T.R | Title | User | Personal Name | Date | Lines |
---|
1736.1 | | CUPMK::SLOANE | Communication is the key | Wed Jan 22 1992 15:50 | 9 |
| Re: .0 and all the medical complaints.
I think we should extract all these complaints and send them to Corporate
Benefits. It might come in handy when the contracts are up for negotiation.
Do any of the contracts Digital has with John Hancock or the HMOs have
penalty clauses for poor work?
Bruce
|
1736.2 | | COOKIE::LENNARD | Rush Limbaugh, I Luv Ya Guy | Wed Jan 22 1992 15:50 | 1 |
| They probably have the same kind of computers/MIS we do.
|
1736.3 | Mark it on the receipt next time | TOOK::MCCAULEY | | Wed Jan 22 1992 16:15 | 10 |
|
For future reference, should you ever find yourself in a similar
situation again, the way that I've been instructed to mark my claim
as having been paid by me is to write (in red, bold ink) "PAID BY
EMPLOYEE" on the receipt being submitted. I have never had a problem
since I started doing that.
I hope you get the money due you...
Laura
|
1736.4 | Once or twice ... | SALISH::LYON_RO | This space for rent | Wed Jan 22 1992 16:19 | 16 |
| re .0
I've submitted claims to JH for reimbursement of services I paid for on many
occassions and have had this happen once or twice. I usually fill out the JH
claim form, add the provider's receipt/claim form and a carbonless copy of my
check, and send it all to JH. If JH gets it right, you get a visibly different
claim summary that has the check along with it. If not, you get the normal
summary telling you the amount will be sent to the provider.
The few times this did happen I just called the provider, told them what had
happened, and had them send me a check (one dentist even forwarded the JH check
to me after he endorsed it).
Maybe I've just been lucky ...
Bob
|
1736.5 | | NOTIME::SACKS | Gerald Sacks ZKO2-3/N30 DTN:381-2085 | Wed Jan 22 1992 16:20 | 3 |
| If you think we have it bad, talk to a provider. BTW, JH once sent a check
to my doctor rather than me. The doctor endorsed it over to me and mailed
it to me before I was aware that there was a problem.
|
1736.6 | | VMSSPT::NICHOLS | It ain't easy being green | Wed Jan 22 1992 16:21 | 10 |
| <I've submitted claims to JH for reimbursement of services I paid for on many
<occassions and have had this happen once or twice.
<The few times this did happen I just called the provider, told them what had
<happened, and had them send me a check (one dentist even forwarded the JH check
<to me after he endorsed it).
metoo
herb
|
1736.7 | bypass JH totally... | SALISH::EVANS_BR | | Wed Jan 22 1992 16:34 | 1 |
| now you know why I decided to go to HMO... bypass JH...
|
1736.8 | no choice here... | ODIXIE::SILVERS | David Silvers, Office Pardner... | Wed Jan 22 1992 16:47 | 2 |
| those of us in remote areas don't have any choice but JH, (tho I
would'nt go with an HMO regardless..)
|
1736.9 | JH is mediocre | SWAM1::MEUSE_DA | | Wed Jan 22 1992 17:19 | 6 |
|
Compared to my wifes' dental plan, John Hancock is a joke. A total
joke. They complain about everything submitted. Real cheap bunch of
crooks.
|
1736.10 | squeaky wheel theory | CSC32::D_RODRIGUEZ | Midnight Falcon ... | Wed Jan 22 1992 17:43 | 3 |
|
... ask for their supervisor next time. Maybe (s)he can help expedite
things.
|
1736.11 | I'm covered through so and so,they'll pay the bill | EMDS::MANGAN | | Wed Jan 22 1992 18:19 | 16 |
| Normally I would insist that the Dentist collect directly from my
provider and send me bill for the deductible amount or services not
covered. Isn't this common practice for most health service
professionals?
