Conference 7.286::digital

    A similar thing happened to me last year, joining Central Mass Health
    Care in terms of a delay between enrollment and getting the cards.
    Pharmacies DID accept the GIA as proof of insurance - try a CVS or ask
    HMO BLue to be available by phone for the pharmacy to confirm
    membership when you go to get a prescription.
    
    best of luck,
    

    I joined CMHC.  Had an apt with a specialist on 1/6 and one for allergy
    testing on 1/14.  I called my Primary Care Physician to get the
    referrals.  They called me back - we need your number.   I called my
    PSA, left a voicemail, no response.  I call CMHC - they said to use my
    ssn and a couple zero's and gave me the group number.  I called my PCP
    and gave them that info - they sent CMHC the referral paperwork. 
    
    Monday of this week, my PCP's office called back - the paperwork got
    rejected by CMHC - reason not a member.  I called CMHC - yes you are a 
    member, we just haven't gotten you into the computer yet.  Have them 
    hold the referral for 2-3 weeks and resubmit, or resubmit with a note 
    "new member, not in computer yet".   What impact does this have on the 
    specialist I saw last week?  It will be payed for - right?   Oh yes its 
    covered, as long as your PCP referred you.
    
    Haven't had to get a prescription yet - but I'm looking forward to that
    nightmare! ;-)
    
    Joyce

    I recently switched to MTHP, an HMO in southern New Hampshire, for the
    same reason as .0.  I filled out the paperwork the first day of open
    enrollment, which was December 13.  Nevertheless, when my wife went to
    their clinic in January we "weren't in the computer yet".  
    
    We've been going to that same clinic under DMP for many years, 
    so they know us.  As a result they are holding the paperwork until things 
    are straightened out.  The local people are absorbing the additional
    burden caused by a foul-up somewhere in the enrollment process.
        John Sauter

It's this way every year.  I've got the paperwork but no cards.  Hopefully none
of us will get sick before they get caught up.

Bob

    This is were DEC says
    
    For the month od Dec. and Jan. you will put on X number 
    more people to do data entry or else.  
    
    Could be also were hmo* says you supply us with the data on 
    line and we will save you some bucks.
    
    
    If you signed up for a new credit card how long would it take
    to get.
    buzz 

    More blues.
    
    I signed up for HMO Blue.  I made a few phone calls at the end of
    December for the new number but got nowhere.  Since my appointment
    with my Primary care physician was not until today, I waited --
    especially when others in my department started to tell me that
    they received their cards.  Finally, last Friday, I received mine.
    End of problem number 1.
    
    Today, I have my first HMO Blue visit with my PCP.  It appears that if
    your PCP is in a certain area, they can only make referrals to
    specialists within that area.  THIS IS TERRIBLE NEWS!!  I believe that
    HMO Blue has misrepresented itself to Digital, and Digital has foisted
    it on us without checking what their procedures are.
    
    Back in November, I acquired a physician's directory from HMO Blue.  It
    included both my PCP and my specialist, so I thought I was covered. 
    But today I was told that since my PCP is in "area A" and my specialist
    is in "area B", I cannot be referred to my specialist (who has my
    history from years back).  I would have to either choose a new
    specialist from "area A" or if I want to keep my specialist, I have to
    choose a new PCP in "area B".  THIS WAS *NOT* EXPLAINED TO ME BEFORE
    and I am extremely upset, to say the least.
    
    I should have stayed with CMHC!!!!
    
    -- Linda 

    RE:-1
    Yup ! They misrepresented themselves and I told them so when they
    came for the health fair here in SHR. The guy told be that if
    your PCP is in health the XYZ HMO circle, your specialist must
    also come from that circle as well. I asked him to show me were
    HMO circles are mentioned in their literature ? He couldn't and
    said that the book is being updated.

    Also, now that we've started to contact those specialist, we found out 
    that even though their in your HMO circle, your PCP must refer you for 
    every visit. In other words if your PCP feels you need to see that 
    specialist 4 times, then he must put in a referral for four visits. If it 
    turns out that you need a fifth visit, your PCP must put in for that fifth
    visit.  I thought that once you were referred, that was it. 


    Jim

Well, I for one have yet to have a problem with my HMO (Bay State).
I went in with a complaint, was referred to a specialist with the
stipulation that the referral was for the life of the treatment.
In other words if it took 1 visit fine if it took more well no need 
to go back to my PCP for another referral.

