Conference 7.286::digital

Go back and read the notes of exactly a year ago when the exact same 
transition took place back east, here in the Greater Maynard Area.
I would have thought they might have learned something from last year, and 
prepared the rest of you a little earlier than November to make your 
transition, which (I expect) is scheduled for the first of the year.

From collected experiences:  read EVERYTHING, get IT ALL in writing,
and KEEP ALL YOUR DOCUMENTATION.  Your HMO(s) WON'T be ready to 
accommodate you on January 1st.

But go back and read the 100's of replies of October 1990 through 
February 1991.

    
    What we pay at Digital for health insurance may seem high,
    especially since Digital has kept the co-payment artificially
    low for so long, thus sheilding employes from the "real" cost
    of insurance, but as employees WE still pay below the national 
    average for insurance paid by most employees.  
    
    On AVERAGE nation-wide, employees pay $76.00 a month for health care.   
    Many companies, even those as large as DEC, IBM... can no longer 
    afford to carry the hugh financial burden of health care costs.  
    Such high costs have resulted many companies raising their co-payments
    and/or premiums!  
    
    So who's to blame?  Well you can bet that your insurance company is 
    still making MEGA bucks while putting the squeeze on the rest of us!
    
    

    > Well you can bet that your insurance company is  still making MEGA
    > bucks while putting the squeeze on the rest of us!
    
    My understand is that DEC self insures.  That is, it doesn't pay an
    insurance company to insure us, it insures us itself.  It pays an
    insurance company to the paperwork.  
    
                                    August G. Reinig

    
    Digital is self-insured and the plan is merely administered by John
    Hancock.  If anyone is putting the "squeeze" on us, it's Digital.
    

    ... I thought "Ski High Healthcare" was referring to healthcare choices
    offered in Colorado Springs ... Never mind ...
    
    :-)

    Personnel sent out the rates here also, and I've got a question
    which someone may be able to help me with.
    
    The rates listing was divided into point of service and non point
    of service areas.  I live in a point of service area.  I am currently
    in an HMO (which I find acceptable) which is listed only in the
    non-point-of-service listing.  There is only one HMO in my area
    which is listed in the point of service area, and previous experience
    has shown that it is TERRIBLE.  
    
    So my question is:
    
    Does anyone know if this round of "health care choices" is limited
    only to those listed under point-of-service if you live in a point
    of service area?

In .2, it is said that the national average for health care insurance is 
$76 per month, and that we're BELOW the average. Well, maybe those of you
in HMO's, but I cannot go to an HMO; the one in my town stinks. (Well, its OK 
if you don't get sick.) I'm paying $34 a week - $136 per month, or almost twice
the average. 

    Rumor here (Mass) is that the cost for employee only is going to
    high 20's or low 30's and that family coverage is going to be over
    $50 a week.  Now for ee's making over $50,000/year this isn't too
    bad.  For ee's like me making less than $25,00 a year, an extra
    $100/week will force me to get a part time job just to have
    health insurance or drop health insurance totally. HMO's aren't an
    option to me as it would require me to stop seeing my curent
    doctors.
    
    Linda
    

    -1 that should read "an extra $100/month", not a week.
    
    I wish that Digital would stop forcing people into HMO's.  
    
    linda
    

    1992 Rates in Eastern MA	Indiv/Family
                            
    Fallon HMO			$0.49	$ 5.93
    Fallon HMO Elect		$2.18	$11.99
    Harvard HMO			$2.84	$15.39
    Harvard HMO Elect		$4.53	$21.45
    Tufts HMO			$4.08	$18.56
    HMO Blue (Montachusett)	$1.78	$ 9.18
    Bay State HMO		$5.09	$17.83
    DEC Plan 1			$16.84	$44.35
    DEC Plan 2			$21.98	$59.00
    
    

How about the rates for other Fortune 500 companies with 100,000+ employees.
Last time I looked there was a BIT more to Digital than Eastern MA.

-dave

re .11:

Since the only rate information that's generally available to ordinary
employees is what's available to *them*, I don't see why you're upset
that .10 entered the rates that he knew about.

I believe that the Digital Medical Plans have only two rate schedules:
the high one for those in POS areas and the lower one for those in non-POS
areas.  I haven't received my rate package yet, but if my deduction for
DMP 1 family coverage is up from $17.50 to $44.35 a week, I'll be very upset.

    My increase in cost for family plan 2 last year was $17, for a total
    cost of $34 per week. Now it is going up another $25 to $59 per week?
    We are being driven out of tradional health plans! The deductable was
    $225 per person.
    
    Is there an HMO for Lahey Clinic?
    
    -Dick

	Yes, there is an HMO for Lahey.  I'm in it.  My current deduction is
under $2.00 ($1.74 I think) a week. (Individual, not family.)  I haven't seen
any new rate information.

						--Doug

    How can DEC put out a memo saying that their cost had increased 30%
    last year and then hit us with a 300% increase. They just took $2000. a
    year out of our pockets.
    

    Here in Minneapolis these are a sampling of the costs:
    
       Plan                     Individual (weekly)       Family
    
    Medica Primary (my HMO)       $0.00 (zip)             $7.57
    MedCenters (HMO)                .20                    7.95
    Group Health (HMO)             2.65                    8.95
    DEC Plan 1                    16.34                   44.35
    DEC Plan 2                    21.98                   59.00 (whew!!)
    
    
    Gene.    

    In Southern California, we have not yet received our re-enrollment
    information with the new pricing.  I hope it does not skyrocket.  
    Both my husband and I are on Plan 2 (we are both DECies) and each
    of us has a separate individual plan.  Is this the wrong way to have
    health coverage?  Should we combine into one "family" plan?  Any
    replied would be appreciated.

	I knew that there was a planned increase in our medical insurance
	in the works ... BUT, WOW!!! ... I HAD NO IDEA THAT IT COULD BE SO 
	MUCH!

	I was forced to live with the increase last year because of a family
	member that had undergone cancer surgery and the Physician not being
	on the HMO list. Now where do I go from here? It isn't that I have 
	anything against HMO's ... I just want to continue with the same 
	surgeon that performed the original surgery.

	This increase cannot be real ... how can I possibly keep up with a
	200+% increase in insurance rates in a two year period when my
	salary (for all practical purposes) keeps decreasing each year as is.

	As far as John Hancock being the administrators of DIGITAL insurance
	... they are the worst, most incompetent group of people that I have
	ever dealt with in my life. Their review board is a complete joke.

    Re .-1
    
    You need to persuade your doctor to join the HMO. There are several
    HMOs that are really just a loose association of doctors. Baystate is
    one.
    
    As you can tell DEC is very strongly financially incenting you to join
    an HMO.
    
    Dave

    The pricing here discriminates against you by geography. The new
    pricing in Seattle, Washington for Plan 2, Family is $59.00 per week
    because there is an HMO locally referred to as "Group Death" while in
    Spokane, Washington, the same coverage is $27.00 per week instead of
    $59.00. What gives?????

    Re .-1
    
    Hello Steve...
    
    You are dead right location does make a difference. Basically if there
    is an HMO choice DEC is saying "JOIN IT". But we will give you a sort
    of choice. If you want to pay megabucks you can still stay on John
    Hancock.
    
    Where there is no HMO choice DEC is charging a lesser amount for John
    Hancock because there is no choice. In other words they're making it
    closer to the cost of an HMO had there been an HMO in your area.
    
    As I said in an earlier note you're being pushed towards an HMO.
    The company says it pays the same amount for your medical coverage
    whether you go HMO or JH. JH costs you more because HMOs are cheaper
    overall. Is this because individual doctors/hospitals throug JH are
    ripping you off or because the standard of health care at an HMO is
    inferior. Everybody has an opinion on this one, you decide.
    
    By the way I joined an HMO last year (Harvard Community Health Plan)
    and I've been very pleased. I've even been in a hospital not controlled
    by the HMO (I was knocked out in a PAINTBALL game and ended up with
    a minor basal skull fracture and internal bleeding in my ear). I was treated
    well at the hospital and the HMO had no problem in referring me to an
    ENT specialist without even having to see the primary care physician.
    They even approved about 21 Xrays of the head and a CAT scan when I
    first entered hospital without a fuss. If I'd been with JH I'd probably
    still be sorting out all the various bills.
    
    Dave

    re: -1
    
    I have been using HMOs for about 8 years now with no real problems. My
    family and I have a couple of doctors we are happy with and request
    them when we have to go. A couple of years ago my youngest daughter
    cracked her skull and had emergency "everything". Never so much as a
    boo from the HMO. They took care of everything. Never saw a single
    piece of paper regarding my daughters accident, hospitalization, and
    recovery. Couldn't be more pleased.
    
    One thing of note. The HMO business here in MN is EXTREMELY
    competitive. There are many to choose from and they tend to offer extra
    incentives to choose them. One of the incentives is agreements with
    local institutions to treat the HMOs patient in an area of expertise
    the HMO may not have or cannot afford. I am talking about world class
    institutions like the Mayo Foundation in Rochester or the University of
    MN Childrens Hospital. I guess it depends on your local situation.
    
    Gene.
    Rochester).

    	Fact.  Only ONE HMO is offered in Seattle, and I had them for
    1988/89 and couldnt leave fast enough.  Now I am being FORCED back
    against my will and pocketbook.
    
    the Air Force had better healthcare
    
    Mark

    	Do any HMOs out there offer Chiropractic treatment? Our two
    local ones do not. So I have a choice? I see...
    
    	I loved the Benefits BULLetin I got last week- it broke the
    news that the Plan 1 and Plan 2 deductibles are going up $50/person
    $150 family, but no mention of the weekly cost increase since this
    is location variable. How convenient. At least I have time to bend
    over slowly (lest I injure my back) before the big bang.
    
    Phil
   

    
    
    	Two of the plans offerred to me in Central Mass. are under HMO 
    	Elect (formerly Health Net). In these plans you belong to an HMO 
    	but can see a doctor not in the HMO and have 70% of the bill taken
    	care of.
    
    	So if you or a family member ocassionally see a specialist you 
    	really like that's not affiliated with a particular HMO but the rest 
    	of the family are not particularly attatched to to a doctor you can
    	sign-up for the HMO Elect plan and possibly save a few bucks that
    	way.

The rates for Cincinnati & Dayton are:

                                1991                            1992
                          single    family                single    family
Name of Plan               rate      rate                  rate      rate
------------              ------    ------                ------    ------
DEC Medical Plan 1        $ 0.00    $ 8.50                $ 0.00    $ 9.79

DEC Medical Plan 2        $ 4.50    $20.50                $ 5.52    $23.92

CYO/HMO Choice Care       $ 2.97    $15.31                $ 0.00    $ 6.04

DYO/HMO Western Ohio      $ 2.87    $15.14                $ 0.00    $ 8.53

Opt-Out                        $20.00                          $21.85


Personally, I have had Choice Care this year, and have been very happy with
it.  

Frank

re .17:

If you're in a POS area, you'll probably be paying 2*21.98=43.96.
If you choose family coverage and one of you opts out, you'd pay
59.00-21.85=37.15.  I think you'll find even more advantage to
family coverage in non-POS areas.

DMP 2 is better than DMP 1 only in special circumstances -- when
most of your medical expenses are hospital and surgery related.
If you're trying to choose between DMP 1 and DMP 2, you should
take into account the out-of-pocket maximum as a limiting factor
on your hospital/surgery co-payments.

As DEC pushes more people into HMOs, DMP rates will continue to
skyrocket.  The only people left in DMP will be those who require
more services.

    To see your rates on-line you can use VTX.  On Monday, November 18,
    the Health Care Choices by Zip Code VTX infobase will be available
    to all US employees.  You can access this infobase a few ways: 
    
    	-  $VTX HCCZ_US
        -  or thru the Corporate VTX Library under Employee Benefits
    
    Select option 2, enter you zip code, and the health care choices
    available to you will be listed.  You can then select a detailed
    benefit comparison which lists details about the vendor, including
    prices.
    
    If an HMO elect is available for your zip code, then you will see
    DEC Plan 1 and 2 within HMO elect (higher prices).  If no HMO elect
    is available, then you will see DEC plan 1 and 2 outside HMO elect
    which lists lower prices.  Therefore, DEC only has four rates for
    the Plans 1 and 2.
    
    I hope we all use this infobase so Personnel will get rid of the
    hardcopy.  Imagine the cost to print the books each year.
    
    Hope this helps.
    
    Chris
    
    FYI... I am not responsible for te Health Care business issues.
    I was the programmer who coded the VTX infobase.
    
    

    Looks like digital's two tier medical delivery system 
    	HMO
    	Private
    can perhaps be likened to the Health Delivery System that I understand
    the U.K. has.
    Namely, one level of service for those in the National Health Care
    system and a different level of service for those who are capable of
    paying for and chose to use the private Health Care System.
    Be interested in hearing some comments from our British/European
    cousins on this.
    
    
    					herb
    

    I just got off the phone with the Mass. Insurance Office.  Now I know
    why Digital decided to have it's own insurance policy.  Any company
    that is it's own insurance company per se is not regulated by any
    state laws and can charge whatever it wants to for rates.
    
    GRRRRRRRRRRRRRRRRRRRRRRRRRR!!!
    
    Linda
    

    
    
    This is not a new problem.  The entire U.S. economy is affected.
    ALL companies, not just Digital, are being pushed in the direction
    that some are saying Digital is pushing us i.e. HMOs.
    
    Actually, Digital is doing this the fairest way it can i.e. pay
    a flat amount toward health care and the employee decides what
    type of plan to apply it to.
    
    fwiw,
    Steve
    
    
    

	1992 Comprehensive Health Care Benefits

					Weekly Costs
					Individual / Family

	Maxicare of SC (HMO)		$7.72 / $22.66
	Companion HealthCare (HMO)	$0.00 / $ 1.00 *** NOT A TYPO ***
	DMP 1				$0.00 / $ 9.79
	DMP 2				$5.25 / $ 23.92

Companion HealthCare weekly deductions for 1991 were approx. $2.50 for 
individual and $11.50 for family coverage. DEC has drastically reduced 
the weekly costs for this HMO while increasing costs for every other option.
The levels of coverage that Companion will provide in 1992 is almost identical
to 1991 levels.

    I'll probably have to switch to an HMO because of cost.  What I can't
    understand, and it really rips me, is why a family of two has to pay
    the same as a family of 4 or 5 or 6.  I have nothing against larger
    families but I can't *afford* to help pay for their health care, if
    that's in fact what I'm doing (and it sure looks like it!)
    
    ann

    So we will put them on welfare or send them through bankruptcy.  You'll
    pay either way.  Maybe we can study Chinese law.
    
    Sorry, but this is a sore spot with me,
    
    Mike

    It is interesting that we get less than a month to make our decisions. 
    Doesn't give you much time to study up on the HMO's that are being
    offered.
    
    Mike

Can the basenoter or a moderator *please* change the "Ski" in the title?
Either that, or take the discussion to the SKIING notesfile.

	My buddy in NY just opened his package and its $23 for JH plan#2.
He as many HMOs available too.  Why $59 for one HMO in rainy Seattle?.

(cuz we're sick all the time with colds?)

Mark

        Re: .29

        Why bother with a VTX infobase that won't be operational until
        after most people have received their rates in the mail?

>    I hope we all use this infobase so Personnel will get rid of the
>    hardcopy.  Imagine the cost to print the books each year.

        Why bother to use the infobase once I've been mailed my rates?

        					B.J.

    If you have "HMO Elect" available in your area, an interesting
    calculation is to see whether it is cheaper than DMP1 if you
    sign up for the Elect plan and then ignore the HMO and continue
    to see the doctor of your choice.
    
    Here in Southern NH the family rate for the HMO-Elect is $920/yr,
    with $300 deductable and 70% coverage above that to a limit of
    $3000 per person for going outside.
    
    The DMP1 plan is $2306/yr, with $250 deductable and 80% above that
    to a limit of $1800 per person.
    
    Say your regular bills are around $300 per year for seeing the
    gynecologist that you *will never leave*, x-rays, and so on.
    
    Igniring for the moment that gynecological visits, pap smears, and
    mammograms are treated specially, lets just take that $300:
    
    	Under DMP1 you pay $2306 + $250 + .2*50 = $2566.
    	Under HMOE you pay  $920 + $300         = $1220.
    
    So you are ahead by $1346 per year to go with HMOE.
    
    If you had tremendous bills and pushed both systems to their limits,
    and *never* used the HMO facilities, the max costs are:
    
    	DMP1 = 2306 + 1800 = $4106.
    	HMOE =  920 + 3000 = $3920.   A win by $186.
    
    If more than one person maxes out, it goes the other way:
    
    	DMP1 = 2306 + 5400 = $7706.
    	HMOE =  920 + 9000 = $9920.  A lose by $2214.
    
    To reach those limits your total bills under DMP1 would have
    to be $24,000, and under HMOE they would have to be $27,900.

    
    I wonder how big a raise and promotion the sleazeball who planned 
    this will get for cutting DEC's operating costs!!
    
    Ok, who do we send hate mail to?
    
    -Ed
    

    
    THE DMP costs, at least here in GMA, appear to be pretty much in line
    with a 50% contribution to BC/BS in a group plan. Not what I'ld call a
    great deal. I've seen contribution breakdowns by percentage for HMO's
    and they're always cheaper. The bottom line is that managed healthcare
    is cheaper. The problem is that this doesn't always make it better.
    
    I belong to an HMO because I've got kids and the coverage is actually
    better for me. I abhor what HMO's have done to the independent
    physician and the independent pharmacist.
    

    Freaking OUTRAGEOUS!!!
    
    Does anybody wonder why Sen. Wofford did so well in the Pennsylvania
    race last week?
    
    Maybe this is Digital's way of getting the employees to take the year
    off to campaign against the incumbent administration!  It's
    inconceivable to me that any national health plan can be more
    inefficient or costly than this!  (Well, if you try, and emulate Poland
    maybe, but I'm talking about the Western world.)
    
    From $17 to $59/week in two years:  How many people have gotten
    $42/week in after-tax raises in all this time?  My take-home pay is
    rapidly approaching zilch.  I already work a second job plus freelance
    income.  I can't join a Healthy Members Only plan since we've got some
    issues that have required treatment by some Boston specialists who
    obviously aren't working for HMO pay!  Yes, they all charge too much. 
    So does Kamikaze General.  Maybe we'll move to Canada.

    .24 raised a point that concerns me.  When HMO's first came to
    the Atlanta area I joined the one and only one being offered.  At
    first the service was pretty good, but it declined with rapid speed
    and I left as soon as I could re-sign with JH.
    
    That was almost 10 years ago.  Since that time I've developed
    severe back problems; a chiropractor (who basically takes a holistic
    approach) has helped me tremendously.  The chiro can't keep me pain
    free (but he keeps me from crawling on all fours); and at least I
    don't have to take all the meds handed out today for arthritis, meds
    that were clearly leading to bleeding ulcers.
    
    If the intent of HMOs is to make it easier to get treatment before
    a condition gets too severe, wouldn't you think chiropractic care
    would be a benefit?  If I were to re-join an HMO I'd probably be 
    given enough anti-inflammatories and painkillers to guarantee me
    a stay at the Betty Ford Clinic...or I might be pushed into back
    surgery that I'm not convinced I need or want at this time.
    
    When Atlanta gets pulled into the HMO network (and I'm sure that
    day is coming), I wouldn't mind paying a portion of a chiropractor's
    charges......but I know I couldn't afford his full fee....not at
    the rate of 2 visits a week.
    
    Are there any HMOs out there who do support chiropractic?
    
    Karen
    

    RE: .44-
    
    	Amen sister. Amen.
    
    	So let's hear it- any HMO's with Chiropratic care?
    
    Phil

    
    Re: several points
    
    It was pointed out that the average cost of health care insurance
    is $76 per month.  The monthly premium for HMO Elect at $17.69 per
    week is $76.60 or precisely at the average.
    
    I hear a lot of anger here.  People are relating it to how our raises
    have not gone etc. and how Digital appears to be mistreating us.
    I suggest, however, that any of you who have friends, relatives,
    etc. who work in the health care industry start talking about this
    issue with them and develop a picture of what is going on.  My wife
    is a registered nurse who works in the Concord Hospital in Concord,
    NH.  She has given me quite a bit of insight into what goes on in
    that environment.
    
    I am *not* trying to invalidate any anger or concern about Digital's
    part in this, but if any of you take my suggestion you may see,
    as I have, that this is a very serious problem and venting our anger
    at the company is simply not going to help.  The health care industry
    is out of control.  In this case, the rates are the evidence and
    Digital could be better viewed as the messenger.  We should be working
    *with* the company to collectively bring some influence on this problem
    and not wasting our energy in conflict with it.
    
    fwiw,
    Steve
    

    Has anyone in the Chicago area received their new rates? Currently my 
    family is enrolled in DEC#1 (JH) and we have no other (spouse)
    insurance. How are the local HMO's. Which hospital's honor which HMO
    and how are you treated. Any information would be appreciated since I
    have a limited time to compare and/or not switch.
    
    ses

    My wife work at M/A Com, Inc. They have similar plan as Digital Medical
    plan 2 and is called M/A Com Comprehensive plan. It covers routine
    physical, unlimited IVF, etc. Their premium this year went down by 8%.
    They have only $200 deductible per person and maximum $400 for Family.
    Premium for family coverage in this plan is only $16.40/Week.
    
    Another note. Premium for Medical Coverage went up by atleast 2 fold
    while Opt Out pay out only increases by mere $1.85. Does this make
    sense?? Certainly not to me.
    
    Bharat

re .47:

I suggest asking in POBOX::CHITOWN.

re .48:

Interesting.  Any idea how MA/COM can offer better benefits than DMP2
(unlimited IVF vs. DEC's limit of 5 attempts) at 1/3 the cost to the
employee *and* reduce the cost to the employee?

The following is a copy of a memo to the Seattle Personnel Office. Therefore,
the rates and HMO is limited to our choices here in the Pacific Northwest:


                  I N T E R O F F I C E   M E M O R A N D U M

                                        Date:     12-Nov-1991 05:35pm PST
                                        From:     Albert J. Serpas
                                                  SERPAS.AL
                                        Dept:     SWS
                                        Tel No:   DTN: 545-4293 [(206)-637-4293]

TO:  Remote Addressee                     ( ROGERS.PATTI @SEO )


Subject: Why not a DMP3?