When I had some oral surgery done about 10 years ago I was referred to
an out patient type service in Concord (right off route 2). I was fully
covered for this type of treatment by my current employer. The guy
wanted a $100.00 CASH "deposit" before he would even see me. I said,"screw
that I'm covered through so and so,they'll pay the bill". I left and
went to FUH in Framingham,saw the best Oral Surgeon in the area and
wasn't asked once to dig into my pocket for anything but my coverage ID
card. Will there always be heath professionals out there that are
interested in money more than the health of a patient? I know "how
nieve"? Did I open can of worms here?
|
1736.12 | cash flow... | NARFVX::FRANCINI | Screwy Wabbit | Wed Jan 22 1992 20:18 | 25 |
| Maybe it is a can of worms...
I see a dentist in Sudbury who's quite good and has a decent chairside manner
(and that's good since I'm extremely squeamish about dentistry). However, he's
got one tiny little problem. He demands payment on the day of service, no
matter what insurance you have. (He does take MC/Visa, though, which can
help a tiny bit with the cash flow).
Up until about 6 months ago, he used to give you two receipts: one for the
insurance with the "stated" charges, and another with a 3% discount for
paying cash up front. You wrote the check for the discounted amount, and
you sent John Hancock the other receipt with the full amount.
Since JH doesn't pay 100% of anything (their idea of 'reasonable and customary
charges' was accurate for 1980, probably), you made out a little better than
otherwise, and the 3% helped make up for the annoyance of having to pay up
front.
All this chicanery wouldn't be necessary if insurers paid their stated
percentages of REAL dentists' fees, not some nonsensical "Reasonable and
Customary" composite.
At least the dental plan is still free for individuals...
John
|
1736.13 | pay for services | NYEM1::MILBERG | squeezed by the grapevine | Wed Jan 22 1992 23:58 | 29 |
| re: .11 - I noticed you said that happened about 10 years ago.
Over the past years I have found that the only health care providers
who will bill the insurance companies rather than insist on payment
when services are rendered are:
1. very few
2. ones I am personal friends with
This is especially true away from the GMA where the John Hancock/DMP is
NOT known. Most providers here in NJ have a posted list of the
acceptable (billable) LOCAL plans that they KNOW will pay (and what
they will pay).
<ready shields - the following is going to draw incomings>
From the other side of the issue - they are a 'business' and are, of
necessity, like us (DEC) trying to fix their accounts receivable (DSO)
problem. If they bill the insurance company and there is any problem
or deductible, that takes 30 to 60 days and then they have to bill the
patient and that may take another 30 to 90 dys to collect. Think about
it - you have to pay the supermarket or cleaner or shoe repair man
immediately for services rendered. Why look for a 'loan' from your
doctor/dentist?
-Barry-
|
1736.14 | Can't avoid JH all the time | SALEM::VINCENT | | Thu Jan 23 1992 07:53 | 2 |
| re-.7
Even with an HMO, JH runs the dental plan.
|
1736.15 | Why can't they read the form?? | GEMINI::GIBSON | | Thu Jan 23 1992 09:14 | 3 |
| I don't mind paying up front, especially when I get a discount for
doing so. I put it on MC and pay when the check comes. BUT I have never
had JH send me the check directly, no matter what I do on the form.
|
1736.16 | me too; dual pricing | SAUTER::SAUTER | John Sauter | Thu Jan 23 1992 09:18 | 10 |
| I have had the same experience described in some of the earlier
replies: no matter what I tell JH, they pay the dentist. I've been
going to the same dentist for several years, so he routinely endorses
the check over to me. It seems rather silly, but it's the easiest way
to "fix" an administrative problem at JH.
By the way, I think the practice of giving you two prices, one that you
pay and a higher one for the insurance company, isn't right. I know if
I were an insurance company I would take exception to this practice.
John Sauter
|
1736.17 | let's help JH solve the problem! | CSOA1::FOSTER | Frank, Mfg/Distr Digital Svcs, 432-7730 | Thu Jan 23 1992 09:22 | 7 |
| > 2. Why does it take JH 2 weeks to find a simple claim that is only 3
weeks old?
