she was being pressured from an agency to do so
           I would find a new doctor.
    
    After reading these notes I went to pull the new std policy and it
    doesn't seem that unreasonable to me.
    If you read the policy it includes definitions of medically qualified,
    meaningful work, reasonable accommodation, accommodated positions,
    rehabilitation positions, and alternate positions.
    Therefore, if a person has a broken leg how long do the readers of
    this note think that person should be out of work? As long as they
    want? Until the cast is off? Until they can drive without soreness?
    Until they have no soreness at all? What about other work? Should a
    person who is out from DEC on a disability who is able to do something
    other than the job they had at DEC be able to do so while they are on
    disability? Something like keypunching? Answering the phone? Other
    types of work that don't require walking or moving around? Why can't
    they do that type of work at DEC then in an "accommodatated position"?
    
    About driving - must a person be able to drive a car to be able to
    attend work? I can understand if a person cannot be a passenger in a car
    because of their condition. But, if a person is able to be driven is it
    ok to say to DEC "I can't drive because I can't work the pedels so I
    can't be at work"?  

    
    re:12 -  You make some good points about the policy and accomdations
    They are outlined clearly and do seem reasonable, I think most 
    people would agree. It sounds as though the base noter is not 
    trying to get around this situation. It sounds like his doctor
    is asking for a reasonable recovery period before sending him        
    him back into the workplace. According to what I read in his note, 
    it appears he just got this cast on last week. A week of resting a 
    foot with cast does not seem like an excessive amount of time to me. 
    
    As for what I think about doing an alternative job - I'm sure in some
    cases that fits the bill. But not this one. The point is the 
    doctor wants him off the foot and not driving, at least temporarily.
    HOw can you really function in the workplace without moving around?
    Going to get lunch, going the the bathroom, the credit union, 
    getting coffee, picking up you mail - etc - how could you really
    remain immobilized here all day - would you assign another employee
    to help this guy out all day long while he can't walk? I don't
    meaningful work would occur when someone has needs to be attended to all 
    day long.  
    
    It sounds like with a week or 2 more of rest, he can attempt driving 
    and can probably get around more effectively on crutches, and more
    importantly, do his job without having to be panic stricken that 
    he has done something wrong. 
     
    As one of the previous noter said - 2% of abuse cases make the other 
    98% look bad. It's a shame people have to feel guilty about
    being sick or injured.  
    
      
    

    Re - 13 If what you stated about .0 is true i'll agree (back to work
    the same week). But, I read in .0 that the injury happened on 7/6 and
    the claim was denied on 7/21 (15 days) and .0 thought it was
    unreasonable for Digital to expect them to return to work
    (after 15 days). That is what I based my comments on.
    
    re 2% abuse. You have got to be kidding. I'll bet that way over 2% of
    WC 4's don't report STD's or even sick days (75% of Digital are wc
    4's). Those are the type of things I see this new policy trying to get
    at..
                                              

    
    Re: 14 
    .0 stated he has his cast on the 15th of July - he was unable 
    to have this done earlier due to swelling. This makes it a little
    over a week he's had it on.... 
    
    As for abuse, it may help you to now I have administered STD's 
    and LTD's as a former PSA. I'm not kidding when I say 2% is 
    about the extent of the abuse I saw. I worked in several organizations
    in several different facilities doing this type of work. I can
    honestly tell you I base my statement on factual experience, as 
    opposed to a mere random guess. Since I have been out of this type
    of work for several years, abuse cases may have escalated. 
    
    just to give an example, different types of organizations can have 
    much higher than normal levels of STD and abuse. For instance, 
    I administered a Facilities group in the Mill. Sheet metal workers, 
    HVAC mechanics, carpenters, were among the types of people I 
    worked with, Needless to say, these types of professions have 
    a more inherent risk of injury than others. But a high rate of 
    STD's for this group would not necessarily mean abuse, although
    it could be interpreted that way 
    
    Also, I'm sure you may have noticed a previous note to this one, that 
    the company is now mandating that WC4's report their sick time, as WC2's 
    do. 
     
    The new STD policy should ensure more equal treatment of both wage
    classes, which I think is long over due. I believe you are right
    in that matter, .14 - WC4's can easily abuse the sytem and have it
    overlooked. Maybe that's a bright point to the new policy.   
    

    Perhaps I need to clarify; my doctor did not SEND me back.....I said
    to h*ll with it!!  I was tired of the constant harrassment at home,
    I was unable to relax and get my bearings, so as soon as there was
    any noticeable improvement, I told my doctor to sign me back.
    
    Further clarification, all the STD paperwork clearly indicated that
    I had a condition that was exacerbated by stress, so the constant
    notices from CMI, the calls etc., caused the opposite result of what my
    doctor was trying to accomplish.  My doctor signed me back against his
    better judgment, but at *my* insistence.  I was tired of being made
    to feel guilty that I had dared to get sick!
    
    My PSA was great, she intervened as much as she could; but she is just
    one human being <--- there still are a few left at DEC.
    
    I agree with the person who pointed out that the basenoter's doctor
    must have had a good reason for wanting the person out for a set period
    of time; what did the *doctor* have to gain from it?  People complain
    about members of the medical profession not caring enough about their
    patients; yet concerned/caring doctors are being pressured by individ-
    uals who have never seen the patients to return these people to work!
    
    The point some of us are trying to make is that we are paying an
    outside firm (I shudder to think of the cost) to monitor disabilities
    of people they have not, nor probably will ever see.  My doctor said
    the CMI doctor he spoke with was most unconcerned about my medical
    history.  Bottomline, give her whatever meds to drop her B/P NOW and
    get her back to work.  Masking symptoms now will probably just set me
    up for a greater fall later.
    
    Years ago I returned to work 5 weeks after major surgery - at that
    time the estimated recovery time was 12 weeks.  I was a lot younger
    and snapped back rather quickly.  I felt I was doing the right thing
    then; I resent being made to feel that I was somehow "milking" the
    system now.
    
    I've busted my butt for this company for 13 years; I've given up the
    notion that I'll retire from here.  Believe me, I *am* watching the
    classifieds.....the sad part is, I really do like my job, but there
    are limits as to how far I will gamble with my health to keep it.
    
    Color me silly, but I'd still like to think we can work lean without
    being mean.
    
    Karen
    

    re .15  My point about abuse of the system is that what we don't see is
    way over 2%. If wc4's aren't reporting when they are out that is abuse
    that a psa or any personnel person will never see. As a psa how many
    wc4's did you see report 5 consecutive sick days so they could be
    placed on STD? I would guess not many. Another issue of abuse you
    wouldn't see is the issue of an employee who is able to return to work
    in the middle of the week and they get their doctor to agree to give
    them the following Monday as a start date. As a psa - how many
    employees had a Monday as their return to work day? I would guess most.
    
    re.16 You ask what a doctor has to gain from allowing a patient to take
    an extra day or two? Most doctors can be easily talked into allowing an 
    extra day or week if a patient asks or if a patient tells them they
    really don't think they are ready to return. Therefore, I ask you what
    does a doctor have to lose by allowing a patient to stay out of work
    for a day or a week more than necessary? 
    As far as you shuddering to think of the cost of the outside vender.
    The reason we obtained an outside vender is because Digital was out of
    control in this area. Digital can't even get a vendor to insure us for
    LTD because our previous vendors lost so much money. 
                                                         

.17>    re .15  My point about abuse of the system is that what we don't see is
.17>    way over 2%. If wc4's aren't reporting when they are out that is abuse
.17>    that a psa or any personnel person will never see. As a psa how many
.17>    wc4's did you see report 5 consecutive sick days so they could be
.17>    placed on STD? I would guess not many. 
    
    I find this diatribe confusing.  The base note talked specifically
    about STD (or Short Term Disability).  Expanding the discussion to a
    more general "abuse of the system" as .15 does simply muddies the
    water.
    
    It's not clear to me, is it good or bad that WC4 do not report 5
    consecutive sick days to be placed on STD?  Seems to me it may be bad
    for proper personnel management etc. or it might be good because it
    reduces STD insurance costs.
    
    Point is, if the response to any disability is perceived as harassment
    rather than sharing a mutual interest in the health and well-being of
    both the employee and the corporation, the response will be to attempt
    to avoid the situation.  Poor reporting may be a symptom, not a root
    problem.
    
    BTW, speaking from my personal experience as a WC4 employee for the
    past decade or so, the majority of my personal sick days have come
    after pushing my endurance under stress to meet deadlines.  I found out
    on the Pro project that working eighteen to twenty hour days for even a
    week or two exacts a physical toll.  When I took a day or two off to
    recuperate from the inevitable cold or flu bug, I didn't feel it was
    something to be reported as sick time so much as comp time earned by
    working more than the standard workday hours.  If that time off is
    considered sick time, should the company be providing for comp time as
    well?

   Re: WC4's do not report sick days
   
   Oh?  I have been a WC4 my 12.5 years at Digital.  When SWS went to
   detailed reporting of time in the early 80's we reported sick time. 
   Digital as a corporation never cared about it.  It has rankled me
   (and many others in SWS) that we have to report our vacation twice;
   once to our secretaries so they can enter it into the SWS time
   accounting system, once on our time cards so some facility person can
   enter it into the payroll system.
   
   In fact, my boss warned me about excessive sick days I took the past
   FY (I was hit twice by the killer flu this past winter; me to my wift
   to my youngest to my oldest and back to me (some family; they didn't
   even have the common courtesy to get the flu twice like I did)). 
   Sick days in SWS mean lower margin (generally).

    .19
    
    You're correct as far as my organization goes.  Everyone, including
    WC4's are expected to report sick time via an "outage", i.e. A1 mail
    form.  We do not show it on our time cards, but you better believe
    it is monitored.....and we are also brought to task for it at PA
    time.  Two PA's ago I was dropped from a 1 to a 2 performer because
    I had missed 7 days in a six month period (basically one illness
    that accounted for the missed days).  Our team has a "norm" that
    anyone who misses 5 days during a six month period is automatically
    dropped into the lowest category for attendance (this is a section
    of our PA). <----- I'm not sure this is corporate policy.....yet.
    
    I hate to sound like a broken record, but there should be some
    distinction made illnesses that are obvious (or can be documented) 
    and someone who's got a bad case of "it's a beautiful day and I
    feel like playing golf" flu!!
    
    Here at the CSC we also have an internal database that tracks our
    time, i.e. time actually spent providing telephone support.  That
    database tracks actual time spent on calls automatically.  We are
    also expected to manually enter our sick days and vacation days into
    this system also.
    
    

    re .18 I was responding to a comment that sais that abuse in this area
    is 2%. I didn't mean to run it down a rat hole I just question the 2%
    figure.
    >It's not clear to me, is it good or bad that wc4 do not report 5
    > consecutive sick days to be placed on ltd.
    IMO, it's bad. WC2's are forced to do it. Anytime you have unequal
    treatment of disabled employees how could it be seen as good?
    
    re.19 The "company" has not required anyone to report sicktime. If your
    group has and that type of reporting resulted in a person being
    terminated or placed on warning if it were challenged the "company"
    would have been on the short end.
   
    I find the argument "I was tired of being harassed so I told my doctor
    to sign me back to work". If this person was able to work is it
    harassment to try to get them back to work?

    re: .18 and .22 by USPMLO::JSANTOS
    
    The author of these replies appears to be John Santos of U.S.
    Personnel located at MLO.
    
    Since we have a real personnel person responding here, it's fair to
    ask: what IS the reported level of STD abuse in the US?  What level
    does U.S. Personnel SUSPECT actually exists?
    
    The base note and some other anecdotes here show that what's intended
    as a cost control policy has spilled over in some cases into creating
    an adversarial relationship between employees who have no desire to be
    in one, and Digital as their employer.  Where does Personnel believe a
    balance should be struck between cost control and friendly treatment?
    
    Curious,
    
    Wes

RE: .22

>    I find the argument "I was tired of being harassed so I told my doctor
>    to sign me back to work". If this person was able to work is it
>    harassment to try to get them back to work?