Patti:

        Could you please forward this to the appropriate person(s) in
"Corporate". Please let me know to whom you forward this.

        My idea is basically to have ANOTHER choice. One with HIGHER
deductibles and HIGHER out of pocket expenses and a HIGHER co-payment.

        If you look at the numbers, my proposed DMP3 would be IDENTICAL
OUTSIDE the HMO. There is NO HMO fee. So therefore, if Group Health is
$11.20 for a Family, then DMP3 would be $17.26 - $11.20 or ONLY $6.06
for a Family. [HMO Elect minus the HMO]

        Hey, I even get a break and save ($8.50 - $6.06) $2.44 a week.
I get a PAY INCREASE!!!



Plan                                               Group        G.H.
Features        DMP1      DMP2      DMP3           Health       Elect

Deductible      250/750   250/750   300/900        N/A    300/900 OUTSIDE G.H.

Co-Payment      20%/20%   0%/20%    30%/30%        Some   30%/30% OUTSIDE G.H.

Maximum         1800/5400 1800/5400 3000/9000      N/A    3000/9000 OUTSIDE G.H.

Individual      16.34     21.98     (3.93-2.24)     2.24    3.93
                                        1.69
Family          44.35     59.00     (17.26-11.20)  11.20   17.26
                                        6.06

The Proposed DMP3 is the HMO Elect WITHOUT the HMO!!!!

It sounds like the BEST deal to me!

I will be posting this to the Conference also.

Thanks.

Al

    My husbands's company (MA) recently changed form Mass BC/BS to Cigna.
    Cigna's menu plan offers better benefits at lower costs than JH.
    We've also found that Cigna is more responsive, reimbursements are
    quicker, and there are fewer foul-ups, etc., than we had with JH.
    
    Perhaps it's time for a change.  I'm particularly bothered by the
    opt-out discrepency as mentioned in one reply.  Even though I
    have chosen to opt out, and receive no benefits from Digital, it
    would seem that I'm being asked to subsidize the plan somehow.
    
    

re .50:

My guess is that the reasoning behind POS systems like HMO Elect is that
people *will* use the HMO for most of their needs, and that the out-of-HMO
expenses will be reduced because of that.  Thus, I doubt if the rates for
your proposed DMP3 would be the difference between HMO Elect and the
corresponding HMO.

It's all a question of how people use the various medical plans.  If people
in HMO Elect do everything outside the HMO, the rates will rise faster.
Likewise, when DEC pushed people into HMOs last year, the handwriting was
on the wall for future DMP rates.  The higher DMP rates go in comparison
with HMO rates, the more likely it is that those who stay with DMP will
have a lot of medical expenses.  The rise in DMP rates is a vicious cycle.

This shift of people with lower medical needs from DMP to HMOs may also
explain the apparent discrepancy between the large increase in DMP rates
and the small increase in the Opt-out payment.  If the Opt-out payment
represents DEC's subsidy of our medical plan, then the subsidy is up
slightly, but the costs of DMP are up considerably more.

    At these prices I may as well go to Blue Cross.
    
    karl

    .34 mentioned the unfair nature of equal payment for unequally sized 
    families.  An earlier note on the "redefinition of family" addresses
    this (FYI). I think each employee should be offered x% of their salary
    as "benefits" to be used as the employee sees fit.  Insure yourself,
    your wife, kids, parents, girl/boy friend, strangers, whatever, just
    don't exceed the total you're allowed to pay.  Or, just insure yourself
    and take extra vacation, or a big fat life insurance policy or any of a
    list of benefits.  Just don't exceed your alloted sum.  You're married
    and have 12 kids?  Well, looks like most (if not all) of your benefits
    money will be spent on health insurance for the kids, but....
    
    ... DON't EXPECT THE REST OF THE WORLD TO SUPPORT YOUR KIDS!
    
    .44 abhored what HMOs have done to private medical practice.  Well,
    maybe it's time for them to join an HMO.  I'm afraid it's a dog-eat-dog
    world out there.
    
    .44 and .24 (I believe) mentioned chiropractic care.  I've got several
    stories of sports related injuries I've suffered that the orthopedist
    wanted to treat with physical inactivity and painkillers.  The
    chiropractor on the other hand took the time to understand the injury
    and TREAT THE PROBLEM, not the symptoms.  I know I'm not supposed to 
    solicit here in the conference, but I'll recommend a really excellent 
    chiropractor in the greater Boston Area that specializes in sports
    related injuries through E-MAIL (CNTROL::DGAUTHIER).  Too bad the AMA
    is too stubborn to recognize or take the time to understand orthopedic 
    treatment that works.  It's too bad that this treatment which costs a
    small fraction of the mainstream approach is not covered by most health
    insurance plans.
    
    Finally...
    
    I've heard a lot of flack about the rise in health insurance costs here
    as DEC. I've heard a couple things about this rise being the same, if not 
    less, that what the industry's experiencing.  The problem, I'm afraid,
    is health care costs in general combined with a sagging computer
    market.  
    
    National Healthcare?  Sure, as long as that's the only option.  The
    double standards we see in England are just setting up a caste health
    care system where the rich recieve good treatment and the rest of us 
    get the veteranary treatment.
    
    Dave
     

re .52:

>    At these prices I may as well go to Blue Cross.

I'm on the board of a non-profit organization with one full-time employee.
Blue Cross costs us a cool $8000 or so.

    Ditto re: Blue Cross.  It should not be viewed as an inexpensive
    alternative.  Nor should any other 'independent' insurance company be
    viewed as a place where you could buy cheap insurance.  I have two
    friends, one who is paying $500 some odd dollars per quarter for a Blue
    Cross policy that will only cover medical costs while in hospital, and the
    coverage is only 80% of the bill.  I have another friends who is paying
    about $200 a month for similar coverage, but it is not through Blue
    Cross.  Both policies are single, not family coverage.
    
    The rates that DEC is charging are not unreasonable...even though I'd
    prefer that they not be increased.  There are a myriad of reasons why
    health insurance premiums, regardless of the insurer, are going through
    the roof.  
                           
    Laura

    I think that it really stinks that we are forced into HMO's when the
    one that DEC prefers in my area has a lousy reputation among personnel
    professionals at other companies and among medical professionals!  Amd
    I know too many people that were not given proper medical care because
    the HMo's were trying to save money by not throughly testing.  HMO's
    aren't necessarily the solution to the health care crises, their just
    pushing the pendulum in the other direction!!

    Re: 34, 53
    
    The insurance company actuaries have found that medical claims do not
    rise in proportion to the number of children in a family.  The claims
    payouts for a family with one child are about the same as the payouts
    for a family with four children.  Insurance rates quite properly reflect
    this fact.
    
    More than fifty percent of health-care dollars are spent on people in
    their last six months of life.  Most of these people are over fifty
    years old, and suffering from terminal conditions for which recovery
    cannot be expected.
    
    Another large percent of health care dollars goes to dialysis programs
    and related organ transplant programs (kidney, liver).
    
    The other big percentage is care for victims of automobile and motorcycle
    accidents.
    
    These catagories overlap to some degree.
    
    A major cost of health-care (to the providers) is malpractice insurance
    premiums.  Only the lawyers gain any certain benefit from this end of
    the system.
    
    If you are not old, not an aggressive driver, not a health care worker,
    or not a lawyer, you are probably not getting as much benefit from the
    current system, as you once did.

re .58:

Those statements might be true for all health care dollars spent in the U.S.,
but that doesn't mean they're true for Digital employees.  For instance,
I doubt if DEC spends a lot on people in the last six months of life --
aren't most such people on Medicare?

The smiley is for "What the heck do I know - I'm only readin' the fine print".
Here's an example:
From the Matthew Thorton Health Plan's Certificate of Coverage (This is the
detailed documentation about what is/isn't covered, etc. Samples weren't out on
display but I got one when I requested it):

Section B: Definitions, #16: Membership Type
MTHP offers three types of memberships:
  a. Single
     Coverage for the Subscriber only

  b. Two-Person Family
     Coverage for the Subscriber and one Family Dependent (not offered through
	some Groups.)

  c. Family
     Coverage for the Subscriber and one or more Family Dependents

Group is defined in Section B as: "An employer or other organization that is
	acceptable to MTHP and that enters into a Group Contract with MTHP."

So now someone will ask "Why don't we have that option?" Well, I did, too. My PSA
didn't know but pointed me to someone in Corporate Benefits. I'll add another
reply with what I discover.

					2_person_family_Trace

    re .57  John Hancock is not Digital's insurance provider.  It is only
            the administrator.  Digital is the provider.
    
    re. insurance rates. Yes, these are unfair.  I used to work for an
        insurance company that had staggered rates, ee only, ee+ spouse,
        ee, + 2 deps, ee + 3 or more deps.  ee only paid the lowest and
        the rates increased with ee + 3 or more dependents paying the
        highest rate.
    
    
    One consideration is using the opt-out program.  Take that money
    and buy your own insurance.  I found an individual plan that has
    $500 deductible and straight 80% of everything.  Taking the
    amount that I would get from opting out plus what I currently
    pay for insurance and I would actually have $10.26 more a month
    in my paycheck than I do now. It's not a great plan, but it's
    an option I have to consider as well as maybe going to an HMO or
    HMO elect.  I can't affored to pay $88/month without working 
    every night and all weekend.  
    
    Linda
    

>>    The insurance company actuaries have found that medical claims do not
>>    rise in proportion to the number of children in a family.  The claims
>>    payouts for a family with one child are about the same as the payouts
>>    for a family with four children.  Insurance rates quite properly reflect
>>    this fact.

Sorry, I find it hard to believe that the number and magnitude of health
insurance claims is no longer a function of the number of people covered
when that number exceeds 3.  Given that an average kid costs $X in health
insurance claims over the course of his/her childhood, multiplying this
cost by an increasing number of children is just going to have to increase
the total cost.  Seems like simple math to me.


>>    The other big percentage is care for victims of automobile and motorcycle
>>    accidents.

And if I had a wife and 10 kids in the minivan? Tell me again about how it
costs the same to treat 12 victims of an auto acident as it does 3?

>>    Another large percent of health care dollars goes to dialysis programs
>>    and related organ transplant programs (kidney, liver).
 
Statistically speaking, every child in a family has a certain probability
of needing an organ transplant.  If you multiply that probability by a
number greater than 3.....  get my drift?
   
>>    More than fifty percent of health-care dollars are spent on people in
>>    their last six months of life.  Most of these people are over fifty
>>    years old, and suffering from terminal conditions for which recovery
>>    cannot be expected.

This I believe, but be careful.  When John Silber stated this fact and
suggested an obvious remedy to skyrocketing healthcare costs, he almost
lost his shirt.

>>    A major cost of health-care (to the providers) is malpractice insurance
>>    premiums.  Only the lawyers gain any certain benefit from this end of
>>    the system.

Touche'

As much as I don't like him, I have to agree with Donald Trumf when he asks 
that the plaintiff of a lawsuit assume legal expenses if the defendent is 
found innocent. I have a feeling that there'd be a drastic decrease in the
number of bogus malpractice (as well as other) lawsuits if this were
straightened out to be fair.  But, let's not forget that our legislators were 
all once lawyers, as well as the judges and existing body of lawers... all 
sleeping in the same stinking bed.  YUK!  The one cheerful thought I have
on this is the thought of a lawyer suing another lawyer for malpractice AND
the defending lawyer claiming a countersuit for the same reason.  A leech 
sucking on a leech.

Dave
(not a lover of lawyers)

                                                             

    re: 17
    
    Yes, the Southern Calif rates have increased, some people have received
    their info today in the mail. Yes the other than Hmo rates have went up
    a lot. I'm already on the HMO plan and the increase wasn't anything at
    all.
    
    

	The higher JH rates only apply to "HMO SELECT" areas.

they are...

	Albuquerque		Burlington VT
	No and SO Calif		Denver
	Detroit			Western and Southeastern MA
	Minneapolis		Philadelphia
	Rhode Island		Seattle (me)
	St Louis		Tempe
	Washington DC	


	Why not NY, Chicago, NJ, Miami...."because they dont have HMOs that
	meet DECS high standards"  is what were told by HR.

mark

The following question concerning the Digital Standards was asked the local
Human Resources department on November 1st. I was told that the questions posed in 
Seattle would be forwarded to "Corporate" for "future considerations". 

Can anyone out there share the information or point me to its location??


	The Benefits Bulletin, For U.S. Employees of Digital Equipment 
	Corporation, that I received in the mail yesterday state the
	following on page 4:

	"..our health care efforts will continue to stress quality -
	the quality of the health care services available to you,
	the quality of the selected health care providers, and the
	quality of out benefit programs."

	It further states: "...Digital set forth an extensive set of health
	care standards for quality...By developing and establishing Digital
	Standards by which our managed care providers are selected, ...."

	Are the 'Digital Standards' used for selecting available for
	employees to comment on?

	Al

    Re: 59
    
    Most of the DMP payouts are probably not for terminal care (John Hancock
    would know for sure).  But it does not matter.  The enormous amount of
    money that is spent in this area raises the costs in every other area
    of medicine.  There are a limited number of health care providers, and
    a lot of claims on their attention.
    
    Re:62
    
    It is logical to assume that medical costs will rise with the number of
    children in a family, but it is not so, when you look at a large number
    of families.  Check the statistics.  I have no good idea what the
    explanation is.
    
    The fact that something is logical does not make it true.
    
    Major corporations (like DIGITAL) are no longer willing or capable of
    protecting their employees from rising health-care costs.  "Health
    Insurance" has become a form of taxation that transfers wealth from
    some pockets to others.
    
    I don't like the new "choices".  I would at least like to choose from
    more than one HMO.  I would like the option of a very high deductable
    insurance coverage ($2000) that would handle catastrophes, like a car
    accident.  These things are possible.  I am angry that they are not
    being done.

	>Why not NY, Chicago, NJ, Miami...."because they dont have HMOs that
	>meet DECS high standards"  is what were told by HR.
    
    	Yet.  In the years that follow, standards will lower, HMOs will
    	flourish, costs will climb...it will be a fine mess.  sigh.
    
    	I'm on the DMP2.  To think I was losing sleep over the thought
    	that my weekly deductible might double, I never dreamed it would
    	triple.  Luckily my next door neighbor is a doctor for Kaiser,
    	one of the better HMO selections and he has promised to take 
    	good care of our family.  Even still, it's tough to give up 16 
    	years of John Hancock and our private doctors/friends. 
    
    	Jodi-
     

    re: .68
    
    $11.62/wk = $604.24/yr.  $2116.96/yr would be $40.71/wk.

    I might as well give it up.  My severe health problems are due to an
    HMO that is well known in MA.  Since they almost killed me 7 years ago
    with their rotten attitudes and incompetent care (I actually had to go
    OUTSIDE the HMO to get the correct dignosis, and they still didn't
    believe anything was wrong with me until I was rushed to the hospital
    cricially ill and 1/2 dead) -- I will NEVER join an HMO.  I literally
    work to pay my medical bills as it is.  It is a vicious circle.  I
    trust my current, non-HMO doctors with my LIFE.  That life was severely
    shortened as a result of incompetence and mis-management of an HMO. 
    The ramifications of what this HMO did to me are unbelievable, I nearly
    lost my job, I lost my health, and literally now live hand to mouth. 
    And when I tried to sue them, they banded together and I didn't stand a
    chance in hell of even making it to court.  By the time I found a
    laywer willing to help me, the medical statue of limitations had
    expired.
    
    I will willingly pay the exhorbitant $ it requires me to have DHP.  I
    am not happy with it, but I'd truly like to live longer than my 29
    years ... 
    
    My entire family has horror stories about this same HMO.  And my
    grandmother died because of this place and was also misdiagnosed and
    had to seek outside doctors who weren't affiliated with the place to
    get a diagnosis.
    
    I recently dated a doctor who told me that he hates dealing with HMO's
    because the mentality is get 'em through the door as quickly and as
    cost effectively as possible.  He fears for his own patients but is
    limited to the amount of treatment he can provide because he isn't
    reimbursed by the HMO for $ amounts over their set limits for care. 
    This makes me sick because I was truly a victim of this mentality.  And
    for those of you who don't sympathise --  I say, just wait until you
    lose YOUR health.  Then you'll see and it is *so* scary.  People really
    do take their health for granted.
    
    

        There have been several comments in this topic (and other topics
        and other conferences) about the quality of care provided by
        HMOs.  I, personally, have received good care through HMOs, but
        I know of others who have had problems.  Some of the problems
        have been with the same HMOs that have given me good care.

        When HMO problems occur, there is something constructive you can
        do:  Explain the problem to the correct person inside Digital
        and ask them to help solve the problem.  The correct person is
        the Digital liaison for that HMO--there is one for each HMO that
        serves Digital employees and your personnel representative
        should be able to locate the correct one.

        The HMOs want to serve Digital employees, they make more money
        if they serve more people, and Digital does use the threat of
        dropping HMOs to make them improve.  Digital does have standards
        for HMOs, and higher standards for the `HMO Elect' program, but
        problems and complaints with HMOs need to be reported before
        Digital can address them.

        					B.J.

    Maybe I'm a little naive here but I'm having a problem with the
    implied differential standards of care between HMO's and non-HMO
    affililiated physicians.  We heard a horror story in .70 regarding
    an HMO, any the note is right, it is scary and we do take our health
    for granted, but I can site several similar stories regarding treatment
    outside HMOs.  
    
    I wonder if any studies have been conducted on this.  Namely, the incidence
    of malpractice/lab blunders/mis-diagnosis/etc... as a function of HMO
    vs Non-HMO.  I believe doctors affiliated with HMOs get paid a "flat
    rate" so to speak and therefor have nothing to gain by ordering un-
    needed treatment or prescribing unnecessary drugs.  On the other hand,
    they have nothing to gain by ordering tests and may be pressured to do
    otherwise by scrutinizing HMO beancounters.  
    
    I wonder....
    
     

    re .64
>	Why not NY, Chicago, NJ, Miami...
    
    Here in Chicago, this was part of a memo we received yesterday
    regarding upcoming meetings on our health care options.
        
        *  In the Chicago Area we will be offering a new medical 
           option effective January 1, 1993, HMO Elect.  
           HMO Elect, previously called Healthnet, will drastically 
           change the current price structuring of the Digital medical 
           plans.
        
    So, I guess we get a year's reprieve until the HMO boom is lowered. 
    And they sure aren't kidding when they say "drastically change the
    current price structuring...." :-(
    
    Mark Lovik

    Although I have my concerns about HMOs, I must agree with the
    point Marv was making.
    
    I can remember a few years back when DEC first initiated the fee for
    Plan 2.....I think it was $3.50 for an individual then...it's $4.50
    now.  A close friend (who was in a much higher salary bracket went
    into orbit and chose Plan 1......zero deduction for the employee).
    
    Her ex-husband required extensive surgery......she required complicated
    surgery earlier this year; that 20% of the hospital bills added to
    the surgeons' percentage wasn't chump change!!  I've been single the
    entire time of my DEC employment......for the first 9 years it didn't
    cost me a dime to have very good medical coverage through JH (just
    my opinion, even with all their warts).  I too, have had 2 hospital-
    izations and other than the charge for the diff for a private room,
    it was great having the hospital charges covered 100%.  Since the
    second hospitalization occurred because several specialists thought I
    had cardiac problems (pinched nerve relieved by chiropractor); when
    I saw the bills submitted to DEC for that last stay (3 days).....the
    fact that I didn't go into cardiac arrest was proof positive my
    heart is OK for now :-)  So I'm more than happy to pay whatever DEC
    chooses to charge me for my personal coverage......but I must admit
    I'm relieved I don't have to worry about dependant coverage.
    
    Karen
    
    PS:  I don't know what critera was used to judge HMOs who do or
    	 do not come up to DEC's standards.....but I know when I left
    	 the one and only HMO here in Atlanta a few years back, I was
    	 called into a meeting (requested by the HMO) along with other
    	 folks who were leaving to determine our reasons for leaving.
    
         After several presented our experiences (backed up with bills
    	 from personal physicians we went to out of desperation), the
    	 rep rather resembled a deflated balloon when the meeting ended.
    

.72>    I wonder if any studies have been conducted on this.  Namely, the 
.72>    incidence of malpractice/lab blunders/mis-diagnosis/etc... as a 
.72>    function of HMO vs Non-HMO.  I believe doctors affiliated with HMOs get 
.72>    paid a "flat rate" so to speak and therefor have nothing to gain by 
.72>    ordering un-needed treatment or prescribing unnecessary drugs.  On the 
.72>    other hand, they have nothing to gain by ordering tests and may be 
.72>    pressured to do otherwise by scrutinizing HMO beancounters.  
    
    There are studies which have been conducted on the high cost of health
    care, I've seen many news reports although I cannot cite any specific
    sources.  There appears to be a general consensus that one of the
    biggest cost factors is the ordering of excessive tests specifically to
    forestall any questions or problems.  Along with this is a frequently
    stated position that the most urgent cost-containment approach for
    health care is the elimination of unnecessary tests.
    
    There are some obvious problems with this, one is the risk of also
    eliminating tests that were in fact necessary.  In general the greatest
    risk of an unnecessary test is economic, with some tests also entailing
    a slight health risk (eg, taking blood can be a risk).  However, I
    believe that almost all tests have less risk associated with the
    procedure than is associated with the condition being tested remaining
    undiagnosed.  So there is an understandable bias in some parts of the
    system toward reducing the health risk by extensive testing even though
    there is an increased economic cost.
    
    The problem with HMOs and any managed health care system is that they
    work on large population statistics, not my individual situation.  I
    don't want to pay exhorbitant prices for health care, but I don't want
    to pay discounted prices for discounted quality health care either. 
    The emphasis on cost containment makes it difficult to have confidence
    that the bean-counters won't be pressuring the MDs to limit testing to
    only the most obviously pressing requirements.
    
    Remember, in many conditions early diagnosis gives a much better
    prognosis.  Taking a "wait and see" attitude to defer tests in hopes
    that they will prove unnecessary may be economically attractive, but it
    is not clear to me that it enhances the quality of care.
    