If anyone knows who the Account Rep who sells to JH, please
forward .0 to him/her.......,..sounds like they need an imaging solution!!
FF
|
1736.18 | Could it be on purpose? | WFOV12::MOKRAY | | Thu Jan 23 1992 09:55 | 7 |
| JH has consistently sent my reimbursement checks to my dentist, rather
than me. Despite clear indications that I'd already paid. What I
learned is tht they reimburse healthcare providers on a different
schedule than us (i.e., only once a month do checks go out). By "making
this mistake" they are helping their own cash flow. Then when the
dentist is negligent in endorsing the check over, it all slows down
even more. Wonderful system.
|
1736.19 | my answer | CSC32::MCDEVITT | | Thu Jan 23 1992 09:56 | 9 |
| John Hancock is one slow company in paying out their bills. It takes
them an average of 6 months to pay my Doctor. The one thing I
notice that my insurance is taken out of my check every week on time.
They want your money and they don't want to pay out.
The problem with John Hancock probable is they are one of the companys
hurting for money. They invested in the wrong things. The longer
they hold our money the better they are.
|
1736.20 | It Confirms my Suspicion | EMDS::MANGAN | | Thu Jan 23 1992 09:57 | 16 |
| Re.13 Why ask the doctor/dentist for a loan?
Not to be-labor the point,however myself as well as my wife have had
regular dental exams over the years and have NEVER been forced to "pay
up front" for any services. Sure the case in example .11 was 10 years
ago and by your reply, it confirms my suspition that health care has
gone to the dogs,by prioritizing its business (raw profit) in front
of "basic care of the patient". BTW, just recently we have had a
difference of agreement with my wife's dentist to the tune of as little
$30. His business ethics in this particular case were atrocious, and with
regret forced me to contact Worcester Community Action Council as well
as the Mass. Dental Assoc. Investigative Unit. It IS a business
"first". How many Dentists do you know who sign there bills as
(Dr. Name D.M.D.)"President"? Sickening!
|
1736.21 | Try incorporation for protection. | CSOA1::ROOT | North Central States Regional Support | Thu Jan 23 1992 10:02 | 8 |
| Most doctors are incorporated just so if law suits are filed you can
only get the money in the business and not touch their personal money.
Without incorporation you could wipe them out finacially with a law
suit.
Regards
Al Root
|
1736.22 | | NOTIME::SACKS | Gerald Sacks ZKO2-3/N30 DTN:381-2085 | Thu Jan 23 1992 10:07 | 14 |
| re .19:
JH just administers DMP and the Dental Assistance Plan. It's DEC's money,
not JH's.
For regular providers, I've found that JH reimburses me 2-3 weeks after
I submit a bill marked "paid." New providers take longer.
My dentist submits bills directly to JH, but I gather that he has a number of
DEC patients. Many providers say they want to be paid directly by the
patient, partly because JH/DMP is notoriously slow in processing *provider*
claims. If they miss the monthly deadline, *provider* reimbursements get
bumped to the next month (I believe *patient* reimbursements are done daily).
JH sometimes misses the deadline because they screw up.
|
1736.23 | No real problems here | USRCV2::SOJDAL | | Thu Jan 23 1992 10:38 | 26 |
| I may end up eating these words but...
I have submitted several dental bills over the past several months for
my daughter to JH. Each of them, with one exception, was marked paid
and the check was sent directly to me not the dentist. The one bill
that wasn't marked paid (I had forgotten to bring my checkbook with me
that day) was paid directly to the dentist. Since the dentist had
already been paid by the time the reimbursment check arrived, he had to
repay me.
In all cases the JH check, while not super-fast, was timely. That is,
I was paid no later than the month following the submission (e.g.
submitted in Dec. and paid in Jan.).
But Geez, after reading some of these other stories, you've got me
worried!
