Conference 7.286::digital

    Ed, this sounds like a real horror show.  I can imagine how painful
    it must be for you.
    
    I am not all that familiar with what the John Hancock plan offers
    or does not offer, but it seems to me that it is WRONG for DEC to
    start reducing benefits to force people into a plan they do not
    want.  Surely, if the cost of "traditional" insurance is getting
    higher than HMOs, then HMOs should be the "standard" benefit with
    full-coverage traditional insurance available as an added-cost extra.
    
    Personally, though, I have found HMOs to be perfectly wonderful.
    My family has been perfectly happy with both Fallon in Worcester,
    and Matthew Thornton in Nashua.  We have not noticed evidence of
    skimping services to save money.  Neither have we seen a great deal
    of waste.  It is not right for everyone, especially if you have
    a long history of a relationship with a particular doctor.  However,
    for my family, it is just right.
    
    Burns

     re .0:
     
     I pay $4.14/week to belong to an HMO (individual coverage).  I would
     pay $0.00/week to use the John Hancock plan.  My understanding is that
     Digital pays a premium to the HMO that is the lesser of (a)the HMO
     monthly premium, or (b)the premium for the Hancock plan.  
     
     I don't think that Digital is urging me to join Hancock because I have
     to pay an extra $200+/annum to use the HMO -- rather, the company has
     made a conscientious effort to offer me a choice of health plans.
     Digital will contribute the same amount to whichever plan I choose,
     and the burden is on me to determine which of the plans is best suited
     for me. 
     
     I understand Ed's complaint -- he's got to pay a fair bit of cash to
     pursue the type of health care he chooses to use -- but I'm not sure
     what he would propose as a solution (assuming that Digital continues
     to pay equal premiums regardless of which health plan is chosen).
     
     --Don
            

    
    I don't think that you totally understand, Don, I don't mind paying
    the bill to use non-HMO services.  I have a problem with denied
    claims (I've had several, and not the 'check-up' type) because the
    procedure is not in the 'book', and the reasonable and customary
    charge clause that is pulled on each bill.  I don't mind the 300$
    deductable, nor the 20% I must pay on the bill.

    QUICK summary:
    	o claims not paid for procedures deemed nessary by a medical
          doctor
    	o reasonable and customary charge phrase used to not pay a bill.
    
    	o reembursments not sent for weeks/months after submitted.
    
    	o beancounter-nurse reviews
    The last two items leading to poor reputation of my insurance by
    the medical provider.
    BTW, JH found a way out of paying for a second surgical opinion
    100%, mine paid at 80%, even though it was a *required* second opinion.
    
    ed badger
    

    
    	I'll definitely have to agree about one part of JH.
    
    	If JH does not owe any money (for various reasons), I usually
    get the return statement in a week or less.  BUT, if they do need
    to reemburse me, it takes months...not weeks.  My doctor and hospital
    are beginning to lose faith in JH.  I now pay the bill and submit
    the claim myself.  I have also had to call many times when the claim
    is too many months late. ( "Oh, that claim...").
    
    
    				mar

    Just one thing to remember here and that is JH is NOT the insurer
    DEC is!  DEC is self insuring for this plan and JH is only the
    administator of the plan.  If you have a complaint with the bean
    counters I think you should tell DEC about it as they hired JH to
    do the job.
    
    	/s/	Roger
    

    There is an interesting situation where one CANNOT use an HMO-
    
    I am a divorced father.  My daughter (and ex) live in Conn.  I live
    in Georgia.  Under the divorce decree (Mass) I have to provide "medical
    insurance" for my daughter.
    
    My belonging to a LOCAL HMO (as they all are) will NOT allow me
    to meet my legal obligations.
    
    	-Barry-
    

    I'm having the same experience with JH as you Ed.  They always get
    you with that "reasonable and customary" clause.  My wife and I
    had a baby boy this last august and JH claims the doctor has charged
    more than other doctors in the worcester area.  I called several
    offices in the area and they are charging about the same.  I'm going
    to have to cough up $400 to pay the difference.  I'm definitly looking
    into an HMO this december!
    
    Bob

    re .7 "I'm definately looking into an HMO this december!"
    
    Isn't this what I was warning about?  A push to HMOs! Hell no, I
    won't go!  Rather then us being forced into HMOs, is there any way
    to push back on mother digital?  I've written my piece.
    ed badger
    

    I have been in the Tufts HMO since I started at DEC three years
    ago.  In the beginning, it was very good.  I got quality medical
    service at a bargain.  Over time, Tufts has really gone down the
    tubes.  Bills are consistantly paid late to the point where I got
    a warning from a collection agency TO PAY OR ELSE!  I called Tufts
    at least 5 times and Marlboro Hospital the same.  Marlboro said
    they sent it several times and Tufts said they never got.  I finally
    resolved the matter by using the three-way conferencing feature
    on my phone!  Tufts appologized by saying that their administration
    has suffered from the overwhelming growth, and that they had staffing
    problems.  As for Marlboro Hospital there is no excuse for them -
    that's the worst hospital I've ever been to in my life.  Unfortunatly,
    that is where I am required to go - because of where I live.  Tufts
    (as well as most HMO's) don't allow you to go to Childrens Hospital
    in Boston if "the same service" is provided at your local area.
    A case in point:  My one-year old son had a suspected kidney problem.
    The pediatrician requested a test in which a catheter had to be
    inserted through his urethera - a delicate procedure for an infant
    boy.  So the pediatrician wanted to do this at Childrens, where
    they have specialists who do it several times a day.  However, Tufts
    denied the request stating that Marlboro provided that service.  So
    off to Marlboro I went.  I got into the room and they found a nurse
    who had done it about six months prior - and never on an infant!
    She was hesitant and nervous about doing it, and I was totally pissed
    off.  I called my pediatrician, and he restated the importance of
    this test, and that I should consider John Hancock in the future
    so that I'll have a choice.  I reluctantly let the nurse perform
    the procedure.  To this day my little boy hasn't gotton over that
    traumatic experience.  He is scared to death of doctors, hospitals
    and anything that remotely reminds him of that.  I feel terrible
    about making my decision.  If I could do it over again, I would
    pay the expenses out of my pocket gladly.  But then what's the point
    of insurance.  To end this, I am throughly disgusted with HMO's!!
    If you have JH stay with it - if you have an HMO change.
    