    BTW, this year I'm stuck with swapping out of the DMP into HMO Elect,
    because of the excessive price increase.  I do not consider a plain HMO
    viable as an option because I have been seeing a chiropractor and they
    do not cover chiropractic.  As things stand, the John Hancock folks who
    run DMP have just requested justification for my extended treatment. 
    I'm only hoping they consider my desire to be able to lift my arm above
    shoulder height sufficient justification.  The chiropractor has
    relieved the bursitis that prevented my doing so at times in the past,
    but the progress from relief to permanent cure has obviously not been
    fast enough for the beancounters.  I just wish I could inflict the same
    amount of pain on them!

    Forgive the afterthought......a co-worker who was recently hospitalized
    commented about being charged $5-6 for an aspirin!!!  She showed me
    a copy of the bill, if I hadn't seen it with my own eyes, I wouldn't
    have believed it.......DEC can't be faulted for this type of nonsense!
    
    Needless to say, if I should be so unfortunate to need hospitalization
    again, I'll take along my own bottle of Arthritis Strength Bufferin :-)
    
    K
    
    
    

    Well with the cost of my current DMP1 going from $8.50 per week
    to $44.35 PER WEEK (talk about inflation!) I guess I need to at
    least look at these HMOs. Is there any consumer group which can
    help you pick an HMO? Bad health care never saves in the long run!
    BTW I live in Md. and have not looked at HMOs before because I trust
    my own Dr. and Her office is much closer than any of the 2 HMOs
    on last years plan. (there are now 5 to select from here)
    Thanks
    Jeff Filer

It ocurred to me while reading this string of notes that little
emphasis has been placed on why this healthcare crisis has taken
place. If we allow multimillion dollar malpractice suits, where are
these costs reflected?  If we want a CATSCAN in every hospital in
the country, who pays?  If we want extrodinary life support systems,
who buys them?  The choices are ours, as taxpayers and healthcare
recipients.  I suspect these issues are being forced upon us as a
prelude to a National Healthcare System of some sort.  How long do
you think it will be before the HMO's start increasing their fees? 
I think probably right after they have us in their back pocket. 
We are the perpetrators and victims in this no matter what our
decisions are and, in the end, we can't have it both ways.

You can't get a good healthcare system that you don't pay for, one way
or another.

Ron.

Jeff --

First step I'd take is to contact the doctor's office and see if she is
affiliated with any HMO (such as MD-IPA, which uses independant physicians).
If she is, you may be in luck.

-- Russ
   also in MD

    re .80
    
    just to add my 2 cents here, that thought came across my mind.  Where
    I live I have only 5 plans I can choose from...
    
    Digital HMO Elect
    Mathew Thorton
    Healthsource
    Digital med plan 1
    Digital med plan 2
    
    I knew my doctor doesn't accept HMO or Mathew Thorton.  I lucked out
    that he does accept Healthsource so it looks as though my family and
    I will be ok.  We'll be paying less than what we are now and we'll
    still have our same doctor as we had under Digital med plan 1
    
    I definetly would check into this before going off the deep end.
    
    Allan

    Maybe our elected officials will do as good a job with national
    health insurance as they have with bank insurance!
    

    Nobody so far has focused on the REAL price hike in all this.  Sure the
    weekly deduction is going to go up, but look at what portion of your
    medical bills you are now going to have to foot.
    
    Per a booklet I got called 'Your Heath Choices for 1992', it says that
    out of pocket for individual is now $1,800.00, for a family is now
    $5,400.  In addition, there is no way to tell if the 'reasonable and 
    customary' allowances are the same or have changed, but if you are
    charged $250.00 for something they say is $200.00 reasonable and
    customary, the $50.00 difference DOES NOT apply to your out of pocket
    minimums.  
    
    I do not have the data but can someone advise what the Out of Pocket
    minimums were for last year or prior?
    
    KO

    1991 out-of-pocket limit is $1500/$4500
    

.77:

Most hospital regulations don't allow you to bring your own medications
(even asprin) into the hospital.  Now we know why.

Someone was asking about quality of HMO vs non-HMO care, partially as a
followup to the war story posted earlier.

It's true that you can find Dr. Duck either inside or outside of an HMO. 
The difference is that if you have DMP, you can go try someone else.  If
you're in an HMO, you're stuck.

A couple of years ago, my ex ruptured a disc.  The first two doctors he
went to insisted that they operate.  He didn't like that.  He finally found
a doctor who prescribed 4-6 months of physical therapy which gave him
relief that's lasted a year and a half so far.  It isn't clear (until he's
dead?) whether that therapy would have been as effective in the long term
as surgery would have been, but it's one that he was *MUCH* more
comfortable with.

DMP #2 covered that therapy, and all the other doctors visits in between at
whatever rate they said they would.  No questions asked, and no problems.

Naturally, last year when we got that first round of pressure to join an
HMO, I put his case to the HMO reps as a not-so-hypothetical.  None of them
would have allowed his treatment.  Most won't cover 6 months in physical
therapy for a back injury.  Most won't cover any sort of chiropractic
expenses (his doctor was an MD, but what she did fell more under
chiropracty, so he could have gotten the same therapy from a non-MD).  None
would allow for a second opinion on the PCP's initial diagnosis and
proscribed treatment.

In fact, when I asked one HMO's rep about second opinions, he said "You
don't need a second opinion with us."  When I suggested that I might want
one, he repeated a little more forcefully that it wasn't my decision.

That's what makes HMOs so scary to many of us:  If we don't like the care
we're getting, we have no choice but to live with it and wiat for the next
open enrollment.  At least with DMP1/DMP2/HMOE you can go find someone else
right away.

FWIW:  Last year, I signed up with "HealthNet".  I've been to the HMO once.
I've done everything else outside the HMO under the JH coverage, and aside
from being covered to a lesser extent than DMP1/2, it's worked out fine.

    RE.86
    
    I've had second opinions with my HMO. I've also switched doctors.
    Mine is totally responsive to my needs and wishes. Hell, my HMO saved
    my life, so I can't complain.
    
    So I suppose it depends on your HMO
    
    I had nothing but problems with the alternatives, mostly with what the
    insurance would cover, billing problems etc. 
    
    Dave
    

    I question this "reasonable and customary charge" bit.  I think that
    theyare not keeping up with the times.  We have three children, all
    were delivered by the same doctor at the same hospital and they were
    all 2 years apart.  We've had the same insurance all along.  The first
    was delivered by c-section, the second naturally with an epidural and
    the last naturally without anything.  The insurance covered 100% of the
    first two but said that the charges for the third were beyond
    reasonable and customary.  I don't get it.
    
    MIke

The answer (author requested I not post it here) involves worrying about basing
the rates on the number of people being covered, eg I'd prefer to see MTHP's
2-person family offered. The response discussed the problems of charging really
high rates for large families and therefore sharing the costs by charging those
with smaller families the same rates. Seems to me MTHP doesn't work that way the
way I read the coverage contract, but perhaps other HMOs & health plans do. In
any case, the response also stated that many others have asked similar questions
and that this issue is planned on being discussed in 1992, so maybe things will
change down the road.

						Trace

    Some things for the MA/NH people to keep in mind about HMO's. Not all 
    are the same. The one I belong to "Tufts", has a listing of Doctors to
    chose from. No HMO facility you are required to go to. Some of the
    practices you may chose have 2 or 3 doctors within them. So if your not
    happy with one you can request another. Of course you can only do this
    so many times a year. You can also check to see what hospital the
    practice chooses to use, to try to stay in you area. Some of these
    options with this HMO are different than the Harvard and Thorton HMO's,
    whose buildings you have to visit to see a doctor. 

>>> Some of these
>>> options with this HMO are different than the Harvard and Thorton HMO's,
>>> whose buildings you have to visit to see a doctor. 

I belong to the Harvard HMO, and I don't visit one of their buildings. I visit
a medical group (Acton Medical Associates in Acton, Mass.) that is affiliated
with Harvard.

I like the HMO Elect system better than a straight HMO and better than John
Hancock by itself. 

Acton Medical Associates has a lot of nurse practitioners (I forget the latest
terminology--physician assistants?), and I can see one of them if necessary on
a moment's notice. Visits are only $3. I like the convenience. I don't know
what their response would be if I had a truly serious problem.

I too don't want to be stuck with one doctor. I've sometimes found that if you
go to a doctor and don't like what you hear, you can go to another one and hear
something different. (Or, more commonly, neither one gives you any help.)

Neither my HMO nor the Hancock plan will pay for acupuncture, which is
currently giving me real relief from headaches and allergies. (I've heard that
Hancock will pay for acupuncture if it's given by a doctor or perhaps in a
doctor's office, but don't know if that's true.) However, I credit my HMO
doctor with recommending acupuncture. "Try it, it really works!" he said. 
"The HMO won't pay for it, though."

Someone asked in an earlier note who to blame for this mess. If I can single
out one person I'd blame, it's George Bush. Don't know whether it's true, but I
heard that Bush was quoted some time ago as saying he didn't know anybody who
didn't have health insurance (ergo, it's not a serious national problem). I
blame the U.S. government (both Bush and the Congress) more than I blame DEC.

Vicki Meagher

Re: .2 

> On AVERAGE nation-wide, employees pay $76.00 a month for health care.

Digital Medical Plan 2 costs $34 a week in payroll deductions now.  That's 
close to $150 a month, nearly double the national average employee payment.
Now we are notified that the cost is going up to $59 a week, or more than
$250 a month.  What excuse does Digital have for charging us well over three
times the average national health care cost?

Factoring in my ratio of take-home pay to gross pay, the latest increase is 
the equivalent of a $2500 annual pay cut.

It's well known that medical costs have soared, but not eightfold in three 
years.  There is no justification for our being ripped off like this!

Re: .4 

>     Digital is self-insured and the plan is merely administered by John
>    Hancock.  If anyone is putting the "squeeze" on us, it's Digital.

The most appropriate term seems to be "highway robbery".  Isn't there any way 
we can prevail upon Digital to roll back these outrageous increases?

    RE: Chiropractic Care
    
    I spoke to my chiropractor last night; the chiro. assoc is upset and
    they are lobbying to try to get coverage in the HMO's. To help this
    process write to your senator asking for chiroprctor's to be
    considered as primary care physicians or at the least to be considered
    for coverage under HMO affiliation.  
    
    I would pick my chiropractor as my primary care physician in a bat of
    an eyelash if I had the option. I see my chiroprator about every 6-8
    weeks, I need to be adjusted at this rate. If I wait for the
    excruciating pain to occur before I seek the preventive adjustment it
    costs more because the adjustment cannot be done in one visit. 
    
    As it is stands now, I *HAVE* (because of costs) to pick an HMO which
    we all know doesn't cover chiro care. Since it is very important for me
    and my body to be adjusted on a regular basis, I have calculated that
    it is to my benefit to pay for my chiro care out of pocket.....at least
    for now. But I will be writing to  my senator's and will continue to do
    so until something is done. 
    
    Rachelle �
    
    
    

    Re. 64 Why not NY, Chicago, NJ, Miami.....
    
    I just received my benefits booklet and as it was explained to me by 
    my PCSA the HMO Elect in the area is affecting NJ, Delaware and PA.
    Although I live in NJ I am considered within the range of the HMO Elect
    (Greater Atlantic Healthcare). This particular HMO does not have one
    single participating Doctor or Hospital in NJ, they are all in PA.  But
    someone has decided that because Philadelpha is a large city, that if
    you are anywhere (even remotely) near any participating Dr. in PA, then
    you are considered eligible for the HMO Elect and therefore have to pay
    the outrageous DMP1/2 charges of $59 per week.
    
    Who makes these decisions?

    Keep the faith, people.  Maybe, just maybe, we will finally get a
    comprehensive health care system for everyone in this country al a
    Canada.  Then a lot of this crap becomes a non-issue.

.86>  That's what makes HMOs so scary to many of us:  If we don't like the care
.86>  we're getting, we have no choice but to live with it ...
    
    No, what's scary is that if they screw up, we may DIE with it.  
    
    That's why I feel very strongly that medical consumers need to have
    control over the providers of their care.  HMOs are not controlled by
    patients, they are controlled by bean-counters, containing costs so
    that corporations (like Digital) will provide them with a customer base 
    captive to free-market economics rather than free competition on
    grounds such as quality of care.  If you are in an HMO and want a
    second opinion, you are at the mercy of that HMO's policy.  One post
    earlier reports no problem, another reports no way.  How you gonna vote
    with your feet when the open enrollment is months away, and DMP is 
    prohibitively expensive anyway?
    
.79>   You can't get a good healthcare system that you don't pay for, one way
.79>   or another.
    
    You can't get a good healthcare system when your definition of quality
    doesn't care any weight compared to beancounters and AMA puppets.
    
.79>   It ocurred to me while reading this string of notes that little
.79>   emphasis has been placed on why this healthcare crisis has taken
.79>   place. If we allow multimillion dollar malpractice suits, ...
.79>   If we want a CATSCAN in every hospital in the country, ...
.79>   If we want extrodinary life support systems, ...
    
    Those are part of it.  But not the whole story.  If we have a health
    care system that is an economic monopoly...  If we have decisions made
    by those to whom dollars and votes are more important than patients...
    
    The cost components in the health care system are fairly well
    understood, malpractice and over-building are significant but so is the
    inappropriate prolongation of life.  Studies show that by far the
    greatest expense area is care of terminally ill patients.  Having gone
    through the loss of two relatives to prolonged illness in the past few
    years I have firsthand knowledge of just how the medical profession
    mindlessly perpetuates biological life long after the quality is gone,
    and just how expensive that is.  I remember just how mad my mother was
    at the doctor who was proud to have cured my grandmother's pneumonia. 
    So this bedridden 86-year-old stroke victim took eight months to die
    instead of a few days!  As a society we have not come to grips with 
    these issues, and until we do the fundamental problems in the medical
    cost equation cannot be altered.
    
    Another fundamental problem is the deference to special interests in
    decision-making.  Those CAT scan machines may be superfluous but they
    are the pride and joy of their owners' egos.  The overbuilding problems
    in the hospital area are another issue.  A couple of years ago the
    Leahy Clinic was battling the Commonwealth of Massachusetts over
    permission to build more hospital beds in an area that did not need
    them.  Seemed like selfish ego outweighed economic sense (or perhaps
    the Clinic felt they would fill their beds so it was somebody else's
    economics that would suffer?).  The AMA has a monopoly on the supply of
    medicine in this country, and their positions very nicely serve their
    own interests quite well (sometimes arguably ahead of those of the
    general population).  Doctors (there are several in my family) are
    taught "bedside manner" to be regarded by all (including themselves) as
    semi-deities.  As long as we continue to kow-tow to them instead of
    expecting them to subordinate themselves to society at large, we won't
    improve the situation much at all.
    
    One good aspect of adopting National Health Insurance might simply be
    that the AMA opposes it. 
    
.92>  Re: .2 
.92>  > On AVERAGE nation-wide, employees pay $76.00 a month for health care.
.92>  Digital Medical Plan 2 costs $34 a week in payroll deductions now.  
.92>  That's close to $150 a month, nearly double the national average employee 
.92>  payment.  Now we are notified that the cost is going up to $59 a week, or 
.92>  more than $250 a month.  What excuse does Digital have for charging us 
.92>  well over three times the average national health care cost?
    
    I don't know what the excuse is, but I wonder if there is a hidden
    agenda somewhere that would explain this somewhat.  For example, I
    believe there is some requirement about providing continued insurance
    coverage for ex-employees (not sure of details but I thought that there
    was something like that in the Consolidated Omnibus Budget
    Reconciliation Act (COBRA) a few year ago).  Could it be that the DMPs
    would have a different exposure to such provisions than an HMO?  I
    wonder if Digital, as self-insurer of the DMPs, would be liable to any
    shortfalls, while HMOs being available to non-employees independently
    of the corporation would leave the HMOs holding the bag.  Combining
    such suspicions with the shape of the curve graphing AIDS cases makes
    me think there may be a good reason for unattractive pricing on the
    DMPs.  The costs of other terminal care simply reinforce the same basic
    motivation.  Adding in the downsizing of Digital's employee population
    doesn't do much to alleviate my suspicions.
    
    The corporation claims that the DMPs are priced according to cost, but
    it is not clear to me that there is an effort to make them attractive,
    or unattractive, in pricing.  One problem I see is that the HMOs skim
    the cream, leaving the population in the DMPs having significantly
    greater than average costs.  This causes the pricing to rise next time
    around, driving out more of the employees having marginally difficult
    situations, leaving an even smaller and more costly base, so the costs
    will rise even more driving the whole thing into an untenable spiral.
    
    Call it free enterprise at work.

    re: .96
    
    And when Lahey couldn't get a Certificate of Need, they went to the
    Massachusetts legislature for permission to expand, bypassing the
    cost control mechanism. Shortly thereafter, Choate in Woburn, a few
    miles away, closed its doors. 
    
    

    Who's fault is it that direct medical costs and health insurance costs 
    have increased to the point where many people cannot afford to get
    sick???  Well, this time it is not George Bush.

    The costs come from the hospitals, assuming a captive audience charging
    $5.00 each for aspirin, and the patient not questioning the charges and
    the insurance company paying out the "reasonable and customary"
    charges, And the Doctor needing cash to buy into a resort complex and
    the hospital administrator needing cash to buy his $300 silk shirts, and
    the insurance company exec who needs money to pay for his vacation to
    the Riviera, and the stock holders of the various conglomerates that
    demand profits. The nurse gets no more pay, the clerk gets no more pay,
    and the patient effectively gets less pay.

    When was the last time an insurance company gave a straight answer to
    how much they paid out??? They had $1M in claims --- OH yeah ---- All
    of those claims were less than the required deductible so how much did
    they pay out?????? they had $1M in claims ---- yes but how many checks
    did they write?? They Had $1M --- You get the idea. 

    Hospitals are not much better in the fact that they always claim to be
    needing more bed space and are always building something --- that in
    most cases ends up being administrative spaces. The last hospital
    construction I saw that wound up being used purely for its original 
    intended purpose was about ten years ago. Also -- why should a business
    type run a hospital and make in some cases, several hundreds of
    thousands of dollars, (plus perks) annually. 

    I agree - we are being hosed with a 300% or more increase in health
    insurance rates, and there are less than reputable medical groups and
    HMOs out there, But would a national health plan really work???? Check
    with Sweden, the UK, Australia, or even Canada. They have national
    health plans and also have some major problems with them.

    Before I say something that will really get me in trouble I had better
    shut up. The only thing to do is make the best choices possible under
    the circumstances and scream like a banshee at every unreasonable
    charge on the bills. 

    re  .previous
    
    Not everyone wants a national health insurance plan or whatever
    you'd call Federally funded medical care.  I personally don't
    believe the government should be in the business of insuring
    anything (e.g. crop prices, S&Ls, health, disasters--you name it).
    
    Medical care, like any product, responds to the desires of those
    who pay for it.  The government and insurers want predicable costs
    and limited payouts.  From a public policy point of view, infant
    care has a greater expected benefit than care for the old; vaccination
    is more valuable than organ transplants.  The individual who wants
    an organ transplant may feel differently.
    
    I suggest you think long and hard before you call for all medical
    care to be nationalized: the nation is not rich enough to buy all
    the possible care for all the people who could use it.  Some will
    go without some care.  Who do _you_ want making such decisions?
    
    			-John Bishop

    Addressing the concern that required tests may not be ordered by HMO
    physicians....
    
    Are HMO physicians presured by the beancounters NOT to order tests?  If
    a consciencious physiciani orders several tests for a patient in an
    effort to diagnos a problem, does he/she get his/her wrist slapped, or
    recieve 1 demerit per test ordered?  
    
    Is there a board of review that could be consulted if a patient
    believes that appropriate tests are not being ordered?  I realize that
    most patients wouldn't know what tests MIGHT be appropriate, but some
    are rather obvious AND, if an illness prevails over a long period of
    time, a patient might request a review, with option to file a complaint
    if appropriate tests were not ordered.
    
    
    
    
    About Lahey (or any other private institution) expanding...
    
    If Lahey owns the land, AND has the money, AND has building permits, 
    what right does government have to tell them they can't build?  
    
    
    
    
    About a National Health plan..
    
    Before jumping on that band wagon, look at countries that already have
    it in place.  I've heard scary stories about double standards arising
    in these situations... the patients of the "National Health Plan" (the
    herd of cattle) and the patients who come in the back door after hours
    and pay out of their pocket (who get the very best treatment, don't you
    know).
    
    You think HMOs are bad?  Try waiting in the emergency room of Boston
    City Hospital when you're in pain.  Mooooooooo!
    
    Seems odd that as grand scale socialism seems to be falling, as in the
    Soviet Union, capitalistic states are migrating more toward socialism.
    
    
    
 

    I love it when people expect that somehow the government is smart
    enought to do what we can't do on our own.
    
    If anyone wants me to join something as badly as the hmo's seem to do
    I say NO WAY.  Sounds like something too good to be true.
    
    How can it cost less?
    Are there less Doctors?
    Do they make less money? 
    Did somebody decide to work for nothing?
    
    I don't think so!
    
    The reason for the high cost of health care is that WE are willing
    to pay.
    And we are willing to let the other guy pay our bills for us. But we
    hate to pay his bills for him.
    
    Of course living in Ma. we have more Doctors than Lawers
    and too many of both!
    
    buzz   

    Whenever I hear the suggestion that the U.S. should institute universal
    free medical care, I cringe. Proponents of this sort of thing always
    cite Canada as the utopian model. Canada has been laboring (or 
    labouring) under a per-capita federal deficit that is typically half
    again as large as that in the U.S. since the mid-70's. By far the
    single biggest federal budget item is the cost of universal free
    medical care (note also that Canada spends next to nothing on defense
    when compared to the U.S.).
    
    For years, the federal government there has been trying to reduce this
    embarrassing fiscal hemmorage by moving the costs and associated tax
    burdens out to the provincial governments, who in turn have been trying
    to do control costs by restricting access to expensive procedures and
    torquing up the co-payments.
    
    Sometimes people forget that governments don't have any money but the
    money we all give them. If health care costs a bazillion dollars, it'll
    cost a bazillion dollars whether you pay for it, your employer pays for
    it or your government pays for it. If you pay for it, you can't use
    that money for other things. If your employer pays for it, they can't
    put that money in your paycheck. If your government pays for it, first,
    they have to take it out of your paycheck, either directly from you or
    indirectly from your employer. 
    