So, are you saying you're in favor of having an employee coerced 
into returning to work earlier than her doctor feels is safe?  
Even if that could have serious negative long-term health 
effects?  You think this is a good thing and Digital should 
support this kind of behavior?

.23>    The author of these replies appears to be John Santos of U.S.
.23>    Personnel located at MLO.
    
    I'd also deduced the same from the node::user and ELF information.
    
.23>    Since we have a real personnel person responding here, it's fair to
.23>    ask: what IS the reported level of STD abuse in the US?  What level
.23>    does U.S. Personnel SUSPECT actually exists?
    
    CAREFUL!  
    
    The fact that someone works in the Personnel organization does not
    imply that they can speak authoritatively outside of their own personal
    niche  (BTW, Mr. Santos, what is your job niche there?  (to be fair, my
    own is sr s/w engineer in Ultrix MSSG development)).  It is unwise and
    unfair to put anyone on the spot about such questions without knowing
    that they are in a position to be qualified and free to respond.
    
    It is interesting to consider the implications of perspective on
    attitude however.  I find it very instructive that the attitude of an
    employee in the Personnel organization seems more inclined to suspicion
    and distrust of employees' (ab)use of the STD program than to sympathy
    and support of employees' health concerns.  Personally, I would hope
    for a more balanced attitude on that part of the Personnel organization
    as a whole, since they are the closest thing to an advocate of employee
    interests that can exist as a part of the corporation.
    

    I didn't have a cast on my leg and I was able to walk into the
    building and get on the phones; just because I was able to accomplish
    this much does not mean it was "safe" for me to do so.
    
    I said my doctor had reservations; he was also alarmed that the
    CMI people apparently alluded to the fact that I could be fired if he
    didn't get me back to work pronto! <---- This was the only reason
    he even signed the release paperwork when I threw my arms up in disgust
    and said I didn't have the energy or inclination to fight it any
    longer.  We asked CMI *repeatedly* for a referral to another doctor
    of their choice if they did not like the course of treatment my doctor
    had decided upon.  CMI was unable to provide such a referral.  If I
    were "dogging" the system, would I have volunteered to be examined
    by another doctor of their choice?
    
    I don't know you Mr. Santos, but as annoying as this discussion is
    getting I sincerely do not wish the same set of circumstances to
    visit you.
    
    I've been a very hard working employee for DEC; as I mentioned before
    I am looking at other options.  I don't want to leave, but I will.
    Must someone keel over at their desk to prove their full measure of
    "loyalty" to DEC?
    
    

.26>    I've been a very hard working employee for DEC; ...
.26>    Must someone keel over at their desk to prove their full measure of
.26>    "loyalty" to DEC?
    
    When management views employees as "resources" then it's only logical
    that pushing employees to the brink of keeling over at their desks is
    desirable as "maximal resource utilization".  
    
    And when they do keel over, it's "maximal resource depletion" (or
    "MRD", as a TLA for Personnel memo-speak).

    I have no problem with the company tracking sick time, much
    the same as I have no problem with the occasional 45-50 hour
    work week which my WC4 status mandates.  Now, if the
    purpose of tracking sick time is to eliminate abuses in the
    system, how about tracking our unpaid overtime too? My 50-60
    hour work weeks are more than occasional, and I don't get
    comp time.  I believe in giving my all to the company, but
    I'd like to believe the company appreciates the extra I give.
    
    Mary-Michael

    I have been a WC4 for about 7 yrs.  Sometimes I think it would be
    better to go back to a time card, and become a WC3 again.  This and
    related notes is really depressing me...

    Jim Morton

re Mr Santos

  Several replies back you asked, How long should some one with a cast stay off
work?

My answer, as the author of the base note is, until in my doctor professional
opinion, its time for me to go back. My doctor (or anyone elses doctor in a
similar situation) knows my situation, my physical condition, the severity of
the break etc. CMI is countermanding my doctors orders based on phone 
conversations and their own agenda.


Others,
Update 

 My doctor called this morning and said he told the CMI Rep, one more time, I 
shouldn't/couldn't drive,walk or bear weight on the foot and was not ready to
return to work. That seems pretty definitive to me.

After several calls I get ahold of CMI and they access my file:

Approximate Conversation

CMI
Receptionist: Yes we've talked to your doctor and he said you can go back to
work in an accomidated position.

ME: That is not what my doctor told me this morning. He was quite emphatic that 
I was NOT ready to return to work. Can I talk to the nurse who made this 
determination or who's handling my case?

CMI: There is no individual person assigned to a case, phone calls are handled
by whoever is available next.

ME: You're (CMI) making decisions that effect my health and livelyhood and there
is no individual in charge of my case?

Receptionist: (short version) yes, We only report findings to Ms X at DEC, who
makes the decisions.(in health services?)  (I get Ms X's #)

********************************************************************************

The conversation with Ms X (not identified here to avoid confusing the issue)
is basically: CMI says you're ready to go back to work. No, thats not right.
I retell the story
CMI is not hearing what the doctor is telling them, they are hearing only the
parts of his conversation that fit their own agenda. (of course they probably
are hearing everything, but are twisting the conversation to suit their agenda)
Who's in charge over there? I can't get anyone to own up to having made any 
decisions or to even discuss my case with me. Ms X gives me a name of a nurse at
CMI. I ask what's going on with the case and she tells me that they will wait to
hear from CMI and would keep my manager advised of the latest development.

*********************************************************************************

CMI:..........

ME: I'd like to speak to Kristin Hayden

CMI: Can I say who's calling  

ME: Thomas Barriano

CMI: Is this a doctors office?

ME: No, I have a claim 

CMI: where did you get Kristin's name

ME: from Ms X at Digital, I was told Kristin would be able to discuss/help me
with my case.

I'm put on hold for 5 minutes or so.

CMI: Kristin will call your doctor tomorrow.

ME: Why? You've already talked to my doctor twice, he says I'm not ready to go 
back to work and you tell Digital that I am. We've been doing this for the last
two days. Can I speak to Kristin?

CMI: No, Kristin was just on the phone to Ms X and will speak to your doctor
tomorrow. Our nurses do not speak to claimants.

So here we are with an STD program managed by a group who refuse to identify the
person responsible for making decisions that effect your health and livelyhood,
who refuse to speak to you, when you finally get a name
who twist the doctors reports to fit their own purposes.

What's wrong with this picture?

If you can't drive, walk or stand, than CMI says OK
We'll give you a sit down job, how you get to work, how you get to the work area
from the parking lot, how you get to the cafeteria for lunch, to the restroom..
... 
You'll have to figure that out for yourself.

Anyone know the name of a good workmans comp/ labor relations lawyer in Colorado
Springs? Please sent mail.

Regards
Barry_the_disgusted

    re: .30
    
    If I were in a similar situation, I'd call and ask for Ms. Hayden
    again and, if stonewalled, do one of two things:
    
    (1) tell the person on the phone I am from the physicians office, or
    
    (2) mention that evaluation of a person's medical condition and
        judging their fitness to return to work could well be considered
        as practicing medicine and, unless Ms. Hayden possesses the degree
        of Doctor of Medicine, may be illegal and that you'd be more than
        willing to have your lawyer talk to her if you can't.  If they
        claim she is a nurse practitioner or physician's assistant, demand
        the name of the supervising physician.  [Before doing this you may
        want to check your state's laws which define medical practice and
        the scope of practice for NPs and PAs.]
    
    Good luck!

    
    I'd like to offer a third possibility....
    
    Have your doctor type up a letter stating the facts, his
    recommendations, everything that has happened regarding CMI.  Send the
    original to CMI with a copy to:
    
    	1.  Your lawyer (making sure that following the lawyers name is
    	    something that identifies him as a lawyer)
    	2.  To Mrs. X at DEC
    	3.  To you.
    
    Phone calls do get twisted, you have no real proof other than someone's
    word as to what took place on a phone call.  A letter, with all the
    details is quite a bit harder to twist around.
    
    Oh, and the letter to CMI....you may want to send that certified mail 
    return receipt requested to that Ms. Hayden (?).  That way you have
    proof it was received and by whom.
    
    Just some suggestions.
    

I was going to say .-1 but am busy at the moment.  Document, document, 
document!  You are dealing with a finger-pointing issue.  If you have the paper
to back up your version of the story, you'll win.  It might be a long
war, but you'll win.

The general lunacy in this note is an indication of a knee jerk management 
reaction.  The one thing I love (d) about DEC was that they gave the benefit of
the doubt to the employee.  Well, at least in my case, I'm sure others haven't
had such nice treatment.

As a general rule, WC4 employees should expect to put in 40 SOLID hours at work.
Many, many times, WC4 people work much longer hours.  The rules say I don't get 
paid for it.  Fine.  But the time you start harassing me about 8 hours 
of sick leave (after I have consistantly put in 50-60 hour weeks) you better
start recruiting.  I have always had this understanding with my bosses.
It has worked for me.

    
    Dear Barry, 
    
    Please know you have the support of many people who read this file. 
    
    As I had mentioned in a previous reply to this note, I found
    myself in a similar situation - a Digital nurse attempting to 
    countermand my doctor's order's. Some things I found helpful
    were: 
    
    Have the doctor write up an explicit, strongly worded note. 
    Have him give dates he expects you to be out, when you 
    can return, and what your restrictions might be. Have this 
    sent certified mail, copying all involved. That way it;s 
    in writing. This phone stuff seems like it could easily be
    challenged as false - it's a very poor way to document 
    medical issues.  
    
    Next suggestion - talk to a Digital EEO representative to 
    find out what your state laws are are regarding this 
    type of harrassment. I did this, and found it extremely 
    helpful. It allowed me to take some preliminary steps to 
    protect myself and my job. 
    
    Please continue to press this issue - you are doing the right thing! 
    It's great you and other noters here are speaking out. In times
    like this, you take a big risk in saying what you feel, especially
    if it happens to be negative towards the company.   
    
     
    

    OK - First of all I do not work in U.S Benefits, but I do work in
    personnel in the Mill as a Personnel Spec. Basically, I do employee
    activities, relocation and I answer basic benefits questions. I also
    deliver specialized programs when they happen (STD training, LTD
    training, SERP training, Stock presentations, SAVE presentations) and
    anything else that gets thrown my way. 
    I have no official numbers on STD, LTD and i'm not the person who
    designs or tracks our benefit programs so I have no official numbers.
    
    The abuse I spoke of in "the system" was not germane to people who are
    out of work for valid reasons, as a matter of fact if you go back and
    read my comments they focused on wc4's not reporting sick time and
    avoiding STD altogether.
    
    People seem to have problems with some of my observations of notes that 
    I have made and I don't have a problem with that. I definitely support
    the recent established policies and practices that support employees'
    timely recovery and rehabilitation and providing reasonable workplace
    accommodations for returning employees, but I know there are some
    problems that still need to be worked. 
    
    I don't know who should make the actual determination of when an
    employee is able to return to work, but I feel comfortable with the
    procedure in place. I definitely do not feel comfortable with a persons
    own doctor as being the only person making that determination.
    How many people have read the new STD policy? 
    As far as me not being supportive to employees? All I will say to
    respond to that is ask someone who has dealt with me (other than
    notes).
    Do people in here agree that we must be able to drive a car to be able
    to work (if our job isn't driving)? 
    
    As far as STD's - If an employee's claim is denied, the employee may
    file a written request for review. I've seen it done - and I've seen 
    decisions get overturned. 

Huh.

Someone goes out on STD because their blood pressure is through the roof, and 
our kind, gentle STD company, and DEC's own personnel department react by trying
to increase that person's blood pressure even more.

Today I learn that as far as the company's concerned, I should consider my
doctor to be a liar if he has the audacity to suggest that I take good care
of myself, and that if I do get sick, my best option is to stress myself some
more by filing a formal request for review.

I can see that for the person who's dealing with the blood pressure problem,
working with the bureaucracy to get the case reviewed is just what the doctor
ordered.  In the mean time, Digital contributes to the bottom line by taking
actions that may well shorten someone's life expectancy.  Well, what the heck?
At least they won't be such a burden on the pension plan.

To the person with the broken bones, and the other person with the three digit
blood pressure:  You have my sympathies.  To those who think their doctors don't
have Digital's best interests in mind, well, I have a new name for the "List
for today".  Keep at it.  We may make the "permanent list" yet.