    Rik

    	Is anybody in here familiar with the Blue Cross and Blue Shield
    Master Medical coverage. While checking out the Mathew Thorton clinic
    in Manchester, I was talking to someone that had the BC+BS MM coverage
    and they told me that for anything they covered, they covered it
    100%. They also said that their out of pocket cost for this was
    less than John Hancock. They were looking at Mathew Thorton as a
    secondary health care plan. I presently have John Hancock now as
    my wife makes regular use of a chiropracter which an HMO will not
    cover at all unless allowed by your assigned HMO doctor. I was also
    told that the chances of a HMO doctor allowing this were slim and
    none. 
    	As far as bills with JH, I've had no major problems. I have
    had major problems with almost any hospital I've been to. I specfically
    request a total bill and will pay it when services are rendered
    at a hospitals outpatient when/if possible. This is sometimes
    impossible however as each department bills seperately. They assure
    you that it is no problem for them to direct bill John Hancock but
    I've yet to see where things went smoothly. I almost always wind
    up getting direct billed from the hospital.
    	If you can explain these problems to the right person, it seems
    as though you can get results. For example, one hospital in upstate
    N.Y. pissed me off so much that I wrote a letter to the head of
    the billing dept. stating exactly what happened and that they should
    consider themselves lucky that they were getting payed after I had
    been out right lied to. I received a letter back apologizing for
    their screw up. It said they had suspected that a problem like that
    existed and it was a matter of a lack of training that they would
    correct. Probably doesn't sound like mich but I got this letter
    after I paid them.
    
    RAYJ
    

    Re: .9
      
    If you live in Marlboro then you should consider Family Heath Plan
    or Harvard Community Health Plan. Don't blast HMO's just because
    you got into a plan that was too small to begin with. FHP allows 
    you to select your own doctor (and see him in HIS office). Each
    doctor is associated with 1, 2, or 3 different hospitals.  If
    you do live in Marlboro (like myself) then the closest hospitals
    that the plan will allow you to go to are Marlboro (I agree with
    you, what a pit of a hospital), Framingham Union (very good 
    Hospital in my estimation), or Leonard Morse Hospital in Natick
    (good, but not as good as FUH although I wouldn't hesitate to go
    to either).  You still pay $3 per visit and are covered 100% on
    almost everything.  HCHP is not to my liking, but may be to yours.
    You have to deal with a clinic type of atmosphere where they have
    all their special needs located at one location. They almost never
    let you go to a specialist outside of their clinic, if you do then
    you pay yourself.  FHP has quite a few specialist available (doctors
    who actually specialize in your problem) that they will refer you to
    without hesitation if they feel they would know MORE about your 
    problem, where at HCHP the doctors get a macho image and think they
    know everything in the world. HCHP deals with Marlboro Hosp, and
    Framingham Union.

    I know quite a few people that are changing from JH to an HMO, 
    because they said "Everywhere I turned I was paying out more money
    for this or for that".  

    The Insurance switching deadline just passed yesterday, so ....

    Dave

    FWIW, I got a letter recently that HCHP is going to be expanding its
    services some time in the near future by working something with
    Multi-Group.  (I forget whether it was exactly "joining" or not...) 
    
    As we're imminently expecting our first, it sounds like we will be able
    to continue with HCHP in Cambridge, but still use a local pediatrician
    in Lawrence/Lowell through Multi-group.  I'm told that driving a half-
    hour into Cambridge with a sick child isn't much fun.  Now, provided
    that the pediatrician provided locally by Multi-group is a good one... 
    
    							Ralph

        Re: .12
        
        Harvard Community Health Plan and MultiGroup Health Plan
        are indeed merging, the new entity will be called Harvard
        Health.  I believe that their styles are a little different
        (MultiGroup is closer to a traditional HMO), but from what
        I have heard both styles will be preserved for at least the
        short term.  Unless someone has a strong reason to switch
        it is probably worth waiting a year to see how they develop
        (not to hard, since it will be a year before the next switch
        period).
        
        					B.J.

    re .9 and .11:  I agree with .11.  If your HMO requires you to go
    to Marlboro Hospital, criticize that HMO, not HMOs in general. 
    I lived in Northboro for 6+ years and went to Fallon.  We found
    them to be excellent:  we were very happy with our doctors at Fallon,
    and with the hospital they sent us to (St. Joseph in Worcester).
    We found them not in the slightest reluctant to send us to specialists
    if needed.
    
    We are now in Nashua and so far have found Matthew Thornton to be
    excellent.  We use HMOs not as a compromise, but as an explict preference.
    
    Of course each person comes to into the medical choice game with
    his own set of prejudices.  I don't blame you for not wanting to
    go with HMOs any more after your bad experience.  I just felt like
    there needed to be a balancing opinion for the sake of people reading
    this who may be trying to make up their mind.

    Burns

    Before you rush out and join an HMO read the fine print about where
    you have to go for treatment.  This Monday night I cut myself on
    a table saw  and went for treatment at the closest hospital.
    Now Multigroup/Harvard Health is refusing to pay for my emergency
    room treatment because I didn't call first and get their permission!
    Attached is a memo I sent to Beverly Robbins, Digital's representative
    to Multigroup/Harvard Health HMO describing the situation.  If you
    have problems document them.  Digital is the largest corporate member
    of Multigroup/Harvard Health HMO
    
    *****************************************************************
    
 _ _ _ _ _ _ _
| | | | | | | |
|d|i|g|i|t|a|l|					INTEROFFICE MEMORANDUM
|_|_|_|_|_|_|_|





TO: Beverly Robbins				DATE: 3-NOV-1987
						FROM: R. Palmer
						DEPT: ITPD
						EXT:  289-1309
						LOC:  AP01-2/F2
						NODE: KELVIN::RPALMER