Also, I have to agree with a remark made several notes back that just
because a dentist or doctor demands payment up front doesn't mean he's
more worried about his money than your health. I've had some extremely
good practicioners who've wanted to be paid up front and some mediocre
ones who were willing to wait for the insurance check. In fact, in at
least one instance I believe the guy got as many patients as he did
simply because he *didn't* hound you for money.
Larry
|
1736.24 | | STAR::DZIEDZIC | | Thu Jan 23 1992 11:31 | 9 |
| It seems that requesting some/all payment up front is developing
into the "norm" for dentists in the Nashua, NH area. Most of
the ones we contacted want 20% of the bill paid up front; when
you figure the "unreasonable and uncustomary" payments of the
Digital Dental Plan it often winds up that the 20% is what you'd
owe on preventive work anyway.
I prefer the "old" bill me later plans, but I can also see the
dentist's side of the coin.
|
1736.25 | try the US Benefits Manager | STOKES::NEVIN | | Thu Jan 23 1992 11:33 | 9 |
| I made a complaint about a similar issue to DEC's US Benefits Manager
and to JH. The Benefits Manager did an excellent job of resolving the
complaint. They are in the DEC phone directory.
I put a post-it note on every claim form I submit to JH stating that I
had already paid the bill. Seems to work. Before I started doing it,
they got it wrong about 50% of the time.
Bob
|
1736.26 | | TEMPE::MCAFOOS | Spiff readies his daring escape plan... | Thu Jan 23 1992 11:40 | 8 |
| The other way to get their attention is to write on the claim form in
BIG letters with a red magic-marker type pen that you have already paid the
bill.
Every time I do this, I get the check. When I forget, the doctor gets the
check.
Bob.
|
1736.27 | Between a Rock and a Hard Place | CTHQ1::ROSENBERG | D. Rosenberg TAY2-1/H15 227-3961 | Thu Jan 23 1992 11:56 | 10 |
| I had a case a while back where JH paid the doctor even though I had
paid him. So when the doctor got the check from JH he dutifully endorsed
it and mailed it to me. When I tried to deposit the check at DCU they
didn't want to accept it becausae they had no way of verifying the
doctor's signature.
It took some arguing (and it probably helped that it was something like
a $15 check) but they finally took it.
Dick
|
1736.28 | | DPDMAI::FEINSMITH | Politically Incorrect And Proud Of It | Thu Jan 23 1992 12:24 | 8 |
| JH seems to have an interesting formula, enter 4 bills, loose 1, enter
4, loose 1. I have just had this problem again ,where bills I submitted
in Dec, magically "vanished". I end up getting a human's name and
fax-ing them copies. This is not an isolated incident, but happens a
number of times each year. They must have real rocket scientists
working there!
Eric
|
1736.29 | Third-party checks are a no no at my bank | LACGID::BIAZZO | Can tune a VAX but can't tuna fish | Thu Jan 23 1992 12:45 | 26 |
| Not accepting "Third Party" checks as they're called, is not just restricted
to DCU. I went into my bank here in Florida with a dental benefits check made
out to my dentist and endorsed over to me and they would not accept it.
The twit bank manager went so far as to call the dentist and ask him if he
had endorsed it to me. He had obviously not endorsed it because the handwriting
was very fluid, frilly, and flowing as that of persons who are typically female.
Anyway, the bank manager said I would have to give the check back to the dentist
and have him write a check to me from his account.
Instead, I went to another branch and deposited the check with no
questions. In this case, the inconsistencies in bank employees worked in my
favor. The inconsistencies with regard to JH for both medical and dental are
unfortunately becoming the rule rather than the exception.
Somehow though I can't help feeling that all these problems began when we
reduced JH's role to that of just administrator. It seemed to work much better
when they were both provider and administrator. I hope Digital is saving
a lot of money because the switchover has cost me a lot of time on the phone
trying to straighten things out.
re: a couple back;
The red lettering trick ie. "DOCTOR PAID - REIMBURSE ME DIRECTLY" seems
to work.
|
1736.30 | | VMSSG::NICHOLS | Conferences are like apple barrels | Thu Jan 23 1992 12:59 | 11 |
| In my 20 years at Digital, J.H. has processed well over 200 claims for
my family. Of those perhaps 4 or 5 had some problem.