    Governments are not the most efficient organizations when it comes to
    running anything, IMHO. Compare, say, Federal Express with the U.S.
    Postal Service. Now, think of it in the context of healthcare. Also,
    bear in mind that the U.S. Congress - you know, the guys who can't 
    write a good check or pay a bar tab - would be called upon to devise a
    system to deliver your universal free medical care. With this in mind,
    please convince me that healthcare would be delivered for less cost, in
    a more efficient manner by these organs of government. Mr. Lennard?
    Would you care to go first?
    
    - Larry.

    re: .86
    
>Most hospital regulations don't allow you to bring your own medications
>(even asprin) into the hospital.  Now we know why.
    
    Perhaps you do.  But, for the record, it has nothing to do with the
    excessive charges for such items.
    
    When you arrive at the hospital with a bottle of what you claim is
    aspirin, how are they to know that it's really aspirin, what the dosage
    is, whether it's been sitting on the shelf above your stove for two
    years and has long since decomposed, etc.?  But guess who's going to
    get sued if something goes wrong because the medication you brought
    in from home wasn't quite what you said it was?
    
    
    In contrast to those who complain that too many hospitals have CT
    scanners, I can't think of a single good reason why any hospital
    with an emergency department shouldn't have a CT scanner.  Based on
    my experience working in a hospital emergency room on weekends for
    the past six months, a CT scanner is as vital in that environment as
    an X-ray machine or a laboratory.  I've seen a number of cases where
    the CT results were a significant factor in the diagnosis - either
    by detecting serious or life-threatening conditions or by confirming
    that certain serious conditions did not exist.  Yes, the machines are
    expensive; they also save many lives.
    
    

    re: .100

>    Are HMO physicians presured by the beancounters NOT to order tests?  If
>    a consciencious physiciani orders several tests for a patient in an
>    effort to diagnos a problem, does he/she get his/her wrist slapped, or
>    recieve 1 demerit per test ordered?  

    An article in a medical journal a few years ago (sorry, I don't
    remember off-hand which journal or exactly when) described one HMO
    where a list of physicians and the number of tests of various sorts
    ordered by each was posted on a bulletin board.  If profits from the
    HMO are rolled back to the physicians (as I believe they were in this
    case) such an action, while not a formal slap on the wrist, can lead to
    a significant amount of peer pressure being exerted against those
    physicians who tend to order more than the average number of tests.
    (N.B. Such a simple metric doesn't even take into account that a given
    physician may see more than the average number of patients or patients
    who are sicker than average.)

    Vicki,
    
    RE >>Acupuncture
    
    I currently have DMP2 and when I looked into acupuncture for pain
    control even though the acupuncturist was a doctor, they refused to
    pay.
    
    Marie

    Based upon what I learned from the two Physicians in my family, in
    todays 'suit-happy' environment, Doctors will order EVERY test
    imaginable because they may have to go to court.  
    
    I am not saying that the tests are unnecessary, however, the necessity
    might not be from a diagnostic point of view, appropriate to rule out
    whatever is suspected of causing your illness etc.  I cannot make even
    a WAG about what impact this behavior has on cost increases, but there
    has got to be some.  

    It's to laugh.
    
    Want to talk about costly healthcare? Let's talk about having to go
    below 40 hours a week and losing ALL of your benefits. Under COBRA my
    monthly medical coverage jumped to $400 for an HMO; after it lapsed,
    the cost went to $ 900/month. JH would have been $2,000/month. This is
    not a misprint.
    
    A company health plan is one of the last great deals in life.
    
    kbs
    

>>>    I currently have DMP2 and when I looked into acupuncture for pain
>>>    control even though the acupuncturist was a doctor, they refused to
>>>    pay.

Thanks for the information. I'm not surprised. Just another example of how the
medical industry (sic) in the US controls what is and isn't considered
legitimate. If the American Medical Association considers a 2000-year-old
tradition "experimental," well, gee, they must be right, huh?

And it's far better for insurers to give big bucks to American Psychiatric
Association shrinks than to neighborhood health centers where a person with a
mere master's degree might help you just as well.

But I'm optimistic. Change will come.

Vicki Meagher

Why does our insurance cost so much?  Because everything medical costs
more, and Digital ain't going to pay any more on our behalf than they did
last year.  Therefore, what's a 30% increase overall comes out to a 300%
increase in our contributions.

Why are medical expenses so high?

Because some people who suffer from non-threatening but incompetent health
care treat it like grabbing the brass ring, and try to sue everyone in
sight.

Because our expectations of health care are driving research into more and
more expensive areas.

Because patents on drugs allow captive audience pricing of medicine.

Because bureaucracies in hospitals, drug companies and the government all
get a cut in the action.

Because health care doesn't come with a warantee:  If they screw up, you
have to pay them again to get it right.  Why get it right the first time?

Because people think life does come with a guarantee: There's no longer any
such thing as an accidental birth defect when the child is born to parents
wealthy enough to hire a lawyer.

And, largely because in the past, the most any of us have ever had to do with
the real expense of health care is to make "tsk" noises at the size of the
numbers on the bills as we stuff them into envelopes and forward them to
the company provided insurance carrier.

I don't know if most of the financial influence in this country has some
form of employer provided health care, but if it isn't "most", it's an
awful big minority.  It's large groups like this that set the national
agenda for what's acceptable and what isn't.  If the majority doesn't like
something, at least in this country, it's probably gonna change sometime
soon.

So, back in the "good old days", when the company paid for all your
insurance, most people simply didn't care how much insurance costed, or how
much the health care costed for that matter.  After all, the company took
care of all the price of the insurance (albeit with the effect of lowering
the employee's potential salary), and the insurance company paid for most
or all of the doctors bills.

So, when someone gets sick, they see that an emergency room visit is
covered 100% by their insurance, but a doctor's office visit is covered
80%.  What do they do?  Well, nevermind that the total bill for the ER
would be higher, because the cost to the patient would be lower.  When
there, sure, run all the tests, 'cause the insurance will cover it.

I can't blame someone from acting this way.  The trouble is that the old
setup very much encouraged people not to be consumerists with respect to
their health care.  If EVERYONE had to pay for their own healthcare out of
pocket (and I am by no means proposing this as a solution), we could be
sure that health care costs would be a lot lower than they are now, simply
because the majority of consumers wouldn't stand for the prices we have
now.  (Of course, quality of care and uniformity of care could very well
suffer in this open market approach.)

Well, now the average person is starting to get stuck with the long term
price of this legacy of consumer neglect.  I just hope like h*ll that when
something happens (and I can assure you it will, and probably soon), it
won't have the effect of returning the health care consumer to their former
complacence.

FWIW:  If you ever have a chance to talk to health care providers working
in hospitals close to this country's northern border, ask them about the
demographics of their patients.  I admittedly only have one data point
here, but it is instructive.

Take your worst description about an HMO, and that's national health
care.  National health care falls into two categories:  A nationalized
delivery system (ie, a government HMO) and/or nationalized insurance.

Nationalized insurance wouldn't be any cheaper.  We'd all be forced to
share in the costs of an even larger pool of persons.  In fact, Digital
employees would appear to be wealthier than the average, so Digital
employees would see their costs RISE.  We might have some trouble
spotting it though, because they could hide SOME of the costs in income
taxes, gasoline taxes, import taxes, cigarette taxes, etc. and only
charge us some directly via a separate payroll tax.

Nationalized delivery is even scarier.  It means that the beauracrats
determine who gets what care when.  It means that their will be
cost/benefit studies and controls on the value of treating an individual.
It means that treatment which can be delayed, will be delayed.

The government is PART OF the problem with medical care costs today.  It
is government interference that is helping to drive up medical costs.
From rediculous reporting requirements, to slowdowns in getting
medications to market.  It is government tort laws that cause malpractice
insurance to be so high, and correspondingly to cause behaviors including
unnecessary tests and unnecessary examinations.

We can fix the current dilema in Digital's insurance policies, by
shifting it to an organization that will make it far, far worse.

    re: .106

>    Based upon what I learned from the two Physicians in my family, in
>    todays 'suit-happy' environment, Doctors will order EVERY test
>    imaginable because they may have to go to court.  

    That's true for some doctors and highly likely in certain situations,
    such as in an ER, but it is certainly not true in general.

    I recently discussed this same issue with a doctor who works for
    an HMO (she's not my physician nor do I belong to the HMO).  The
    HMO requires that patients receive authorization from the HMO for
    ER visits if the condition is not life-threatening.  The HMO
    physician on call has the option of coming in to the ER to see the
    patient or allowing them to be seen by the ER doc.  She said the
    HMO strongly encourages them to go in to the ER to see the patients
    for two reasons:

    	(1) they are not charged for the ER doc's time
    	(2) the HMO has done studies which show that their docs order
    	    significantly fewer tests than the ER docs

    When I asked about her own behavior she said she felt she did order
    fewer tests on her own patients and those she is familiar with due to
    frequent ER visits; however, when seeing unfamiliar patients her
    testing patterns seemed to be similar to those of the ER docs.

                 

    Just got "the package" in Albuquerque....
    
    "Make benefits choices by December 13th" it says...
    
    I'll let the wife open it tonight...  (oooo, I can't look!)
    

    
    	re: -1
    
    	I'll beat you to it. My Digicock insurance went from 20.50
    	a week to 49$ per week here in Albuquerque.
    
    	From a company that is not giving much if anything in the way of
    	raises, this is an incredible hit.
    	
    	/john
    	

    Re: -1
    
    Curious, do you know anyone in the Lovelace plan?  How much did it go
    up.
    
    --- Gavin
    (Los Alamos)

    From today's Boston Globe ("Health Costs to Jump Again"):
    
                 The rising cost of health insurance
    
    				  Cost of monthly     Estimated cost of
    				  family premium      monthly family
    Company			  Jan 1, 1991	      premium Jan 1, 1992*
    
    Bay State Health Care	  $437			$502
    Blue Cross Master Health Plan $647			$724-782
    Blue Cross HMO Blue		  N/A			$451**
    Fallon Community Health Plan  $306			$336
    Harvard Community Health Plan $397			$433
    Pilgrim Health Care		  $418			$467
    Tufts Associated Health Plan  $433			$477
    
    * Numbers for 1992 are approximate; final rates have not been filed.
      Prices are averages and will vary according to a number of factors.
    **HMO Blue figure is a composite average that includes both Eastern
      Massachusetts and Central Massachusetts.  Prices in Eastern Massa-
      chusetts generally will be somewhat higher.
    SOURCE: Division of Insurance and figures provided by the companies.
    Statistics are for large companies.
    
    The article mentions several causes for increasing rates: "medical
    inflation rate" at 8% despite overall rate at 3%; use of services
    (especially outpatient) climbing; prescription drugs (prices up,
    use climbing, expensive new non-generic drugs); aging work force
    (due in part to younger employees losing jobs, leaving the state).
    Also, "stress" at "companies in distressed industries" and "move(s)
    by employees to get medical work done while they still have jobs &
    insurance."

    Well, mine went DOWN.  I'm currently enrolled in Tufts for $31.69 a
    week.  Next year it will be $18.56.  Or, I could switch to Fallon for
    $5.93.  This is all for the family plan.  This is the first time ever
    I've had a decrease in costs.  I believe the reason for this is that
    last year my area wasn't eligible for the HMO Elect program and a few
    of the offerers had just expanded into the region and so were setting
    their rates with little or no foundation to the actual costs (I know
    this was the case for Tufts).
    
    Here's the chart for zip 01440:
    
    
    	Provider					Indiv	Family
    	------------------------------------------	-----   ------
    	HMO Elect (Fallon)				 2.18 / 11.99
    
    	Fallon						 0.49 /  5.93
    
    	Central Mass Health Care             	         7.73 / 26.52
    	(CMHC)
    
    	HMO Blue (formerly Montachusett)      	         1.78 /  9.18
    
    	Tufts                                   	 4.08 / 18.56
    
    	Digital plan 1                             	16.34 / 44.53
    
    	Digital Plan 2                             	21.98 / 59.00
    
    Both CMHC and Tufts are "you choose your primary care physician from a
    list".  HMO Blue and Fallon others are "you go to their clinic".

    Nationalized health care along the Canadian pattern is cheaper.  The
    per-capita cost of health care in Canada is much less than here....AND
    that includes covering EVERYONE.  There are 40,000,000 people in the
    U.S. that don't show up in any of our statistics
    
    One of the big cost savings is in the whole area of administration.
    In Canada, everyone has a "charge card", period.  That is the sum
    total of documentation required.  I read once that Mass General has
    over 200 people in it's billing department.  Toronto General, an even
    bigger hospital has two (2).  That's where the real savings start.
    They also require everyone to participate... i.e., no private
    insurance.  That way, the wealthy/fussy/etc., contingent keeps pressure
    on the system to keep standards up.
    
    ....and then there is just that absolute bottom line issue, i.e., if
    the AMA doesn't like it, it simply has to be good.
                                                      

    re: .117
    
    You forgot to mention the large number of Canadians who come across the
    border to the U.S. to have urgent pocedures performed here because
    they are put on excessively long waiting lists in Canada.  And without
    insurance they have to pay the entire bill out of pocket.

Reading the health care brochure, I think I see where DCU got the idea for
their "Choices" brochure.

The Canadians do have an effective health care system.  Just pulling
numbers out of my backside, it appears that 80% are covered directly in
Canada, 10% get sent across the border (to the US) by the government for
procedures not available in Canada (or not available before the patient
dies), and 10% end up coming to the US and footing the bill out of pocket
because the waiting list is too long.

I don't know what the exact numbers are, but there is a lot of traffic of
Canadians coming to the US to get whatever health care their government
can't provide.  This, in itself, might not be such a bad system.  Good
cheap(er) health care for the majority of people for the majority of
illnesses, with the US doing hot backup for the places where the Canadian
system falls down.  The Canadians win, and the US health care system (at
least the part close to the border) wins.

My concern is that if we adopted the Canadian system (which I don't
necessarily see as a bad idea), where's the escape valve for both the US
and Canada?  For the Canadian system to work as well as it does now, the US
system has to exist.  When the US system ceases to exist in its current
form, aren't we hurting a few US and Canadian citizens?

.100>    About Lahey (or any other private institution) expanding...
.100>    
.100>    If Lahey owns the land, AND has the money, AND has building permits, 
.100>    what right does government have to tell them they can't build?  
    
    The government has the right to apply rules agreed upon within our
    representative democracy, and among those are some provisions for
    subjecting medical care providers to more-or-less independent
    regulation.
    
    One part of the regulation goverment imposes upon the hospital industry
    is what is known as a "Certificate of Need".  In short this requires
    that the hospital show the need for additional facilities sufficient to
    justify their proposed new addition.  
    
    Lahey was denied this, because there were already more than enough
    adequate facilities in the service area.  They then went over the head
    of the regulators and appealed to the elected Legislature (obviously a
    much more knowledgable and reliable group) and got a waiver.
    
    The issues around requiring a certificate of need are to balance the
    need for alternatives in the area and the concern that overbuilding
    will lead to under-utilization.  Under-utilization can be shown to lead
    to financial shortfalls, and there seems to be a valid concern over the
    potential effects on care quality.
    
    As previously noted, after Lahey went outside the system, a neighboring
    institution closed due to financial reasons.  This may well have
    deprived some of their service area of facilities not replaced by
    Lahey.
    
    Seems maybe Lahey was properly denied a certificate, but a lot of good
    that does now, eh?

    
    	New Mexico correction.
    
    	Old plan II= $20.50
    	New plan II= $59.00
    
    	/john
    

    I realize that this belongs elsewhere, so this will be my only word on
    the subject:
    
    a.  Since the government already regulates so many facets of healthcare,
    why is it such a mystery that the costs are so high?
    
    b.  For those proponents of nationalized medicine:  Name a single
    instance where a public agency (or any enterprise run by a government
    anywhere) has proven itself more efficient than private industry.
    
    Coverage of those who are not currently able to obtain insurance is an
    achievable goal of nationalized medicine; lower costs for the same
    level of service are highly improbable.
    
    Al
    

        Medical choices / prices here in the Chicago area:
        
        HMO/Plan			Indiv.	Family
        ---------------			-----	-----
        RUSH-Anchor HMO			3.51	12.47
        Chicago HMO			3.38	20.22
        Humana/Michael Reese HMO	1.78	9.88
        Digital Medical Plan 1		0.00	9.79
        Digital Medical Plan 2		5.52	23.92
        
        
        BTW, in these times of cutbacks (when one of them seems to be ME
        :-<), Digital went to the expense of sending us one copy of this
        material at home, and then less than a week later, sent another
        copy to us here in the office. Why spend twice as much?
        
        If I had $1.00 for every piece of junk mail Digital has sent me
        that went straight into the trash, both at home and at work, that
        would probably be significantly more than what I am being offered
        as my "package".

Re: Canada Medical care

I *don't* want the Canadian setup repeated here... their taxes are
OUTRAGEOUS up there. Here, in the US, they are merely awful.

Lee

    re. 1668.16
    
    Is HMO Blue different from Montachusett?  I am a member of Montachusett
    now and there is no clinic.  We are able to choose our own physicians
    and go to their private offices, assuming they belong to the plan.  Has
    this changes, or are you assuming they have a clinic because the name
    has changed?
    
    I guess we'll find out on HMO day, but I'm just curious if you have
    additional info.
    
    Thanks,
    Robin

    Sorry about the typo in my previous note...my question should have
    read, Has this changed?

    I don't doubt that these regulations are in place, but I do have a
    difficult time understanding their motive and question their legal
    morality.
    
    In a capitalistic society, the fact that the "other guy" couldn't
    compete and had to close shop is simply "too bad".  As a prospective 
    patient, I can't for the life of me see why I'd choose one institution 
    over another based on how many empty beds they happen to have at the time.
    If I have to pay a certain percentage of my medical bill, and Lahey is
    relatively highly priced (due in part to paying for unneeded
    expansion), I might opt for another institution on that basis. If
    my employer sees that an HMO associated with a certain hospital is
    relatively expensive because of poor judgement in a decision to expand,
    that HMO might be dropped. 
    
    I may be wrong, but perhaps this expansion is an attempt to leverage
    off of other existing government regulations to put others out of
    business.  If THOSE regulations were eliminated as well.....
    
    In other words....
    
    Why can't the medical industry be left to run competitively like any
    other industry?  Does not competition weed out low quality care?  Does 
    not the customer base (patients + employers) pressure the industry to 
    low competitive pricing while maintaining high standards of care?
    
    
    Dave_just_a_little_tired_of_government_mismanagement_of_everything
    
    I think many of the financial woes we associate with medecine would
    dissapear if gaovernment would just back off, don't you? 
      

Re: .125, Humana comments

Caution: They are/were a large customer of ours. (So is one of the HMO's
         in the Central Ohio area.)

Lee

    By raising DMP rates (Digicock -- great name!  thanx) to the sky,
    they're forcing everyone who can stand it to move into one of the other
    plans.  The Healthy Members Only plans are cheapest, though I've found
    that _most_ (not all) providers that I deal with in MA are covered by
    Bay State.  That insurance company (not HMO; they call thenselves an
    IPA) is owned by its providers, who revolted against management last
    summer.  They announced a big rate hike _after_ Digital's choices were
    announced.  Old management's books didn't pass new management's audit.
    Providers I've talked to (I've been calling around!) now seem happy
    with them.  Compared to last year's slow payments.
    
    Workaround for "managed care":  If you need a specialist's care more
    than a "primary care provider", and have to go through a Primary to get
    to the specialist, call up the specialist and ask them to refer you to
    a primary who'll automatically refer you back...  Let the tail wag the
    dog!  (That applies to plans like BayState and Tufts.  Clinic plans
    don't hack it.)
    
    So if you move _more_ healthy members this year into other plans, DMP
    will be left with _needy_ users, who will drive up the average again
    _next_ year... Chelsea, anyone?  (All the money's gone, and the poor
    are left behind, paying.)  I wouldn't be surprised to see $100/week
    for DMPII next year.
    
    Canada spends maybe half as much the the US, per capita, overall, on
    health care.  Germany also has a national plan, with (nominal) 1400
    private insurance companies, with cross-subsidies, common procedures
    and government funding of those without employer funding.  They've had
    it since the Kaiser's day.  EVERY civilized country save the USA has a
    national health plan.  Finding flaws in one doesn't invalidate the
    concept.  What we have at Digital here is flawed.

    Anent .130:  How do you reconcile your statement that Canadians spend
    half as much per capita as U.S. citizens on healthcare with the opinion
    expressed in this topic that Canadian healthcare costs (taxes) are sky
    high?
    
    Do you have any insight as to how the costs can be lower that you could
    give to those who believe any government control invariably raises
    costs and inefficiency?

    People get all hung up on the Canadian Federal Income Tax rate which
    IS higher than the U.S.  But, across the board, considering all taxes,
    their load is only slightly higher than ours.  Most health care I
    believe is paid for by a system of provincial sales taxes.
    
    In response to .122........yes, government does do somethings better.
    How about the TVA, the REA, the interstate highway system, the massive
    power projects of the 30's, like Hoover, etc.  Of course a lot of these
    things were done long before our government started really ripping us
    off.                                                         

    WE IN VERMONT ALSO RECEIVED THE INSURANCE OPTION PACKAGE.  UPON
    OPENING THESE WE DISCOVERED THAT SOME PEOPLE WERE ELIGIBLE FOR HMO
    AND, SOME WERE NOT.  UPON SEEKING CLARIFICATION I WAS TOLD THAT THE
    GUIDELINE WAS THAT IF YOU WERE WITHIN 30 MILES OF AN HMO YOU WERE
    QUALIFIED TO JOIN THAT HMO.  HOWEVER, THE DETERMINING FACTOR IS YOUR
    ZIP CODE.  DRAW YOUR OWN CONCLUSIONS.

>Most health care I believe is paid for by a system of provincial sales taxes.

In Quebec, the sales tax is about 15.57%.  About 7% federal and 8.57%
provincial.

    The VAT, newly enacted in Canada, is driving shoppers over the border
    in droves. Was this tax in response to needed funding for the health
    care system?
    
    

It seems pretty obvious to me...