SUBJECT: Problems with Multigroup/Harvard Health HMO

Beverly,
	I have been a member of Multigroup HMO since January of 1987 and 
have been pleased with the non emergency service they have provided.  
However last night an incident occurred that has caused me to reconsider 
my Multigroup/Harvard Health Coverage.
	On November 2nd I was in an evening wood working class at Norwood 
High School.  I slipped while using a table saw cutting the tips of the 
second and third fingers of my right hand.  The wounds were bleeding a
great deal.  As I wrapped my hand in a paper towel another person in the 
class offered to drive me to Norwood Hospital.  I did not feel strong 
enough to drive myself.
	Upon arrival at Norwood Hospital I handed the administration 
person my Multigroup card and informed her to call Dedham Medical 
Associates.  The doctor at the hospital then attended and splinted the 
injury.  The administration person informed me on my leaving the 
hospital that Dr Mirel, my Multigroup physician, requested that he perform 
all follow up care.
	This morning I called Dr Mirel to set up an appointment to have 
the dressing of the wounds changed.  Much to my shock his secretary 
informed me that my treatment at Norwood Hospital would not be covered 
because I did not call ahead and get permission to go to a local 
hospital rather than the Faulkner Hospital.  When I explained that I was 
not near a phone and had no way of getting to Faulkner Hospital she 
informed me that I could take the matter up with a review board.  I 
immediately called the hospital back and asked to speak with a person 
in billing.  The person again told me that the bill for emergency 
services at Norwood Hospital would not be paid because I did not call 
before seeking treatment.  She informed that only "Life Threatening" 
injuries would be reimbursed without calling ahead.  When I asked her to 
explain what a "Life Threatening" injury was, she replied "something like 
a heart attack".
	I then went to personnel to explain my situation and was 
referred to you.  You explained the procedure and wanted to make sure 
that I had talked with the Multigroup Member Service Advisor.  After our 
conversation I called Dedham Medical Associates and asked to speak with 
a Member Service Advisor.  As I began to explain my situation, she said 
that she was familiar with my case from my morning conversation.  It 
then became clear that the information I received about reimbursement 
in the morning was not a mistake, but was Multigroup policy.
	I have two very serious questions that need to be resolved 
before I renew my Multigroup coverage for 1988.  The first pertains to 
my events of last night.  Was I supposed to drive to a phone to call 
Multigroup before I drove to the local hospital?  How could a doctor know 
over the phone if my saw cut was "Life Threatening"?  I feel it would have 
been a life threatening situation if I had attempted to drive myself to the 
Faulkner Hospital.
	My second question is related to the information I received as 
part of my benefits when I signed up for Multigroup.  When is it OK to 
seek the fastest treatment for an injury?  What is Multigroup's specific
requirements for an injury to be declared life threatening?  When I had an 
ear infection it was painful, but I was able to drive myself to Dedham 
Medical Associates.  If had I sprained my ankle I would have waited to
have someone drive my to DMA.  However if I or a family member is severely 
bleeding or has sustained a head injury I do not want to waste valuable 
time checking with a doctor to be sure that I will be reimbursed seeking
the fastest treatment.
	The fundamental reason that I carry medical insurance is to be
sure that in case of an emergency I am covered.  Three dollar office 
visits and eye exams are nice but can not make up for questions on how 
to proceed during crisis situations.  My events of last night and the 
lack of exact information describing when to seek immediate care leave 
me wondering about the value of my family's Multigroup/Harvard Health 
Medical Plan.

    

    Suppose you had slipped bigtime, and sliced off your hand at the wrist.
    Someone applies a tourniquet and rushes you to Norwood, along with your
    hand on ice.  From there you are airlifted to Boston and your hand is
    reattached.  With the tourniquet, your life was not in danger ( of
    course you might have lost your arm... ).  Would Harvard Health have
    denied payment because your situation was not "life threatening"?  Does
    that mean the proper choice would be to go the rest of your life
    without a hand?

    It seems like their policy is unreasonable.  Let us know how you make
    out; I for one will be leaving HCHP if they refuse to pay your bill.
    I don't want to bleed to death while I wait for someone to decide where
    I should go, and almost no situation is "life threatening" in
    retrospect, unless somebody died.

    Yeah, be carefull with this one. I know of a person here in Colorado
    Springs that was refused payment for treatment of a HEART ATTACK
    at the hospital where he would have sent anyway because he did not
    call first. The HMO said he was not likly to have died in the few
    minutes it would have taken to call, therefore he should have
    called, therefore no payment.
    
    Dick

    I have worked out an agreement with my primary physician that allows
    me to receive the necessary medical attention first, and notify
    her at the soonest possible moment afterward.  Most physicians realize
    that you may or may not realize the extent of an injury until after
    you receive medical attention.  
    
    Mark.

	Almost all  HMO's  have  this  policy, all I did was to have the
    emergency  care nurse [at the hospital I went to] call my HMO number
    [on  the  member card - Fallon Clinic] and explain that I was in for
    treatment   and   verify  that  I  could  NOT  have  driven  out  to
    Worcester/Westboro from Boston.   

	HMO's are  not  very pleasant if you are sick. Ironic, but true.
    They  are  Health  Maintainence  Organizations and are very good for
    testing  and  full  physicals  or  social  work,  but  they are very
    annoying to dealth with if you are going for teatment.

    I am fortunate enough to be married to a nurse that has responsibility
    for the entire 5th floor at a major hospital here.
    
    The stories she could tell you about people being denied "help"
    all because it was "not authorized" scares the hell out of me.
    
    All I can say is we DON't have the HMO plan....
    
    							Warren
    

    re .15-.20
    
    	Hey, everybody, how about waiting with the flames until the
    complaint is finally resolved?
    
    	I have been a member of HCHP since 1970, a few months after
    it was founded, and I have always been quite pleased with their
    performance, whether for emergencies, routine illness, prevention,
    in-area, out-of-area, etc.  Yes, occasionally there is a question
    over whether and how much payment should be made, but a few phone
    calls to the right person (at HCHP, not at Digital) have always
    clarified the rules.
    
    	HCHP is a very large organization these days (something over
    a quarter of a million members) and like any large organization
    they are going to have bureaucratic foulups and contradictions.
    Sometimes they aren't going to seem to understand their own rules.
    However, in my experience, they are willing to take the time and
    answer the phone until you finally get the answer you want in a
    dispute.
    
    	Yes, you can just carry private insurance and go to your doctor,
    hospital, and emergency room of your choice.  It'll cost you a heck of a
    lot more in the long run to do that, with much larger out-of-pocket
    expenses and more frequent disputes with the insurance company.
    It'll also be more inconvenient in the long run, since you won't
    have all the specialists and services you need under one roof.
    
    	So, I think the flaming in the preceding set of messages is
    premature, since the complaint hasn't been resolved yet.  Sure,
    you got some twit who doesn't know the interpretation of "emergency"
    vs. "life-threatening", but if you give up there and don't use the
    system that does exist, then you're expecting the system to be
    something it can't possibly be.  Yes, if you go to a doctor and
    they say "This is my rule," that's it, and you have no appeal. 
    What do you think HCHP has their whole administrative structure
    for?  Sure, they're trying to keep costs down, since that's one
    of their strong selling points, but they have enough people in place
    to insure that you will get a fair hearing--if you ask for it.
    