    > "Anyone else having problems?"
    
    WHAT AN UNDERSTATEMENT! This is getting to be a yearly problem. I
    have the same concerns as our base noter, and I just finished sending
    my PSA a nasty letter airing my feelings. My opinion is that there is
    nowhere near enough time to process applications to change HMO's. 
    
    I just called HMO Blue again and I'm still not on their system! I'm
    glad I got my form in early in December. This is a repeat performance
    of last year when I switched from J. Hancock to Bay State. I got my
    cards in early February!
    
    What bothers me the most with all of this is that I'm being deluged
    with literature from my old HMO, Bay State, thanking me for selecting
    them once again this year, complete with new insurance and prescription
    cards, and big brochures. What a waste of money! Where the hell in the
    process do they get notified that I dropped them??
    
    Something's wrong with this picture. I expect personnel to have some
    answers.

    
    	I've got a question.
    
    	The opt-out plan gives someone about $21 to leave the insurance
    plan altogether.  I do find it hard to believe Digitals claims of 
    thier rising costs when they only tempt us with $21.  Can that possibly
    be all that Dec is saving?  Wouldn't a more realistic offer temp others
    to opt-out, thus saving Dec more money?  I just can't find the
    relationship between "get out for $21" and "Dec is paying out more
    every year".
    
    sean

        Re: .6

>    Today, I have my first HMO Blue visit with my PCP.  It appears that if
>    your PCP is in a certain area, they can only make referrals to
>    specialists within that area.  THIS IS TERRIBLE NEWS!!  I believe that
>    HMO Blue has misrepresented itself to Digital, and Digital has foisted
>    it on us without checking what their procedures are.

        Find out (through your PSA) who the Digital liaison is for HMO
        Blue, and make your complaint to that person.  Make sure that
        the correct person in Digital knows about the problem.

        (This also applies to any problem that an HMO can't or won't fix).

        					B.J.

    
    
    .9 "I expect personnel to have some answers".
    
    	HHHHHAAAAAAAAAAAHHHHHHHHHHAAAAAAAAAAAAAAAHAAAAAAAAAAAAAAAAA
    
    	you break me up!!
    	B*)
    	rich

    re .12
    
    Glad to see I put joy in somebody's life!  The rest of us are too busy
    moanin' and groanin'.
    
    By the way, I spoke with my PSA and she is putting together a recomm-
    endation to send to Group personnel to have the open enrollment be
    completed by Dec. 1. That way, we will only have to wait until March
    of the following year to straighten things out!
             

		Sounds like the HMO is on PCP (Angel Dust).


	With all the TLA's running rampant in this note I just could not 
resist.


	Personally I think the opt-out program is fine. The idea is not 
to make a huge profit for the employee. It is basically just an incentive 
to use a spouses medical plan. And hey $1100 extra never hurts, even if it
is taxable. 


Todd

    We joined Montachusett last year.  They are now called HMO Blue.
    At the time, we had to wait 2 or 3 months to get our cards.  It
    was a pain, but they did pay 100% of our maternity costs in February.
    This year, we card our cards on time (actually before 1/1/92).
    
    

    Healthsource New Hampshire must have its act together.  I transferred
    back to them during the open enrollment in December and received my
    card and orienation package on 1/9.
    
    Mark.

I signed up with an HMO a couple of years ago and have been pretty happy with 
it.  Our HMO merged with another HMO last year and we really didn't experience
any problems as a result, although we're fortunate and don't have any health
problems that send us to the doctor frequently.  We also have the added 
benefit that my wife is a medical technologist that works for our PCP.  That
makes it a little easier to see the doctor that we want to see and also to get
referrals.  

When we have had billing issues, they have generally been resolved with one 
phone call.  And to make things even better, our cost went down this year!!

Of course, I saw our governor on the national news the other night talking
about statewide healthcare reform (we're in Minneapolis).  So I'm sure that
something in there will screw up the works :-).

Doug
    

I agree Mark, Healthsource NH has been excellent.

I'd recommend them highly.

daryll 

    Well I owe my PSA a beer. She got my I.D. number for me and got me
    into the HMO Blue system. The person from HMO Blue that I talked to 
    yesterday never got back to me, and from what my PSA said, after
    talking with her representative from HMO Blue, the person shouldn't
    of been involved.