-right now we pay $x for decent health care.
-Only y% can afford to pay $x
-The remaining z% of the population can't afford to pay, so they get shoddy
 care at a cost of $m (<< $x)
-IF we get across the board care, EVERYONE will be getting (for arguments sake) 
 $x worth.  The money still has to come from somewhere... SO, our new tax will
 be (z%*(num_people_with_care)*($x-$m))/(y%*(num_people_with_care))

Bottom line, we have three choices:

1) Leave things alone, people who can pay (or have good insurance) get good care
   and people who can't die young
2) Let everyone have good care and the people who can pay now will end up paying
   the increased cost either in higher insurance premiums or taxes...
3) Let everyone have mediocre care with the "haves" paying more, but not quite
   as bad as scenario 2.  The only winners here are the ones who can buy
   free market care independently of insurance.

Three seems to be the way the world (and Digital through this HMO Elect BS is 
headed).  And don't let them fool you, HMOs are a device to limit the kinds of 
care and the cost.  

We have a trade to make...  no holds barred attempts to get well (which is 
what we like and is so expensive), or people making trades which aren't always
what we would like (but, hey they saved a few bucks)...

    re -1 .... I simply have to respond to your comment about HMO's.  I've
    been with HMO's now for ten years, and have never felt the slightest
    "limitations" on care......and for me and my wife it has included some
    major health crises.  The care provided as been consistently excellent,
    and administrative hassles virtually non-existant.
    
    As far as limitations are concerned, if anything I feel they have gone
    slightly overboard in making sure that every contingency was covered.
    
    Your comment is not fair!

    Last year at this time, under the DMP, I underwent some surgery. I was
    still receiving popstoperative care, with possible additional surgery
    in the future, when I switched to HCHP HealthNet. I asked for a
    referral to my surgeon, also a HCHP provider, for the remainder of
    my care. My request was refused. When I brought up the possibility of 
    more surgery, I was told to "try losing weight, sometimes that helps."
    Then I recieved results for a test I never had, and my old medical 
    records from one of my doctors was lost. That was the last time I ever
    entered HCHP. 
    
    I used the HealthNet portion of my policy as my only insurance until
    my husband put me onto his Baystate plan in April. this year I will
    either take an individual Baystate policy or opt out. No more HCHP for
    me!!
    
    Linda  
    

    Having just written out a check for about $600 of miscellaneous things not
    covered under usual and customary and deductables, I guess I can
    understand why this note has so many replies.   
    
    I have no choice other than Digital/John Hancock because my children
    and I live in different locations and can't be covered by any other
    plan.
    
    I remember back to the good old days when Digital had a health plan
    that was worth something.  I understand about the high cost of medical
    care and all that, but this plan is really getting to be a joke.  Only
    problem is those of us stuck with it aren't laughing.
    

From today's Boston Globe:

Angry physicians at the Harvard Community Health Plan, New England's largest
and oldest prepaid health plan, are demanding the resignation of its chief
executive, Thomas H. Pyle, who has been pressing physicians to see more
patients or suffer pay cuts.
...
It is the second major Massachusetts HMO to experience management problems
in recent months.  Bay State Health Care, the state's second-largest HMO,
this month reported a $24 million negative net worth following a physician
revolt that led to the ouster of its top management in August.

What really burns my goat about most of these 'miscellaneous' items not covered
under HMOs is the fact that they are necessary!

I just read the Tufts HMO benefits (or lack thereof) and it considers the
following as a luxury and consequently, will not pay for them:

Glasses
Hearing Aids


Wow!! I didn't realize being able to see and hear was a luxury! I'll remember
that next time I have to shell out $800.00 of my own money to pay for my 
luxury hearing aid.

Stupid

Scott

    I agree, it is stupid (items not covered) but these aren't covered
    under Digital Medical Plans or the previous John Hancock plan either.
    
    Has anyone used HMO Blue (Montachusett) before or have any current
    information on it?  My decision now is between Tuffs or HMO Blue and
    the facility I work at doesn't have any brochures on HMO Blue.  They
    will be having an information day but reps. from HMO Blue aren't coming
    here.  With HMO Blue can you chose your own doctor?  What extra's do
    they offer (fitness plan, etc.)?
    
    Marie

    	Very few health plans provide glasses.
    
    	I wonder when health plans will start paying for condoms...

    RE: .143
    
    >I wonder when health plans will start paying for condoms...
    
    I'm afraid that would make too much sense.  Most health plans
    will not cover any kind of birth control, but will cover childbirth
    or abortion. I could never understand why these plans don't look
    at healthcare as preventative medicine.  Cover contraceptives and
    save hundreds of dollars on labor/delivery and unnecessary procedures 
    like abortion.  There are more lawsuits attributed to these two 
    situations than birth control, as well. The dollars add up quickly.
    
    

    re:.131 
    As .132 said, taxes and spending on any given item aren't necessarily 
    linked.  Total health care spending in any given country is the sum of
    many factors, but in Canada, it's almost all paid through one place.
    Here in Gringonia, it's a combination of insurance payments,
    co-payments, tax payments (Medicaid and Medicare), and employer
    payments (like DMP).  When you add it _all_ up, it's the world's
    highest, by a substantial margin.  
    
    Much of it goes to billing overhead. (Avoidable with a different plan.)  
    
    Much of it goes to defensive medicine and death-prolongation. 
    (Probably not related to insurance or payment.)  
    
    Much of it goes to paying a lot to fix acute problems that
    could have been prevented cheaply, had there been medical care in
    place.  (Definitely a result of having uninsured people who end up in
    the costly emergency room because that's all they get.  And taxpayers
    pay.)
    
    Much of it goes to overpaying a minority of providers who get very,
    very rich performing fee-for-service medicine for a disjoint payment
    system that doesn't keep track of how much they overcharge or
    overperform a profitable service.  (Avoidable with a different plan.)
    
    Healthy Members Only plans avoid the last problem, since they pay
    salaries, and (as noted in today's paper a few notes back) often
    overwork doctors.  Managed-insurance plans, like Bay State, limit it
    by keeping an eye on their providers.  Pure indemnity is stuck with it.
    
    Canada's not the only model, nor is the UK. 
       fred

    re: .144
    
    About 5 years ago when I was a member of Lahey, they *did* cover birth
    control!  And they were pro-active in scheduling check-ups, etc.  Lahey
    is the only *true* Health _Maintenance_ Organization I've experienced so
    far; I wish I still lived in their service area. (I used their
    Burlington, MA facility.)
    
    /Diane

    re:  .144
    
    Intergroup of Arizona (HMO) provides coverage of tubaligation
    and vasectomy.

    Here in South Carolina where the Digital Plan is *relatively* cheap
    (Digital Family plan @ $59.00 would represent 15% of my weekly check) 
    you've got a choice:
    
    1. Go with the HMO and suffer for lack of service. No matter how sick I
    was I waited 3 to 4 hours just to see a physician. Some of the
    physicians are the subject of repeated complaints from patients. Employees 
    who have gone with the HMO's complain that getting referred to a 
    specialist is very difficult. You are treated like cattle in a stock
    yard (no matter how nice the decor and how well the receptionists
    handle your visit). The strong point here is you do not put out a lot of 
    money if you're willing to invest a lot of time . . .waiting.
    
    2. Go with DEC's plan and suffer for lack of cash. I pay at the
    receptionist's desk, submit the bill to John Hancock and wait 5 or so
    weeks before I get a statement saying the deductible has not been met
    and no reimbursement is forthcoming. 
    
    That's the downside.
    
    I chose DEC. The HMO's are not worth the savings. I would rather pay
    for reasonable service in a smaller, more efficient office. Part of the
    healing process is confidence in the service being rendered. Our family
    physician knows our income and is frugal in his treatment (as
    incredible as that may sound to DEC health care planners). 
    
    Today I payed $20.00 for a brief office visit at a university clinic of
    which I am an alumnus. Then I went to a local pharmacy and paid $6.00
    for a prescription that would have run me over $90.00 for 30 tablets
    (Floxin 400 MG). 
    
    I am not complaining about DEC's plan for S.C. But if I felt pressured
    by an increase in weekly deductions in the DEC plan for S.C. next year
    I'd be very reluctant to go to the HMO. Maxicare and Companion (HMO's)
    are rough. Sit there for three hours with a crying 10 month old whose
    ear is splitting with pain and you'll understand. Yesterday my
    workmate's wife had to be given oxygen in one of those facilities - she
    had waited so long that her fever rose!
    
    

    During a visit to the chiropractor this evening I asked the same
    questions posed earlier:  Do any HMOs cover chiropractic?  The answer
    is NO.  Fallon was SUPPOSED to pick it up.  Nah.  Perhaps HMO Blue;
    doubtful.  
    
    There's a serious problem with the medical profession not recognizing
    chiropractic.  It's a hands-on, rational approach to resolving *so*
    many medical problems without the use of pain killers, muscle relaxers,
    etc., etc.  The MDs are afraid of losing buck$ to finance their
    Beemers, so they lobby the politicians.
    
    I am looking into the option of an HMO Elect, but the 70%, after the
    deductible, doesn't pay.  It's probably cheaper to pay for each and
    every chiro visit out of my own pocket.  
    
    Chiropractic deserves recognition as the practical, efficient,
    low-cost treatment... that affords so many people comfort and relief 
    from so many maladies.
    
    Rgds,
    marcia

    
    
    	It was my understanding from last years site meetings with 
    	personnel that each HMO had a Digital overseer to monitor 
    	complaints etc. If a healthcare provider did not meet Digital's
    	standards it was dropped. And the personnel person gave names of
    	HMOs in the area we had formerly done buisiness with. 
    
    	That's supossed to stop problems like .148 described ( stock yard 
    	atmosphere )
    
    	My HMO, Fallon, has been great. My wife and I had a baby recently
    	the whole thing with TV and private room ended up costing us
    	$25.00. There is always a doctor on call, the pediatric clinic is 
    	open till 9:00 every week night and till 5:00 on weekends. Visits
    	are $2.00.
    
    	I hurt my back a few years ago doing yard work, herniated (sp?) disk, 
    	With some physical therapy, back shool and a few Motrin from time
    	to time things have worked out well, again with each visit only
    	being $2.00. Prescriptions are also $2.00. The 400 mg Motrin at
    	$2.00 for 100 is less than a bottle of asprin and a whole lot more
    	effective.
    
    	Last year I smashed my finger with a hammer finishing my basement took
    	a ride to the nearest hospital , NOT affiliated with the clinic, had 
    	what was left of the fingernail taken off and never saw a bill. All I 
    	had to do was call the clinic tell them what had happened and I needed
    	to call again about 2 weeks later to determine whether any follow-up 
    	care was needed. 
    
    	Those places that have HMOs just starting up may find they'll
    	experience a sorting out process where some may fall by the wayside
    	but in my opinion here in central Mass. there's some good HMOs to
    	pick from.
    
    							Mike
    							----

    re. .142 (Marie's question on Montachusett)
    
    We've been members of Montachusett this past year and have been fairly
    happy with it.  We had a baby in February and they paid for the entire
    cost of maternity/labor/etc.  They also cover contraceptives as any
    prescription ($5).
    
    You are free to choose your own doctors and go to their offices for
    check-ups.  That is, if your doctor belongs to Montachusett.  My 
    obstetrician does, which is why we chose that plan last year.
    
    The only problem we had, was when we first selected a prinmary care
    physician, that particular doctor was still negotiating with the HMO.
    One month he belongs, the next he didn't, (we switched) and then he
    joined again.  We stuck with our 2nd choice, a bit farther from home,
    and have been satisfied.
    
    Montachusett also covered an eye exam every 2 years.
    
    I'm not sure about fitness stuff because I'm not interested in it.  If
    you'd like a copy of their brochure, Marie, please contact me thru
    VAXmail and I'll try to get an extra copy for you when we have HMO day
    in December.
    
    
    Robin

>>>    For what its worth, I believe that chiropractic "medicine" treats
>>>    symptons and not causes.  If I have a sore back the chiropractor will
>>>    make an adjustment and I'll feel better for a while.  But only for a
>>>    while.  The real cause of my pain might be a bad knee that I'm favoring
>>>    or even a plaintar wart that caused my gait to change.

Well, you're lucky if you can find a physician who can discover the real cause
of chronic pain and fix it. Most of them just tell you to live with it. 

Most doctors who practice medicine treat symptoms, not causes. They're good at
treating illness caused by bacteria, they can set broken limbs, they can excise
offending growths such as tumors. But most of the time what they do is give you
a prescription to diminish symptoms.

Vicki Meagher

    RE: CHIROPRACTICS
    
    FWIW I had bad back problems fromthe age of 16 thru 35. I am now 44 and
    counting. During those years I miswsed 2-3 weeks/yr flat on my back.
    There were also many other single days when I would be home trying
    anything to get confortable. I went to Dr after Dr, specialists, x-rays
    and all the rest. For years they all would find nothing wrong; "perhaps
    weak back muscles, do these exercises!". How can I excercise to get
    strong when I'm not strong enough to exercise!
    
    Finally, with all the experts and x-rays telling me there *nothing
    wrong* My wife helped me out of bed and took me to a chiropractor.
    
    For the last 9 years the suffering has been 98% eliminated. I do not go
    every week/month, only when I need to; perhaps 3-4 times a year. I
    haven't missed a day of work from back problems in over 8 years!
    
    I am not saying that they are for every ailment but they certainly
    have their place in treatment.
    Chiropractors should be covered!
    
    Mike

re .140:

According to today's Globe, HCHP accepted Pyle's resignation.

    re: .149
    
    If you're really sold on chiropractic, you might want to check out a D.O.
    (Doctor of Osteopathy); from my perspective, they provide the same sort
    of therapy, are better trained, are recognized by the 'medical' profession, 
    and more likely to be covered by HMOs (at least they're covered by mine
    - Health Network of CO).
    
    -Len

.151>    For what its worth, I believe that chiropractic "medicine" treats
.151>    symptons and not causes.  If I have a sore back the chiropractor will
.151>    make an adjustment and I'll feel better for a while.  But only for a
.151>    while.  The real cause of my pain might be a bad knee that I'm favoring
.151>    or even a plaintar wart that caused my gait to change.
    
    A lot of the symptoms treated by chiropractic are not handled any
    better by traditional AMA MDs, who cannot/do not get to the cause
    either.  Instead they feed painkilling drugs and don't even treat the
    symptoms, they just try to mask them.
    
    As far as chiropractors are concerned, there is a tremendous amount of
    variation among them all.  The first one I saw was very good, but then
    I had to try quite a few before finding the one I currently see.  It
    seems that chiropractic is as much the art of the practitioner as it is
    science.  I think this is part of the AMA's opposition, the problem is
    that such opposition overlooks the valid scientific foundation upon
    which that art is based.  Empirically I have had some good results from
    chiropractic, treating things I could not get treated any other way.
    
    Also, both my present chiropractor and the first one I saw have
    consistently looked beyond the immediate symptoms for the root causes. 
    I started seeing the present one because of bursitis that made it
    impossible for me to lift my arm above shoulder height on occasion. 
    After that acute problem was cleared (within a couple of visits) there
    were some underlying structural factors that showed up in the upper
    back and shoulder.  They were addressed over a longer period, but kept
    recurring (albeit less frequently and seriously).  Most recently we
    have been working on some problems in the pelvic and hip areas that
    seem to be causing imbalances that result in the other problems.  I
    think the root cause is actually the effects of ankle surgery for a
    high school athletic injury about twenty years ago.  The present
    chiropractic treatment is the first time I've had hope of completely
    curing some of those effects (hip pain, shoulder and upper back pain).
    
    Recently I have been harassed by John Hancock over the extent of my
    chiropractic claims.  For about six months before that their claims
    processing seemed to be a black hole.  As a result I now have the
    feeling that our coverage is good only if you don't try to really use
    it.  Somehow the current open enrollment period isn't doing anything 
    to change my negative evaluation of Digital's current benefits packages.

    
    I must say I find it a bit amusing that some of you folks down in the  
    USA think we in Canada pay lots and lots of our hard-earned money in
    taxes to support our health care system, while you are apparently 
    paying as much as $250 each month in health care insurance.  Whether 
    you call it tax or insurance doesn't make any difference to the bottom 
    line in your bank balance.

    In Canada, health insurance is administered by each provincial 
    government.  The services that are covered are remarkably similar 
    between provinces due to the fact that the federal government can 
    dictate that certain benefits must be available within each of the 
    provinces.
  
    Funding for the health care system in Ontario comes from several 
    sources.  Insurance premiums are paid by employers for each employee 
    they have working for them.  Money is also budgeted from the 
    provincial treasury (from money collected from taxes).  The profits 
    from several provincial lotteries are used to provide additional 
    funding for various special equipment and services.  Some major 
    hospitals also raise funds through charitable donations, local 
    telethons, sponsored marathons, etc..

    Almost all doctors and surgeons are self employed.  The provincial 
    health insurance plan is simply a method of payment.  The doctors do 
    not work for the government.  Hospitals are funded by the provincial 
    government but are administered locally.  If a hospital wants to 
    provide a new service, buy additional equipment or expand then they 
    make a business case to the provincial ministry and try to get the 
    necessary additional funds for their project.  If they fail to get all 
    (or any) additional funding, they can apply to the Ontario Lottery 
    Corporation for a grant.  The final source of money for most hospitals 
    is the charity route.

    How does it work from the patient's perspective?  I can go to ANY
    general practitioner that I wish.  If I need to be referred to a 
    specialist I can let my doctor recommend someone or, if I know a 
    specialist that I want to see, I can request my doctor to refer me 
    to a specialist of my choice.

    I do not pay my G.P. or any specialist that I see.  They bill the 
    provincial health insurance administration directly.  Hospital 
    treatment (both in- and out-patient) is fully covered by the 
    provincial insurance plan.  My wife was in hospital earlier this year 
    for open heart surgery to repair a hole that was enlarging.  With a 
    team of five specialists and 48 hours wired up to a very hi-tech 
    recovery station with one nurse to each patient for every minute - day 
    and night I can imagine the cost would be considerable (I was told 
    about $100,000 in the USA) but in Canada it is fully covered.

    Digital (Canada) health insurance is a benefit paid for by the company 
    to cover some of the costs that are not covered by the provincial 
    insurance plan.  These are for the entire family and include:

	      -	   Dental
	      -	   Orthodontic
	      -	   Hearing Aids (over and above provincial benefit)
	      -	   Eye Glasses/contact lenses
	      -	   Additional Chiropractic (over and above provincial 
                   benefit)
	      -	   Prescription Drugs (including contraceptives when 
                   prescribed by a physician)
	      -	   Little luxuries while in hospital - like television 
                   and private telephone
	      -	   Additional coverage while in the USA (on our 
                   shopping trips :-) )  Without this benefit I could 
                   be bankrupted if any of my family was taken ill or 
                   involved in an accident while over the border.

    Would I swap all this for some tax savings -- no way!  If I didn't pay 
    the tax, I'd have to pay insurance and would probably lose much of the 
    freedom I have in which doctors and surgeons I and my family can see. 

       - Gerry (Ottawa, Canada)

Re: .158

Gerry, what percent of your income goes to taxes?  (I realize that not 
all your tax money goes to fund Canada's health care system).  I've heard 
mostly good things about the quality of health care in Canada.  It's nice 
to hear from someone who lives with it!  But it would be interesting to
learn what the cost is.

    re: .159.
    
    I would also be interested in knowing the real % of taxes we in the
    States pay. I know each State is different. I feel that fees are also
    taxes. I know that is debatable.
    
    Fed income taxes
    
    Social security taxes
    
    State income taxes
    
    Gas taxes
    
    Property taxes
    
    Excise taxes 
    
    Sin taxes, booze, cigs, etc...
    
    Fees - drivers licenses, user fees, trash fees in some towns, etc...
    
    Water rates, anyone in the MWRA area?
    
    On and on and on it goes.
    
    I'd really be surprised if the total 'tax' burden is less than 50%.
    
    Jim C.
    
    
    

Re: .160

Another biggie... sales tax.

    	Re:  D.O.'s
    
    	Doctors of Osteopathy take chiropractic as an elective.  They
    	may not have chiropractic experience at all, and they certainly
    	do not become masters of the ART at all.  At best they are
    	amateurs when it comes to chiropractic.  Kind of like a house
    	painter vs a master in seascapes.  Sure they can crack your
    	back, but can they ADJUST it?
    
    	Chiropractic DOES work as preventative maintenance.  In having
    	your vertebrae all in line and not impinging any of the nerve
    	trunks that exit from between them, all biological functions
    	of your body are given the maximum potential to behave properly.
    	If vertebrae are misaligned and impinge the nerve trunk functions,
    	the biological processes controlled by those trunks can falter
    	or even cease.  
    
    	It may take years for that process to break down, and may 
    	not be accompanied by back pain.  An MD would never associate 
    	a misalignment with sinus problems, or skin lesions, or 
    	vision impairment, or digestive maladies, or chronic bad
    	breath, or an unlimited host of things.  Most D.O.s that do	
    	chiropractic do it solely on a symptom-relief basis.
    
    	And most chiropractors would not say that they can cure any of the 
    	above in just a few visits.  Proper treatment would be to keep the 
    	spine properly aligned and free the nerve impulses, and to allow the 
    	body to then correct itself as a fully-functioning unit.  Proper 
    	treatment would be a series of continuing visits, the frequency of 
    	which being determined by how well your spine remains in proper 
    	alignment between visits.  Perhaps that has to be once per week.  
    	Perhaps it is once per month.
    
    	My HMO has a D.O. on staff.  Still I choose to pay for chiropractic 
    	out of pocket (reimbursed by HCRA), and I find it well worth it.  
    	It has made a difference in my health and my life without question.  
    	My chiropractor has a family plan that allows unlimited visits as 
    	deemed necessary by her for every member of my immediate family 
    	for $125/month.  It is important to her that chiropractic treatment 
    	begins for a person AS A CHILD, as that is a critical time in the 
    	formation of the spine.  ("Just as the twig is bent, the tree's 
    	inclined..."  and all that.)  With 4 kids, among my family we 
    	probably do over 30 total visits per month.  If I were to be 
    	paying full price ($30/visit) that would be $900/month.  She has 
    	her program in place to allow pediatric chiropractic to be 
    	affordable.  I see it as a gift to my kids, the benefits of
    	which they will reap long after I'm gone.  Also, since starting 
    	the program 6 months ago or so, none of us have beed to an MD for 
    	anything other than physicals.  I'm almost saving what I pay 
    	for chiropractic on what I no longer pay for co-payments!
    
    	Joe Oppelt

re: .-1, .-2, etc.

