Conference 7.286::digital

    <much forwarding deleted>
    
From:	SKETCH::DFONTAINE    "Dennis Fontaine * MLO8-2/L13 * 223-5709"  5-JUN-1987 13:29
To:	@ID,DFONTAINE   
Subj:	ins memo

      To: All Dec Employees                From: Dennis Fontaine
      
      
      Subject: Do you know what to do if you need to be hospitalized?
      
      Under the new rules you must inform John Hancock of any 
      hospitalization whether it is planned or an emergency. If you fail 
      to notify them they will only reimburse your hospital room and board 
      at 80%.  As a matter of fact even if you call them they may still 
      not reimburse you, it seems that there is at least one and I suspect 
      there are several incompetent people who answer your medical 
      questions. So to protect yourself in the event you or your 
      dependents are hospitalized I suggest you call John Hancock 
      immediately, get the name and badge number of the person you are 
      speaking to and ask for their supervisors name, you may need this 
      later on should you have to bring legal action against them.
      
      Ah, how do I know this. When my son was hospitalized I called John 
      Hancock at 223-3300 to inform them due to the new hospital review 
      board. The women I spoke to said don't worry you will be covered and 
      that I really didn't have to call for this type of hospitalization 
      and that there was some automatic process that took place. Well here 
      it is three months later and I owe the hospital $900 because they 
      say I never notified them. Well the truth in the matter is that 
      223-3300 was not the correct number to call but its the only one in 
      the phone book and further more the person who answered the call 
      should have instructed me to call the hospital review board number 
      which is not listed in the digital directory, I guess that was too 
      obvious a place to put it, more incompetency.
      
      I hope this doesn't happen to you and would be interested in hearing 
      from you. How many of you have had problems with John Hancock and 
      how many of you know you have to inform them for all types of 
      hospitalization, do you think the system is easy to use?
      
      Anyway I submitted an appeal which was denied, they believe I'm 
      lying and never made the call and these are Digital people who 
      reviewed my appeal. I now have to appeal it to a higher committee, 
      if that fails I will have to bring legal action against them. It 
      really makes you feel good to know you work for such a nice company 
      who trusts its employees.
      
      Please forward this message to as many people as you can so they 
      won't get taken for a ride.
      
      Sincerely
      
      Dennis Fontaine

    Unfortunately I believe .-1
    
    The new John Hancock cards have the number to call on the
    back, it is the same number that is called to verify coverage.
    
    I think that the best method is to get the facility providing
    the care to call and verify coverage.  Two years ago I had
    a serious stroke and was discharged from the hospital early
    (my choice) since in home therapy could be arranged via the
    VNA.
    
    Six months later John Hancock claimed that they did not cover
    the services the VNA had provided.  The VNA had kept records
    of their call to verify coverage. John Hancock shut up.
    
    - gerry

The procedure to call John Hancock's regular number to initiate
medical review doesn't go into effect until July 1. Until then you
will have to keep the special number in your wallet. Having a
special number is awkward and I'm glad it's being abolished. What
if you are out cold and don't come to until it's too late to make
the call? I'm sure that happened to someone. The literature we got
recently suggests that you give your next of kin John Hancock's
number and give him/her instructions to cover the above situation.

    re .2:  If you called from a DEC facility which records out of facility
    phone calls you should at least be able to prove you made the call
    to that number by getting a copy of the phone records.

    
    another note in the same vain:  JUST because you call John Handcock,
    Just because they acknowledge your call, IT DOESN'T MEAN THAT THEY'LL
    PAY 100%.  My son went in the hospital last year.  The nurse-bean
    counter that interfaced with my son's doctor gave the doctor a hard
    time.
    My doctor wanted my son to say an additional DAY.  The nurse-bean
    counter didn't agree with the doctor!  I had my son stay anyways
    and worked out the payment.  I trust my doctor over a bean counter
    any day.  Doctor knows ALL my son's history, of nearly loosing my
    son twice.  Bean counter only knows $$$ and is measured by that.
    Thats the reason I stay away from HMOs.
    
    One of the unfortunate drawbacks of Digital self-insuring is that
    it wont fight for you.  The appeal process doesn't work either.
    
    ed
    

     In reply to .2
    
       When the review process first took effect, my son had to go into
    the hospital.  I also called the number, 223-3300.  The person I
    spoke to assured me that I needed a second surgical opinion and
    that was all to receive 100% coverage.  Well WRONG!!!!!.  After
    asking her specifically if their was anyone else I needed to talk
    to about this, she said NO, that a second opinion from the doctor
    was fine.
    
       Well to say the least, his bill was paid at 80% and I covered
    the remainder.  After a few phone calls, I found it probably wasn't
    worth the effort in arguing over the 20%.  I chaulked it up to a
    lesson learned.
    
    Nancee
     

    I am not sure where to turn so I thought I'd try posting my question
    here.  I need to find out who within Digital, not John Hancock,
    I can contact regarding the insurance coverage John Hancock provides.
    John Hancock will not cover a medical charge that I feel they should.
    My wife suffers from a rather strange eye disease.  There are only
    two treatments for this disease; special contact lenses or a cornea
    transplant.  The problem?  John Hancock will not cover the cost
    of the lenses and follow-up visits (they are very expensive).  Other
    insurance companines have, in the past, covered this charge eventhough
    they did not cover expenses related to "routine eye care" as JH
    is claiming.
    
    I am looking for the name of someone within DEC I can turn to.
    
    Thanks in advance.
    
    Bob Newman

You want the corporate benefits manager - look in the back of the DEC 
phone book.  My experience (though from 1980) was that they were 
responsive and helpful.  Remember, DEC sets policy and funs the plan, 
JH only acts as the service bureau

    Thanks,  I'll give a call