We have been submitting monthly bills - every month- for more than 8
years in connection with ONE family situation, as well as quarterly
bills for 15 years for another family situation, as well as 2-4 times
a year for 20+ years for pediatric matters. On two occasions J.H has
sent a check to the physician when I expected to receive the check. In
both cases I had neglected to indicate on the bill that the bill had
already been paid.
There has NEVER been a problem with our dental bills
|
1736.31 | | CARROL::LEFEBVRE | Watcher of the skies | Thu Jan 23 1992 13:14 | 15 |
| <<< Note 1736.19 by CSC32::MCDEVITT >>>
> The problem with John Hancock probable is they are one of the companys
> hurting for money. They invested in the wrong things. The longer
> they hold our money the better they are.
JH only administers the plan....Digital is the provider.
Although I've switched back to Healthsource, JH never was a problem and
I was hospitalized twice during that duration. One thing I did learn,
however, was that you need to keep all your paperwork in order to
cross-reference your bills when your JH statements come in.
Mark.
|
1736.32 | Well, um, maybe... | LYCEUM::CURTIS | Dick "Aristotle" Curtis | Thu Jan 23 1992 13:37 | 12 |
| .16, on .12:
John, if I read John's note (.12) correctly, he's actually getting a
small rebate or discount specific to paying the dentist on the spot.
I suppose that he could simply stop doing that, and live with the
cash-flow problems that might ensue if no patients pay on their way out
the door.
But then, I'm assuming that the amount paid by the insurance is less
than the bill, even after the discount.
Dick
|
1736.33 | Follow-up: It pays to scream? | CUPMK::SLOANE | Communication is the key | Thu Jan 23 1992 14:25 | 27 |
| Here is what has happened since I entered the base note.
I got a copy of the dentist's bill and with it in front of me
I called John Hancock again. I read the bill to them: "The charge was
$129; the dentist was paid $129; the balance due is zero."
She (I am not mentioning any names to protect the guilty) said she
still hadn't retreived the bill from their files. Could I fax my copy
to them? (Apparently it's faster to get a fax than to retrieve the
file.)
I faxed it. A few minutes later she called back, and said she didn't
see that the bill showed that I had paid the dentist. I read it to her
again: "See the top line? The charge was $129 ... etc." She said, "Oh,
I didn't see that line. Let me talk to my supervisor and I'll call you
back."
About an hour later she called back. She had the fax, plus the original
bill, plus my paperwork that clearly said to pay me. She said they are
sending me a check for $110 tomorrow. I said that the original
reimbursement was for $100. She said that they "recalculated" the
reimbursement and that it should have been $110.
So, according to them I should be receiving a check from JH for $110 in
a few days. Any bets on when, or if, it will arrive?
Bruce
|
1736.34 | Forget 3rd party checks! | EMDS::MANGAN | | Thu Jan 23 1992 15:03 | 6 |
| Forget 3rd party chaecks....I went to DCU yesterday to cash AND DEPOSIT
into MY savings account 5 checks that were made out to me. I must have
looked like a criminal because the teller asked for my SS #, hire date,
account #,license, looked at my DCU atm card and my DCU Visa! Its nice to
know that the bank you've been doing SUBSTANTIAL business with for 5 years
doesn't know you. I know a little off the subject track of .0.
|
1736.35 | Don't bother with a live teller... | NARFVX::FRANCINI | Screwy Wabbit | Thu Jan 23 1992 19:51 | 28 |
| re .34:
Don't bother with a live teller. I've been using strictly ATMs for all my daily
banking for the past 12 years, and have never regretted it.
No nosy tellers snickering to themselves about your account balances or
activity.
No having to produce umpteem forms of ID.
No restriction to ludicrous "banking hours" that have more in common with the
stock market's (equally ludicrous) trading hours.