    			David

    We have been members of the Montachusett HMO for about two years
    and have generally been satisfied with the service we've received.  
    We are seriously considering switching back to John Hancock, however, 
    and appreciate all the input to this note.  Fortunately, we haven't 
    had to use any emergency room services but I have been concerned
    about situations arising such as those described earlier.  This
    is of special concern since we are planning a 3-week out of state
    vacation.  I would hate to think of having to call Fitchburg from
    Florida to get permission to go to an emergency room, particularly
    on the weekend.  But what has really started me thinking about
    switching back is our primary physician's reluctance to refer, even
    when he should.  For example, our daughter was in a serious accident
    over 10 years ago and the plastic surgeon wanted us to bring her
    back in about 10 years to see how she was doing.  When my wife requested
    a referral from our primary physician, he grumbled something under
    his breath about losing money, and he still hasn't referred us.
    My understanding is that the primary physician receives a monthly
    payment (I heard around $12/month) for each family member and that
    when he refers the patient to another practitioner, the $12 goes
    to that practitioner.  Does anyone know if this is true?  If so,
    it certainly puts a damper on a doctor's desire to refer.  This
    really bothers me since in our case we have 5 family members and
    to-date have all been in very good health and see the primary physician
    very rarely.  If he's been getting $60/month for our family for
    the last two years and we've only gone in for visits less than a
    dozen times in that period, I can't understand his reluctance to
    refer.  Any similar experiences?

    HMO's aren't the onlyones....
    
    There was an article in the Globe this morning about a regular
    insurance plan which wouldn't pay for someone to have surgery because
    they had not received 'permission' to go to the hospital.  The doctor
    had told the patient to check in, and now he's left holding the
    bag.
    
    This is all an effort to stem the rising cost of health care.  It's
    a real pain in the ass when these people say "But that is the rule"
    with no room or adjustment.  It happens everywhere, but when you
    scream loud enough, long enough logic will usually prevail.
    
    
    -bill
    (who just broke his ankle a couple of weeks ago and found the emergency
    service at Harvard Health VERY good.  After they confirmed that
    I had broken my ankle (rather well by the way) they sent me to
    Newton-Wellesley Hospital.  I had to wait around for a couple of
    hours at N-W, but at Harvard (Wellesley office) I was X-rayed in
    less than 10 minutes.
    
    -bill

    As a follow-up to .22, a recent survey of Massachusetts HMOs shows
    that Montachusett members have the lowest number of hospital days
    per year, by a fairly wide margin.  So, either MHP got lucky, and
    only 'healthly' people join, or they intentionally limit hospital
    admissions and length of stay...  You draw your own conclusion.
    
    Bruce
    
    P.S. We are CMHC members, and haven't had any serious problems,
    even when my wife got sick out-of-state on vacation.  It took a
    while (and several phone calls), but we were completely reimbursed
    for the doctor visit and lab tests, and received the normal
    prescription allowance.

  HMO'Ss are a real mixed bag.  My wife and I both are Deccie's and have
HMO coverage.  During the delivery of our two children we couldn't have
been more happy with treatment, *but* my wife developed phlebitus in her
leg after our first child was born.  The night the symptoms appeared she
had terrible pains behind her knee, we called the HMO number and got an
answering service, they took all the information down and said the 
physician on call would get back to us.  This took 20 minutes; he said
that she should elevate her leg (we had had it elevated for over an hour
by then), and he said to place warm packs around it and to call back if
there was any change.  About an hour later my wife could barely stand the
pain and we noticed that the leg was turning purplish.  I called again, got
the same answering service, same information.  We waited about a half hour
and called again, the answering service people were a bit indignant, said
they had already called the doctor but they would page again.  We got a
call back from the doctor on call, this time it was a female, I told her
what had happened and she told me we should have gone to the emergency room
right away.  After checking in at the hospital the doctor and nurses treated
my wife like a true medical emergency, they called in a specialist, and she
ended up in intensive care for the next 8 days.  We found out later that
the physician on standby changes at random depending on the schedule of
each doctor, so you can't be sure your going to get the same doctor even
on the same day handling your problem.

  We felt that the procedures for emergency's are vague at best.  What is
life threatening?  We certainly weren't expert's on phlebitus, nor are we
medically educated enough to diagnose each other for more than the normal
afflictions (bumps, bruises, etc), I really don't like being put into the
position of having to determine what could kill me and what couldn't.  I lodged
my complaint with the HMO, they were less than sympathetic.  I suggested
that instead of me trying to play doctor at home, we could use their emergency
care facitilty (open until 11pm) for diagnosis by a *real doctor* before
going to an emergency room.  Their answer was that the emergemcy care facility
was operated as a seperate entity and that our insurance coverage did not
aply.  If we do go to the emergency care facility we pay a minimum of $15.00
and their recomendation to send us to the emergency room will not replace
having to call the doctor on standby.

  We are trying to weigh the pro's and con's of HMO's.  As I see it now:

PRO HMO

  o  Save's money for routine visits. (Great for small children needing
     several early visits and shots)

  o  Physicals are just $3.00

  o  Lab work (limited) is done ASAP on the day of your doctors appointment

  o  Prenatal care is good.  Reduced costs for Birthing classes, again routine
     visits are a bargain.

  o  The use of Physician Assistant's usually means that you can get an appoint-
     ment on short notice for minor ailments like colds, flu, etc.

CON

  o  Emergencies - Having to call to find out if your life is in jepardy is
     a major problem (especially with young children) It scares you to not
     know how severe a problem is in the eyes of the HMO.

  o  Limited selection of doctors.

  o  Limited clinics to use.
     
  o  Limited to only HMO approved Pharmacy's. (There are two in this area, and
     they both close at 5pm)

  o  Referral to a hospital if the clinic lab can not perform required tests.
     Usually means missing work on another day for testing.

  o  Limited to specialists on the HMO staff until they decide you have a 
     problem they can't handle. 

  o  Can't always get in to see your primary care physician, the medical
     assistants try to have you see a physicians assistant before scheduling
     an appointment with a real doctor.

  Our kids are now beyond the age of frequent shots and routine appointments,
we aren't going to have any additional off springs, and my wife will have a
life long problem with the phlebitus, so we would like for her so see a special-
ist on a regular basis for it, As for routine visits we think that a family 
doctor would be nice, someone who knows all the family, and if possible is an
osteopath.

