Conference 7.286::digital

    Well DEC *does* offer HMOs as well. I assume that DEC offers JH
    because a great many people (myself included) prefer not to use
    an HMO. Also not everyone is in range of an HMO. As long as they
    have to give some people JH why not give everyone the option to
    use it?

    			Alfred

    With the John Hancock plan, you can choose your own doctors.
    

        I believe John Hancock was the only choice, long before
        the "HMO" came to be.  Rather than eliminate John Hancock
        and replace it with HMOs, Digitial decided to simply add
        HMOs.
        
Jim Stratton
        

    Also with JH, you can use an HMO clinic.
    
    JH, and Blue Cross before it, was offered long before HMOs came
    about.  I use JH, and would not change to an HMO.  I have gone
    to an HMO clinic when needed and find no MAJOR with the service.
    I had a nasty cold, and went in on a Sunday because it was convenient.
    I was told just to ride the cold out.   I went back to work Monday,
    got worse, missed the rest of the week, and needed to go to my regular
    doctor for medication before getting better.  I'm not implying that
    will always be the case, but it was my experience.
    
    I also like knowing I can see the same doctor everytime I need to
    go.  It lets me build up a trust.  Not something you can do if you
    see the next available doctor.
    
    Largely it is personal opinion, I would not take kindly to being
    forced to change.
    
    
    

    There are also some additional advantages of JH - as INSURANCE vs.
    an HMO - as a 'local' medical facility:
    
    1.	if you travel or want to for medical assistance - when I lived
    	in Atlanta, we went to NY for a specialist 2nd opinion on some
    	surgery.  Now we live in NJ but use a specialist in NY for some
    	specific things
    
    2.	if you are required to provide medical insurance for a dependent
    	by the terms of a divorce decree and the dependent lives in
    	another part of the country where your 'local' HMO is not.
    
    		-Barry-
    

    JH coverage of alcohol abuse is better than HMO's.  Plastic surgery
    not covered by HMO.  Foot problems not covered by HMO. Therapy sessions
    only covers 5 visits.  Have had HMO for 2 years, went back to JH
    for much need plastic surgery.

    RE .6  Which HMO?

    I use JH because it's less expensive than any of the HMOs I'm eligible
    for.  I'm sure that with the right kind of sicknesses JH would end
    up being more expensive, so I'm assuming we won't need that much
    medical care each year.
    							Larry

    I switched from Blue Cross to HMO when I came to DEC.
    I have the same doctors I did under BC/BS as you can chose anyone
    on the list they provide. I sat down before making the decision
    and looked at what services I had used in the last 15 years and
    found 90% of them had not been covered under BC/BS and they would
    have been under HMO. HMO Allergy testing and on going medication and
    shots, physicals need for my exercise program, school physicals,
    pre-natal classes, nutrition classes etc. etc.
    
    In our city it is cheaper than JH or BC/BS, however it is not for
    every one. As your kids approch college age and go away to school
    they would have to come back home for care if the schools doc
    recommeded extended care or more specialized care! I'd consider
    switching when the time comes.

    For those of you who don't know: There are two kinds of HMO...the
    clinic kind, (where you see any available doctor) and the other kind
    (where you have your own doctor) My doctor,my wife's,our kid's and
    practically every other doctor and facility in the area,is on the 
    HMO list of doctors and hospitals etc. This
    means that *everything* is the same as with JH except that the cost
    of each service is much lower.(my wife has a heart murmur and has
    an occasional echocardiagram...try and get one of those for five
    dollars!) Granted,the weekly cost is more than JH,but it's well
    worth it. 

    RE: .7
    
    Tufts.
    
    Alcohol coverage bear minimum
    Plastic surgery: JH states surgery should have been done yrs. ago
    
    marie

        In complaining about your HMO, please be explicit about which HMO
        you don't like.  There are MANY of them out there, they are run as
        independent business, they don't all have the same rules or
        coverages.  
        
        And remember this really important rule: DEC gives you a choice.
        If you don't like what you've got, then change at the next
        opportunity (once a year).  Complaining here doesn't fix the
        problem. 
        
        Tom

    The big consideration for me has been that JH covers chiropractic
    care, while HMO's (regardless of which one) do not.
    