Reasonably complete anonymity. (I know some banks will display your name on
the screen when you "login" and "logout", in an effort to be friendly, but my
bank [Baybank] doesn't do that.)
I can deposit any kind of 3rd party endorsed-over check and they'll take it.
I've never had any sort of problem.
And with "deposit with cash back", I can cash checks on the spot.
BTW: It sounds like your local DCU clerk needs a bit of reeducation. I always
thought that upon presentation of your badge, no other form of ID was
necessary for withdrawls. For deposits, no extra IDs should be required --
after all, it's a DEPOSIT!
john
|
1736.36 | Reasonable and customary charges | MSBCS::KING | VSS BXB/LTN System Management Group DTN:293-5677 | Sun Jan 26 1992 11:30 | 13 |
| My dentist just takes what John Hancock sends them. I once sent
him a check for the balance, $12.00 and he sent it back saying that
what John Hancock sent him was satisfactory. He's a friend of the
family.
I concur with other replies, you need to indicate in big red
letters on the form that you've paid the Dentist up front. That's
what Hancock told me a couple of years ago when they did the same
thing to me. What do you expect, they're an insurance company!!
/Bryan
|
1736.37 | | BSS::D_BANKS | David Banks -- N�ION | Mon Jan 27 1992 17:48 | 13 |
| Our dentist bills JH within two working days of a visit, and many of the bills
were more than 90 days overdue at the last count.
In the past couple of weeks, I've received a barrage of notes from JH regarding
Dental charges, some dating back to last March! I guess they're trying to
clean up last year's mess.
Three of those documents showed one charge last June as "covered", "not covered
because not enough time had elapsed since the previous visit", and "already
covered". Three different interpretations within a few days of each other.
Clearly they have no idea what they're doing.
- David
|
1736.38 | You have to get their attention... | SCAACT::RESENDE | Pick up the pieces & build a winner! | Mon Jan 27 1992 22:56 | 22 |
| I also had the problem of JH reimbursing the dentist (or doctor) even
though I had already paid. I finally printed out a page that says, in
1-inch high bold print:
THIS CLAIM HAS BEEN PAID BY THE EMPLOYEE.
PLEASE DO NOT PAY THE PROVIDER.
==============================
THE EMPLOYEE SHOULD BE REIMBURSED DIRECTLY FOR THE MEDICAL EXPENSE.
A PAID RECEIPT IS ATTACHED.
I Xeroxed a whole bunch of these sheets, and attach one to each and every
claim I submit. I also use a highlighter and mark on the receipt where it
shows the bill has been paid (doing this alone didn't work, which is why I
resorted to the more drastic measure mentioned above).
Since I started doing this, I have not had a single case where they paid
the provider in error.
Steve
|
1736.39 | | ESMAIL::BEAN | Attila the Hun was a LIBERAL! | Tue Jan 28 1992 08:37 | 7 |
| I learned years ago the safest way for me to get paid directly is to
write, in big bold RED ink, diagonally across the claim form the phrase
"PLEASE REIMBURSE ME DIRECTLY"
it's never failed.
tony
|
1736.40 | Backwards Assignment | PCOJCT::BAIO | | Thu Jan 30 1992 16:53 | 32 |
| I think we are missing the point of this note. Why do we need work
around solutions to get paid directly. The John Hancock plan provides
"automatic" assignment of benefits to be paid directly to the provider.
Why is this?
If you go to your Dentist and ask for a copy of a generic insurance
claim form there is a place where you must sign to authorize
payment to the provider.
If this is my insurance why aren't benefits automatically assigned to
me? Then I could mark in bold red letters, DENTIST HAS NOT BEEN PAID
and maybe, just maybe John Hancock would send a check to the dentist.
Isn't this preferable. Who is this plan protecting, me or my dentist?
I think our insurance should not automatically assign benefits to the
provider. There should be a place to indicate my preference, that must
be signed by me.