    
    	I've talked to my doctor and he agreed with me that I should
    have gone directly to the emergency room.  However he is not involved
    in the process of deciding who will pay.  As I understand it I will
    receive the bill from the non HMO emergency room because the HMO
    will reject paying because I did not call before treatment.  I then
    have the option of submitting the bill to the HMO review board.
    When I talk to the doctor types at the HMO they say it will be covered.
    The clerks are not so sure.  I'll post the results.
    	I like the non emergency care at the HMO.  I really like the
    fact that the primary hospitals are Mass General, Faulkner, and Brighams
    & Womans.  I wish I had a better feeling about the emergency care
    provisions in the agreement.  I refuse to wait bleeding while some
    bean counter checks the books. 

    HMOs seem to have a big procedural hole, don't they?  But then,
    it's the same hole that's existed in bureaucratic health care for
    decades.  I remember Monty Python sketches in which people stagger
    into emergency rooms just *gushing* blood, only to have the nurse
    ask for wallets...
    
    Some HMO physicians are bypassing the problem.  My family is in
    the Tufts HMO, and my own personal-care physician has told me that
    in an emergency, I should go wherever is closest, then call him
    within 24 hours to get a referral.  This method worked once even
    when I didn't call for a week (I thought it was a Workman's Comp
    injury, but noooooo), though it took nearly a year to straighten
    out.
    
    Talk to your doctor.  Cut a personal deal.

< Note 212.21 by RIVEST::OFSEVIT >
    
>    	Hey, everybody, how about waiting with the flames until the
>    complaint is finally resolved?
    
 I had never seriously considered joining an HMO, but R. Palmer's experience
convinced me. Even if someone eventually gets reimbursed for 'unauthorized'
emergency room treatment, it's an awful emotional burden to have to think for
months on end about possibly paying a 4-figure bill out of your own pocket.
And I don't want my life and/or health to depend on an intricate communication
network (call hospital, call doctor, have doctor paged, wait for doctor to re-
turn call) working properly. What if there is a hurricane, or any other situ-
ation that interferes with the phone system? Phone people assign top priority
to keeping the fire/police/EMT phones working, but that doesn't mean Dr. Smith's
phone will work.

    RE: .28
    
    	...or what if the doctors beepers battery runs out?
    
    	I'm not crazy about John Hancock but I'm DEFINATELY not impressed
    	with HMO's after all of this..
    
    							mike

    HMOs are what their title describes, HEALTH MAINTENANCE ORGANIZATIONS.
    They work to keep you healthy. That is they work as long as you
    do not get sick. People I know who belong to them, seem to extol
    their virtues of paying $2-5 for office visits but they curse and
    moan when they get sick and need hospital care. 
    
    Morale, only join an HMO is you don't expect to get sick.

>   Morale, only join an HMO is you don't expect to get sick.

Or have an accident.

        I have John Hancock coverage for my entire family.  My
        wife has HMO (Bay State) coverage for the entire family
        also.  (She started at Digital a couple of weeks ago; I've
        been here 10 years.)
        
        Who picks which agency we can use?
        

>        I have John Hancock coverage for my entire family.  My
>        wife has HMO (Bay State) coverage for the entire family
>        also.  (She started at Digital a couple of weeks ago; I've
>        been here 10 years.)
>        
>
>        Who picks which agency we can use?

from the comments in this file, I would say use the HMO for checkups 
and JH when you're actually sick or injured :-}        

    re .32
    I did't think one family was allowed to be covered by both an
    HMO and J. H. I assume that you list your wife as a dependant and
    she lists you as a dependant. I thought you could not do that. But
    if I am wrong, it certainly won't be the first time.

    I like HMOs, I think they work, I've had NO problems with them.
    
    I hate health insurance with its 90% of this 80% of that, second
    opinion "requirements" ...  tons of paper work and perennial checks
    for $4.97 and bills for $17.22.
    
    Re .-1
    
    I was a member of an HMO for years, then moved out of their service
    area and into an area where my wife had HMO coverage available to
    her at a weekly cost less that the same coverage from DEC [She works
    for a town and the town also had Blue Cross/Shield which is even
    more expensive that JH.  Since they contributed the same to the
    HMO users, the cost was less.]
    
    So I went to personnel and told them that I wanted to drop medical
    coverage.  I was told that I couldn't.  (like the mandatory --
    optional long-term disability, no doubt)  Finally it turned out
    that I could drop the HMO and be picked up by JH with employee only
    coverage for no cost to me (just to DEC?)  So now I'm in the middle
    (again) of a co-insurance situation.  That is that I should bill
    things to JH, since it is my primary coverage, and then bill to
    the HMO (almost a contradiction in terms) since I am covered as
    a dependent there.  In general having dual coverage seems to increase
    my out-of-pocket costs.  So I'm keeping the JH coverage a secret.
    
	signed "v" (not my real name ;^)))

    On the dual coverage issue. All companies require you to notify
    them if you are covered by more than one health insurance company
    (either insurance, HMO, PPO, etc.).
    
    The following resulted from a lawsuit a few years ago. Basicly someone
    was covered by two companies and sued to get full payment from both.
    For example a $1000 dollar hospital charge would normally be covered
    80% or $800 by both companies. This person submitted the bill to
    both companies and expected $800 from both resulting in a reimbursment
    of $1600. The companies said no way and he sued. The result was
    a finding that he could only get $1000 dollars no matter what. All
    companies have since written into their policies an inter-company
    agreement that:
    
    1) If covered by two or more policies, one is declared primary and
    pays its normal amount.
    
    2) The remaining amount (deductables, percentages, etc.) can be
    submitted to the other companies and they will pay what they will
    cover until the bill is paid 100%. You can get no more.
    
    This applies to HMOs and insurance companies etc. The implementation
    can get very complex any you may never really get you 100% except
    on major items you follow up in detail. The selection of the primary
    coverer gets complex but basicly your primary is your employer's
    company and your spouse's is their employer's company and there
    is an algorithm for assigning dependants to companies and you do
    not have a choice in this. 
    
    The bottom line is the selection of insurance types and coverages
    when both spouses work can get complex and you need to think about
    the options in some detail or you may end up getting the shaft.
    