    Not true.  Matthew Thorton has referred my wife to a chiropractor and
    are covering the cost.
    
                            August G. Reinig

    I prefer to use John Hancock because I like to select my own doctors.
    Also, I live 60 miles away from work.  The only HMO I can join is
    80 miles from home...which makes joining an HMO out of the question
    for me.  
    
    
    (I live in Dudley, MA, work in Enfield, CT, and the HMO is in
    Wallingford, CT)

    We joined an HMO this year, mainly because JH was kicking back every
    claim for one excuse or another.  They eventually pay, but we always
    had to go back to the doctor for more information, write a letter
    of explanation, etc.  Lacking the time to file 3 or 4 times for
    every claim, we hoped the HMO route would be better.  Now, 6 months
    later, we can't WAIT to get back to JH.  Never again!
    
    The medical care we've received seems adequate.  The administrative
    system of this HMO (Kaiser Permenante) is HORRENDOUS!  I have to
    call them back 3 or 4 times over a period of 2 or 3 weeks just
    to get an appointment.  "Sorry, the doctor is full up for the rest
    of this month, and next month's appointment calendar isn't in the
    computer yet" is the standard answer.  When I finally get an
    appointment, it's 4 to 6 weeks away.
    
    The current issue of Money magazine has an article about HMO's and how
    many of them are in financial trouble.  The article strongly implies
    (without actually saying it) that the difficulty in making appointments
    is intentional -- the HMO hopes people who don't have life-threatening
    illnesses will eventually just give up and not make an appointment.
    That way, the monthly fee still rolls in and the HMO has to provide
    less medical care for it. 
    
    God forbid Steve or I should get really sick before December 31. Once
    we get out of this poor excuse for a business, we will NEVER go within
    50 miles of an HMO again. 
    
    Want me to tell you my REAL opinion???  (^;
    
    							Pat

    Personally, I'd never get near an HMO.  My initial reason was because
    my family's medical history is somewhat extensive, and I didn't
    figure this would get proper attention unless I went to *my* doctor.
    
    My feelings against HMOs have been reinforced recently.  My father
    died a few weeks ago.  He had an HMO and went to his clinic because
    of chest pains.  He was bounced around from doctor to doctor, each
    for their various tests.  On June 12, he went into the hospital
    for a test.  On June 13, the procedure was done, and he was supposed
    to go home on June 14.  On June 15 he was dead.  Between the 14th
    and 15th, I can't count the number of doctors who saw him -- none
    of them coordinated with the others, and no one doctor seemed to
    have control of the situation.  The night of the operation, he was
    in agony, but the night doctor down-played his pain and other symptoms,
    and never alerted the "attending physician" to the problems.  
    
    This isn't intended as a "poor me" sob story; he had lung
    cancer and would have died from it.  My point in this discussion
    is that, at times when coordination among doctors is most critical,
    the HMOs don't seem equipped to handle it.  Dad first went to a
    doctor in April, went to *at least* four different clinics/hospitals
    for tests, had delays in scheduling the tests for each hospital
    he had to go to, and rarely, if ever, saw the same doctor twice.
    He had to schedule each procedure and appointment himself -- no
    one helped him.  That doesn't seem to be me to appropriate treatment
    of someone with an obviously serious illness.  
    
    If he had a "normal" health plan, he most probably would have gone
    to his own doctor, and THE DOCTOR would have arranged for the
    tests and visits to any specialists.  I'm positive it would have
    been a swifter resolution.  Maybe, with earlier detection, he could
    have lived a little longer (maybe not) -- but, more importantly,
    maybe his last months would have been less difficult for him and
    his last hours might have been a lot less painful.
    
    

    

    I can't buy the recommendations to stay away from HMOs because
    someone has had a bad experience with their HMO.  The world is full
    of horror stories about doctors, and they aren't all at HMOs.  For
    that matter, I'm sure you can get just as many horror stories about
    the medical bureaucracy at traditional large hospitals as at HMOs.
    
    Our own experience with Matthew Thornton has been consistently
    satisfactory.  My daughter has had the whole run of childhood ear
    infections:  each time she was seen promptly on the same day we
    called.  Her pediatrician had no hesitation about referring her to a
    local ENT specialist when she was concerned about the repeated
    infections. 
    