    Re:     About driving - must a person be able to drive a car to be able
    to attend work? I can understand if a person cannot be a passenger in
    a car because of their condition. But, if a person is able to be driven
    is it ok to say to DEC "I can't drive because I can't work the pedels so
    I can't be at work"?
    
    
    I'm curious to know if DEC would pay the cab fare in this case....  I'm
    wondering what the cab fare would have been from Cambridge to Maynard
    and return every day when I worked at the Mill.  I'm also wondering if
    a person can't drive a car, how they're supposed to get to the bathroom
    and so on.
     

    
    Re: driving a car.  If I were unable to drive a car (say I broke my
    right foot), it would be next to impossible for me to get to work. 
    First, we are a one car family.  And I use the car to get to work. 
    Second, my husband starts work 1/2 hour before I do.  He works 1 mile
    from the house and bicycles to work.  I have a 16-17 mile commute. 
    There is no public transportation and as far as I have been able to
    determine, only ONE person in my building (it's a small building) that
    lives anywhere (with 5 miles) of me.
    
    Well, I'm a secretary.....maybe my boss would send a limo for me!
    
    Sheesh!!!!  I still don't understand how a doctor or a nurse who has
    never seen a patient can make a diagnosis of that person.  Is this
    called Dial a Doctor?
    

    re. .38 
    
    So if your car breaks down, does DEC pay you to stay home until it's
    fixed?  :-)
    
    
    

This note has been a real concern to me, I wasn't aware of the
new STD procedures.

A couple of years ago I had Carpal Tunnel surgery. Normally this
is a simple procedure. It was my right hand. Although I have an automatic
shift, I had to reach my left hand over to use the shift between the
seats to shift. I didn't go very far too soon, I went out a couple of times
with someone in the car to see how well I did driving. Also with the highway
driving, I occasionally need two hands on the wheel when alot of traffic
is around. Also I worked on a hotline, so I needed one hand to answer the 
phone and be able to work the keyboard (one-handed ?) and possibly write.
I was out for about 2 weeks. I wonder what the time-frame would be on such
a simple procedure now.

I had artroscopic surgery twice on my left knee. Normally this type of surgery
is quick recovery (?). It is when you are in perfect physical condition prior
to the surgery. I had been in auto accident in '76. My knee took enough
impact at that time to dislocate and fracture my hip, thus the knee hasn't
been too well since.  I had cartilage removed once, and last year, just a 
couple of years later, had torn meniscus (sp) removed, plus arthritic
material scraped. I was out for about 6 weeks. I was going to therapy
3-4 times a week and didn't get around too much at home initially.
Again, it was my left leg, so I could drive, but I didn't travel much
other than to therapy and close to home for only absolutely necessary
trips.  I wonder now, how that would be handled ?  again, arthroscopic
surgery is simple procedure, but what they do when they get in there is
something else.

Also the other factor is the physical need to rest. It takes alot out
of you being on crutches, going to therapy, and all when you've just
been thru surgery.  I would have been totally exhausted driving from
home to work to therapy then home 3 times a week, plus I needed to do
exercises at home and walk as much as possible to get things going again.
I couldn't sit comfortably for a few weeks without elevating the leg.
Some days worse than others.

for me, I work in MR2, the cafeteria is in MRO3, and there aren't always
people who want to carry everything around for you each day when you have
two hands full of crutches.

I know this is lengthy, but I think this is a good example of how would
these two "simple surgical procedures" be treated now ?

I am really concerned and hope I don't have to deal with any of this
under the new rules.

							Sue ...

    RE: .37
    
    I'm not being sarcastic at all .. and I'm new to this notesfile ..
    and there's something you said that I am not "getting" .....
    
    I am not understanding what you mean when you ask if you can't
    drive your car how will you get to the bathroom .... 
    
    What does one have to do with the other?
    
    
    Re: Basenote
    
    A co-worker of mine was on restriction for driving due to seizures and
    the medication she was taking to control same, but okayed to return to 
    work.  She obtained a ride from various friends and co-workers, and of
    course her manager understood there were times when her schedule had to
    accommodate the rides available to her on a given day....
    
    But she was present at the workplace, and did her work.
    
    (Far as I could tell, she even got to the bathroom ok ....)

If you can't get to the bathroom at work, how can you get to the bathroom
at home?

    Let me put some folks minds at ease and suggest that folks get a copy
    of the STD policy (managers have them). Its not as some folks have
    suggested in here (I'm sure they haven't read the policy). Your doctor
    is the focal person to determine the length of the disability when it
    first happens. Then the disability vendor checks in with the doctor to
    insure the patient is on schedule of recovery. If somethings happens to
    change the initial return to work date (determined by your doctor) your
    doctor will need to document specific reasons why. If your doctor can't
    document why their initial determination has changed thats when most
    problems come into play.

I am normally a read-only for notes, but have a couple of issues here
that are bothering me from my own experience.

1.  Being WC2, when you return from a disability, you are returning
with no sick time, you have used all, and have to start accumulating
from scratch. Thus if you can't drive, and have to take time off because
you can't get someone to drive you, you lose pay for the days you can't
get in. When you return to work, you should be able to guarantee responsibility
for yourself to get into work and other people cannot always guarantee
that. I had a hard time just getting rides lined up for follow-up appointments
and therapy before I could drive, let alone someone who could commit to
transporting me to work every day. You should be fully recovered and not
need the time off for the follow-thru of your condition. Some places want
you back full time and say they prefer you wait until you are 100% ready
to be asked to do all portions of your job.

2.  The thing about getting from one place to another, to kitchen at home
v/s cafeteria at work, or to the bathroom.  At work the bathroom near you
does not always have electronic doors. you can easily put some part of
your body in jeopardy trying to hold crutches and push the heavy doors open.
At home may people have bathrooms off the bedrooms and don't have to worry
about making sure all doors are closed behind you and sometimes have someone
at home to assist you

3. Maybe when the new illness procedures are in place for all wage classes
and all are treated the same, then others will understand this. But from
what I can see, one stress that WC 4/s haven't had to deal with was a 
interrupt in their weekly pay check, even if they come back and have
to continually leave early or stay home a day because they over did it
on their first few days back.

(I know some people are not going to like some of the above statements
but try to look at them with an open mind).  I wonder if some of you
you have replies about the driving and bathroom situations have actually
had to deal with physical disability yourself.  It is amazing being on
crutches and see how many times people will just watch you and see how
you are going to handle juggling everything instead of helping.  Until
you have been thru it, you don't have some of the compassion and understanding
of others going thru it

The only time I dealt with a cast was when I was completely immobilized
in a body cast. I don't think I could even comprehen what it must be like
having to drag around a cast for any distance.

					Sue ....

 I imagine not all of us have to traverse the length of a football
field at home to relieve ourselves, as if often the case in many
Digital facilities.  This one task was mentioned within a myriad of
others, such as getting lunch and so on, that could certainly add up 
to a very exhausted individual. 

re  <<< Note 2006.42 by NOTIME::SACKS "Gerald Sacks ZKO2-3/N30 DTN:381-2085" >>>

>If you can't get to the bathroom at work, how can you get to the bathroom
>at home?

That was just an example of one of the places that I might need to get to.
Actually the restrooms are fairly close to my normal work area, the problem
is I normally work in a production area that requires safety shoes.
The parking lot, the cafeteria etc. are some distance away

Update:

  Thanks for all the advice and expressions of concern

I received a letter from CMI today (7/24) that was written on 7/21 that states
it has been determined that your disability may extend through 7/15  I'm 
expected to return the first workday after the benefit expiration date
(or earlier if I get a written release? where's that darn time machine 
when you need it) It says that if I can not return my doctor should call the 
800 #, so I guess I'm covered. This is a real neat ploy, put pressure on you to 
return to work by giving a return to work date a week before they sent out the
letter? If I'd actually been able to return to work the day I got the letter
would I have been paid for the days between the 15th (when benefits expired)
and my return?

Putting aside the specifics of my particular case, the horror stories related in
these replies, and the ones that must exist in other cases (non noters) seems to
indicate that there is a SERIOUS problem with the administration of the new STD
policy. Is anyone investigating this situation or is this the way Digital wants
to do business now? 
I hope not :-( 


Regards
Barry

Re: .43

	Then it seems that CMI needs a copy of the STD policy more than the
	people here. The replies in this string seem to show at least two
	instances where the CMI doctor has stated the employee is ready to
	return contrary to what the personal physician actually recommends.

	I think the stories here warrant some investigation of CMI's
	practices, don't you?

Larry

Barry,

Looks like you'll be spending  most of the rest of your "recuperation 
time" dealing with the paper work.  I don't know how anyone is expected
to stand up under that kind of pressure. Certainly doesn't help the
recovery..

I guess we've seem many situations mentioned since your note was posted.
Maybe some of them have been sarcastic, some very serious, some with
much frustration. The fact that these entries have been put in suggests
that there definitely seems to be a problem that needs to be addressed.
I feel bad that you are going thru this, but I hope somehow this note
may help bring the issue to light so that others don't have to go thru
the same aggrevation.

						Sue ....

>	If your doctor can't document why their initial determination 
>	has changed thats when most problems come into play.

	Perhaps CMI needs to understand the medicine is an art, not
	a science. They don't call it "practicing" for no reason.
	Sometimes people don't respond as expected, for no apparent
	reason. It is hard to understand why, (and often the reason
	why is never determined) but that doesn't change the facts.

	Also, Doctors, being human may be mistaken in their initial
	diagnosis or prognosis. Then, documenting why their initial
	determination has changed is an admission of error, something
	that comes more easily to some people than to others.

						Tom_K

    There seemed to lots of extreme positions taken in this note by both
    "sides" of the argument.  The "car argument" is probably one of the
    strangest ones I've heard yet.  And it is disturbing to hear that our
    outside agency may be distorting or misrepresenting the messages coming
    from the doctors who are certified by law to be competent in judging
    our conditions.  I can only hope that these types of situations are the
    exception and not the norm.
    
    Where I see the real breakdown in this whole system is that Digital is
    trying to waffle between two goals and not accomplishing either one.
    They are promising programs that are necessary for employee loyalty,
    satisfaction, and productivity.  And they are using a system oriented
    toward making these programs as cheap as possible financially.  The net
    result is that they may or may not be saving money, but they certainly
    have reduced the value of these programs in the minds of the employee,
    or at least they have to me.  I don't hold much confidence that Digital
    will look out for my best interests based on the current track record.
    
    My message:  If you can't do a job well, then it's probably not worth
    doing at all.  If Digital can't manage an effective STD program, or
    even understand what an STD program is supposed to accomplish (that
    being employee confidence), then WHY HAVE AN STD PROGRAM AT ALL?
    Let the chips fall where they may, let the employees go work for some
    other company that *does* take care of them, and save a ton of money.
    After all, employees are expensive nuisances for the most part, or
    so it seems ...
    
    Regards.
    

    re.50 Have you compared our STD program to others? 
    
    Can someone tell me what they see as "the real issues" here. People
    have written notes taking things way out of context. I got hammered
    about an employee who was forced to return to work. Then that same
    employee writes a note saying that the STD was in fact extended.
    I got hammered about an employee that had a cast on for 1 week and was
    asked to return to work. Then that person enters a note telling us that
    there is in fact no cast. We see notes about employees being harrassed, 
    but I haven't seen anything that appears to be harrassment other than
    that persons doctor being called for more information.
    Please, read the policy. It does make good business and it is fair to
    all employees. And, most of all - it will match up against most others
    in our industry today. 

    >>                     <<< Note 2006.35 by USPMLO::JSANTOS >>>
>>    
>>    The abuse I spoke of in "the system" was not germane to people who are
>>    out of work for valid reasons, as a matter of fact if you go back and
>>    read my comments they focused on wc4's not reporting sick time and
>>    avoiding STD altogether.