    Dick

    A year ago I went to visit a knee specialist at the UMass Hospital
    in Worcester, MA.  While there I briefly chatted with one of the
    nurses and told her that I was thinking about joining a HMO.  She
    said she knows a lot a horror stories releated to HMO's but she
    would not elaborate and I kinda dismissed her comment.  But now after
    reading some of these notes I now believe there was a lot of
    truth to her comment.  I for one have no intentions of joining a
    HMO anytime in the near future.  I use power tools and welding
    torches and it doesn't take much for a accident to happen.  The
    last thing I want to worry about is who do I get permission from
    and how do I get ahold of them.

    	I think the lesson of much of this discussion is that it is
    important to investigate whatever health provider and insurance
    you choose.  
    
        I would be particularly leery of something that calls itself an 
    HMO but doesn't have its emergency number constantly attended *and*
    backed up by sufficient staff.  Compare the horror stories that
    have been told here to what it says on the back of my HCHP card:
    
              IN THE SERVICE AREA:  In a Medical Emergency, call you
              Health Center and state that it is an emergency.  HCHP
              medical staff is available at all hours to meet your
              emergency needs.  A member in shock or unconscious should
              be taken to the nearest hospital and HCHP should be notified
              as soon as possible.
              
              OUTSIDE THE SERVICE AREA:  If you are temporarily away
              from the Service Area and more than 20 miles from home,
              you will be covered only for the unexpected onset of a
              condition requiring immediate medical or surgical care.
              Follow-up care is covered only when provided by HCHP.

    That sounds fair enough to me, and I have had enough experience
    with them that they will settle claims fairly.  It is in their interest
    to make sure members get emergency care as fast as possible, since
    the alternative is to spend a lot more of the plan's money fixing
    a problem that doesn't get solved right the first time.
    
	There have been too many organizations recently, calling themselves
    HMOs, when all they are are loose confederations of doctors sharing
    a common prepayment and billing mechanism.  That's not my idea of
    an HMO.
    
    			David

     
    Will DEC ever institute the Health club benifit which Tufts offers?
    When asked, Tufts said "Digital has not elected that benifit at
     this time." Why haven't they ?

    This seems to be borderline False advertising, as Tufts radio
    commercials constantly tout about free health club memberships
    when you join their HMO . . .
    
    
    							John
    					

     Many years  (and  employers)  ago,  I had Prudential Insurance (they
     administered the health  ins  plan like JH does for DEC) and my Wife
     had RI BCBS (she  worked for a Town in RI), but we lived in CT.  For
     her to collect from BCBS, she only got  80%  of  RI  coverage if she
     used  "out-of-state" (non-RI) doctors/hospitals.   My  coverage  had
     Deena as a dependent (when I  started  work  for  General  Dynamics,
     Deena was still in College and had  no  other  medical coverage) and
     paid the same regardless of where you were  treated.  Thus, we never
     told anyone about BCBS.  After I quit GD  and filed my last extended
     benifits claim, we never got  reimbursed.    Upon  inquiry, Prud Ins
     told us to collect against RI  BCBS!!  It finally took a letter from
     RI BCBS stating that they would pay  nothing since the claim was too
     "old", AND a threat of a lawsuit to  GD  and  Prud Ins before we got
     paid.  Bottom line seems to be that each Ins Co will send you to the
     other  one  first  and it will take an infinite amount  of  time  to
     collect whatever you are due.  [I do understand their desire  not to
     pay you a sum total > than the actual cost, but they do get full ins
     premiums don't they?]
     
     As for HMO's, NEVER!  You can't  plan  your  future  health  and  in
     serious  cases,  you need the BEST medical care  available  for  ANY
     chance  of  survival!    An example:  ~3 years  ago  my  Mother  was
     diagnosed to have a rare form of brain cancer.  I immediately set up
     a  consultation  with THE world-renowned expert on brain tumors from
     Harvard Medical School/MGH.  It was a slim shot at best, but we only
     had one  chance!   The tumor was removed, but statistically only 50%
     survive after 6  months  (post-op!)  and only 20% survive 12 months!
     My Mother lived 15  months post-op and only during the last 6 months
     was she in need of  constant  care.    If she had been in an HMO, we
     would have had to beg for  a  consultation  and  it  would have been
     THEIR choice of who we could go  to.   NO THANKS!!!  Think about it,
     we are extremely lucky in the Northeast to  have many of the world's
     best medical experts.  If God forbid, something terrible  happens to
     us or a loved one, the expertise is here.   To  be told that the HMO
     will not pay for it/authorize it would be a terrible thing  to  live
     with.  For the rest of my life, I can at least  know  that my Mother
     had absolutely the best medical advice/chance available at the time,
     I will not have  any guilt feelings that we may have skimped or that
     she might still be alive  if  only  we  could have afforded the very
     best!  [BTW:  My Mother  was  very aware of her condition/prognosis,
     and all that was done for her up until ~3 months before she died.]
     
     Another  HMO  (minor)  example:  We just  returned  from  a  2  week
     vacation  in  the Caribbean.  While on vacation  Deena  and  I  both
     caught colds.  Unfortunately, Deena caught it near the  end  of  the
     trip  and  ended  up  with  a severe inflamation of her  ears  (from
     flying, Bonaire-Curacao-St.   Maartin) and visited the Doctor at our
     timeshare resort in St.  Maarten.  Was it an "emergency"?  I am sure
     that an HMO would  disagree,  but  at least with JH we might stand a
     chance  of  getting reimbursed.   [Making  a  phone  call  from  St.
     Maarten to US can take many  hours  to  get a connection, so calling
     the  HMO  for "permission" or notification could  take  longer  than
     flying home.]
     
     HMO's are great for routine visits and for  children's "well visits"
     which  conventional  insurance,  like  JH, don't pay for.   I  can't
     predict  the  future  (health),  but  I  can predict that HMO's  are
     extremely inflexible when you might need them most!
    

	     > OUTSIDE THE SERVICE AREA:  If you are temporarily away
             > from the Service Area and more than 20 miles from home,
             > you will be covered only for the unexpected onset of a
             > condition requiring immediate medical or surgical care.
             > Follow-up care is covered only when provided by HCHP.

Sounds to me that if you are on say the beginning of a 4wk vacation
in Alaska and you have something that requires immediate medical care
that if a further treatment is required then either you pay out of your
own pocket for the additional treatment or terminate your vacation and
come home.  With JH, at least I might be able to salvage some of the vacation
without paying for all the additional treatment(s) or wasteing my airfare.

        re .36 - "On dual coverage".  Thanks, Dick; I suspected the
        situation was relatively complex.  I don't expect to submit
        the same claim to both insurance companies.
        