The whole issue of taxes is a red herring thrown up by corrupt politicians
to invoke the proper knee-jerk Pavlovian response from the voter.  The real
issue that never gets talked about is VALUE--are we getting something that
is roughly the same value to us as what we're paying in?  Other than idiots,
everyone should realize that you can't get something for nothing, TANSTAAFL,
"you can pay me now or pay me later", etc.  If a government supplied 99% of
our needs/wants in life, who would complain about a 99% tax?  The problem is
that the average citizen either doesn't get his/her money's worth back from
the government for the various taxes/fees/surcharges/etc. paid (because the
government is out of touch with or uncaring about what Mr./Ms. Average needs)
or Mr./Ms. is so out of touch with reality that she/he doesn't recognize or
takes for granted the benefits that the government IS providing (sometimes
it takes something like Operation Desert Storm for people to realize why we
do spend so much money on a standing army and how at risk our "way of life"
would be if we didn't have one--just as one "for instance").
									- paul

    Re .-1
    
    I think the example of a "Standing Army" as something that is of value
    to the general population is a very poor one. A standing army does more
    harm than good, witness the fact that people were unneccessarily
    killed due to participation in Desert Storm. In my view this is one of
    the poorest investment's of the US Government. To argue this further is
    more appropriate for SOAPBOX rather than here. I just wanted to point
    out that there is certainly not general agreement on what is a good
    investment of government money.
    
    Dave                        

re: .164

Not sure what you mean by "general agreement"...certainly there is not
and most likely never will be anything close to unanimity about what
activities of government are of value.  My guess is most Americans would
think that our military participation in the war with Iraq was a better
alternative than what we would have been faced with if that participation
had not been an option (namely ceding the Kuwaiti/Arabian/etc. oil fields
to Saddam Hussein and letting him set American oil prices to whatever he
wanted for the next decade).  Not arguing morality or anything, just
popular opinion.
								- paul

    RE:.164
    
    The vast majority of people killed were bystanders not participants in
    Desert Storm.  The same has been true of all modern wars.  Standing
    Armies are universally a burden on the general population, and a threat
    to their health and well being (ask any Croat or most Guatemalans). 
    They are of value to the ruling classes.
    
    See, it is pertinent to this topic	:-(
    
    ken

>The vast majority of people killed were bystanders not participants in
>Desert Storm

Huh?  There were only a few thousand civilians killed; there were a few
more than a hundred thousand soldiers killed.

Of course, one could argue that Saddam's conscripts were just bystanders...

Ahhh Gi'day...�

    Whether you  are slaughtering them from killing machines 8 miles in the
    sky  or  gas  ovens  at  the  next  concentration  camp,  you're  still
    slaughtering them.

    Okay, I pulled out my UK (socialised healthcare) and US (private
    healthcare) pay cheques, and present you with a comparison. So you don't 
    all guess what I get paid I've mutiplied all numbers by X. The big
    difference in pay is interesting, as I had the same job code and
    the same % in band in the US and UK!
    
    Description		US/Weekly/$		UK/Weekly/$ (1.7 exchange rate)
    
    Income		725			335
    
    Payroll Tax			128			 41
    SocSec Tax	(1)		58			 30
    employee medical(2)		13			  0
    employer medical(3)			35			21
    				---			---
    total payroll tax		199(27% of takehome)	71(21% of takehome)
    
    Sales tax	(4)		24(6.25% in CSprings)	35(17.5 nationwide)
    Property tax		13			13
    
    Total Tax			236(32.6% of gross pay)	119(35.5% of gross)
    
    Assumptions.
    
    (1) US pays for medical and pension and social security if you become
        indignent.
    	UK pays for pension and social security regardless of income,
    	state pension is approx $60/week, families receives $10/child/wk
    (2) assuming HMO elect in US, National Health Service in UK
    (3) shown for interest only. Digital UK has all employees in private
    	health plan
    (4) Assuming 3/4 of take-home is spent on saleable items
    	

    
    It seems that the tax burden is very similar.
    
    But the *QUALITY* of healthcare is much different. Thinking about it I've
    had 4 grandparents die that if they had the same thing happen in the US
    they'd most likely have survived. For example, in England the
    ambulances are expected to be at the scene in 17 minutes 90% of the
    time. In the US I understand it is 8 minutes 90% of the time.
    
    Two grandparents died in their home of heart attacks. I think if the
    same thing happened in the US a fully-equipped ambulance would have
    been there a lot quicker. The majority of English ambulances don't have
    defibs! The other two died in hospital from complications(unable to
    withstand knee surgery!). Again, in the US they'd have probably been
    hooked up to zillions of machines and would probably have lived to
    discharge. The surgery wasn't that major.
    
    Soo, I'd perhaps vote for the US system of private healthcare. I think
    the costs need to be brought under control, but for services it far far 
    outranks the UK's antiquated underfunded unaccountable system.
    
    Simon

This is taking on the dimensions of a cosmic rathole--and the original point
had nothing to whether "war is kind" or the Gulf War was justified or
anything else like that.  Simply that most of the time the average citizen
doesn't see any benefits resulting from my paying a large percentage of
his/her taxes for the military.  After the Gulf War i would bet that most
citizens feel more positive about the military and about paying money to
support it.  This has nothing to do with morality, but a lot to do with
people perceiving (rightly or wrongly) that they're gaining some value from
their tax dollars.  Moronic slogans like "no new taxes" really mean: "Your
federal (or state) taxes will stay the same other than things we can disguise
as new fees or surcharges, plus we'll cut services, plus we'll vote ourselves
and our cronies a fat pay raise, plus we'll cut aid to state (or town)
governments forcing them to either raise your taxes at that level or cut
their services to you, etc., and oh by the way Have A Nice Day!"
									- paul

See page 20 of today's New York Times for an article on how Canada's
$60 billion national healthcare system is in serious trouble.

Read about how 8 provinces pay for it out of the general tax fund, but
how four provinces use employee contributions (currently modest but due
to be increased) to help pay for it.

Read about how the 1966 act may be amended to require co-payments for
emergency room visits to curb abuse.

Divide $60 billion by Canada's 26.6 million population to get $2255.64
per _person_ per year.  Multiply that by the U.S.'s 251.4 million population
to get $567 billion per year.

Divide $60 billion by Canada's 13.5 million economically active population
to get $85.47 per employee per week.  Divide $567 billion by the U.S.'s
125.5 million economically active population to get $86.88 per employee
per week.

Draw whatever conclusions you wish.

/john

    Does .-1 include the currency exchange rates?

    re .-2: Amounts to roughly the same figures as paid in Germany.

    
    	I agree with Paul's assesment that the average tax-payer thinks
    all to little, if at all to the services they receive.  Being active
    in municipal government, we see routinely see out and out hostility
    any time a proposal to raise revenue is proposed.
    
    	Last year, to fund fire and police levels, we put a ballot question
    to overide 2.5 to the amount of $.30 or so per $1000 of valuation to
    pay for keeping the police and fire staffs where they were. We
    presented a whole menu of overide options, showing the cost of each, so
    they could pick and chose what they wanted.
    
    	Needless to say, it went down in flames. Needless to say, the most
    vocal opponents of the override, are now the most vocal about how
    we have gutted these two departments.  Although our former town manager
    literally rescued the town for over .5 million in debt, reorganized
    town government, saved an average of 47k per year through efficient
    management, and restored the town balance sheet to operate with a
    positive balance, he and the accursed selectmen are obviously a
    bunch of total fools.
    
    	I blame much of this attitude on the legacy of the Reagan/Bush
    years. It dictates that you need not pay as you go, that everything
    about government is corrupt - we should kill off programs, not
    fund them.  Notice that not much has been killed off and the debt
    has soared.
    
    	Even worse, voters have abandoned the polls - the above attitude
    convinces folks that the system is non-reformable, and they do not
    show up anymore.  If folks either neglect to vote, or worse, vote
    based on either sex appeal or the most blatant hate message designed
    to rile passions, we as a society are indeed SCREWED!
    
    	Last week, we held a special town meeting to transfer funds
    into a badly depleted  school budget due to unplanned emergency
    repair items, and unexpected special needs expenses that would have
    been met in other years by contigency funds in the budget, but due
    to 2.5 and voter anger have been cut out.  That morning I also attended
    (as a finance comittee member) a breakfast meeting presented by
    school officials for local municipal leaders and members of the
    business community where a presentation was made by a member of
    the Mass Business Alliance, concerning their proposals for reorganizing
    public education in Massachusetts.
    
    	This meeting was well attended, and frankly it was very heartening
    to hear that there are some concerned business folk trying to address
    what is rapidly becoming a calamity in this state - public education.
    They quite rightly noticed that the ENTIRE system, from funding to
    metrics is failing in a big way. They propose solutions that are
    comprehensive, and definitely designed to turn things around. They
    recognize that education will not get cheaper, but that the alternative
    to turning things in the right direction is even more expensive both
    in terms of doing business in this state and in attendent social costs.
    
    	However, at the town meeting, we listened to the diatribes as to
    how the school committee payed no attention to expenses, and listened
    to folks whose children have come an gone argue for the gutting of
    our education system.
    
    	You can't imagine how delighted I was to get up, sympathize with
    their frustrations, and mention how the majority of our community
    leaders are not only concerned, but attended a meeting just that
    morning to address these issues, and how we'd really welcome their
    support in energizing voter support for FIXING things instead of
    merely railing against them!
    
    	We are facing the same crisis in health care - some 35 million
    Americans have no health insurance of any kind. These are costs we
    all will bare even while ruining the lives of those who can't afford
    or obtain health care. 
    
    	We will not solve any of these problems until the all citizens
    wake up, and instead of bellyaching about politicians, use the true
    lever we all posess - the vote.  Here in Massachusetts, we finally
    got a delayed reaction in the last general election - voters at
    least expressed they wanted a change in how we do business. However, I fear
    a lack of diligence on the voters part, to continue to express they
    want systems fixed, and government working towards common goals.
    It's time to focus on solutions and not diatribes.  The loud-moouthed
    fool finds it very hard that we live in a pluralistic society - that
    change is by consensus, and their "it's simple, do it my way" approach
    does not occur in democracies. It's always a messy business, but it
    gets real nasty when people abandon the process - that is when special
    interests easily take over the government. Things like term limitations
    only highlight what a bunch of dummies the public is for not exersing
    their rights.
    
    
    	enough, enough - i'll shut up...
    
    	bob
    

    Like everyone else, I was looking through my booklet and decided to go
    with John Hancock plan 1 at $ 44.35 per week. 
     
     Then I noticed what seems to be a extra bonus catagory a few will fall
    into. Pay for a HMO and get on John Hancock plan 2. On page 6 under
    enrollment limits.  
     "The HMO's participating in HMO elect have carefully reviewed and
    planned their capacity to ensure that they offer the best possible
    care. Although it is unlikely, if you enroll in an HMO elect, you might
    find that the HMO has reached its enrollment limits on the day your
    coverage becomes effective. If this happens, you will automatically be
    enrolled in the Digital Medical plan 2 until an opening occurs in the
    HMO. During your temporary enrollment in Digital Medical Plan 2, you
    will pay the weekly deduction you initially agreed to for HMO Elect"
    
     Does that mean us John Hancock members have to subsidize these poor
    folks. Someone has to make up the difference. I for one don't want to.     
    Does anyone know how this is supposed to work......
    
                                          Mike 

re .176:

The way I read it, this is considered highly unlikely.  As such, I'd guess
that the rates don't reflect the possibility of this occurring.  Probably
DEC will absorb the extra cost.

    Someone with an HMO via another company mentioned to me about her son
    not having his prescriptions covered during the first year with this
    new HMO (because of a "pre-existing condition".  Anyone know if this
    is true with the Digital offered HMOs?  I didn't see anything in the
    documentation.
    
    Thanks,
    

Re:                 <<< Note 1668.178 by DEMOAX::GLICKMAN >>>

>    Someone with an HMO via another company mentioned to me about her son
>    not having his prescriptions covered during the first year with this
>    new HMO (because of a "pre-existing condition".  Anyone know if this
>    is true with the Digital offered HMOs?  I didn't see anything in the
>    documentation.
    
The last time I checked on this, all the Digital HMO's were required to accept 
pre-existing conditions with no penalty.  But to be seure, check with your
local personnel rep about the HMO you're interested in and get it in writing if 
you don't feel comfortable.

-  David

There is another aspect of the current situation which is even more
troublesome to some of us who may travel:

Most HMOs have a limited coverage area.  Once you are outside that area, your
coverage is severely limited.  In the case of the ONLY HMO offered to me
(Group Health), outside of your local service area, you are only covered
for EMERGENCY ROOM services, and then there is a $100 deductible!

Now, I work in what used to be EIS. (I figure if you know the current name of
your organization, you must either be a manager, or not working very hard!)
I do work in projects.  The current move is, when there isn't much local work,
to keep folks earning revenue by farming them out on short-to-mid-term
assignments all over the country.  If I'm in an HMO (As Digital clearly wants
me to be), and I spend 6 months in, say, Santa Clara Calif., and I get
sick in a non-life-threatening way, I am on my own.  I can abuse the system and
go to an emergency room for a bad earache, but I'd probably just about
break even with the deductible, so...

It seems like a valid cost-cutting measure ("Incenting" folks to move to HMOs)
is getting in the way of a valid business practice (Keeping folks earning
revenue when there isn't local work).  

Who is there that could do something about this conflict?

Kevin

    Put it on your expense account and see what happens.

    re .180

    This exact question was asked at the open enrollment meeting in our
    area. The answer for us was that if we are out of the area and it is a
    life or limb threatening emergency go to the hospital and call when you
    get a chance-- preferably within 2 or 3 days. If it is not life
    threatening but you do need to see a doctor, call the 800# first. Our
    rep had no knowledge of any one ever being refused payment when the
    procedure was followed.

    If you are out of the "coverage area" of your HMO for an extended
    period of time many do make concessions and allowances. Call the
    coordinator or talk to your personnel person. You may have to pay the
    out of pocket but it probably will be re-embursed. 

Re: 182,
I hope that's the way it works out, however the ground-rules which I stated in
.180 were given to me in response to a direct question in a benefits meeting
where there were both an HR rep as well as a rep for the HMO in question...
The HR person said they would "Check with corporate on this and be sure to get
back to us before Dec. 13"...

If I do end up in this situation, I fully intend to include in on an expense
voucher. Had I not been on company business, I would not have incurred the
expense, so it seems valid to me.  I expect push-back, but we'll see.  With
luck I will never have to force the issue.

Kevin

If I were a cynic, I might be inclined to speculate that Digital has
increased the cost of non-HMO health care to encourage older employees
to leave the company.  Older employees are (IMHO) more likely to have
developed relationships with certain doctors (and other health care
providers) and therefore are less likely to switch to an HMO.  Also, IMHO
the probability of older employees needing expensive medical care is
higher, so for the most part it is to Digital's advantage if these people
leave the company on their own.  Lower expenses for Digital's self-
insurance fund, and no expensive TFSO payments.

Somehow I thought the idea of insurance was to spread the risk.  If all
the health care required by DEC employees was added up and divided by
the number of employees, then some percentage of this was paid by Digital
and some percentage paid by each employee, the result should be a fair
cost to each employee.  It would have to be adjusted a little to account
for dependent coverage, but it would still be a simple and fair concept.
Some people would still think the cost was too high, but at least everyone
would be paying the same amount based on their dependent care options.
Would everyone leave the HMOs?  Probably not.  The HMOs would have to
compete based on the quality of service that they provide.  Maybe that's
not such a bad idea.

The current plan where some employees pay a few dollars a week while
others pay over $60 each week, just seems unfair.  It's a good idea to
find ways to lower health care costs, but virtually forcing people to 
join HMOs by unbelievably high differences in employee cost is the
wrong solution.

    As it was explained to us last year, DEC used to pay x% of the premium
    regardless of the type of plan selected by the employee. Employees 
    in more expensive plans received a bigger dollar benefit than those
    in the less expensive plans. 
    
    As the HMO Elect option becomes available, DEC is switching to paying 
    the same number of dollars per employee (or family) regardless 
    of the plan. Employees must make up the difference between the 
    fixed DEC contribution and the total premium. 
    
    The problem is compounded in areas that were not HMO Elect last year. 
    This year they get hit with a double whammy. Next year's hit in new
    HMO Elect areas should be unbelievable. Until the HMO Elect option 
    is nation wide, there is a two-tiered medical benefit system.
    
    
    Linda 

    re .184, "fair"
    
    Unfortunately, different people have different definitions of
    fairness.  There are several competing popular definitions today:
    
    o	Everyone pays the same actual amount;
    
    o	Everyone pays the same percentage of income;
    
    o	Everyone pays an amount related to how much they are
    	likely to consume (based on age, number of dependants,
    	etc.);
    
    o	Everyone pays an amount related to how much they
    	actually consume.
    
    The above list is not exhaustive.  Digital has picked the third
    version, .184 has picked the first.  
    
    		-John Bishop

    re .186, < What do you mean by "fair"? >

    Ok, I see your point.  But from my perspective I don't see Digital's
    health plans as being fair based on any of the definitions that you
    list.

    What I see is that I will be paying several times more than only a
    couple years ago and will be getting far less coverage.  My wife and
    I see our doctor a once or twice a year, mostly for checkups.  We've
    been seeing the same doctor for many years; we like him; he knows us;
    and we want to continue having him as our family doctor.  At the same
    time that we are paying Digital a LOT more, we have to buy independent
    insurance for our daughter who is in college now, but because she is
    over 23, can't benefit from my dependent coverage.

    -Chuck

re: 1668.185                  Sky High healthcare                    185 of 187
>--------------------------------------------------------------------------------
>As the HMO Elect option becomes available, DEC is switching to paying 
>the same number of dollars per employee (or family) regardless 
>of the plan. Employees must make up the difference between the 
>fixed DEC contribution and the total premium. 

Sounds like the same understanding I got from reading over the literature
and talking to 'other' folks.

The rise in health care coverage is so critical in some area, that several
companies ( Cracker Barrel Restaurants being just one of them) are firing
people who are in a "higher than average" risk category, such as sky divers,
parachutists, bungee jumpers, mountaineers, smokers, overweight, drinkers .. 
and amount of alchohol .. not just alcholics, etc. And so far, are doing do 
'legally', as there are no discrimination laws pertaining to 'activities', 
external to the workplace.

In my HMO (Fallon Clinic, Central Mass), my share cost is scheduled to drop
in cost from 14.85 a week to 4 someting. And interesting thing about this,
about Fallon Clinic, is their *urgent* care is fantastic .. no complaints
about accidents, emergency room treatment, etc. However, the weekly costs
have decreased, the prescriptions have jumped from $2.00 to $5.00. For
my family, this is not a significant difference. 

I *almost* gave it up though because of  the "pushing out" routine care 
visits, allergies, allergy shots, etc. I had a routine visit with my
"personal physician" (that's a joke! .. I got to select one of 5 doctors
that were available); anyway .. the visit was scheduled for November
21st at 1:30 pm (I work in Merrimack, NH) .. when I tried to reschedule
the Physical Therapy followup visit, the next Available appointment is 
in mid-January !

Being part of an HMO, I *give up* the luxury of elective doctor visits
to suit my schedule; in exchange for lower premiums, and by the way, the 
children are only covered to age 23, living at home, and/or a full time
student.

I "read" the Health Care choices being that of choice .. either paying
for the convenience of a real "personal care physician", or being one of the 
masses waiting to see the doctor ... don't get me wrong .. my 'physician'
seems as genuinely concerned for my care as any other physician I've ever had.
Its just that now he's protected from law suits by a corporate umbrella called
an 'HMO' ...

At least in Central Massachussets, there are several choices of plans,
each with their differences in opportunities, health care providers, long term
health care, low or no deductibles ... with a family of four (soon to be five)
living on one income, cost is important. Because my wife is somewhat timid, 
the HMO is ideally suited for her temperament. And I am confident the care is
outstanding. Its just not convenient (sometimes) for routine visits. I have
to stress 'routine visits', because the URGENT care is available and 
first class.

Just my opinion.


Bob
(this is not a recommendation, but my observation and opinion)

re .188:

Is alcohol served in Cracker Barrel Restaurants?

re .184

>If I were a cynic, I might be inclined to speculate that Digital has
>increased the cost of non-HMO health care to encourage older employees
>to leave the company.  Older employees are (IMHO) more likely to have
>developed relationships with certain doctors (and other health care
>providers) and therefore are less likely to switch to an HMO.  Also, IMHO
>the probability of older employees needing expensive medical care is
>higher, so for the most part it is to Digital's advantage if these people
>leave the company on their own.  Lower expenses for Digital's self-
>insurance fund, and no expensive TFSO payments.

Say what?

I don't understand your logic here at all.  I have been with DEC for twenty
seven years and, in the last five years I haven't reached my deductable
even once.  You can't generalize a group of employees because of their
age.  (IMHFO) The higher health costs are from younger employees with 
multiple dependents not older employees who have no dependents.  The cost
of medical insurance should be on a per dependent basis anyway.

The fact is, HMO's only want healthy clients.  Their bottom line is to
make money and, they can't make money if they have to give any more than
superficial treatment.  The only Doctors and Dentists who participate in
HMO's are the ones that can't make it on their own.


           

        Re: .190

> You can't generalize a group of employees because of their
> age.

> The only Doctors and Dentists who participate in
> HMO's are the ones that can't make it on their own.

        Your note is a libelous attack against the many good doctors I
        have used inside HMOs.

        I'm not sure why you think it is bad to generalize based on age,
        but acceptable to generalize based on the type of practice a
        doctor chooses.  There are many reasons why a good doctor would
        choose to practice as part of an HMO--inside an HMO there is no
        need to worry about the business and billing aspects of setting
        up a private practice, and you have a large set of specialists
        you can easily contact if you need them.

        					B.J.

Has this been mentioned before?

The cost of HMO Elect is going up, too.

Last year, Matthew Thornton cost $2.54/week (single).  Adding Healthnet upped
the price by a dollar: $3.54.

This year, my "choices" brochure gives me $2.54/week for MT, but $4.23/week to
add HMO Elect to MT.  That's a $1.69/week premium for HMO Elect this year
vs $1.00/week last year, while the price for MT was held constant.  Admittedly,
a 69% increase isn't as much as the increases we saw for DMP1/2, but it's still
a hefty increase.

I have to wonder what the HMO Elect increase will look like next year after even
more people have signed up for it.