    We are now with a local family practice office of Matthew Thornton,
    where we have our own family practitioner, who recently referred
    Elspeth for a CAT scan at Memorial Hospital in Nashua just to
    be safe.  (All normal, thank heavens.)
    
    In any case, the suggestion that one should stay away from HMOs
    because of the possibility of bad medical care seems to ignore
    the possibility of bad medical care anywhere you go.  
    
    	-Neil

        Thanks, Neil, for a very reasonable reply.  You've hit the nail on
        the head -- each person has to decide for him or her own self what
        health care provider is best, and if it turns out to be a bad
        decision, to change to one of the other alternatives.  One thing
        that's good about Digital is that you have choices. 
        
        Let me remind people that this conference is NOT the appropriate
        place to record extremely negative remarks about businesses and
        people who don't have the opportunity to defend themselves. 
        
        Thank you.
        
        Tom

>        Thanks, Neil, for a very reasonable reply.  You've hit the nail on
>        the head -- each person has to decide for him or her own self what
>        health care provider is best, and if it turns out to be a bad
>        decision, to change to one of the other alternatives.  One thing
>        that's good about Digital is that you have choices. 
        

Yup, but I would not deter people from continuing to express their
desires in an an appropriate way. Every so often I read about another
corporation which is ELIMINATING this choice (so-called "traditional
health insurance) for their employees.  HMOs are fine, and are the
right choice for some people, but i think its OK to keep letting
DIGITAL know that <some> of us really prefer the traditional option. 

    re: .21
    
    Especially true because DEC covers so very much territory.  Its
    easy to forget that HMO service in Connecticut, or California or
    even Pittsburg PA is not equal.
    
    I'm glad to hear that there are quality HMOs building reputations
    for themselves, because they have certainly gotten a lot of bad
    press.
    
    But the decision can and SHOULD be made by the individual.  Its
    not fair to be limited to an HMO in an area that has notoriously
    poor HMOs.
    
    Jim
    

    Here in Colorado Springs, the HMO's each have a list of "Primary Care
    Physicians" who are simply doctor's with regular practices but who are
    also affiliated with the HMO.  He is, in effect, your family doctor. 
    
    When I decided to change HMO's (for reasons of convenience with
    obtaining prescriptions), I didn't have to change the family doctor
    because he is affiliated with both HMO's.  And he's a great doctor
    too...
    
    -  David

Certainly your family doctor is affiliated with <some> HMO.  But if
your family uses OB, pediatrician, G.P., perhaps a couple of
specialists (dermatology, etc) you run into a problem if they're not
with the <same> HMO.  Often the better specialists aren't affiliated
with an HMO at all.   

    When I transferred from the field to Area Support I did not know
    a Docter in the city of Atlanta, so I joined a HMO. Biggest mistake
    I ever made. I fell off my moter bike and reinjured my neck, it
    was causing the loss of the use of my left arm and hand, it also
    caused such savier pain that they had to put me on adictive narcotics.
    Three nero sergeons turned me down for surgery and said if I did
    not have the sergery I would have a wastted limb, I am an electrical
    engineer. The last surgeion said he was not qualified but there
    was a sergion in New Orleans named Dr. Kline that was problable
    the only persion in the world who could help me, he put this in
    wrighting to the HMO who said no. They decided I could not see this
    man and could not have this sergery even though I would lose the
    use of my arm. Well I weightted till Jan. and changed to John Hancock
    had my sergery in New Orleans and am doing great.
    
    HMO ____ NO

        OK, you had a bad HMO.  That can happen.  You could just as
        easily have had a WORSE experience with a personal physician
        and John Hancock.  Like anything else, you have to take some
        responsibility for being an educated consumer.
        
        What's really getting to me lately is the "Blue Cross/Blue
        Shield" commercials that are airing on the radio in the MA/NH
        area.  If the attorney generals were serious about "truth in
        advertising", these wouldn't be allowed on the air, because
        they *imply* that all HMOs are managed incompetently, don't
        provide quality service, etc.  Now, clearly, this may be true
        of *some* HMOs, but it's potentially *just as true* of some
        private physicians, some group practices, and some hospitals.
        *Their* attitude seems to be that you have a *right* to health
        care, no matter what the cost, and that they are the best way
        to make sure that you'll get whatever your heart desires, no
        matter how much it costs your employer or society at large.
        