    So I recommend having your PSA deal with HMO Blue instead of yourself.

    Jim

    
    
    re.17
    
    	I saw that same news cast. They want to charge a family of four
    	$4000.00 a year. That comes out to approximately $83.00 a week.
    
    	Makes the DMP plans look good.
    
    						Mike
    						----

Maybe this latent period before members are entered into the computer would
prove to be an effective marketing lever for new business (that is of course
assuming that it's not DEC hw/sw that they're using now :-O)


re .17
    
>>Of course, I saw our governor on the national news the other night talking
>>about statewide healthcare reform (we're in Minneapolis).  So I'm sure that
>>something in there will screw up the works :-).
    
State or Federal run health care, now there's a scary thought.  Seems things are
migrating in that direction though and all I ever hear from the politicians is
that "business" will have to bear the financial burden.  Then DEC stops 
providing employees with healthcare benefits and just pays the state/feds $ 
instead.  I suppose that'll cut down on the red tape when you go to have your 
heart surgery, because nobody'll know or care who does the cutting as long as 
it's done inexpensively and quickly enough to hose off the table for the next
patient.  

If HMO Blue is doing the best they can, then they're doing the best they can.
If the problems are due to laziness or mismanagement, then that's another 
story, but I tend to believe the few data entry people they hired are working 
doubletime and a half with the influx of new patients.




    

        Re: .21

>Maybe this latent period before members are entered into the computer would
>prove to be an effective marketing lever for new business (that is of course
>assuming that it's not DEC hw/sw that they're using now :-O)

        It would probably help considerably if Digital used an on-line
        system to register rather than 5-copy paper forms.  Then each
        HMO could be given the choice of a magnetic tape or a legible
        printout (rather than the current barely legible copies).

        Imagine--HMO cards on-time with names correctly spelled.

        As a bonus, an on-line system should eliminate the need to list
        your home address and all of your dependents every time you want
        to make any change to your health care.  The requirement to fill
        out the form in full detail each time is a pain.

        I'm going off to send this to DELTA.

        					B.J.

I think one of the five parts is labelled "data entry."

Must be dependant on the HMO......

I signed up out here (L.A.) with Pacificare... I had to see the doctor
on 1/6 , no problem. Also resulted in a prescription, again no problem.

I received the full packet with cards on 1/14.........


Bob

    I'm starting to understand how this is all supposed to work...  :-)

    Linda, your mistake was that you _believed_ the HMO Blue marketing
    literature.  I got the same packet you read, thought it was too good
    to be true (cheaper than CMHC but see the same people).  So I called
    HMO Blue and asked very pointed questions.  After 10 minutes, three calls
    to HMO Blue to verify the answers and three calls to CMHC to hear their
    side of the story ("I'm thinking of leaving your HMO to join HMO Blue --
    what's the catch?"), I knew I had to stick with CMHC.

    The rules for HMOs are:

      1. Don't believe anything in the glossies.  They're always
         "being rewritten."
      2. Learn to play "Simon Says."  Ask explicit yes/no questions.
	 If you can't formulate the question as yes/no, you have to learn
         more about the process :-)
      3. Get three random opinions on everything.
      4. Record all phone calls (Radio Shack sells a pickup for 6 bucks).
      5. Save all paperwork, including postmarked envelopes.
      6. Never, NEVER get offended by the jerks on the other end of the
         line, even when they put you on hold to order a pizza (yes I've
         heard this when someone missed the button :-).  If you're sweet
	 and compliant, they _might_ help you.  Once you act disgusted,
	 you'll be hit with a wave of paperwork and mistakes which wil
	 drown you.

    Well, I have to go now.  I've got four more bills to forward to CMHC
    for a claim from last summer.  Another three rounds and I might get
    the bill paid (If the collection agencies don't show up first).

    Well, I need to refill a prescription so called HMO Blue to ask if
    my card is coming soon.  So far, I'm not even entered in their computer
    yet and after I am entered the woman said It may take another 3 weeks
    to get the card.  This is totally pathetic!  Of course I can use my
    benefits form for the doctor but for the pharmacy I have to pay for the
    prescription myself ($80.00) and they'll "reimburse" me.  Ya, right.
    Is there anyone who's just signed on for the first time who has
    actually gotten a card???
    