For some people, it would be more cost-effective to join HMO Elect and go
outside the HMO for everything than it would be to join DMP 1.  If a lot
of people do this, I expect HMO Elect to go up substantially.

    re: .190,.191
    You can not generalize doctors and their practice so easily. My doctors
    here in Cincinnati all have well established practices and handle all
    types and forms of medical insurance claims including multiple HMO's
    and plans like the Dec medical plan 1 & 2, Blue Cross, Medicare and
    Medicade from many different insurance carriers. These are not clinics
    but concerned doctors with practices containing from 1 to 5 doctors
    covering all fields of medicine. Choice Care (DEC's HMO in Cincinnati)
    has over 3000 doctors and 360 pharmacies and 20 hospitals just in 
    the greater cincinnati area. Our cost for this convenience is
    listed below. We have many HMO's here in the Cincinnati/Dayton Ohio
    area. These are the ones DEC chose.
    
    			   1991			   1992
                        single  family		single	famile
    Name of plan	rate    rate            rate	rate
    ===========================================================
    Choice Care	 (HMO)	2.97	15.31		0.00	6.04   (Cincinnati)
    Western Ohio (HMO)  2.87	15.14		0.00	8.53   (Dayton)
    Dec Plan 1		0.00	8.50		0.00	9.79
    Dec Plan 2		4.50	20.50		5.52	23.92
    
    The lower cost this year is not a typo.
    		
    Not all doctors and HMO's are alike. We have some that use the clinic
    setting and some are very restrictive but these that dec chose are no
    different then having your normal family physician which is what my
    family has now. Of about 10 doctors/specialist we had before switching
    to choice care only 2 were not under choice care because they were
    outside the area by about 50 miles and were reduntant. All in all we
    are very satisfied with the choice after 3 surgary's and many doctors
    visits.
    
    Regards
    Al Root
    
    

    re:.194, etc.
    Some of what DEC calls "HMOs" aren't.  They're really insurance
    companies that only provide coverage when service is provided by their
    own member-providers (or out of area).  At least in Mass., I believe
    these are regulated as insurance companies. 
    
    Some HMOs, like Harvard and some HMO Blue plans, are classical clinic
    plans, or are small practitioner groups who operate like an HMO out of
    offices they own themselves.
    
    A few notes ago, somebody commented that HMOs tend to employ doctors
    who can't get better jobs.  I concur in part:  Some clinic
    practitioners do seem to be in that category, but most doctors nowadays
    accept payment from insurance companies that Digital calls HMOs.  
       fred

.187>    What I see is that I will be paying several times more than only a
.187>    couple years ago and will be getting far less coverage.  My wife and
.187>    I see our doctor a once or twice a year, mostly for checkups. 
    
    	So why pay the high prices for something you won't collect against?
    	From what you describe, you don't even hit the deductibles anyway.
    	In effect, you don't get ANY coverage now if that's all the medical
    	contact you have.
    
    	Why not do an HMO to cover emergencies, but pay out-of-pocket
    	for your regular visits to your own doctor?  (In effect you pay
    	out-of-pocket now anyway until you hit the deductibles...)
    
    
.187>    we are paying Digital a LOT more, we have to buy independent
.187>    insurance for our daughter who is in college now, but because she is
.187>    over 23, can't benefit from my dependent coverage.
    
    	My sister is almost 40 and still in college.  How long is DEC
    	supposed to cover "depentents"?

    I have a question about Matthew Thornton and Healthsource, both in NH. 
    Their material says that they don't cover experimential procedures or
    drugs.  Do bone marrow transplants and some of the new cancer drugs
    qualify as experimental, that they won't pay but John Hancock does?
    
    I ask, because in the newest US News magazine, they did an article on
    Blue Cross in NH.  There is this woman in Portsmouth who has breast
    cancer and she needs a bone marrow transplant.  Blue Cross wouldn't pay,
    because it is experimental.  The NH courts ordered Blue Cross to pay.
    
    Also, in the literature I received from the health plans, they say they
    won't pay for a prescription over 25 days in one case, and 34 days in
    another.  Does anyone have a chronic condition that they need
    medication all the time for, and what is your experience with an HMO
    and/or Healthsource?
    
    Thanks,
    
    Tina

    I don't know about the experimental procedures with Healthsource,
    but think I can explain about the prescriptions.  All it means
    is that they can only fill one month at a time - I think to prevent
    patients asking for several months at once and only having to
    pay for it once.
    
    Hope that clears it up!
    
    Nancy

  <<< Note 1668.194 by CSOA1::ROOT "North Central States Regional Support" >>>

>    You can not generalize doctors and their practice so easily. 

	Quite true. LAst year when we made the switch from DMP to
	HMO Colorado we didn't change Doctors. Turned out that our
	family doctor was also a PCP with the HMO (don't you LOVE
	acronymns?) as well as having a substantial non-HMO practice.

Jim

    re: .198
    
    I take a medication that I will probably be on for the rest of my life. 
    I can get a 90-day supply for $6 with my PCS card on DMP-2.  I think I
    could do some mail-order procedure and get that same supply for $2.
    
    If I switch to one of the HMOs in my area, they will only give me a 28
    day supply, which will cost me $5.  So, in 3 months I will pay $15 on
    the HMO vs. $6 or $2 on DMP-2.
    
    Bob

    I believe you can get only a 30-day supply in a drug store with PCS,
    for $6, but the mail-order procedure gets you a 90-day supply for $2.
    
    The only problem is getting the prescriptions fast enough -- it takes a
    couple of weeks, so it really is good only for things you take on a
    long-term basis. It's not effective for the first prescription you need
    for a drug. Also, not all drugs are available through the mail order.

.200:

Not necessarily true.  I'm on something that I take once a day.  Back in the
old days of being able to afford DMP, I used to get the prescription filled
on my PCS card.  They'd give me 30 pills (one month) at a time.  Maybe 60.
Later, when I signed up with the HMO, I got the new prescription for the same
thing filled, and the same pharmacy handed me a bottle of 100 for the normal
HMO $5 copayment.

Lest we think the HMO is a better deal, I think that the last prescription I had
filled with my PCS card also got me a bottle of 100 for the normal PCS 
copayment.

What I think happened here is that my pharmacist decided it wasn't worth it to
have my mug in his store once a month for a lousy $5-6 extra, so he just started
giving me 100 pills at a time.  Both the non-HMO doctor and HMO doctor 
(different doctors) were writing me prescriptions for 100 pills, 3 refills, so
I think there may have been some pharmacy discretion going on there.

    I just checked the 1991 "Your Benefits" book. It says that under PCS:
    
    "You can purchase up to a 34-day or 100 unit supply (whichever is
    greater) at any participating pharamacy."   (for $6)
    
    On the next page, about Express Pharmacy Services (EPS) mail order
    prescriptions, it says:
    
    "Your cost for up to a 90-day supply ordered through this service is $2
    per prescription."
    
    I think that what you get is determined by how the doctor writes the
    prescription. I've had a hard time getting doctors to write the
    prescription in the most cost-effective way (for me), and also getting
    them to write "no substitution" so I don't get generic drugs, which the
    pharmacist HAS to give you by law if the doctor doesn't specify.
                                  

>        to write "no substitution" so I don't get generic drugs, which the
>   pharmacist HAS to give you by law if the doctor doesn't specify.
                                  
This is the law in MA, not in the whole US.  I once had to go from pharmacy
to pharmacy because they all seemed to be out of the generic -- they had
plenty of the non-generic.

    Sorry to be so provinical :^(
    
    Why did you want the generic? I assume you just weren't covered for the
    cost of prescriptions. There have been a lot of reports the last few
    years that generic drugs are not always as effective as the brand-name
    varieties.

I didn't care whether I got the generic or not, I just wanted to get the
prescription filled.  I don't think there's a way (or at least an easy way)
for the doctor to write a "don't care" prescription in MA.  If they say
"don't substitute" it's got to be the brand name.  If they don't say it,
it's got to be generic.

My HMO (HCHP) has a contract with CVS pharmacies.
I can get a 3 month supply, but I have to pay the co-payment on a 30-day
basis, or $9 (3x$3 per monthly increment).

Simon,

You might want to bring this up in the NOTED::RESCUE_FIRE_EMS notes file. 
We have EMT's from all over the world that might like to comment on the
times.


Regards


Bob

    Taken in its entirety from Business Week/December 16, 1991 pg. 20 
    without permission.
    
    "Where Employers can find Sanctuary from Medical Bills"
    
    There's a simple way for individuals or employers to reduce the
    escalating cost of medical insurance: Relocate to a city where medical
    bills are low.
    According to a recent survey of typical group health insurance packages
    for a worker and his dependents by actuarial consultants Milliman &
    Robertson Inc., "the differences in medical costs throughout the
    country are staggering."  Based on data provided by major group health
    insurance underwriters for the nation's 400 largest metropolitan areas,
    the firm found that such costs are more than twice as high in the most
    expensive city, Los Angeles ($7,577 a year per worker), as in the least
    expensive city, Glen Falls, N.Y. ($3,197).  The national average is
    $4,380 per worker.
    Of the 10 highest-cost cities, seven are in California and three,
    including Miami, are in Florida.  As for New York, Boston, and Chicago,
    they rank 19, 51, and 58, respectively, registering costs 39%, 17%, and
    14% above the national average.  The 10 least expensive areas were
    smaller cities in New York, Wisconsin, and North Carolina.
    
    --------------------------------------------
    
    Now for those of you who aren't good with calculators:
    
    New York      $6,088  (4,380 * 1.39)
    Boston        $5,125  (4,380 * 1.17)
    Chicago       $4,993  (4,380 * 1.14)
    
    And as we all know, Digital has offices in all of the above, and most
    likely in the rest of the top 10 cities.

re: .193

>For some people, it would be more cost-effective to join HMO Elect and go
>outside the HMO for everything than it would be to join DMP 1.  If a lot
>of people do this, I expect HMO Elect to go up substantially.

I've tlked to about 8-10 folks here in Phoenix who have been on one of 
the DMPs and are now being "forced" into an HMO. Every single one I 
talked to plans on going to HMO Elect and continuing to use their 
existing Drs. outside the HMO.

For us, who have been on DMP1, the family rate went from $8.50 per 
week to $44.35 per week !!!! That's a 500% increase !! DMP2 went to 
$59.00/week. 

Even to join the cheapest HMO we are offered doubles our weekly 
deduction for a great reduction in service, quality, and options. The 
people here are sooooo P***ED at Digital that they would kill if they 
knew who to target.... to have this dropped on them with no warning at 
the end of the year is so incredibly (@#$!#$!@($   that everyone was 
sure it was a misprint at first. I don't think I've had a year yet 
when my family racked up more than $1000 in medical bills... I can't 
imagine paying over $2200 per year for insurance.

My wife talked to all three of the Drs. she visits during the year and 
none of them belong to any of the HMOs we are being offered, and said 
they have heard nothing good about the care available thru those 
particular HMOs. 

At any rate, everyone I've talked to here is going to take HMO Elect 
(at more than 2x what we're paying now for DMP1)  and use their own 
Drs. with the 70% coverage and higher deductable. 

	The reported increase in .210 is NOT accurate.

	It is a 5.21 "times" previous amount.

	Is is "O-N-L-Y" a 421.75 % INCREASE.

	Al

re: .211

>	The reported increase in .210 is NOT accurate.
>	It is a 5.21 "times" previous amount.
>	Is is "O-N-L-Y" a 421.75 % INCREASE.

True, but if you take into account the increased deductable along with 
this the weekly cost increase, the net effect is probably over 500%.

    The increase to $59 per week is just too much for my family to we have
    opted for one of the HMOs offered here in San Diego at about what I
    paid for DMP2 this year.  I didn't select the HMO Elect because the
    outside doctor we would see is a chiropractor and we can have two
    visits a month for less than the extra premimum, the deductables and
    the 30% copay.

    My wife was crippled by an HMO surgeon who cut her leg in the wrong
    direction.
    
    A friend of mind died when, following knee surgery, he got pneumonia. 
    The Emergency Room treated the pneumonia without ordering a CAT scan
    (which is apparently indicated when pneumonia follows surgery).  Two
    days later the blood clot which caused the pneumonia dislodged.
    
    A bad back causes excruciating and severely life-limiting pain.  Yet
    most HMOs do not cover Chiropractic care, though they will readily
    prescribe pain medication.  Chronic pain medication has severely
    life-limiting effects too, like causing auto collisions...
    
    Have you noticed that JH does not investigate excessive overcharging? 
    I am convinced that some health care providers take advantage of 80/20
    plans and jack up the fees.  For instance when I went to a
    Chiropractor, he charged JH $68.  A friend of mind visited the same
    fellow and paid $28 cash.
    
    I am covered by both JH and my wife's employer's 80/20 plan.  What do
    you do when you receive a computerized letter from both insurers
    offering to pay once they receive an EOB from the other?  I've tried
    forwarding both letters to the other company, but then they send me
    computerized letters requesting a copy of the bill.  I guess I need to
    hire somebody to carefully maintain insurance files and make copies of
    each bill, forwarding each statement from each insurance company to the
    other one while appending copies of each itemized receipt and a short
    letter explaining what the other one has or has not done.  It doesn't
    take very much of this to bury me in paperwork.

Would somebody mind stepping forward to explain why a CAT scan was too
expensive to perform on my friend whom I mentioned in .-1?  And if
you're willing to explain this to ME, would you care to explain it to
his widow and his children?

    (re .214 par 3)
    
    	HMOs don't cover Chiropractic care however they (or CMHC anyway)
    	do cover Osteopathic care.

    As to not investigating overcharges, I've seen JH do a good job of
    doing exactly that. While hospitalized in Feb., the bill had a
    duplicate charge (in error?) for one day of monitoring. I notified JH
    when I found the duplicate, but when I got my copy of the JH statement,
    the FULL AMOUNT was paid! And they didn't have to do any hunting, I
    told them exactly where it was within 3 pages of bills!!!!!!
    
    Eric
    
    

Re:          <<< Note 1668.214 by THEWAV::GASSNER "Juggler not" >>>

>    Two days later the blood clot which caused the pneumonia dislodged.
    
While not trying to minimize this tragedy, I think there's a little confusion 
here.  Pneumonia is not caused by a blood clot.  It's an infection which often 
follows surgery due to the body's weakened condition.  In all likelihood, the
blood clot came from the site of the surgery -- a risk any time surgery is
performed. 

-  David

    In between screaming and yelling about this health-care "benefit"
    fiasco, some of us in So-Cal have been discussing how Digital could
    have handled this situation differently.  I have heard ideas such as
    a sliding scale for families who are very sick, or have severe medical
    issues to deal with (kinda' like assigned risk with car insurance) or
    even higher premiums for larger families.  I really do think that
    there a pile of alternatives that should have been attempted before
    raising the premiums out of reach for everyone.  
    
    I *had* the Plan 2 coverage for my family.  My husband also works
    for DEC and took the Opt-Out.  Except for the year that I gave birth
    to my son, it has always taken me almost an entire year to even meet
    my deductible.  .....and wouldn't you know that this month I was
    informed that I will probably have to have surgery for a T.M.J. (jaw)
    type problem, and of course the HMO's don't cover that!  
    
    The real bun-burner is that while my premium tripled, my husband's
    Opt-Out amount only increased by $1.85/week.  What rocket-scientist
    came up with that amount?!!....sure sounds "fair" to me!(ugh!) 
    
    Who do we write to????
    
    -Elizabeth 
                                                     

I think JH could do a lot to reduce their costs. I remember looking at all 
the itemized stuff from knee surgery last year. The hospital charged 
$6+ for a pencil. I can only assume it was used to mark the spot where they
were going to cut. That was only one of many outrageously priced things.

I also called one day to investigate something (I'm on my husband's family
plan) and they asked me a question about "Matt's" coverage. Matt is my husband's
ex-wife's son by another man (he was born after they were divorced). I told
them that Matt shouldn't be covered. Later my husband called to find out what
was going on. I guess his ex-wife had been bringing both her kids in to the
doctor (one is my husband's kid) and using his policy to pay. My husband told
them he was not responsible for that kid. They just said "Oh well, it happens
all the time". They had no intention of trying to get the money back.

Jenna

    re: .220
    
    I had a situation with JH where I had to make a big case about
    an incorrect charge, and it wasn't five or six dollars, it was
    over $200.  They made me feel like I had to work the issue
    as opposed to them taking the information and following it 
    through to completion.  What's wrong with this picture?  
    
    After writing a reply to this note last night and having 
    yet another conversation with my husband about this healthcare
    issue I thought about where do we go from here?  Do we just
    say "oh well, I guess I'm just glad to have a job"?  Do we
    accept this without any concrete evidence of the reasons behind
    the decisions?  I'm not so naive that I don't see the spiraling
    cost of healthcare, but how much of our new premiums are due to
    just plain mis-management? 
    
    I just don't want to bitch and moan about this anymore, I want
    to be part of a plan to address this.  If we just accept this
    and don't try to "fix" it, then we are just as apathetic as those
    who don't practice their right to vote. 
                                                                     

I agree with .221... I think Digital went over the edge on this one 
and I'd like to see 90000 memos flying back to whatever group arrived 
at this plan... 

    I think we can consider ourselves lucky. My step-father's company just
    dropped their previous health plan and switched to HMO Blue. He now has
    to pay $107.00/week -- yes, per week!

One other tidbit...
In a benefits meeting, I had a personnel rep tell me that (and this is a 
quote) "Seattle and L.A. are the only areas who have any problems with the
new plan.  The rest of the country is not complaining at all"

Now, I maybe I'm severely confused, but I THINK that several of you live
outside of those two areas. I also THINK that some of you are not happy
with the new situation.  I also THINK that this mis-representation STINKS.
I assume that you are all loudly letting your personnel reps know what you
think.  Either they are not getting the message, or they are trying to
make it seem like its only a few of us complaining.  Divide-and-conquer.

I will suggest that this person read this topic, and we'll see what the response
is...

Kevin

    re: .225
    
    I have noticed a majority of we "complainers" are from the West
    Coast, but there are also people from other areas such as Arizona,
    Colorado, New Mexico, and so on.  It could be that it seems like
    more because of the large employee population located on the West Coast
    and the fact that our Region was one of the most recent to fall
    victim to the new plan.
    
    You know, since our company is on this Total Quality Management kick,
    I was thinking that it would be interesting to take some of the
    same comments and replies that we hear from our Personnel reps and
    imagine if we said the same thing to our customers.  Can you imagine
    making the following statements?!-  :) :)
    
    "Mr. Customer- you know, no one else is complaining as much as you are."
    
    "Mr. Customer - we can't manage our costs, so you will have to pay
    triple for the same service."
    
    "Mr. Customer - that's just the way it is."
    
    I spoke with another employee here who is a member of a team who meets
    on a regular basis to learn how to work together more effectively as
    well as troubleshoot various problems.  Anyway, their team decided
    to address this healthcare issue and see if they could provide some
    input to Corporate.  They sent their ideas via E-mail to the cluster
    of facilites here in the So-Cal District, and to Ed Brady at Corporate
    Personnel.
    
    If there isn't already some sort of Advisory Board of employees for
    healthcare issues, there should be.  I should mention that this team
    did receive a response from this Ed Brady, but I have not seen it yet.
    I think if we are going to write someone we should start with him.  
    I believe that there would be quite a contingent who would be willing to 
    participate in some capacity to look at alternatives.  
    
-Elizabeth
                                             

    re: .226
    
    Address your input to:
    
    Ed Brady @MSO 
    
    U.S. Personnel
    
                        

    re: .215

>Would somebody mind stepping forward to explain why a CAT scan was too
>expensive to perform on my friend whom I mentioned in .-1?

    Assuming the information presented in .214 is correct (and I'm not
    certain that it is - see below), perhaps the reason for not performing
    a CT scan was other than financial (e.g., the doctor didn't think it
    was necessary, the scanner was down, etc.).

    re: .218 (re: .214)

>>    Two days later the blood clot which caused the pneumonia dislodged.
>    
>While not trying to minimize this tragedy, I think there's a little confusion 
>here.  Pneumonia is not caused by a blood clot.

    You are correct.  However, in certain cases the symptoms of a pulmonary
    embolism (of which a blood clot in the lungs as described in .214 is
    a specific case) are very similar to those of pneumonia.  Neither are
    uncommon following surgery, so a prudent differential diagnosis under
    the described conditions would have to include both possibilities.

    re: .214

>    A friend of mind died when, following knee surgery, he got pneumonia. 
>    The Emergency Room treated the pneumonia without ordering a CAT scan
>    (which is apparently indicated when pneumonia follows surgery).  Two
>    days later the blood clot which caused the pneumonia dislodged.


    (1) In many cases pulmonary embolisms are difficult to identify without
        performing specialized tests such as lung perfusion scans and
        pulmonary arteriograms.

    (2) None of the 5 medical texts I checked covering both Internal and
        Emergency Medicine - all less than 5 years old - mentioned the use of
        CT scans in the diagnosis of either pneumonia or pulmonary embolism;
        a text on CT scanning techniques recommends against using CT in the
        routine diagnosis of pneumonia and noted that the results of CT scans
        in most cases of pulmonary embolisms are relatively nonspecific
        (i.e., you can tell something is wrong, but not what the problem
        is).

    (3) I was unable to find any references linking pulmonary embolism
        and pneumonia - in general or in the post-surgical patient -
        although, as mentioned earlier, neither is uncommon, in isolation,
        in the latter case.  Thus, if the workup of the patient uncovered
        a case of pneumonia consistent with the severity of the reported
        symptoms and there was no other evidence of additional pathology,
        nothing I've read would indicate the need to search further for
        a pulmonary embolism.

    N.B.  The information presented above is the result of rather quick
    research and may or may not represent the current medical standard of
    care.  It is presented here only to illustrate that the need for a CT
    scan in the situation described in .214 is not as clear-cut as was
    implied by the author of that note.

    There are several other aspects of the description from .214 quoted
    above which lead me to believe it is significantly inaccurate.  Which
    is not to say there was no negligence involved in the patient's death -
    only that it is impossible to draw any conclusions from the information
    presented here.

If you look at last year's topic on health care costs, the complainers were
primarily from the GMA, since that's where costs went up significantly.
Sure, they went up a lot this year for GMA folks, but it wasn't as much
of an increase as the west coast got, and we've already vented our spleen.

re .226:

There used to be an employee advisory group on medical costs.  I don't know
if it still exists.