>    The bottom line is the selection of insurance types and coverages
>    when both spouses work can get complex and you need to think about
>    the options in some detail or you may end up getting the shaft.
     
        Who can provide details on our two specific companies?
        I'd guess that it's Personnel's job, but after reading
        the other currently-hot topic here, I'm not so sure.:-)

>>        Who can provide details on our two specific companies?
>>        I'd guess that it's Personnel's job, but after reading
>>        the other currently-hot topic here, I'm not so sure.:-)

    Kidding aside, it *is* 'Personnel' who does this, but it's the
    Personnel Services Administrator (PSA), not the recruiting arm.
    PSAs seem to know what's going on (at least here in the mill; I
    don't know about any other location).

    
    I've been a member of a HMO ever since I moved to this area (nashua)
    some five years and three companies ago.  For the most part I like what
    I get, but emergencies are a serious problem.  (Like the time I was
    bleeding internally and couldn't get an "appointment" until 2 days
    later, we called the doctor directly bypassing the front desk [having
    an ICU nurse for a wife helps!])  We have raised this issue with them
    but they haven't figured out a solution yet.  However, a more serious
    problem is their billing cycle.  Twice we have been almost referred to
    collection agencies for failure to pay in one case an emergency room
    bill, and in a second case a consulting fee for a referral they sent us
    to.  In the first case we had to pay and then hassle with them to pay
    us back.  They seem to be on a minimum of 120 day outpay cycle whereas
    most hospitals are on a 30 day in-pay cycle. Since typically you have a
    90 day "grace" period before any legal action can be taken (minor
    things like attaching your house) and 30+90=120, you end up on the
    hairy edge of the end of the "grace" period.  However, they do seem to
    pay local stuff earlier, its the out-of-state hospitals/referrals that
    they drag their feet on. The moral of the story is check to see what
    their billing/pay-out cycle is and get in it writing.  Also get any
    referrals in writing to help protect you when the institution you owe
    money to comes after you. 
    
    Why am I still there?  Because the actual clinical staff is quite
    good once you get past the beauracratic front layer.  The times
    we've had trouble the doctors within the HMO have helped straighten
    things out.
   
    

A friend of mine is a staff internist with an HMO.  He has had quite a few
cases in which he judged that a referral to a specialist outside the HMO was 
necessary for the interests of a patient.  Each time, he has had to get his
referral approved by the HMO administrator.  Sometimes it's been approved,
but sometimes not.  On several occasions, he went to the mat for his patient
but was overruled by the bean counters.  The hardest thing he has had to live 
with was the death of a patient who was denied coverage by the HMO for an 
outside specialist who could have saved her life.

What's medical insurance *really* for?  To save you money on routine office
visits, or to cover you for unforeseen medical circumstances when you couldn't
afford the best treatment on your own?  It's said jokingly that "HMO" stands
for "Healthy Members Only".  I'll stay with John Hancock as long as I can.

    I switched to CHMC (Central Mass Health Care) last January and I
    am totally please with it.  I have taken my kids into the emergency
    room at the Leominster hospital on the weekends for ear infections
    several times and have never seen a bill or had to fill out any
    paperwork.  I have saved at around $200 this year by switching to
    CMHC and I am using the same physicians and getting the exact same
    care that I had with JH.  The CMHC plan does not have a clinic.
    You visit the physicians that are part of CMHC in their office and
    the physicians that we had been going with JH are the same. I received
    the exact same care with the exact same physicians and paid $200
    less.  Many physicians in central Mass are part of CMHC and chances
    are your specialist is too.  As far as the referrals go, I have
    had absolutely no trouble getting a referral. My wife and I have
    asked for 3 or 4 this year.
    
    Why did I switch to CMHC from JH?  Back in one of the earlier notes
    of this file I described the situation when my son was born and
    how JH wouldn't pay $400 of the bills.  Well, over the past year
    I have battled with Digital and JH over this issue.  I finally was
    able to set up a meeting with the corporate benefits manager with
    the help of the local personnel person. After questioning him he
    admitted that the schedules used to make the reimbursement payments
    were at least nine months out of date and did not reflect the "real
    world" cost of medical care and that was why I did not receive full
    benefits. So whay do you think they did for me? NOTHING! I was told
    that it was unfortunate the my son just happend to be born during
    the time in which the schedules did not reflect the real world costs.
    If he had been born a few months later I would have been fully covered.
    This is not a story I made up, this is true.  I also know that I
    was not the only one effected by these out of date schedules the
    benefits manager admitted that there were others. This is why I
    switched to CMHC. So far, I am being treated better there, so I'll
    stay there for now.  Don't think you're immune to getting soaked
    just becuase you have JH. It can happen anyway.
    
    
            

Several years ago I worked for another company, and belonged to Multigroup.
I was hit in the eye with a softball, which broke the lens of my glasses 
which in turn scratched my cornea, and gave me a cut below the eye. Not
life-threatening, but I was concerned about my vision. Anyway, a teammate
drove me to the nearest hospital where they sewed up the cut and treated the
eye. The next day I called Multigroup and explained what had happened. They
paid the emergency room cost, and referred me to an eye specialist.

When I started at DEC, Multigroup wasn't yet available in my area so I
joined Mathew Thornton. I had to raise a stink with them just to get
a physical exam! Later when Multigroup became available in my area I
switched back to Multigroup. However, I can't say I've been real happy
with them and I intend to switch to JH. .-2 really cinched it for me.
I'll pay a little extra for the routine stuff, so that I know that should
I need the unroutine, I won't have to worry about dealing with an HMO's
bureaucracy.

					Tom_K

    Referrals, consultations, and second opinions:
    
    	1.  HCHP, which is my HMO, has a very good reputation for getting
    consultations and second opinions.  Since they work through the
    Brigham, Mass General, and Beth Israel (among others) they have
    access to many of the best doctors in the world.
    
    	2.  In any case, you can always pay out your own pocket for
    what you might consider to be a more expert opinion.  I'm not a
    medical expert, and I trust my [HCHP] doctor's judgment better than
    I trust my own.  It would take a lot of consulting fees to make
    up for what I've already saved by belonging to HCHP vs. regular
    insurance.
    
    Emergency:
    
    	1.  HCHP does *not* require a phone call to get emergency care.
    An HMO which does place that barrier in the way is indeed flawed.
    
    	2.  The question of what you do if you're far away at the beginning
    of a long vacation and need follow-up care is interesting.  I'm
    not sure what HCHP policy really is.  I'll look into it.
    