    Marie

    I thought I was waiting a long time for Healthsource, but I guess I'm
    lucky -- my subscriber card came last Friday (1/17) but Healthsource
    had told me it would be late because I made an error on my enrollment
    form. In the meantime, they told me to just use my social security
    number and mention I was a new Healthsource member should I need
    medical/pharmaceutical services prior to receiving my card.
    
    Mike

    I talked with the DEC HMO Liaison at cooperate personnel and he said that HMO
    Blue cards won't be out until mid Febuary. He said that this was NOT
    HMO Blue's fault, but Digital's for having open enrollment so late.
    Also, DEC refused to use HMO Blues system to input the enrollment forms
    electronically and chose to hand over forms that had to be put in 
    manually.

    At any rate, he is trying to get HMO Blue to call my pharmacy to make
    arrangements. He has not gotten back to me.

     What I'd like to know  is, who's holding the money that's been taken
    out of our paychecks the last three weeks ? Wouldn't you like to have
    a few million in your hands to play with, for just one day ?
    
    Jim

    We have a DEC HMO Liaison?  Could you post the phone number?
    
    Thanks,
    
    Marie

    The HMO Blue/Baystate Liason is John Santos (me) and my number is 
    223-5402. Every HMO has a different liason and if you need a number 
    for any of them please, send me a note or give me a call. We might as
    well make this note a place to get answers to how HMOs are suppose to
    work. Please note; Your PCP manages all your care including who you see
    for a specialist and this is clear in *all* HMO material. Therefore,
    even though you might see your specialist listed you will only be able
    to see your specialist if your PCP refers you to him/her. 

Several people, it seems, have been told to use their social security number
until they get their new card (for whatever HMO they're dealing with). 
Thoughts on this?  I was somewhat uneasy about this when I found out that's
what Bay State uses for its member numbers....

-- Cathy

    re - 31
         Baystate does use SS#'s, but not all the HMO's do. I would call
    the pharmacy or doctor before you go there to make sure they will
    accept it. If not, call me to let me know what pharmacy/doctor you are    
    going to and I'll have a rep from Baystate call them to confirm you
    are a member. This will work for HMO Blue and Baystate, but other HMO's
    handle it different.

Re: .31

(An undocumented opinion, based on what I remember about the rules for
using Social Security numbers.)

Technically, your HMO cannot use your Social Security number to identify
you.  That's against Federal law.  On the other hand, the HMO is free to
use a membership number for you which just happens to be identical to
your Social Security number.  Since Social Security gets mixed in at
some point in the health-care payments, DEC has to provide them with
your SS#.  It appears that some HMO's (like the Massachusetts Registry
of Motor Vehicles and the Internal Revenue Service) then use an
identical number by default to identify you.

You can, of course, object to this practice.  If you're at all nervous
about it, you can request that your HMO (or the Registry or even the
IRS!) supply a different member number (or license number or Taxpayer
ID Number).

Just be prepared for a hassle if you want to exercise the privilidge!

				- - Steve

    RE. SS#  I saw on a T.V. news program the other day that you also do
    not use your SS# when you get your drivers license.  You can ask for a
    random number.  (Mass.)
    Anyway, back to HMO Blue/HMO's.  I knew about PCP's/specialist etc.
    from the Open House more than from the literature.  I had heard alot
    about HMO's before hand and evidently knew the right questions to ask.
    No surprises.  I chose HMO Blue because I felt they offered the best plan 
    for me. However, I have a prescription I need to fill in 1 week.  They 
    don't make a generic so it cost $80.00 for a 1 month supply.  I don't have
    $80.00 whether they'll "reimburse" me or not.  I didn't expect to have
    to wait until mid to late of February to get prescriptions.   You would 
    think they could set up some type of temporary plan for such an emergency. 
    I know I'm not the only one in this situation.  The guy in the office next
    to me is in the same boat.
    
    Marie

    I don't have HMO Blue, so this may not apply, but with CMHC (Central
    Mass Health Care), we called their customer service number and were
    told to take the enrollment form to the pharmacy (CVS) and have them
    call the HMO office (with form in hand).  The HMO office then
    authorized entry of the individual who needed the prescription (my
    wife, in this case) into the computer under my SS# and their provider
    number.  It was relatively hassle-free.  I don't know when I'll get my
    CMHC cards, but so far it has been no problem getting HMO rates for
    PCPs, referred specialists, or prescriptions.
    