    What is the problem with WC4's not reporting sick time?  I am getting
    tired of what I perceive as WC4 bashing.  WC4's are SALARIED...  We are
    not under LABOR LAWS.  We are paid for a job.  It doesn't matter if
    that job takes 1 minute a week or 160 hrs a week, we are expected to
    put in what is required to do the job.  No overtime pay and no
    compensation for the job, just our paycheck.  I don't hear complaints
    that WC4's need to account for the overtime, so that the DIGITAL won't
    abuse the WC4.  LOOK AT BOTH SIDES.  LOOK AT THE DEFINITION OF SALARIED
    BEFORE MENTIONING WC4 ABUSE...

    	Now I can assure you that my manager and my peers know when I am
    out.  I don't get away with anything.  Where is the abuse?

>>    
>>    procedure in place. I definitely do not feel comfortable with a persons
>>    own doctor as being the only person making that determination.
>>

    Excuse me!  Who would you feel comfortable with, making that decision?
    Maybe you mean you want a second or third medical opinion. That is
    fine.  But to say that a doctor or nurse who never saw the patient
    makes a decision via some book of rules is acceptable, is unacceptable
    to me, and is STUPID.

    	I have to ask.  Why are you not comfortable that a persons doctor
    shouldn't decide when a person is well enough to return to work?

    Jim Morton

.52 makes a point that's been kicking around in my head concerning this reporting
of sick time thread.

Being a WC4, I'm expected to do certain things in whatever time it takes me to
do them.  For the most part, my employer isn't really concerned how many hours
I work, as long as I deliver what they're asking for when they asked for it.  If
I come in on time and on budget, they're happy, and I've fulfilled my 
obligations.

At times, this has required me to work through my holiday weekends, after hours,
in the middle of the night, and to forsake days off.  At times, I've had to do
this not because of my own incompetence, but because what I'd been asked to do
was difficult to do in the time alloted.

Still, I do my best to deliver in the time allotted, and my bosses have always
done their best to ignore the overtime I've put in to do it.

Now, if someone comes along and suggests to me that maybe I'm "abusing" the
system by taking too many sick days (for the record, I rarely take a sick day),
even though I'm performing up to the expected standards, my only response is
that whoever's making that accusation hasn't got enough work of his own.

It's been the deal all along:  I do what I'm asked to do, and if they don't 
bother me about the "undertime", I don't bother them about the overtime.  I
can assure you that over the long haul, the company owes me a lot more comp time
than I owe them sick days.

>    Excuse me!  Who would you feel comfortable with, making that decision?
>    Maybe you mean you want a second or third medical opinion. That is
>    fine.  But to say that a doctor or nurse who never saw the patient
>    makes a decision via some book of rules is acceptable, is unacceptable
>    to me, and is STUPID.

Not just stupid.  Dangerous.

>I got hammered
>   about an employee who was forced to return to work. Then that same
>   employee writes a note saying that the STD was in fact extended.

Are we talking about the same person here?  I went back and reread all the
replies by the woman with the high blood pressure/heart problem, and didn't
see anything about her STD getting extended.  All I saw was strong arm tactics
on the part of CMI.

    re: .51  comparison of STD programs
    
    My comments are certainly not intended to be a personal attack. I
    simply tried to make the point that employee benefits exist to
    attract and retain the best possible employees.  If any benefit
    fails to be useful in this manner, then the company is wasting
    money by having it at all.  An STD program that puts fear and
    loathing into employees is unlikely to be viewed as a "benefit".
    
    I have worked for three other companies, and for Digital.  Of the
    three previous companies:
    
    One had no STD or LTD plan.  If you could not show up for work, then
    you didn't get paid.  I chose to work for this company for the high
    wages they paid and because the work itself was entertaining.
    
    Another had very liberal insurance and employee benefits.  It was a
    small company and they employed mostly older workers who were highly
    experienced.  The company seemed to have put these programs in place
    to meet the specific demands of the employees, and so they had very
    little turnover.  I, on the other hand, was a young and inexperienced
    person in an unskilled job, so I got paid beans.  I left.
    
    My third company was quite in the middle.  A large regional bank, it
    had health plans, but they were not terribly generous.  There were
    completely separate health plans for "key" employees.  They had a
    high rate of employee turnover, and it was an accepted phenomenon
    that the Bank did not go out of it's way to "coddle" employees.
    
    If Digital is aiming to be in the middle of this range, then fine.
    The employees will figure this out and act accordingly.
    
    Regards.
    

RE                     <<< Note 2006.51 by USPMLO::JSANTOS >>>

  >  I got hammered about an employee that had a cast on for 1 week and was
  >  asked to return to work. Then that person enters a note telling us that
  >  there is in fact no cast. We see notes about employees being harrassed, 
  >  but I haven't seen anything that appears to be harrassment other than
  >  that persons doctor being called for more information.

 John,

  As far as I can recall, I'm the only one in this note who's mentioned a cast.
I don't know where you get the idea that "there is in fact no cast" or where you
think you saw that statement. I injured my foot on the 6th, it was splinted on
the 8th (too swollen to cast) it was cast on the 15th, which is also the date
that CMI selected as my last day of benefits, the DAY the cast was put on.

  My doctor has not been asked for more information, but the same information,
again  and again, it hasn't changed. My doctor has said "no driving, no bearing
weight,  limited walking with crutches, NOT ready to return to work. CMI
insists on the position that if they provide a sit down job than that solves the
problem. We've gone around and around by phone, you never get anyone in 
authority at CMI, just a receptionist who reads you your file and tells you
"Yes, it says here that you're ready to return to work" this is right after
you've just spoken to your doctor and been told " Everything is straightened out
I emphatically stated you are not ready to return to work" Someone told me in 
mail, that CMI was real good at playing "he said, she said" with phone calls
and chasing you all over the place, boy did they hit the nail on the head.

 Since CMI can't or wouldn't listen to what they're told on the phone and since
phone conversations are too easy to misconstrue and so hard to document. Phone
calls are out, I will not call CMI or talk to them on the phone, I will suggest
to my doctors office that they do the same. Any futhur correspondance will be
by E-Mail to Digital representatives, and by registered letter to CMI. I will 
not spend my recuperative time playing games with CMI.

Regards
Barry 

    The August 1992 issue of Consumer Reports, in the middle of an article
    on HMO's has a sidebar on p. 520 entitled "'Utilization Review' - Does
    it cut costs - or imperil patients?"  Some quotes from the article:
    
    "But accounting for how much money it has saved is a matter of debate,
    since there's no uniform way to collect data or measure the results.  
    Furthermore, some utilization-review firms overstate the savings they
    report."
    
    "The kind of treatment you can expect may vary from firm to firm and
    will even depend on the orders your employer has given the company. 
    "We don't have one standard approach," say Ronald Gomes, an Intracorp
    vice president.  If an employer instructs the firm to take a soft
    approach, the nurse may be more lenient in allowing someone to go to
    the hospital.  If the employer says to take a harder line, the nurse
    may be quicker to say "no."  
    
    "The utilization-review industry is largely unregulated, with few
    outside standards for review criteria or protocols.  In most states,
    firms don't even have to reveal how they do their reviews.  Secrecy is
    necessary, they say, to keep doctors from getting around the rules."
    

    
    re: 39
    
    If my car breaks down, I can rent a car.  If I can't drive...well that
    becomes something different.  Also, I am fortunate that my mechanic
    provides door to door service at work.
    
    If I have a broken right foot, it don't matter whether I have a car or
    not.  I wouldn't be able to drive a car period.
    

    Maybe time to a new note, but- I'm tired of self righteous WC4's
    thinking the company owes them something for such "long hours worked".
    Does 1.5 hr lunches fit in there?  Does general BS in the halls, cafes
    whereever fit in there?  What job are you getting paid for?  WC4 abuse
    the system much more than WC2 because they believe they have a right to
    do those sort of things. (IMVHO)
    
    When a WC2 is out, who does their work?  Right. No one, until that
    person comes back.
    
    We're talking about MEDICAL benefits here.  Not comp time, not free
    time-plain and simple equal medical benefits for the human population
    of Digital.  Whether you're a WC4 or 2, if you're sick and/or broken,
    you should recieve equal time.
    
    I know in my world, it is expected that I perform as efficiently and
    proficiently as the WC4.  Since when is a WC4 job turned over frequently
    to WC2's and the 2 not reap the same bennies?  I can understand the pay
    differential, but when it comes down to medical bennies, we all should
    recieve the same.
    
    Rambling and upset and probably not making much sense.
    
    Reg.

    I think your generalizing a bit too much here.   I don't think
    every WC4 in this company takes 1.5 hours lunches...and I believe
    every person (WC2 or WC4) do some BS during the day.
    
    I am a WC4 and have been known to assist our secretary many many
    times to complete a task.   And I just got back from vacation...and
    nobody did my work either.  I don't believe this issue is a WC2/WC4
    issue....it's turns into an issue when management allows WC2/WC4 to
    take advantage of the company.
    
    I do agree benefits should be equal for all....and very glad to
    see this new policy being implemented.
    
    Sandy...
    
    

                       
    How about 15 minute lunch breaks... and 2 minute tea breaks - as for
    chatting, its pretty hard in these PigPens they keep us WC4 (ie
    salaried) engineers in :-)    
                       
    Mind you, notes is another matter :-)
     Winton            

    I think some mindsets need to be changed around disability at DEC and
    what return to work means. IMO, these are the two areas that need to be
    clearfied in this note because when I enter a note to try to express an
    opinion I am working off the basis of the new (we keep saying new, but
    its actually been in place for 6 months) STD policy.
    
    First I will address disability at DEC;           Employees
    who are absent for more than 5 working days are *required* to file a
    claim for STD benefits. This means both wc2's and wc4's (no matter how
    much comp time they think they are owed). This standard is in place so
    all employees are treated the same in terms of disability because
    of the termination *requirement* that has been written into the policy.
    Employees who have returned to work after 26 weeks and haven't
    found a position after 13 weeks of when they returned are terminated.
    
    Now I will address "return to work"; An employee is considered to be
    Medically Qualified when he/she has been cleared to return to work by
    Digital's Health Services Department in conjunction with CMI or other
    authorized insurance carriers if they are able to perform meaningful
    work.
    Meaningful Work; enables the employee to perform work which is
    productive and neccessary for the company with a fixed and continuous
    work schedule of at least 20 hours per week with reasonable
    accommodations if necessary.
    Reasonable Accommodations; For the purpose of this policy,
    accommodations consist of: changes in normal work schedules, changes in
    the tasks required of an employee, changes in the way required/assigned
    tasks are performed, modifications to the work place, the provision of
    equipment or apparatus, or any other justified assistance provided to
    help a disabled employee perform meaningful work as defined. An
    alternate position may be in a different job group, job code, or
    function and may also be at a different salary range level than the
    position held at the time the disability commenced. However, the salary
    range for an alternate position must be able to accommodate the
    employees current salary. ***It may also be at a different work
    site***, provided the change in worksite does not constitute a
    reimbursable move within the meaning of the company's relocation
    policy. 
    

    Re: the termination *requirement* that has been written into the policy.
        Employees who have returned to work after 26 weeks and haven't
        found a position after 13 weeks of when they returned are
        terminated
    
    Boy, am I glad I'm not disabled.  Can you explain the above more fully?
    We were _never_ notified about such a policy.  Do I understand correctly
    that an employee who is disabled for 26 weeks and then becomes capable
    of working again, has likely kissed his or her job goodbye?  I thought
    there was some federal prohibition against "disappearing" the job of an
    employee on short term disability.  I sem to remember that from
    discussions of pregnancy leaves.
    

RE                     <<< Note 2006.62 by USPMLO::JSANTOS >>>
    
>    Now I will address "return to work"; An employee is considered to be
>    Medically Qualified when he/she has been cleared to return to work by
>    Digital's Health Services Department in conjunction with CMI or other
>    authorized insurance carriers if they are able to perform meaningful
>    work.

Any "return to work policy" that does not include the primary care physician's
input as the primary means of determination, isn't worth the paper its written
on! 
My ability to return to work is going to be determined by Health Services who
spent less than 10 minutes wrapping my ankle and making a report (and made no
mention of followup or getting xrays?) and a CMI rep who may or maynot have been
one of the unidentifiable/ uncontactable evaluators who actually talked to my
doctor or his nurse? With this kind of evaluation and care, I'll be on long term
disability before I know it.
If your input (.62) is from  Policy & Procedures, or other official sources
could you give a pointer to what sections?