        Tom

    Re .-1
    
    You day that you could have a worse experience with a physician
    and JH. All very true but there is a big difference, with JH you
    have the power to tell your doctor to take a hike and go to anyone
    you choose. With an HMO you don't get that choice. In other words
    you loose some control of your own life. I think this is graphically
    illustrated in .-2.
    
    Dave

        Right, but let's get real.  It's non-trivial to find out, except
        by personal experience, whether a particular physician is good or
        bad.  With JH, it's a crap-shoot, exactly the same as with an HMO.
        
        In a well-managed HMO, the physicians are working as a team to
        provide health care, and effectively using other competent
        health-care professionals to minimize costs.  If you don't like
        the physician you're currently seeing as your "primary care
        doctor" (or whatever your HMO calls it), you can switch to
        another, within the same HMO.  If you don't like the HMO, you can
        switch back to John Hancock, or to another HMO.  
        
        Just because you can switch to a different physician at any time
        with JH doesn't mean that it's better, just that it's different.
        If you're seriously ill, are you going to tell your doctor to take
        a hike and start shopping around for another one?  Good luck. What
        kind of flowers would you like me to send to your funeral? 
        
        I'm not trying to defend all HMOs.  I personally have never had a
        bad experience with HMOs, and I've been covered by various ones
        for roughly the last 25 years.  Clearly, some other people have
        had bad experiences with some HMOs, but that doesn't mean that 
        all HMOs are bad, or that all non-HMO physicians are good. 
        
        Tom

    Re: .26 and .28
    
    Right! Let's get real. Notes .26 and .28 totally miss the point .25 was
    making. 
    
    It is difficult to find a good physician. But with JH, when you do find
    him, you can go to him. With an HMO, as .25 described, even if you do
    find him, you may not be able to go to him. 

>        What's really getting to me lately is the "Blue Cross/Blue
>        Shield" commercials that are airing on the radio in the MA/NH
>        area.  If the attorney generals were serious about "truth in
>        advertising", these wouldn't be allowed on the air, 

Geez, cool down!  They're just making a point thru a combination of
satire, exaggeration, and a bit of humor.  Weak companions to the ATT,
MACintosh, and maybe even the Wendy's ads. 

Gee Tom, it must be tough not to be able to set the radio "no-write" :-)

    
    RE: .24 (I think)
    
    Speaking of the ads, how can you say this about Blue Cross/Blue
    Shield when THEY are the ones getting the misleading advertising
    bashing from the HMOs (Sing the Blues etc).  The HMOs claim that
    they only cost 3$ per visit, they intentionally mislead people into
    thinking that that's the ONLY cost. They conveniently leave out the
    fact that there is a much larger weekly/monthly/yearly charge whether
    you use the HMO or not.
    
    	I have used JH since joining DEC in '79 and have never paid
    more (including deductibles, 80% this and that) for it that I would
    have for the cheapest HMO (wife & two kids included). In fact, I've
    never experienced any of the billing headaches and/or horror stories
    either and I'm very happy with JH in general.
        

    Just for the record, the HMO ads that sing the "Blue Cross, Blue Shield
    blues" partly because BC/BS "only pays 80%" are intentionally trying to
    mislead people in Massachusetts. 
    
    This state has a law regarding what is called "balanced billing" with
    respect to Blue Cross and Blue Shield. In effect, even though they only
    pay 80% of the billed fee, hospitals and doctors who accept payment
    from them are prevented BY LAW from EVEN ASKING FOR the balance from
    you. So, in effect, that 80% is as good as 100% to a BC/BS subscriber. 
    
    This is not so with Hancock and other private insurers where the
    customer must come up with the remaining 20%. 
    
    -joet

    As I said in .5 - there are some of us who are REQUIRED by divorce
    decrees and such to provide medical INSURANCE for dependents who
    may NOT live in the same local area as we do.  For us, an HMO is
    not available.
    