    Has anyone explored this angle with HMO Blue?  Why would they be so
    different?  Or is this one reason for the approx. $15 per week higher
    cost of CMHC?

    re - 34
         As I stated in note 30 - you can call me and give me the
    information and most pharmacys will accept a call from HMO Blue
    confirming your membership and all you'll have to do is pay your
    co-pay. 
         Please note; If your dealing with a CVS pharmacy this process
     won't work because CVS won't accept a phone call as proof of
    membership.
                

    
    A couple of things....CVS won't accept a call but will call to confirm. 
    It helps if you give them a name and phone number.  I had the same
    problem regarding getting a perscription filled.  It worked with no
    problem.
    
    My problem developed with Harvard.  All I can say is, keep making phone
    calls, stay polite but firm.  Your Digital liason can definitely help.
    
    It is amazing that once it gets rolling, it works fine.
    

    I got my HMO Blue cards Saturday. Don't know if they work at the
    pharmacy or not yet.

    Jim

    .25 - Hassle Free if you appear during normal business hours-- nothing
    I could possibly do.  If I go to get a prescription filled, it's after
    hours.  Nor do I have the time to make phone calls during the day
    (trust me).
    
    I just switched to CMHC; no card yet.
    
    Quick question for anyone who might have this experience... what about
    a prescription that was written by an allergist you were referred to
    under your old HMO.  Under refill, it states, "CKW."  
    
    I wonder if the new plan will pick it up, or if I need to go through a
    referral to an allergist again, allergy testing again, etc.  (NO WAY!)
    
    Thanks,
    marcia

RE: -.1

    Call your CMHC rep to find out for sure, but I think you will probably
    need to go to an allergist that is part of your current HMO. S/he will
    probably just transfer the prescription for you after reviewing your
    medical history.

    Well, I'm all set ! The HMO Blue cards went through at the pharmacy and
    doctors. Look's like it's gonna work out OK.
    
    
    Jim
    
    
    

    Called the allergist, said I needed my prescription updated and moved
    to a different CVS (I did).  No problem; they'd phone it in!  Yay! 
    Next called the pharm and asked them if they'd fill it-- they would--
    if I came in before 4:30.  Are you kidding?  Phoned Member Services of
    CMHC and they intervened.  Hopefully, when I get there tonight, the
    prescription will be there!  Making personal phone calls these days -
    even at lunch time... just isn't always possible!
    
    Thanks for the advice.

    I must give credit where credit is due.
    
    Thanks John Santos.
    
    John called HMO Blue and HMO Blue did try to help get my prescription
    filled but now my pharmacy threw a monkey wrench into getting the
    prescription filled....sigh.  Thanks for all your hard work anyway
    John.
    
    Marie

    Yup, thanks to John Santos and Janice Carlson my PSA here in SHR !
    
    Jim

Well I was one of those die hard John Hancock supporters.  Forced to HMO due 
to the expense I signed up for Healthsource in NH.  I picked a Doctor out of 
their book and turned in the papers.

During the first week of Jan I took sick and wanted to see a doctor.  I call 
the one I selected and guess what.  We are no taking on new patiences at this
time.

Well, not feeling well to start with, I launched like a V2 rocket.  My PSA got
the first blast.  She quickly refered me to Healthsource.  Loading the second
blast I call Healthsource.  They were upset that the doctor had refused to take
me.

They helped me find a new doctor which ended up closer to my house.  I called 
for an appointment and they got me in right away.  When I arrived at the doctors
office, ready to unload blast #3, all went very good and I was treated.  I gave
my $5.00 and went home.

I took quite ill due to a drug store mix up and was required to go to the 
hospital via ambulance.  My wife gave the hospital the Healthsorce card and 
that was all that was required.  

So, unloading my blaster, I think I will like the new program.  So far So Good


Regards


Bob
   

    RE:  earlier note from me:
    
    "Hopefully, when I get there tonight, the prescription will be there!"
    
    The prescription was there, but my wonderful contact at CMHC never
    called CVS, as she had agreed to.  Is this any way to treat a customer?
    