Regards
Barry

There seems to be a missing person in the ever-growing polygon of people that get
into STD reviews -

So far we have: the employee, the personal physician and 
Health Services/Personnel/CMI. The first wants to get healthy and keep a job,
the second wants to get the first healthy, the third wants to maximize labor
availability and minimize cost but has no direct link to the employee aside from
collecting information and acting like a debt collection agency in terms of
harassment.

WHERE'S THE EMPLOYEE'S MANAGER IN THIS SCENARIO?

WHO is it that comes up with job redefinitions to allow for changed or reduced
work descriptions at (perhaps) different DEC facilities? Is not the manager a
key agent looking out for both the company and the employee? [I'm not looking
for a clutter of replies indicating that there are incompetent managers - I've
had my share - and have had many more that fulfill the role of looking out for
both DEC *and* the employee].

I'd like to think that if I were laid up, not being tremendously in tune with the
very latest constantly changing Orange Book info and getting the kinds of
phone harassment from CMI that the base noter reports, I'd be in touch with my
manager very very quickly. At the very least, the manager will be getting info
from other than Personnel/CMI and can make decisions accordingly.

Norm.

    Is time out on short-term disability deducted from your time in DEC? 
    For example, if you are out on STD for a month, does that push your
    anniversary date back a month?
    

RE     <<< Note 2006.65 by BKEEPR::BREITNER "Sr. Sales Support Consultant" >>>
                     -< Where's the local manager fit in? >-

There seems to be a missing person in the ever-growing polygon of people that get
into STD reviews -

>WHERE'S THE EMPLOYEE'S MANAGER IN THIS SCENARIO?
 
Norm,

   My manager was on vacation untill recently, he has been contacted by the
Corporate Health Services Rep (I think thats her title) with a list of work 
restrictions. The problem is that the list is not inclusive of all, my doctor
said. As I've mentioned previously, my doctor has said, no driving, VERY limited
walking on crutches, no weight bearing. CMI has misscontrued this to mean that
if they provide a sitdown job than everythings OK. Well I can't drive to work,
if I did get there, than I couldn't walk to my work area, if I managed to get to
my work area than I wouldn't be able to get to the cafeteria etc. etc.

  CMI was supposed to call my doctor last Friday AM and get everything 
straightened out. I talked to my doctors nurse, friday afternoon and she said
she'd heard the doctors side of the conversation and didn't see CMI could fail
to understand his wishes. I talked to a lawyer this morning and now I'm just
waiting to see what happens next. 

Regards
Barry

    .30 Bulls-eye!!
    
    I was the person with chest pains, B/P problems.....  I thought I had
    made it clear, when the CMI doctor pressured (suggested/recommended)
    whatever, that my doctor prescribe medications that my doctor felt would
    be detrimental to me in the long run; we ASKED the CMI doctor and then
    again the CMI rep for a referral to another doctor of CMI's *choice* in the
    Atlanta area.....CMI was unable to provide such a referral!!!!
                             ~~~~~~
    I was seeing my doctor on a weekly basis so he could monitor the effect
    of the meds he had prescribed; in my particular situation it took over a
    month to get a combination of drugs that started to bring the physical
    symptoms under control.  I was also seeing a cardiologist, had tests
    run by another specialist to make sure the high B/P had not caused
    kidney damage <-- I was exhibiting symptoms here also.  
    
    My STD *was* extended beyond 2 weeks, but my doctor said there were
    constant calls for info to his office (they tried to get his nurse
    to discuss my case with him....by doctor says HE is the only one who
    will discuss the details).  CMI recommended my doctor prescribe
    Xanax for me; when he refused they suggested Valium....both of these
    drugs can provide immediate "short-term" improvement, but also are
    highly addictive, thus my doctor's reluctance to prescribe them. He
    also comprehends better than CMI that my job does not consist of
    sitting in a corner sucking my thumb; I have to be able to function -
    something my doctor didn't feel I would be able to do on the dosage
    CMI was apparently recommending.  As I also previously mentioned, my
    doctor handle Workman's Comp for GE and Frito-Lay; believe me he is
    no push-over.  He is definitely a believer in getting people back to
    work ASAP.  The reason my doctor was so irritated by CMI was their
    seeming indifference to the value of his time.  Once I explained some
    of the details to the DEC Health Services nurse, i.e. my doctor always
    getting an answering machine when he returned the CMI doc's calls...
    she was able to determine that the CMI doctor was in his office every
    time my doctor called, but chose to let an answering machine take the
    message so he could return the call at *his* convenience....this after
    my doctor's nurse had explained repeatedly about my doctor's office
    hours and the 3 hour time difference.  My doctor was also concerned
    that he didn't feel comfortable discussing my case because he was not
    positive he was speaking with a medical professional at all times. 
    
    I was getting notices at home (obviously pre-programmed, cautioning
    on upcoming stoppage of benefits); then the call to my home by DEC Corp
    Health Services because a Mr. Rob Wright had complained that the necessary
    paperwork had not been processed.  If you can share, I would dearly
    love to know why all the CMI paperwork was coming out of Massachusetts,
    yet the doctor assigned to my case was in California?
    
    I had FED EX'd the paperwork out the day my doc said I couldn't go
    back to work.....CMI's receptionist had the hard copy.......almost
    4 weeks later that data was not "on their computer"???  Why?????
    
    Mr. Santos, since you say you're trying to enlighten us; can't you
    see that we are trying to enlighten the powers that be to the down-
    side of some very serious problems with CMI?
    
    Don't get me wrong, I KNOW there have been abuses of the STD process;
    I was surprised to see the percentage as low as was stated...but it
    is truely upsetting to see that because of the sins of a few, everyone
    is being treated as abusers of the system.  I have been all too aware
    of a few co-workers who took advantage of the disability program and
    had the bad form to return to work and brag the details to those of
    us who worked short-handed.
    
    I'm paraphrasing here but to "who should make the determination as to
    when an employee returns to work.  I definitely do not feel comfort-
    able with a person's own doctor as being the only person making that
    determination".  I would like to add to that; how would *YOU* like to
    be the person with chest pains, B/P & possibly kidney problems seeing
    several doctors in the Atlanta area (one doctor weekly) having your
    primary care giver being told what to do by a doctor in California
    (who has never ever seen you and apparently isn't interested in your
    medical history)?  If you were in MY shoes, who would you trust?
    Remember *we* asked for a referral to another doctor, CMI was unable
    to provide such a referral.
    
    I've spent considerable time with my PSA and another person outlining
    *detailed* info; I've provided names, dates, times, copies of notices.
    I did this with the thought that hopefully the "bugs" would be worked
    out of the system and people would not have to go through what I did.
    My "adventure" with CMI started in February, 1992.....reading the base-
    noter's story indicates to me that precious few "bugs" have been
    ironed out of the system.
    
    Perhaps you think I'm being over-dramatic; I assure you I'm not,
    infuriated, yes!!
    
    You may consider the base-noter's situation and mine exceptions to
    the norm; would that it were true.  Unfortunately, I've seen several
    of my co-workers have to tolerate the same treatment from CMI....
    their response has been much the same as mine; the aggravation of
    dealing with CMI was not worth prolonging it.  You can interpret that to
    mean we weren't REALLY that sick after; a number of us interpret as
    taking steps to make sure we aren't stressed any further.
    
    There is a cliche' that hindsight is 20/20; one of the reasons I stuck with
    DEC when I had better job offers was the total package, not just the
    salary.  There are many at DEC who would like to promote the idea that
    DEC's benefits can't be topped; as someone who is actively looking, I
    suggest that DEC look again.
    
    I'm am very familiar with the "requirements" for STD; my concern is
    the implementation.....this new STD policy is getting old very fast.
    I can't praise my local representatives enough, they were and are
    outstanding....they were very supportive.  Their frustrations with
    CMI were fairly evident also.
    
    
    

    I just thought I'd throw another gripe in here -- this number about
    John Hancock, which consistently "reimburses" medical and dental bills
    at a fraction of their cost because they claim the fees are too
    high.  You probably couldn't hire a witch doctor out here for what they
    claim are normal fees.
    

    re .68
    Looks to me like your case is ready to be taken to an attorney who
    could get an injuction to get CMI to cease harrassment of the patient.
    As far as I'm copncerned the employee's primary physician is the one
    qualified to determine when the employee is ready to return to work.
    Also, perhaps DEC and CMI should sign a statement indicating their full
    liability for the any ill effects to the employee as a result of
    premature return to work. Am I irritated by the callous way employees
    are being treated? You bet!
    
    
    bobk
    

The Wall Street Journal
28-Jul-1992
Front Page

Second Opinion

Firms That Promise Lower Medical Bill May Increase Them

Cost Police Pile Paper Work On Physicians, Hospitials, Which Pass On Expense

Is Patient Care Suffering?

"The University of Chicago Medical Center has hired 15 employees to
specialize in a new area of health care.  They aren't treating or
operating high-tech equipment.  Rather, the sole task of the workers,
who are costing the hospital $500,000 a year, is to answer questions
from medical cost cutters known as utilization review companies.

In recent years, such firms have become immensely popular with
employers seeking to control their health-care costs.  According to a
survey expected by trade publisher Faulkner & Gray Inc., U.S.
employers and insurance companies this year will pay an estimated $7
billion to have their medical expenses reviewed.  Utilization review
firms perform that service by questioning the necessity both of
recommended treatment and treatment already administered.

But a backlash against these new companies is gathering momentum.
Increasingly, doctors and other health-care officials complain that
these firms are denying required care to people with serious
problems."


[The above is only the first three paragraphs which is probably only
 5+% of the entire article]

re .69:

I don't want to continue your rathole, but the dental plan isn't *intended*
to pay all your dental bills.  It's called a dental assistance plan, not a
dental insurance plan.  Instead of an annual maximum that *you* pay, there's
an annual maximum that *they* pay.  They emphasize preventive care, unlike
the Digital Medical Plan which pays for physicals only on a scheduled
(infrequent) basis.

    I really don't want to keep commenting on individual cases other than
    to say if you think you are getting the run around (i.e CMI can't/won't
    supply a name of another doctor, calls from CMI other than to clearify
    case issues) please, give me a call DTN 223-5402 or (508)493-5402 and I 
    will direct you to the proper person whether it be the OHR (Ocupational
    Health Resource) who is responsible for your case or Corporate Employee
    Relations if you think you are being treated unfairly or improperly.
    
    A couple points of clearification - Do I think we have problems with
    CMI? Definitely. Is anyone from DEC doing anything about those problems?
    Definitely. 
    
    As far as the local people at a site doing everything they can to
    resolve the issues I read about in this note? I don't know exactly what they
    have done or who they have contacted to try to get answers for folks,
    but if these issues are trying to be dealt with at the local level only
    something doesn't sound right.  
    
    Where to get the policy? - all managers and personnel folks should have
    copies of the policy. It is called "Disability Income Protection
    Policy". I'm sure there is a soft copy in VTX. 
    Managers role? - The manager is not involved in the determination of
    when an employee can return to work. 
    BTW - as I read the policy "return to work" could mean working at home.
    Although the current policy contains no decisions or definitions as to
    whether, and under what circumstances this may happen. But, *IMO*, an
    employee who breaks his/her leg and can not travel to work, but *who is  
    otherwise capable of performing productive work* from home for the
    company could do so.

    >>Second Opinion
    >>Firms That Promise Lower Medical Bill May Increase Them
    >>Cost Police Pile Paper Work On Physicians, Hospitials, Which Pass On
    >>Expense
    
    No kidding?
    
    Hasn't anyone ever thought to apply elementary Six Sigma, beginning
    Deming, or TQM 101 to employee benefits? 
    
    The folks who brought us CMI, and managed health care seem to have had
    their irony gland disabled. How else to explain the quaint but very
    improbable notion that adding a complete additional bureaucracy, with
    all its own waste, profit motive, and inefficiency, will reduce costs
    and improve the quality of service to employees. (And, by the way, has
    their been significant reduction in **Digital** bureaucracy as a result
    of hiring them?)
    