    The entire health care industry is irretrievably screwed-up as to
    funding/insurance.  It isn't just Digital's problem.  Other companies
    have been sticking it to their employees even worse than Digital.
    
    I went though the pain of this last year when offered a choice between
    Healthnet (one provider), HMO or massive increase in JH.  I considered
    what the Company was doing, their explanations and logic and accepted
    what I considered to be a fair, and inevitable--if not a thoughtful
    response by Digital.
    
    We took Healthnet (now HMO-Elect) and have been pleasantly surprised.
    
    As to JH's not doing all it can to keep costs down--that's to be
    expected.  Digital is self-insuring.  JH has a contract to administer
    plans 1 & 2.  JH passes the costs on to Digital.  Obviously, the
    incentives to JH are insufficient to motivate the desired behavior.
    Sure, there are other alternatives, and no doubt they are evaluated
    regularly.  But there are complications, too.  Being self-insured
    allows a company to duck some mandated (by state) benefits.  And who
    thinks its better to hire and run Digital's own administration of Plans
    1 & 2?
    
    I come back to my original point.  The health costs/insurance situation in
    the U.S. of A is totally appalling.  Political action is the only
    rational response.
    
    gordie

    RE: 230
    
    Political action is the only rational response??????
    
    Since when can you use "political action" and "rational" is the same
    sentence??                  

Re: .230 

>    It isn't just Digital's problem.  Other companies
>    have been sticking it to their employees even worse than Digital.

This is what we were told at the Healthcare Choices meetings.  Unfortunately,
we are not being told all the relevant facts.

I investigated what two other large companies are doing with their employees'
healthcare costs.

Raytheon had not been charging employees for their health benefits until
last year.  As of January 1991, they initiated a payroll deduction of 1% 
to cover a plan similar to DMP 2.  As of January 1992, they are NOT raising
the deduction at all.

By comparison, a DEC employee earning $60,000 pays 5% of his or her
gross income for DMP 2.  We're charging our people FIVE TIMES what Raytheon
is charging for similar coverage.

IBM is a different story.  Their coverage, again similar to DMP 2, is at
NO CHARGE to their employees.

Other large employers are looking out for their people in the healthcare area. 
Digital, on the other hand, seems to be sticking it to us.  As of January, 
DMP in Massachusetts will be costing 800% of what it was three years ago. 
That's right, EIGHT HUNDRED percent.  We've all heard how much healthcare 
costs have gone up.  But the DMP increases are just way out of line.

The bottom line is Digital is not acting like a major player when it comes to 
employee benefits.  I hate to say it, but what Digital is doing is more like 
a bush-league company.  

Isn't there SOMETHING we can do about this?

    Sorry to say, the answer is probably to go to work for IBM or Raytheon.

.232:

> Isn't there SOMETHING we can do about this?

Yes, but I'm afraid it means changing jobs.

I think this increase in health care costs really s*cks.  For me to get the
same medical benefits every year, I have to take a noticeable pay cut.  I have
chosen instead to take a smaller (but still noticeable) cut in pay, and make up
for it with a much more noticeable cut in benefits.

On the other hand, in this day and age of people inventing "rights" for 
themselves, I have to remember that I have no right to health care, simply
because I have no such right.  By the same token, Digital has no obligation
to provide us with anything more than they do, and in fact, they probably
aren't even obliged (in all states) to give us what they're giving us.

As usual, we're all free to vote with our feet.

Personally, I think I'll just stick around and complain about it.  �-)

    re: .232
    
    David-
    
    I agree with you, I have also been going out of my way to check
    with friends and relatives about what kind of coverage they have
    and what their premiums are, and I tell you I have been shocked.
    What I am finding is that from large companies like major divisions
    of Anheiser Busch to small companies of 200-300 employees we are
    definately paying more for a DMP2 type plan and in some cases WERE
    paying more than before this recent hike.  I really expected to
    hear that other companies were taking similar measures as Digital
    and so far I haven't found that at all.  
    
    An earlier note mentioned that we should take political action,
    and I agree that this whole issue needs to be addressed both
    within our company and with our legislators.  However, I think
    that if our larger companies feel enough heat they will certainly
    be more powerful lobbyists.  I personally feel that DEC took the
    easy way out by just pushing the costs down to us.
    
    I look at my healthcare, stock and so on as part of my salary and 
    DEC certainly fosters that attitude by sending me an annual statement
    to show me my yearly salary with benefit dollars included.  We have all
    endured the years when raises were frozen, and even when we did
    get our raise it most often did not keep up with the cost of
    living.  We have also endured cuts in headcount which have caused
    many of us to work longer hours to keep up with the extra work.
    Most of us have understood that this is what we needed to do to
    get our company back to "lean and mean".  Most of us are stockholders
    and surely want to do what's right for the company and the bottom line.
    I do not agree with the latest cost-cutting measure.  It's like
    cutting your head off to cure a headache.  Geez, couldn't we have
    tried some aspirin first?!
            
    
    
    

    You can examine *all* of DEC's US medical plans with
    the 'Health Care Choices' VTX (VTX HCCZ_US) by entering
    <PF1/gold><KP7>*<Return> and selecting from the resulting menu.

    I don't have the article in front of me at the moment, so I am quoting
    from memory.  In the Seattle P-I this morning it talked about many
    companies discontinuing medical benefits all together.  It talked about
    the 37.5 million people who are working, yet have no medical benefits
    whatsoever.  Yeah, I agree.  What we are paying for health insurance
    is high, but I'm grateful to have it.
    
    Karen

    You can't arbitrarily compare the medical benefits packages of two
    different companies. There's a lot more to consider than just medical
    benefits. What kind of stock options are available (if at all)? What's
    the salary? How many employees are there? What's the dental plan like?
    Is there a pension plan? And the list goes on. I know people working
    for smaller companies reaping better medical benefits than I am but
    their salaries and benefits don't compare.

I just spoke with Ed Brady, Digital's Benefits Program Manager.  He revealed
several interesting pieces of information about the increases in payroll 
deductions for the health plans.  First, the payroll deductions are based 
on HMO costs rather than indemnity costs.  Second, responsibility for the 
decision making process is vested in Digital's Board of Directors.

I expressed frustration at there seemingly being nothing I could do about 
the huge increases in the payroll deductions.  He told me that there are two 
things that can be done:

(1) Utilize the ODP, or
(2) File a benefits plan appeal, which may take the form of an online mail 
message sent to him (ALLIN1::BRADY).

I plan to compose an online appeal claiming that the payroll deductions for 
Digital Medical Plan 2 are excessively high compared with other major 
companies and compared with the increasing costs of coverage.

    re .239, David, if it would add to your...oops...OUR cause here to be
    able to attach a gazillion "I agree" memos from various people who
    agree that the costs are too high, let us (at least ME) know, kind of
    like an electronic petition...
    
    Jon

Instead of stirring up an electronic petition, I would recommend that
people who are dissatisfied with the high level of the healthcare payroll 
deductions might consider filing their own benefits plan appeals.

    We all might consider what health care would cost us if Digital was not
    picking up the lion share of the monthly charges.
    
    Try between $155-$250 a month for single medical only coverage, no
    dental 80%/20% for the first $1500.
    
    There are many people with no health care insurnance at all who would
    be happy to fork over between $20-$30 bucks a week.
    
    And you are all right the hand writing is on the wall for all to see,
    read and heed....HMOs are the way of the future...it is called "Managed
    Health Care". 
    
    Frank

    When HMO's offer a sufficient level of quality care, there really isn't
    much of a problem, but many HMO's have been known to put $$$$ first,
    and that's where the problems begin.
    
    Eric

    "Managed Health Care" is a great marketing phrase.

    I'll stick to reality:  "Rationed Health Care"

    re:  .243   (and attacks on HMOs per se)
    
    Eric,
    
    1.  Your note is an expression of opinion, not fact, and is the type of
    word-of-mouth slander that offends the informed, misinforms the
    uninformed, and panders to the biased.  You imply that no HMO provides
    a sufficient level of quality care, and that problems are inevitable.
    It's an empty accusation that is both indefensible and unassailable.
    
    2.  I would hope that our economic system justifies the making of
    profits so that the enterprise might sustain itself in order to
    continue providing service.  This includes HMOs, PPOs, physician PCs,
    John Hancock, the Blues, Digital, you, and me.
    
    I can no more let a remark like that go by unchallenged than you or I
    would let an attack on our Constitutional rights go by unanswered.
    To not challenge it is to accept it.
    
    \Gary

    Question...
    
    How long does it take for your payroll deduction to change?
    I switched to an HMO this year for financial reasons and this week
    they still took out the old amount.
    
    Marie

    This week's deduction was the last for 1991. Next week will be your
    first deduction for your 1992 coverage.
    
    However, if you elected an HCRA, this week was the first deduction for 
    that option. 
    
    Linda

    Re: .-1
    
    	>> However, if you elected an HCRA, this week was the first deduction
    	>> for that option.
    
    Unless you are in Colorado Springs.  Due to an error, there were no
    HCRA deductions on Jan 2.  The problem should be fixed on Jan 9, with a
    double HCRA deduction on Jan 16.

    re:  .243, .245

    Sorry, I can't let this one go, even though it's getting kind of
    sudsy...

>>  1.  Your note is an expression of opinion, not fact, and is the type of
>>   word-of-mouth slander that offends the informed...

    I'll quote Eric's note in entirety for those of you who may have
    overlooked it for its "slanderous" nature:

>   When HMO's offer a sufficient level of quality care, there really isn't
>   much of a problem, but many HMO's have been known to put $$$$ first,
>   and that's where the problems begin.

    The thing I want to point out is, he says "many ... have been known".
    Wouldn't be hard to back that up with facts.  You want anecdotal
    evidence, I can give you four anecdotes from my own painful
    experiences.  And yes, I'm still in a Healthy Members Only, because I
    can't afford the alternatives.  My personal experience is that
    HMOs keep costs down by:

       A. Making it difficult to dispute their pay/no pay decisions.  (I'm
	  still staring at bills which the HMO should pay, but which have
	  not been acted on for three months).
       B. Treating the doctor's office like an assembly line (wait two
          hours for an appointment for X, see doctor for 2 minutes about
	  X, say "could you check out this mole", and have doctor say
	  "make another appointment and come back").
       C. Rationing the quantity and quality of care by limiting the
	  options for treatment of an illness.  (I'm not necessarily
	  against rationing, but it should be done by medically competent
	  people, not the HMO's or Primary Care Physician's answering service).

>   2.  I would hope that our economic system justifies the making of
>   profits so that the enterprise might sustain itself in order to...

    Our government has, in the past, recognized that our economic system
    has a positive feedback problem when it comes to monopolies.  The
    medical "trades" have a powerful lobby, and if you look at the behavior
    of the insurance/hospital/HMO industry as a whole, you'll see a strong
    tendancy to behave in an "un-market-like" way.  Maybe not a monopoly,
    but getting close (what is the term, monopsony?).

    While you're challenging opinions, I'll give you another opinion, which
    is only mine.  I don't believe the answer is to move to HMO's because
    one of two things will happen as the population moves to HMO's:

       1. As people who _need_ good care are forced out of the more
	  flexible plans move to the HMO's, the cost advantage will
	  go down.  HMO's are at an advantage because anyone who
	  wants quality care (because they're sick) is trying to stay out,
	  therefore leaving a healthier population at the HMO.  This is
          conjecture on my part -- I would love to see a breakdown of the
	  demographics for several HMO's and plans like DMP 1 and 2.

	  Digitals' price structure is encouraging this demographic split.
	  As we choose our program for the next year, we try to weigh the
	  odds for needing care against the level of choice we get.  As the
	  DMP price goes up, people who believe they won't need more than
	  $XXX.00 worth of care switch over to the HMO.  As the price goes
	  up, the breakeven point shifts up, and only people who are in
	  expecting to need more expensive care remain in the DMP.  As soon
	  as we decided that DMP was too expensive and raised the price, we
	  guaranteed that it would become costlier as "healthier" members
	  switched, guaranteeing its demise.
    
       2. HMO's will continue to show a cost advantage by increasing
	  the degree to which medical care is rationed.  When it becomes
	  painful enough, the medical side of the health care lobby will
	  step in and push for national health care.  Then the government
	  will do the rationing instead.  But this will reduce the net
	  cost, because the structure for delivery of medicine will not
	  be changed (Congress is too cowardly).  We will simply see our
	  medical insurance costs go down and our taxes go up just a wee
	  bit more...

    Until someone can show me data to the contrary, I will continue to
    believe that HMO's are an inferior service and only show cost reduction
    because of a different level of rationing.

    I would be much happier if we replaced both HMOs and the JH mechanism
    with something which allowed me to make an informed choice (I'm happy
    to ration my own care), and allowed me to shop for cost-effective
    quality service.  Neither the "Primary Care Physician referral system"
    nor the "second opinion/must use the first doctor" mechanism accomplish
    this.

    Until consumers are informed and empowered, the health care crisis will
    continue to drive Digital's and your and my rates up.  Adding new
    levels of beauracracy just adds more mouths to feed on the health care
    side of the pie.
                     <<< Note 1668.245 by GLDOA::REITER >>>

    re:  .243   (and attacks on HMOs per se)
    
    Eric,
    
    1.  Your note is an expression of opinion, not fact, and is the type of
    word-of-mouth slander that offends the informed, misinforms the
    uninformed, and panders to the biased.  You imply that no HMO provides
    a sufficient level of quality care, and that problems are inevitable.
    It's an empty accusation that is both indefensible and unassailable.
    
    2.  I would hope that our economic system justifies the making of
    profits so that the enterprise might sustain itself in order to
    continue providing service.  This includes HMOs, PPOs, physician PCs,
    John Hancock, the Blues, Digital, you, and me.
    
    I can no more let a remark like that go by unchallenged than you or I
    would let an attack on our Constitutional rights go by unanswered.
    To not challenge it is to accept it.
    
    \Gary

    Didn't proofread my last reply very carefully.  Somewhere in there, I
    said "but this will reduce the cost", where I obviously meant "but this
    will not reduce the cost."  From the context, it's pretty clear what I
    was trying to say...

    RE: .249, Peter, you beat me to the reply to .245.
    
    RE: .245, Gary, please reread my reply in .243 to notice that it was
    not an attack on ALL HMOs, but only certain ones. Depending on how the
    HMO is set up financially, there can me a major incentive to cut
    corners for the sake of profits. If the staff is paid X$ flatrate, but
    are pushed to see more patients/day than the doctor feels is proper,
    then something has to give. Those programs where you subscribe to but
    see your doctor of choice seem to work better than some of the "clinic"
    types. Again, depending on your personal experience, your mileage may
    vary.
    
    Eric

    Just read something interesting in my local paper. It seems that 
    there is a law in Massachusetts that any employer who offers health
    coverage must offer an indemnity plan in addition to HMO's. My town 
    used to offer Blue Cross Blue Shield. Because of lack of participation
    (below 20% of employees) Blue Cross dropped the group.The town was
    unable to obtain any other indemnity coverage because new insurers
    required paticipation of at least 70% of employees. We haven't heard
    yet what happened to the BCBS subscribers, but the town is now in
    violation of the law. They are petitioning the legislature to modify
    the law requiring indemnity offerings. 
    
    As long as this law in in force DEC must offer some form of DMP, but 
    there is no requirement that it be affordable. If the law is changed, 
    who knows what will happen?
    
    Linda

    Those of you who have recently switched from DMP (or "Hancock",
    or whatever you want to call it) to an HMO or some other plan,
    and have dependent children to be covered under your new plan,
    might want to contact someone working in your new plan to ensure
    that your children are indeed listed.
    
    For some reason not relevant to the topic, we called our new HMO
    the other day, and in the course of the conversation we mentioned
    our children to the person.  The reply was along the lines of
    "Children?  What children?  I don't see any children here...".
    Even though we'd clearly specified them on our Digital benefits
    change form, Digital's data entry people just entered my wife
    and myself.
    
    The HMO person was positive that the error was Digital's because,
    as they put it, all the HMO gets is a magtape with all of the
    pertinent data records as entered by Digital, and that the HMO
    just uses the data as is.
    
    How does one do an "eyes-rolling" emoticon in Notes?...
    
    Chris

Re:                  <<< Note 1668.252 by GEMINI::GIBSON >>>

>    Just read something interesting in my local paper. It seems that 
>    there is a law in Massachusetts...
>    
>    As long as this law in in force DEC must offer some form of DMP,...

...At least for those who work in Massachusetts (still a minority of all 
Digital worldwide employees, I believe  :-)

-  David

    Correction to my reply .253, regarding leaving the kids off
    the coverage list:
    
    A Personnel representative from Digital just informed me that
    for the vast majority of HMO's (including Bay State, the one
    in question here), Digital does not provide magtapes containing
    the data from the benefits change form.  Instead, a copy of the
    form is given directly to the HMO.  In fact, we don't have any
    such "data entry people" here at all, as the HMO rep had claimed.
    
    So the error appears to have been on the part of Bay State after
    all, and the HMO rep apparently wasn't aware of the details of the
    information transfer process, or may have been simply deflecting
    any anticipated criticism (of which none was forthcoming, since
    it was easily correctable).
    
    In addition, even though the children had not been listed at first,
    it's important to note that they are still covered, as long as
    the information on your benefits change form is correct.  The
    health care facility may simply request that you bring a copy
    of your copy of the form in with you.
    
    My apologies for the earlier mis-information.  As usual, if you
    have any questions or concerns regarding your benefits, you can
    always speak with your PSA or the HMO rep.
    
    Chris

re .254:

The proportion of U.S. DEC employees in Massachusetts is high enough that
DEC often applies Massachusetts legal restrictions to all U.S. employees.
Two cases I can think of: mandatory coverage of infertility treatments
and the biweekly pay fiasco.

>the biweekly pay fiasco

Although there is evidence that Massachusetts law may have influenced the
death of the biweekly pay idea, there are plenty of large employers in
Massachusetts paying monthly -- Raytheon, for example.  In apparent flagrant
violation of the law -- but employees seem to be afraid to complain.

There is also sufficient evidence that Jack Smith realized that almost all
of the claimed savings was a transfer of interest earned from employees to
DEC, and _did_the_right_thing_ and killed the plan.

/john

>Although there is evidence that Massachusetts law may have influenced the
>death of the biweekly pay idea, there are plenty of large employers in
>Massachusetts paying monthly -- Raytheon, for example.  In apparent flagrant
>violation of the law -- but employees seem to be afraid to complain.

    There is nothing illegal about paying monthly. Paying more than a week *in
arrears* is what has beeen claimed to be illegal. I know that Arthur D. Little,
at least, paid second week in advance in order to do a biweekly pay.

    
    
    >There are plenty of large employers in mass. paying monthly --Raytheon
    >for exaple.  In apparant flagrant violation of the law.
    
      Somebody posted the applicable law in the bi-weekly paycheck
    note.    I'm pretty sure the wording of the law contained an
    exception for bi-weekly (in arears)  payments as long as they
    were part of a Collective Bargaining agreement.  Raytheon
    is unionized.  DEC is not.
    
    						-al
    

re: 1668.242 
    
>    There are many people with no health care insurnance at all who would
>    be happy to fork over between $20-$30 bucks a week.
    
$20-$30 yes, but not the $50-$60 we have to fork over now, as an 
increase from $8-$10

>      Somebody posted the applicable law in the bi-weekly paycheck
>    note.    I'm pretty sure the wording of the law contained an
>    exception for bi-weekly (in arears)  payments as long as they
>    were part of a Collective Bargaining agreement.  Raytheon
>    is unionized.  DEC is not.

I am that somebody, and no it does not.

"No person shall by a special contract with an employee or by any other
 means exempt himself from this section..."

/john

    Stayed with Plan 2. No dependents. First week with 'new' deduction.
    Went from $4.50/week to $21.98/week.
    
    Ridiculous.

    Just looked back at reply .10 - IMHO this amounts to extortion _not_
    to sign up for plan 1 or plan 2.

    Personally, at this moment, I'm real sorry I didn't pay the higher
    premiums for DMP2.  I went with our local HMO and I feel I was given
    some misleading information.  I sent the following note to my personnel
    reps this afternoon.  Keep in mind I was angry when I wrote it, I'm
    still miffed.
    
    Karen

Subject: Group Health Coverage

    Patti and Ann,
    
    I got my Group Health packet today.  There was not a card in there for 
    my son, who I added to my medical coverage during open enrolloment.
    
    When I called Group Health, they said he was not eligible for coverage 
    from Group Health because he doesn't live here in the area and because 
    he isn't a college student.  WHY WEREN'T WE TOLD THIS DURING THE 
    MEETINGS IN NOVEMBER?????  I made it very clear that I am a 
    non-custodial parent and that my son lives out of state.  What I was 
    told was that GH would cover him for emergencies only out of state.  
    Now I'm told he's not covered at all?????  Yes, he is covered under the 
    elect plan, WHICH is MORE money out of MY pocket.  Also, this is a 
    separate issue.  I was told he WOULD be covered under the Group Health 
    policy out-of-state for emergencies.
    
    Yes, I am angry at the moment.  I feel that this fact was very 
    conveniently hidden, only to be found out after the open enrollment.  I 
    want my son covered under the option I chose.  This is misrepresenation 
    at the least.
    
    I hope this problem can be resolved by having my son covered under the 
    Group Health plan.
    
    Karen
    
    

    I think that rather than HMOs deliberately misleading anyone,they are
    guilty of assuming too much. Like they assume that everyone
    automatically knows that they operate only in specfic area(s).
    
    Ken

    Well, we're finally getting the 2-person rather than family coverage
    I'd pondered back in '91 in .60 - 'course it's through my wife's new
    job. But it does make for interesting comparison since it's in the HMO
    (Harvard Community).
    
    Through Digital, we pay $87.57/month for HCHP family coverage with a
    	$3 copay for office visits and prescriptions.
    At Deb's company, we'll be paying $46/month for 2-person coverage
        (includes out-of-network coverage, eg Digital's HMO Elect for which
    	Digital requires a greater payment), with a $5 co-pay for visits and
    	prescriptions.  Their family rate, again with out-of-network, is
        $60/month. Out-of-network deductable is $200/person or $600/family
    	with out-of-pocket max of $1500/person & $4500/family.