    	-Barry-
    

         
    Unpaid Bills by HMO
    -------------------    
    I'm a Digital employee working out of the office in Columbus, Ohio, and 
    I too am having problems getting HMO to pay the bills they are 
    responsible for.  These pending bills are for doctor visits and 
    emergency surgery performed on my wife over a year ago.  Note the 
    latest happenings between HMO and myself:
    
    	On Wednesday, 15-Nov-1988, I received a letter from OSU Hospital 
        requesting payment of bill within 5 days.  This bill was for work 
        performed on my wife over a year ago.  I called HMO to find out why 
        it was taking them over a year to pay my bills.  An now that the 
        hospital, and soon the doctors, are requesting payment in full 
        within 5 days or they will get a collection agency involved, thus 
        affecting my credit!
    
    	HMO tells me that once they are notified of a bill, it takes them 
        about 35 to 40 days for them to process and pay a bill. If that is 
        so, then why is it taking them over a year to pay my bills!!  I 
        have informed HMO of these bills:
    
    	o   By mail, when we first received them from the doctors, or 
            hospital, over a year ago...
    
    	o   In person.  Last year The HMO/Maxicare office was located at 65 
            S. State Street, which is the same building where I am on 
            residency for a DEC customer.  Several times, I personally took 
            the bills to the HMO office and personally handed it to an HMO 
            Consumer Affairs Rep.
    
    	o   By mail again.  During the summer of 1988 (June or July of 
            1988), the HMO/Maxicare office moved from 65 S. State Street in 
            downtown Columbus, to way up in North Columbus (I believe they 
            were tired of my visits).  So I mailed the bills to them.
    
     	o   By mail again (The cost of postage stamps is adding up)!!  I 
            mailed them the bills again in September of 1988.
    
    
    You would figure that benefits should not cause mental strain. 
    
    I have brought this issue to the attention on my Unit Manager, the 
    Personnel Office at the Columbus, Ohio Office, and today to the 
    attention of the EOD District Manager.  I thank God that I have given 
    Jesus Christ control of my life, because if I was in control, ooooh I 
    just don't want to think of what I would do after experiencing what I 
    have mentioned in this note...

    Daryl 
    

        Just out of curiousity, when you have mailed the bills to them,
        have you kept copies, and sent the bills by registered mail,
        with a return receipt requested?
        
        Under the circumstances, I think you should notify the people to
        whom the payments are owed that you are covered by this HMO, and
        that it's the responsibility of the HMO to pay the bills; that you
        have forwarded the bills in a timely manner to the HMO; and that
        they should contact the HMO directly with regard to their
        payments.  If you do this, you can at least *hope* that they will
        go after the HMO, instead of after you. 
        
        Depending on the amount of money involved, you might be able to
        sue the HMO in small claims court to recover the moneys you need
        to pay to the creditors that they should be paying on your behalf.
        If nothing else, this would get their attention.  But it would
        also put you on their list of non-favorite people, so you might
        not want to do it unless you were planning to switch to another
        HMO or to private insurance.
        
        Note:  I certainly wouldn't try to defend this particular HMO's
        business practices, which, if this account is true and correct,
        are shady at best.  I would, however, remark that this isn't a lot
        different from what some physicians and hospitals run into trying
        to collect from the major health insurers. 
        
        Tom

>        I would, however, remark that this isn't a lot
>        different from what some physicians and hospitals run into trying
>        to collect from the major health insurers. 
        

Sorry Tom, I disagree.  -.2 makes a good point about a fundamental 
difference:

	HMOs can have internal cash flow problems, this can delay 
	their payment of bills (remember, they're a FOR PROFIT 
        business, they make money every day they delay a payment)


	JH is merely an administrator.  They are not for profit, and
	do not get rewarded by <independently> finding ways to pay
	out less, all they do is execute DIGITAL policy, and spend
	DIGITAL's money.

    I use JH but I am sure that for the HMO user it is the same for
    doctor and hospital bills.  In actual fact, as far as the hospital
    or other is concerned, you are responsible for the bill.  This means
    that you must watch what your insurance does and take a hand when
    things go wrong.  In other words, I have been arm twisted into paying
    bills I knew JH would cover.
    
    I must say I have been fortunate in having JH in that on one occasion
    my wife and I inquired of doctors in several states for referal
    to a specialist.  We used the specialist most of the doctors suggested
    who was only 60 miles away.  It is not at all clear we could have
    made this selection under an HMO.
    
    Chuck