    Those of us who have been involved with concurrent engineering, DFM,
    Six Sigma, etc. recognize that process simplification may be the single
    most important factor in achieving significant and sustainable
    reductions in cost and improvements in quality. So let's simplify the
    STD process by adding a whole other bureaucracy? 
    
    It certainly isn't rocket science or brain surgery to see that if you
    can't inspect in quality in hardware that you probably can't do it with
    controlling medical costs either. 
    
    If we really want to help the company out of the doldrums, we ought to
    hire the CMI salespeople. They're the real creative thinkers.
    
    John H.

    re72:
    why you are so upset as if you paying the cost of the dental insurance 
    to Jhon ,last month I payed from my pocket $ 379 for my wife root canal
    some time I pay dentist more than I spend on food.
    Either Jhon hankock should limit how much dentist charge or raise
    their contribution ,I agree with 69
    
    Ali

    re.71 All I want to say to that note is you make some very, very good
    points. Maybe I am bias but I believe that our internal Health Services 
    folks would have been better at handling this work, but this is not my 
    area of expertise so I could be wrong.
    
    Re.72 What you are talking about are "reasonable and customary costs"
    and I think you may see something shortly about increasing this.

.74:

Well the real question is to find out what problem we're trying to solve here.
There are two that I can think of:

1) Cutting costs on STD
2) Cutting down on abuse of STD

Note that they quite definitely aren't the same problem, although there can be
and probably is some significant overlap between the two.

If our goal is to simply cut down on what STD costs the company, then we do
just that - cut costs.  This might mean taking a harder line on STD, but real
cost cutting will almost certainly allow some of the more cunning abuse.

I've worked around governmental offices and other companies where the goal was
to cut abuse.  Quite often, you'll find hundreds of thousands of dollars spent
to uncover and eliminate a couple thousand dollars worth of abuse.  This is
fine if your goal is to cut abuse, but it's hard to argue its cost effectiveness.

Clearly, there has to be some middle ground between leaving the system wide open
with buckets of money that anyone can come grab, or having things closed down
so tight that we're paying millions to make sure there isn't a single case of
abuse.  Interestingly, those two extremes also always mean making a choice 
between always providing the benefits to anyone honestly in need of them, or
making the decision to withhold benefits from some legitimate recipients as a
side effect of implementing a system that eliminates abuse. 

Turning the screws tighter means hurting more innocent people.  It's a decision
you make.

I *THINK* the company's not quite clear on what their goal here is (cutting 
costs vs cutting abuse), and as a result is lulled by the siren's song of CMI.

I would have to agree, though, that adding bureaucracy on both sides (CMI on
one side, and the doctors and nurses to argue with them on the other side)
doesn't do a thing to cut costs in the legitimate cases.  The only question is
whether the abuse that's cut will pay for that added cost.  Actually, another
question is whether we're transfering our expenses to someone else (the doctor,
the insurance company, our payroll, etc).

.35>    I don't know who should make the actual determination of when an
.35>    employee is able to return to work, but I feel comfortable with the
.35>    procedure in place. I definitely do not feel comfortable with a persons
.35>    own doctor as being the only person making that determination.
    				^^^^
    
    Implicit in this is the inclusion of the personal physician among those
    making the determination.
    
    Problem with the present procedure is that it seems designed to omit
    the personal physician, or to include the personal physician in an
    adversarial proceeding.  That's a problem because adversarial
    proceedings are more hospitable to attorneys than physicians.
    
    Maybe that's what it will take to correct the problem with the present
    implementation of the official policy (Mr. Santos earlier described a
    policy that sounds much more reasonable than the experiences described
    by several employees shows the reality to be).  I'd think that the
    person who described high blood pressure problems could make a strong
    legal case that CMI and DEC share responsibility for any medical
    complications resulting from failure to follow the advice of the
    personal physicians involved.  When and if such a case ever occurs, the
    cost savings of "utilization review" will be lost (and I'd bet a lot of
    hospitals and doctors will gladly break ranks and testify for the
    plaintiff in such a malpractice suit!).
    

    
    After spending over ten years as a hospital social worker in a 
    surgical/rehabilitation setting dealing with third party rehab.
    personnel on a daily basis, I can say that assuming CMI has in-
    deed done what has been alleged that they have prostituted the 
    true purpose of utilization review.  Utilization review supposedly
    serves both the patient and the party paying the medical bills. 
    
    If CMI has somehow received "signals" from DEC that they are to 
    be "hard" on employees, this scares me; if CMI has decided on 
    their own to be "hard" on employeed, this also scares me.  Could
    it be that CMI has run amock in their desire to contain costs?
    And if this situation has gotten out of hand where can the employee
    turn to find an advocate?  I thought the employee's advocate in 
    DEC could be found in Personnel.  In one instance a valiant PSA did
    what he/she could but to no avail.  
    
    To the basenoter and other facing similiar situations, please don't
    give up, a lot of people are routing for you!  
    
    

    
.79> And if this situation has gotten out of hand where can the employee
.79> turn to find an advocate?  I thought the employee's advocate in 
.79> DEC could be found in Personnel.  In one instance a valiant PSA did
.79> what he/she could but to no avail.  
    
    With very few exceptions, this would be a complete reversal of the
    personnel role...
    

    > I thought the employee's advocate in DEC could be found in Personnel.
    
    I just checked and saw only 3 references to Personnel.
    
    1. I've outlined the above to personnel and Human Resources. Both reps
       admitted they were experiencing a few "bugs" in how they understood
       CMI's administration of STD was to implemented and they would look
       into it. Obviously, I haven't heard anything back.
    2. My PSA was great, she intervened as much as she could; but she is
       just one human being.
    3. Any futhur correspondance will be by e-mail to Digital
       represenitives.
    
       I listed my dtn and outside number for people who were having
       problems finding the correct people to work issues and not a single
       person has called.
    
       If you don't like me or what I have to say call me on it, but to say
       Personnel is not an advocate because of what you read in this note I
       take exception with that. 
       I started with this company 14 years ago as an assembler and worked 
       up to where I am today, but I will never forget where I came from.
       I care very much about the people who work here and I do my best to 
       insure people are treated fairly. I see notes as a place for people
       to vent. 
            The policy is the same for me as it is for anyone else,
       including the people who wrote it. It just so happens that I have
       been involved with this policy from the other side (patient with a
       severe back problem), although I didn't have a problem with CMI my
       doctor wasn't real happy with them, but in no way did I feel he or I 
       were being harassed. 
     
            I see this policy as getting what we asked for (if you have
            read it you will know what I mean by that) because it is not
            a policy that a manager or employee will read and ask themselfs
            "what did that say?" or "now what am I suppose to do?" or "I'll
             just do this because I think it is the right thing to do".
    
            The Policy is very clear about what is suppose to happen and what 
            will happen. If a manager doesn't know about this policy or hasn't
            informed their employees I don't think we can blame Personnel.
            All managers have been sent copies and have been invited to
            training (from what I see about 30-40% bothered to show).
             
            Here is an open invitation once again for anyone having a problem 
            around this issue and can't find a person who can help.
            PSA's and Consultants are as helpful as can be, but they are
            not the people who should be *working* CMI issues.  
       
    
       

    re: reasonable and customary
    
    Yes, in kvetching about John Hancock, I'm talking about the following
    -- there's a doctor's or dentist's charge for N dollars for a
    procedure.  John Hancock says, sorry, it should only cost about 70% of
    that, so that's all we're going to reimburse.  The general belief
    around here is that John Hancock either doesn't have a clue as to
    reasonable and customary charges in the San Francisco area, or that
    it's deliberate underpayment.  I'm glad to hear this might get fixed.
    
    re: what are the real costs
    
    As someone else noted, the amount of employee time that's spent trying
    to straighten med stuff out can easily exceed the amount of money in
    question.
    

re .82:

Read your benefits book.  The medical and dental plans are fundamentally
different.  The dental plan isn't *intended* to cover all dental expenses.

Regarding "reasonable and customary" expenses and the DMP, I've said it
before and I'll say it again.  We've used some very expensive specialists
in a very expensive city (Boston), and we've never had JH reject any of
the expenses as beyond R&C.  I don't doubt that others have had a problem
with this, but I don't understand why there's such a disparity.  Is it
the type of procedure or is it the location?  BTW, R&C is supposed to vary
by zipcode.

    Re: .83: BTW, R&C is supposed to vary by zipcode.
    
    Zipcode of employee or physician?

    re: .85
    
    Zipcode of physician. 

    re .83 R&C and the dental program - I guess I should have my dental
    work done in Boston instead of Worcester - I just had a crown done and
    my out-of-pocket was $265 :-)!
    

    re.86 Maybe that would have been a good thing to do. If you can get
    your dentist to tell you the exact procedure being done you
    could call Hancock to find out exactly what your benefit will be for
    that procedure. Some dentists charge much more than others..

    A the person who followed on to the question of anyone else having
    problems with CMI; I did what I thought I could *at the time*.  If I
    understand correctly, my PSA is part of Personnel and I feel she did
    an outstanding job - above and beyond the call considering the limita-
    tions on her time.  I've been back to work since the end of
    April, the next person I spoke to was a Human Resources person.  Maybe
    I didn't make it clear.....I don't really expect anything to change as 
    far as it pertains to *me* in this incident....it happened; I'm back at
    work. My hope in speaking to the HR person was to spell out some
    obvious glitches in the process and put an end to some of the practices
    ASAP and spare my fellow employees the same grief.  Seeing the base
    note after this much time indicates that precious little has changed.
    I do not fault my HR person; I've worked other issues with him and he
    is a caring, considerate human being.....I'm sure he's done what he
    can to relate my circumstances to the people he hopes can clean up the
    "bugs".
    
    It's very easy to see *now* that perhaps I should have pursued this
    more agressively at the time, but I simply did not have the physical
    or emotional energy/strength to do so *while it was going on*!!  I find it
    ironic that the name of the company is Core Management, Inc.; I felt
    I was forced to "manage" my own disability at the time.  This type
    of treatment was so foreign compared with the other time I was on STD for
    surgery, I simply didn't know what to do while it was happening!!
    
    If CMI is taking the stance they are so they can come back to DEC as
    say "look what a good job we did get all the gold-brickers back to
    work", then I too fear the the future.  I'd still like to believe that
    DEC has *not* imposed some of these arbitrary practices on CMI...perhaps
    CMI has taken this stance so they can prove their value to DEC, I don't
    know.  
    
    My doctor has a busy practice; the CMI doctor felt it was OK to do
    things at his leisure....but my doctor and myself were made to jump
    through hoops.  
    
    I'm not a person whose mind immediately defaults to thoughts of
    litigation and since I'm back at work for now, it's moot.  As far as
    the future goes, my doctor insists I'm being given warnings....I either
    heed them or pay the price (again, based on my medical history).  When
    reading of lawyers, for me it's a stretch to believe that I might be
    around to do anything it <--- this is the part that scares me :-(
    
    Somehow, it's small comfort to know what I've participated as a "field
    test site" for CMI.
    
    
    
    

    Re: Read your benefits book.  The medical and dental plans are
    fundamentally different.  The dental plan isn't *intended* to cover all
    dental expenses.
    
    
    No, you're confusing the workings of the dental coverage (with which
    I'm familiar) with the dispute over what reasonable and customary means.
    

    For noters having probs w/STD:
    
    call 1-800-TALK-YES  Chuck Harder  talkshow host who broadcasts LIVE
    EST 2-5 pm on For The People.
    
    You'll be amazed at what he knows.
    
    Local to Lowell,Ma area For The People is on CAP 980AM.  A call to
    1-800-999-8888 (or 888-9999 I forget which one it is right now) may be
    able to tell you what station carries FTP in your area.
    
    Reg.

>    No, you're confusing the workings of the dental coverage (with which
>    I'm familiar) with the dispute over what reasonable and customary means.

If you weren't complaining about R&C as regards the dental plan, why did you
mention dentists in .82?