    Fortunately, this was allergy medication I needed, not heart, insulin,
    etc., or any other more serious medication.  
    
    Rgds,
    marcia

    My CMHC card *finally* arrived last week!  On top of that, I findout
    the Co-pay has gone from $3 a visit to $10.  Other HMO's have gone
    from $3 to $5 (or so I've been told).  I never saw anything in the
    literature about rates increasing, I never saw anything in the mail
    saying my Co-pay was going up.  I was told by my doc's receptionist
    that as of Feb 1, the Co-pay went up.  Was anyone else taken by
    surprise?
    
    Joyce

	My CMHC copay remains at $3.We work for the same company.Perhaps
the receptionist made a mistake because copay fees can vary from company
to company.

Mike

    re .47  Something is wrong there it should be $3. Can you give me a
    call so I can help you fix this problem? I'm at 223-5402
    
                                  John

Co-pays can and do vary based on the plan.  The HMO I use here in the springs
has two different plans - one with a copay of $10 and the other with a copay
of $5.  DEC has the plan with a copay of $5, but most doctors in town are
used to dealing with the copay of $10.  My card states right on it what the
copay is for a particular service - usually just pointing it out to the
doctor takes care of any issues.

The only other minor problem i've run up against is that sometimes plans
will cover different procedures at different levels - and this is usually only
documented in the literature the HMO sent me;  So, unless I remember to ask
the doctor to verify with the HMO the coverage (or maybe happen to bring
my HMO book) then I have been charged more at the time of service, but
got re-imbursed once the HMO paid the doctor.

--Scott

    I finally got my card, too!  FINALLY!
    
    Watch out for this one-- the prescription plan is what's called $3/$9. 
    That stands for $3.00 generic brands and $9.00 name brands.  When I
    picked mine up-- already filled-- at 8:30 PM, the pharmacist gave me a
    very curt NO when I asked if there was a generic to the allergy stuff I
    was getting.  Sheesh, no harm in asking?  It WAS a surprise, though. 
    You may want to ask your physician, if that $6.00 difference matters
    that much to you.  (in my case, every penny matters! :-} )
    
    Rgds,
    marcia

    
    
    MASS State law requires the pharmacist give you generic brands if they
    are available.
    
    
    
    	Jim

re .52:

Unless the doctor specifies that it should be the non-generic.  Mass law is
so perverse that if there's a generic but the pharmacy is out of it, they
can't fill the prescription with the brand name drug (this in the case
where the doctor didn't specify).  I once had to go to three pharmacies
to find one that had the generic -- fortunately it wasn't a life-threatening
situation.

    While the active ingredients are supposed to be identical between a
    generic drug and a brand name one, the filler agents, which form the
    bulk of the pill or whatever, may well vary.

    Your doctor may have found that some generic drugs give side effects
    from the filler, or the filler may have in some way interfered with the
    speed or blood level of the drug. Thus he may deliberately prescribe a
    brand name drug in your interest. If you suspect that he is always
    prescribing you brand names, ask why.

    Jamie.
                                                

    There are some drugs that they haven't made a generic for.  I take
    Zantac and there is no generic for it so I'm stuck with paying the
    $9.00.  The way I understood the literature from HMO Blue, if you can
    find a site-based pharmacy you can get brand name drugs for the $3.00.
    
    Marie

      <<< Note 1721.55 by HUMANE::PROXY::HOPKINS "All one race - Human" >>>


	Just as a point of information, our HMO (HMO Colorado) has
	a $3 co-pay for prescriptions. This applies to "name brands"
	if no generic is available. The opposite (down-side) of this
	is that if a generic IS available and the Doctor specifies
	"No generic", you pay retail (HMO pays nothing).

Jim

    I had to follow-up with the doctor's office just now.  I mentioned that
    I'd spoken with John and he informed me that the CMHC co-pay was $3 not 
    $10.  The nurse checked with the billing clerk, it hasn't gone up.  
    
    Seems the receptionist was confused.  State and Federal co-pay have gone 
    up, but not private companies.
    
    problem solved - thanks
    
    Joyce

	Maybe that's what she... whoops he or she, (the nurse), ...was
	thinking. 

    re: .56
    
>    Just as a point of information, our HMO (HMO Colorado) has a $3 co-pay
>    for prescriptions. This applies to "name brands" if no generic is
>    available. 
    