    Motto:
    
    	All HMOs are not created equal.  Don't judge them all equally.
    
    			David

There is a little known policy within Digital that one employee cannot be
covered under another employee's policy. Some PSA's are not aware of the
policy and allow the coverage to happen. I have talked to personnel on
several occasions about this, because it seems crazy that I have to pick up
my own health insurance when my husband carries family coverage. Their
only reply is "The policy is reviewed yearly and there is no reason to 
change it"

    My recollection is that "your own" health insurance is covered by
    the company; only the family coverage is extra.
    
    rmm
    

    RE .48
    	Read your Harvard Health/Multigroup coverage book and look up
    what they consider to be an emergency.  A heart attack is an emergency
    that doesn't require calling in, a laceration requiring stitches
    is 'urgent' care situation that requires preapproval.
    					=Ralph=

    What exactly IS "preapproval"?  Does it have to be notarized or
    can it be verbal?
    

.51>    Read your Harvard Health/Multigroup coverage book and look up what they
.51>    consider to be an emergency.  A heart attack is an emergency that
.51>    doesn't require calling in, a laceration requiring stitches is 'urgent'
.51>    care situation that requires preapproval. 

    	Well, what it says in the book is one thing, and how they handle
    things in practice is another.  In the two cases I've used them
    for out-of-area service, both were ear infections, hardly major
    or life-threatening conditions, and in both cases I submitted the
    bill and was reimbursed promptly and fully.
    
    	I'm repeating myself in this series, I know, but the bottom
    line is to find out how a plan actually operates, who the people
    are behind it, and what their priority is.  All insurance is a gamble,
    and you have to know the odds.

.51>                       -< Read the book before you sign >-

    	Forget about the book, check out the product.  When you buy
    a car, you pay a lot more attention to the vehicle than to the owner's
    manual.
    
    	After all, if we all went strictly by the book here at Digital,
    we'd never get anything done. 
    
    			David

    
    	RE .53
    
    		The problem in my case is that it was NOT an out of
    	area service.  If this had happened in Buffalo NY things 
    	would have been fine.  However, my accident happened 
    	WITHIN my local area. According to Multigroup/Harvard
    	I HAD TO CALL in order to get reimbursed because I only
    	cut my finger on a table saw which is by their definitions
    	URGENT care not EMERGENCY care.  With the amount I was 
    	bleeding my only thought was to get to the closest hospital.
    	When I got to the NON Multigroup/Harvard hospital my dad
    	called Multigroup immediately, but this was not good enough.  
    	According to them I should have called Multigroup/Harvard 
    	and, over the phone they would have determined if my cuts 
    	were serious enough to go to the closest hospital, or I should 
    	drive an additional 12 miles to the Faulkner Hospital
    

    re .54
    
        Multigroup and HCHP have only recently merged.  Did this incident
    occur as part of Multigroup or HCHP?  I suspect you may have run afoul
    of the inevitable bureaucratic problems resulting from the merge, but
    that depends on when the incident occurred.  
    
        In any case, how high up in HCHP did you pursue it?  They need to
    know that, if this is indeed a correct interpretation of their policy
    (and I hope it isn't) that such a policy is just plain wrong, since it
    increases the time for "urgent" problems to be attended to, with an
    increased chance that expensive follow-up care might be needed. 
    
    	If it turns out that this is their policy, the next step is
    for Digital members to put on pressure, through our Benefits program,
    to get it changed.  

    			David

re Note 212.54 by PALMER::PALMER:

>     	According to them I should have called Multigroup/Harvard 
>     	and, over the phone they would have determined if my cuts 
>     	were serious enough to go to the closest hospital, or I should 
>     	drive an additional 12 miles to the Faulkner Hospital
  
I am struck by the irony of this.  Most doctors, in my experience, do not like
to draw conclusions about potentially serious medical problems over the phone,
because there is a real possibility that they won't be given all the relevant
information (the person on the other end may have no idea of how to determine
it).  Yet HMO's want to require such determinations in emergency cases.

I'm glad that I'm still with JH, but I fear that similar "cost control"
requirements are being instituted for all insurance.  (JH may not care where
you go, but they still may try to control if you go and for what treatment.)

Bob

    Much as I hate to push more business for ambulance-chasers, I wonder
    what the repercussions would be if you sued the HMO for damages.
    Are they allowed to drop your coverage?
    
    I also wonder if the telephone-determination-of-severity rules could
    be grounds for negligence and reckless endangerment if their usage
    should cause someone to die while they are diagnosing the problem?
    
    Of course, that doesn't do the former patient any good, but ...
    

    There is some food for thought in these notes, but for balance I
    will recount my positive experiences with Multigroup HMO.
    
    Besides being excellent during the recent birth of my daughter and when
    I sprained my ankle they also came up trumps in the two 'emergencies'
    we had, fortunately both minor. 
    
    Two years ago my wife suffered from an allergic reaction to cold
    in (believe it or not) Hawaii. We just visited the nearest doctors
    office, paid the fee and were refunded in full upon return.
    
    In February I had a minor skiing accident requiring 5 stitches. I
    just attended the emergency room of the nearest (Leominster) hospital
    to get it seen to. The hospital worked the charges directly with
    Multigroup. 
    
    Neither case was anywhere near life threatening. In neither case
    did I contact Multigroup first, and in both cases the bills were
    settled with no fuss.
    
    Tim

        Re:  Note 212.49 by RUBY::KELLY, "On DUAL COVERAGE" -- contrary to
        what you have said, a Digital employee can now cover his or her
        (employee) spouse under family coverage.  This was in the November
        1987 "Benefits Bulletin" that was mailed to your home, as well as
        being mentioned in the "Your Medical Choices" bulletin that just
        went out. 
        
        Tom

    
    
    	I wish I could cover my Mom under my plan.. It'd help save
    	her a bundle and give me a piece of mind when she gets alot
    	older..
    
    	If DEC is supporting the family, then they should start with
    	our parents..
    
    							mike

    re: "cover my Mom" under ins. plan  -  That's an idea.  Is there a precedent
    in another company?  What about guardianship situations?   Would
    she (or Dad) have to live at home for n-years before qualifing?
    
    rmm
    

If you established your parent as a dependant, I would think that your
insurance could cover them.  Gaurdianship may be similar.  I know when
I went above 21 my dad had to do something to keep me on his medical
insurance, the default was to drop me since they assumed I was no longer
a dependant (who in school has any $$?).