Update,

    I got a letter from CMI yesterday. My STD benefits period has been extended
to 8/18. I guess this proves the theory, about the squeaky wheel getting the 
grease. I'm pleased, to finally get this situation rectified. However, my 
experience and the experiences related by other noters, indicate that there are
serious problems with the way our new STD Policy is administered. I would feel a
lot better, if I thought someone in authority was looking at the STD policy
administration.

  The replies to this note, as well as replies to the Open Door Policy, Are 1's
really 1's, Union, etc. notes, indicate a need for an employee's representative
or Ombudsman (Ombudsperson). Too many people feel threatened by management and
their policies and don't think anyone is watching out for the interests of the
average employee. We'll see what happens.

 Now, I plan to spend some of the next three weeks catching up on reading some
of the technical books I've collected over the past year :-)

 Thanks for all your advice and encouragement.

Regards
Barry

 

    
    re .87
    
    John,
    	 I tried getting John Hancock to tell me what would be reasonable
    and customery charges for dental and medical procedures here in
    Colorado. In each case I was told that this was not information that
    could be released. The reason given was that the docters and dentist
    would then "RAISE" their rates to that level. So far that has never
    been a concern for any medical or dental practitioners in this town.
    	Can you get the information as to what constitutes reasonable and
    customary charges for the Colorado Springs area and post them. I need
    to visit the dentist in this area and I would like to know if John
    Hancock will cover it - or how much out of pocket expense I will face.
    
    Greg - WHO_ALWAYS_SUPPLEMENTS_JOHN_HANCOCK_PAYMENTS
    

    Hancock will not supply a list of procedures and the costs of those
    procedures. You need to find out exactly what procedure is being
    performed (from your dentist or doctor) then call Hancock and ask about
    that specific procedure in your service area. 
    I just tried to call the Hancock Customer Services Manager but he is on 
    vacation until tomorrow. I will call him tomorrow and post what he
    tells me.
    
                      John 

	It would seem reasonable that an agency enforcing "reasonable and 
	customary" limits should, on request, supply to a client a list of 
	5 care providers in their area who will provide the care for
	the "reasonable and customary" limit being enforced.

					Tom_K

Re .93

Ask your dentist.  The dentist that I see does a lot of business with Digital
people here in the springs, and as such, they know almost to the cent how
much you'll have to pay out of pocket.

I have heard the comment by the office staff that they'd like to know how
J.H. arrives at the R&C figures though, since they are so much lower then
what everyone in town seems to be charging.

--Scott

    The way reasonable and customary limits are determined from the way I 
    understand it is this. The larger insurance firms collect cost data
    from the doctors and dentists in a specific zip code area. This data is 
    rolled up and an average is taken as the reasonable and customary.
    Therefore, if you ask Hancock what the rates are for specific doctors
    and dentists they won't have that information.

    They definitely need to take the survey again!  I'm getting reimbursed
    well under 50% most of the time for dental work.

    I think you must be going to the expensive dentist - I asked mine one
    time if JH was better about dental paperwork than they used to be about
    medical paperwork (though they were better than the HMO I had to
    join!!!).  He said that for some procedures he does, they pay more than
    he charges, and for other things they pay less.  For my family, it
    usually just about breaks even.  Every once in a while I get a bill
    from the dentist for some small amount ($20 last year) so I guess on
    the average his rates are a little bit more than than what JH thinks is
    "customary" here, but I really can't complain.
    
    /Charlotte

    ...and is not meant to.  Re: .99, .98, and several previous, the
    Digital Dental *Assistance* Plan pays a pre-determined amount--it may
    be a percentage of R&C--more for preventive care (e.g., cleanings and
    check-ups), less for restorative care.  There are also yearly and
    lifetime limits on certain procedures.
    
    /Ed

JH pays pretty much what my dentist charges for routine stuff - cleanings, 
fillings, checkups, etc.  But, they tend to view the more heavy duty stuff
as being "optional".  When half a molar broke off one day, JH's view on my
getting a crown was purely cosmetic, and thus paid less than half.

Actually, I got along with the half molar a lot better than I'm getting along
with the crown, so maybe they were right.  

Anyway, I think it depends on the dentist, and I think it depends on the
seriousness of the work.  The more involved it is, the less JH covers.

    My complaint is when they claim to pay 100% of their version of fair
    and reasonable, and it comes out to less than 50% of the cost.  I hope
    they recalibrate the scales soon.

         Once the reasonable and customary rates are obtained, the schedule
    of benefits is based upon the 85th percentile for each dental
    procedure. This assistance plan is usually updated every *few* years.
    

    re: .103
    
>    Once the reasonable and customary rates are obtained, the schedule of
>    benefits is based upon the 85th percentile for each dental procedure.
    
    Are you sure about this 85% (percentile?) thing?  I'm currently
    fighting with an orthodontist in Worcester over a >1 year old bill for
    a root canal.
    
    	Me:	$200 up front
    	JH:	 312 insurance payment
    	Me:	 325 balance due
    
    So that's an $837 procedure that JH paid $312 (or about 37%) of.
    
    I haven't talked to Hancock about this since I don't expect any help
    from them.
    
    -joe tomkowitz
    
    P.S.  There was a cover story on some magazine about a year ago that
    went: "The new UNsurance -- You get sick, they don't pay!"

As a prior reply pointed out, the dental plan pays more for preventive
procedures than for ones that repair damage.  Perhaps the 85% is for
things like checkups.

    re.104  Yes, 85% of reasonable and customary is correct. But,
    reasonable and customary figures aren't updated every year. The
    benefits book says they are updated every few years, therefore
    reasonable and customary from a few years ago could very well be 37%
    today. 
    
    I spoke to the Customer Services Manager at Hancock about getting
    prices for procedures before the procedure takes place. He said they do
    in fact give out quotes when people call with the exact procedure being
    performed. He also said people will need to give them (Hancock) the
    name of the doctor or dentist. 
    If anyone has a problem getting the information I mentioned above
    get the name of your customer service rep. then give me a call (223-5402)  
    and I will work it.
                              John
                                  

    Yes, .105 is correct, I had a dental work done on my tooth # 23
    the other day, it costed $90, Harvard medical plan only paid
    $30, I paid $60. It is only a filling, just a normal run of the mill
    type filling. I dont understand it, may be because I asked for
    the white filling not the mercury one.

    so, before you go to Dentist, make sure you ask what you'll end up
    paying.

    /nasser

    Re: .106 by USPMLO::JSANTOS
    > ...benefits book says they are updated every few years
    
    So when were they last updated and when are they scheduled to be
    updated again?

    
    
      Given the rate of inflation for medical costs,  re-evaluating
    "every few years" could result in a substantial underpayment.
    
    					-al

Re 99 & 102

I suspect your dentist is high priced. I had similar problems as you then I
talked to people about other dentist's they liked called and checked their prices
and now get better service at at least half the cost. The old dentist was 
relatively new, had an oversized office staff, computerized, and is neighbor but simply overpriced and
I had to switch because of the overpriced service. 

    re.108  I'm not sure when they were updated, but I would guess 3 or
    more years ago. I hope to see an update this year, but I am not sure.

    
    Re .110:
    
    Correct. I use a dentist who works alone, with one secretary/assistant.
    My preventative work (checkup/X-rays/cleaning) is covered in full.
    My wife uses a dentist with a large staff, aquarium in the waiting
    room, etc. Same work for her costs almost twice what JH allows.
    
    I also believe that corrective work is covered at much less than 85%.
    I find myself paying for roughly 30-40% of the total cost for a
    filling, for example.
    

    
    
      rep 104.
    
      $837 for a root canal is insane. The third harbor tunnel won't
    cost this much;-) I had two done a few month back for 5 c notes.
    JH paid all of it.
    
    BAL

    My auto insurance company recently settled on a vandalism claim.
    They were willing to provide the names of several (five?) shops
    in my area which WOULD do the repair work for the amount which
    the insurance company appraiser approved.  In fact, the insurer
    called my preferred shop and worked out the slight difference in
    estimate/appraisal with the shop so I didn't have to pay extra.
    
    Contrast that with our dental plan.  It's next to impossible to
    EASILY locate a dentist who will charge what DEC approves.  If
    you DO manage to get an estimate or decode the indecipherable
    procedure codes yourself, odds are you'll STILL wind up paying
    due to the outdated "reasonable and customary" fee schedules.
    
    I'd GLADLY pay a few bucks/week extra to get a dental plan which
    wasn't such a hassle; I bet a lot of others would too.
    

Perhaps a moderator could move this dental rathole (cavity?) to another topic.

Not all root canals are equal.  The $837 one may have included a crown.

    >>                 <<< Note 2006.111 by USPMLO::JSANTOS >>>
    
    >>re.108  I'm not sure when they were updated, but I would guess 3 or
    >>more years ago. I hope to see an update this year, but I am not sure.
    
    How often do they change their rates?
    
    John H.

    re.116 If that question was for me I don't know. I suppose it would
    depend on the doctor or dentist. 

    There are other alternatives than JH that might save the company 
     money, and increase the value of the benifit to the employee.
      does anyone know if dec is even willing to look at other types
     of dental programs?  I think JH needs to revalue thier paying 
     structures for various proceedures.
    
    Bill-

    >>re.116 If that question was for me I don't know. I suppose it would
    >>depend on the doctor or dentist.
    
    Nope. I meant the insurers, as I suspect you knew.
    
    It would surprise me very much if they went three to four years between
    rate adjustments. Maybe rate increases should be given as often as they
    update the reimbursement schedule.
    
    John H.

    No, I honestly didn't know, but I can't remember the last time we had
    an increase in *dental* rates. BTW, I knew when I saw the node name I was in
    trouble. 

    
    Come on, folks, it's a BUSINESS.  You can bet they 'watch' the rates
    ALL THE TIME - our dentists send them information every time they
    submit a claim.  They KNOW what the charges are!  The issue is:  how
    much are they willing to pay?  That amount must be negotiated with
    their clients - in our case, DEC.  We must have an agreement or a
    contract.  What the contract says is what they pay.  
    
    	If we (DEC) want to change the rates, we renegotiate the contract.  
    If JH doesn't, we can locate another insurer.  I know that's a pain for 
    the 'health plan admin' group, but that's their job (if they choose to 
    do it).  They may have become so bureaucratic that they chose not to 
    and so we pay.
    
    	So, Mr. JSANTOS, what does the CONTRACT say?
    

Isn't the dental plan self-insurance like DMP?  If it is, don't blame JH
for DEC's failings.

    What does the contract say? I don't know and I haven't seen it. 
    Did I miss a note or something? 

Most people probably believe JH is parsimonious with the benefits so that they
can make a profit with a fixed fee schedule billed to Digital. My understanding
is that we are self insured and we pay JH a fee to administrate our dental plan.

It does not matter to JH how many valid claims are paid as they are are assured
a profit as long as their administration costs are kept in line. My former 
dentist thought JH did'nt pay his full fee because "Insurance companies were in
trouble because of real estate loans going bad". Notice I said former because
I shopped around and found that his fees were way out of line - That was the prob
lem. 

I would encourage people to compare notes on the Dentists fees and service. Some
believe they need to make it a lot quicker than others and are not good business
people. My former dentist sent his two clerks and himself to school in Arizona
on how to bill customers. Thats right! He only needs one clerk etc.. I only got
involved initially because he was a new neighbor.

I went back to my original dentist. 

.124> Most people probably believe JH is parsimonious with the benefits so 
.124> that they can make a profit with a fixed fee schedule billed to Digital. 
.124> My understanding is that we are self insured and we pay JH a fee to 
.124> administrate our dental plan.
    
    I don't believe that about JH.
    
    I do believe that JH is paid to administer Digital's self-insurance
    plans (medical and dental) so that the minimum payout is acheived.  
    I don't know but I'd bet that there are incentives for them to keep the
    costs down (certainly the renewal of their contract, at least!).
    
    
.124> I would encourage people to compare notes on the Dentists fees and 
.124> service. 
    
    Unfortunately the present Medical benefits plan penalizes this, in at
    least one situation which I personally experienced.
    
    I had a knee injury which was diagnosed as requiring arthroscopic
    surgery, by the local orthopedic surgeon.  In order to satisfy the
    benefits requirement for a second opinion before surgery, I consulted a
    specialist in arthroscopy, who confirmed the requirement.
    