    This USED to be the way it worked here in Mass.  Now, for sure, HMO
    Blue makes you pay the $9 regardless of why you couldn't get a generic
    (i.e. none exists, pharmacy out, etc.) unless it's filled at some
    special centralized place, nowhere near me.
    
    It's like Unix documentation.  If you already know the answer, the manual
    explains it perfectly.
    
    -joe tomkowitz
    
    P.S.  A pharmacy may force you to pay full price for birth control
    pills under HMO Blue.  It only takes a couple hours of phone calls to
    straighten it out after the fact.  It helps if you switch drug stores.

    re: .58
    
    CMHC prescription co-pays did *not* go from $3 to $9.  The co-pay is $3
    for a generic, $9 for the brand name.  Office visit co-pay is $3.
    
    Dick.

    Re: 60
    
    Dick,
    
      Yes, CMHC co-pay did go from $3 to $9 dollars for a prescription. I
    have had CMHC for 6 years now and up until this year I paid $1 for a
    generic prescription and $3 for a non-generic. As of now I have to pay
    $9 dollars for the same non-generic and $3 for the generic.
    
      How is this misinformation, it is fact. Generic went from $1 to $3
    and the non-generic went from $3 to $9, a 300% increase.
    
    Brian
    

.59:    The prescription I needed was not available
	in non-generic, so I paid 9$.  But you 
	are correct.

    Time out... You guys are talking about two different things
    
    >>CMHC co-pay did go from $3 to $9 dollars 
    
    Should read $3 and $9 
    
    As you explained in your note co-pay went from $1 AND $3 to $3 AND $9
    this year.
    
    Dick was saying the co-pay did not go from $3 to $9.  It is still $3
    for generics and $9 for name brands.
    
    Marie
                                        

    re 63:
    
    Marie,  
    
        Last year the prescription rider on CMHC had co-pays of $1 for
    generic/ $3 for non-generic. This years plan has $3 for non-generic/ $9
    for non-generic. Where is the play on words that the same prescription
    I had filled in December 1991 at $3, and it now cost me $9. To me this
    is an increase from $3 to  $9. If I am mistaken, please explain how.
    
    Brian
    

    Brian,
    
    Let's see if I can explain this.  Someone complained about this years
    co-pay going from $3 TO $9 which in fact it hasn't.  People who signed
    on this year knew from the start that the co-pay would be $3 for
    generic and $9 for brand name.  You already had CMHC which evidently
    payed $1 for generic and $3 for brand name previous years.  So for you 
    the rates DID go from $1/$3 (last year) to $3/$9 (this year).  But not 
    $3/$9 (this year) to $9/$? (this year).  Am I making sense now?  The 
    rates for people who just signed up for CHMC this year are the same as 
    when they signed up for CHMC beginning Jan 1. 1992.
    
    Marie

    re: .64
    
    Brian, Marie beat me to it.  If you had said in your original note that
    CMHC prescription co-pay had increased from $1/$3 last year to $3/$9 
    this year, that would have been a true statement.  The statement that 
    co-pay increased from $3 to $9 was misinformation.  That is all I was 
    pointing out.  No big deal, just correcting a nit that could have lead 
    to a rathole (like the one we're in now).  8-).
    
    Dick.

    Another problem with HMO Blue
    
    
    In August we adopted two girls.  I read my membership brochure, which
    said that we had to inform HMO Blue about the addition within 30 days,
    which I did (return receipt requested, thankfully).  We never got an
    enrollment form and never got cards for the girls.  We went to one of
    the doctors in the membership handbook and said that we wanted them to
    be our primary care physician.  They said OK.  We got checkups for the
    girls.
    
    
    Then we got a bill.  Our primary care physician was not our primary
    care physician.  
    
    We never got enrollment forms, so HMO Blue signed us up with a random
    physician.  They never told us that they did that.  
    
    We called them to find out why we had this problem.  They explained
    that they set us up with a physician (though they never told US that),
    and that we would have to go through the APPEAL PROCESS if we didn't
    want to pay the bill.
    
    It's not so much that a screw up was made as it is that it takes a
    lengthy process to correct it (including 10-15 minute holds on their
    customer service line every time I've tried to get through) that makes
    my choice for an HMO this year pretty clear.