    When it came to scheduling the surgery, I decided I would rather have
    my operation done by someone who does the same sort of procedure much
    more frequently, on the grounds that his expertise and technique were
    more likely to be more polished.  Thus I preferred the specialist in
    arthroscopy over the orthopedic generalist.
    
    But the medical benefits only reimburse the full R&C for the surgeon
    who initially diagnosed the need for surgery, and reimburse surgery
    done by the doctor providing the second opinion at 80% of full R&C.
    
    I understand the desire to minimize any financial incentive for the
    second-opinion to confirm the need for surgery, but it seems obvious to
    me that this also biases against using the highest quality medical care
    provider, because the initial opinion is most likely to come from a
    generalist while the second opinion is more likely to come from a
    specialist.  It seems to me that there should be no real need to impose
    a financial penalty for chosing either doctor, because I think most people 
    (and doctors too, really) tend to prefer to avoid surgery rather than
    to seek it out.  I believe that having a truly independent second
    opinion should be enough to qualify the surgical procedure for
    identical coverage regardless of which physician performs it.
    
    BTW, one consequence of this experience for me personally is an
    inclination to increase my personal medical costs.  Now I will seek to
    have the first opinion from the more highly qualified physician if it
    seems there is any chance of getting into such a situation again,
    rather than using the more convenient and less expensive local
    practitioner.

My wife is an office manager for a dentist in NH, so she is quite familiar
DEC's JH Dental plan as well as many other plans for local businesses.  She 
claims that the JH schedule is designed to pay about 80% for preventive work
and 60% for restorative (reapirs) work.  These are approximate.  

However when you factor in the no deductable part of our policy it makes it 
a pretty good policy, compared to many others which pay higher percentages 
but impose high deductables.

So it could be worse!

However, on another note, I am disappointed in the upcoming changes to our 
disability plan.  It looks like WC4 benefits for STD/LTD are being cut back.
They havent published the rates for the option A & B (new LTD) but I have a 
feeling it is going to be substantially more than it is now.  Must be a sign
of the times....

gary

    re: .115
    
>    Not all root canals are equal.  The $837 one may have included a crown.
    
    Unfortunately, no crown.  I can't afford to even ask what that would
    cost.  I gotta find another dentist.
    
    -joet

.103>  I'm currently fighting with an orthodontist....
                                      ^^^^^^^^^^^^
	Maybe this is the problem. Don't orthodontists specialize
	in bite problems, and generally occupy themselves with
	putting braces on people? I'm sort of surprised that one
	would even do a root canal. Maybe you should try a dentist
	who does general dentistry?

					Tom_K

    re.126
    
    I agree.  I just received my "Benefits Bulletin Update" and after
    reading the entire pamphlet, only to find that these Options A&B rates
    "have yet to be determined", I have concluded that, in the 'guise' of
    equality, Digital is shafting the employees again, just as they did
    last year with the Medical Plans.
    
    When I came to DEC, I purchased the LTD option (DEC was the first
    company I worked for which offered it) because my father-in-law has now
    been on disability from the phone company for 7 years and his plan has
    provided benefits at 66 2/3 of his salary TAXFREE.  The new Digital
    proposal will allow you to purchase Options, rate yet to be determined,
    at a pre-tax rate but if you ever draw benefits you will have to pay
    taxes on your disability PLUS maintain your health & dental premiums
    whereas currently DEC pays these premiums for you while on LTD.
    
    I realize we must reduce expense wherever possible and I've been
    turning off my printer & monitor, turning off lights, not printing my
    A-1's, etc. which I believe every responsible employee should do.  But
    for the employee population to "shoulder" the expenses for these
    benefits is hard to take.  I know my salary increases have not kept up
    with inflation but all of our governments are raising taxes......I
    better shut up now.
    
    It's probably to late to do anything by September 28th when these new
    changes take affect but I believe it's prudent to start carefully
    reviewing every future personal expense in order to try and stretch the
    greenback to cover these benefit premium increase!
    
    Ron

    re: .128
    
.103>  I'm currently fighting with an orthodontist....
                                      ^^^^^^^^^^^^
>    Maybe this is the problem. Don't orthodontists specialize in bite
>    problems, and generally occupy themselves with putting braces on
>    people? I'm sort of surprised that one would even do a root canal.
>    Maybe you should try a dentist who does general dentistry?
    
    Ortho-, endo-, whatever.  Even if I get his title wrong, he still
    cashes the checks.  My next step should probably be to find a vet
    and see how his fee schedule fits into the "reasonable and customary"
    scheme of things.
    
    -joet

    
    I am confused by the following paragraph, page 3, column 2, para. 1.
    
    	" Because Digital pays the full cost of the core benefit and you
    pay for Option A or Option B on a pre-tax basis, the benefits received
    from the new program are subject to ordinary income taxes."
    
    Does the mean that not only is coverage reduced, BUT we also have to
    pay the Income Tax for the 50% core that Digital covers? If this is
    the case why are we using pre-tax dollars? I agree with the comments
    in here relating to a slow, but steady, reduction in benefits, and
    an increasing transfer of these costs from company paid to employee
    paid.
    	
    	The scales once again begin to adjust.
    
    				fred deady

    re: .125

    I agree with everything you've said, except for...
    
    >specialist.  It seems to me that there should be no real need to impose
    >a financial penalty for chosing either doctor, because I think most people 
    >(and doctors too, really) tend to prefer to avoid surgery rather than
    >to seek it out.  I believe that having a truly independent second

    Unfortunately, surgeons have very little incentive to NOT suggest
    surgery.  They don't make much money on office visits and like any
    othere skill, surgery needs to be practiced if it is to stay sharp. 
    Also, you may not be aware, but it used to be (I'm not sure if it still
    is) routine for various specialists to provide 'referral bonuses' to the
    physician who referred the patient.
    
    I wonder if this might work... Dr. A thinks you need surgery, refers
    you to Dr. B who confirms it, you get surgery done by Dr. C, who is the
    Dr. you wanted to do the surgery in the first place.  All you would
    have to do is tell your GP to refer you to the 2nd best specialist for
    the second opinion, rather than the best.
    
    Bob

The list of surgeries that require second opinions is surprisingly short.
I think it consists of fewer than ten procedures.

    The LTD rates are;
    
                       Option A (75% option) .40 per $100 (base salary)
    
                       Option B (100% option) .90 per $100 (base salary)

.125>    Unfortunately, surgeons have very little incentive to NOT suggest
.125>    surgery.  They don't make much money on office visits and like any
.125>    othere skill, surgery needs to be practiced if it is to stay sharp. 
.125>    Also, you may not be aware, but it used to be (I'm not sure if it still
.125>    is) routine for various specialists to provide 'referral bonuses' to the
.125>    physician who referred the patient.
    
    True, but there is also some finite risk in any surgical procedure
    (even the most minor) which surgeons do consider.  So it is unlikely
    that two seperate opinions will both favor totally needless operations.
    The question really becomes what level of justification is appropriate. 
    Myself, I do not want surgery if it is inappropriate but I also do not
    want to avoid surgery where it is appropriate.  As it stands, the
    system of benefits tries to induce a bias against surgery to
    counterbalance the possible bias in favor of surgery by surgeons, which
    I think is exaggerated (especially in peer review insurance cases).
    
    BTW, there seems to be nothing in the existing insurance system to
    prevent an analog to "referral fees" in second-opinion cases, so that
    point seems specious to me.
    
.125>    I wonder if this might work... Dr. A thinks you need surgery, refers
.125>    you to Dr. B who confirms it, you get surgery done by Dr. C, who is the
.125>    Dr. you wanted to do the surgery in the first place.  All you would
.125>    have to do is tell your GP to refer you to the 2nd best specialist for
.125>    the second opinion, rather than the best.
    
    That might work.  I think that should be explained more clearly up
    front, maybe stated as a suggestion of what to do if you think you
    might want the procedure performed by someone other than the original
    diagnostician.  In my case I didn't recognize the situation until too
    late, so it cost me (and reduced my respect for the quality of our
    medical benefits significantly as a result).
    
    --bruce

>    The LTD rates are;   
>                       Option A (75% option) .40 per $100 (base salary)   
>                       Option B (100% option) .90 per $100 (base salary)

.40 for 25% or .90 for 50%.  Why the extra .10 for 50%?  I guess we get no
discounts for buying in bulk...

I assume the rates are weekly salary.

         ...I was in a similar position.  If you want the surgery done by
    the "second opinion" surgeon, you just need another second opinion. 
    You are not limited to one "second" opinion.

    I just did the numbers on the LTD payments for my situation:  
    
    If I choose the 100% option, my payments each week will be  248% of my
    current rate.  If I choose option (B???), my payments each week will 
    only be 110% of my current rate.
    
    As has been said before, the SPIN doctors are at work again:  It will
    cost you more $ for the "new benefits" being implemented.
    
    Sigh.......
    Chet 

Is it such a surprise that a company in financial difficulty will decide to 
pass its expenses on to others?  Is it such a surprise that they don't have
the courage to come right out and say that they're increasing the cost of our
benefits?

    so many people cry about how pc something is or isn't is my guess to
    the reason why people as whole aren't told the straight dope anymore.
    "We don't want to hurt their feelings! Let's just wait and see if they
    figure it out on their own.  In the mean time we can contract out the
    writing of the speech we'll give to them so that they'll see how good
    it is for them. (and then stick it to them anyway)".
    
    Some humor, mostly serious.
    
    Reg.

    REPLY to .139
    
    With everything else happening within the employee population, are you
    going to listen the next time "Management" gives us a rah-rah speech
    "lets win one more for the Gipper"( or KO) and by the way, we need to
    reduce your benefits AND increase the premiums, but sorry there is no
    money for Merit Increases while we move managers around and let
    individual contributors go???
    
    There is one born every minute!
    

    I've tried to move the replies discussing the LTD changes to one topic,
    2008.  Please continue the discussion there.
    
    Thanks to JSANTOS for pointing out the parallel discussions.
    
    Bob - Co-moderator DIGITAL

    2006.73 and all others by you...
    
      I have never , never responded to a note before, your attitude about
    the people has convinced me to have a lawyer on record if I get hurt or 
    sick.  In Mass. Workers comp must pay for the lawyer the employee
    hires.  I'm convinced I would be stupid not to hire one from the
    hospital.  We don't even rate a nurse in our building,  chest pains
    mean probable death around here.  I have to go on leave (maternity) 
    in February,  I plan on having a lawyer ready to file suit if I am
    layed off because of this or CMI sends me one ridiculus letter.  I
    never believed that Digital as a company would want their employees
    harrassed.  Obviously things have changed even more than I thought.  I
    dont know Colorado law, but how much money is DEC saving if they have
    to pay for that employees lawyer.  As I remember he was hurt on DEC
    property,  As soon as the harrassement started I would have given them
    one phone call to straighten it out.  Then let the lawyers handle it.
    I do not believe infrivoulus lawsuits but I will not be accused of
    trying to steal from the company just because I am sick or hurt or God
    forbid worked my but of to be a WC4 engineer.  You've given me proper
    warning thankyou,  I have the registered mail receits in my home before
    I go into labor... If CMI doesn't insist I have to work until I am
    actually about to deliver
    
                              Disgusted and very sad...
    
                                  KB
    

    With the assistance of John Santos, I received a call from a 
    representative of Core Management regarding my concerns.  She listened
    very closely, expressed concern that my STD had to be *more* unpleasant
    than it was.  The rep also outlined "changes" that CMI will be making
    based upon input from many people like myself who *did* try and change
    the system......I wasn't just griping for the exercise in doing so.
    
    Last Friday, my HR rep copied me on the documented changes; they fell
    in line with the info relayed to me by CMI.  I'm not sure all the
    "bugs" are out yet, but I was pleased to see the at least 2 of my
    suggestions (perhaps others made same suggestions) are being
    implemented.
    
    I know John and I went at it a bit early on in the chain, but John
    DID get the ball rolling as far as investigating the info I relayed
    and getting people back to me for further detail.
    
    Karen