I recently had a problem where John Hancock paid my dentist directly
for a claim that I paid the dentist in full. Since my dentist
does not give me the completed claim form the same day, I ask him to
mail it to me so I can implement the red letter solution. He forgot
and sent the claim to john hancock. John Hancock paid the dentist
using the bulk payment method, they pay several Digital claims on one
check.(I didn,t know other employees were using this guy.) Well of
course now the dentist got confused because of this consolidated
payment, and the bottom line is that I had to go there on saturday
and sit down with his office clerk to solve this problem. I did
get my money, but why is this necessary? The default payment should
be me, not the dentist.
|
1736.41 | | DPDMAI::FEINSMITH | Politically Incorrect And Proud Of It | Thu Jan 30 1992 18:19 | 7 |
| Well, by paying the provider, they sit on the reimbursement for a
month, often more, so its free interest in their pocket. Plus, the turn
around time for claims in general is "piss poor" normally. If I ran
a business like JH runs theirs, I doubt I'd have any supplier that
would ship me anything!
Eric
|
1736.42 | Kiting funds- we're Pros. | PTOECA::MCELWEE | Opponent of Oppression | Fri Jan 31 1992 02:22 | 17 |
| RE: .41-
JH runs DECs business (DEC medical plan _administered_ by JH).
Since DEC is famous for accounts payable delays, is the scheduled
payment/lump payment confusion any surprise?
Also, since DEC is self insuring for the DEC medical plan, there is
no accountability to insurance commissions for the policies employed.
How convenient.
My pager service and those of 3 others were shut off by the vendor
after the invoice went unpaid from June/July 1990 until Dec. 1991 due
to A/P and incomplete vendor transition in our region. I spent at least
one man-day notifying, tracking, and getting this fixed. I doubt that
the former vendor ever got their due.
Phil
|
1736.43 | What's His Phone Number | ALFPTS::COBBR::RCOBB | | Fri Jan 31 1992 13:18 | 16 |
| RE: 37
Do you think your dentist family friend would provide the same bargain to
other Digits? If so, it would be worth while for me to travel there to
get service, based on the paultry amount Digital has been paying lately.
I recently had a $450 bill for a crown needed when more than half a molar
cracked band roke off. JH initially allowed only $37, saying that I should
have had only a filling! After appeal they finally paid just over $200.
When I asked how that amount was determined they said it was the prevailing
rate for the service in my zip code. When I asked them to give me the
name and phone number of a dentist who would do the same work for that
amount they said they could not give out referrals.
What a rip off.
|
1736.44 | Can you share the source? | LJOHUB::BOYLAN | | Fri Jan 31 1992 17:03 | 9 |
| Re: .38
Sounds like you ought to make a PostScript file available for
anyone who has to get reimbursed . . . they can just print it
out on red paper, and voila!
:-)
- - Steve
|
1736.45 | Beware of "CHEAP" dentists! | CIMNET::WOJDAK | Rich Wojdak DTN:291-7787 | Mon Feb 03 1992 07:33 | 12 |
| >rate for the service in my zip code. When I asked them to give me the
>name and phone number of a dentist who would do the same work for that
>amount they said they could not give out referrals.
And even if they did give out a referral for someone to do the
work at their price, would you REALLY want to go to that dentist?
I had a dentist who used to do the work at what the insurance
paid.I had more problems than I care to relate.Then I switched
dentists.
|
1736.46 | Where in the Phone book is the US Mgr? | CIMNET::MCCALLION | | Tue Feb 04 1992 15:06 | 12 |
| I'd like to call the US Benefits Mgr and find out WHEN DIGITAL might
catch up with the Dentists charges. My dentists are complaining that
Digital is paying at 1987 rates and that is costing me lots of money.
My husband needs dentures badly and according to the office it's going
to cost close to 5k out of our pockets due to Digital using 1987 rates.
Now where in the DEC phone book is this person listed? I looked under
Benefits, Insurance and US but didn't locate the Benefits Mgr. Could
you please post or send me the number?
Thank you.
Marie
|
1736.47 | | UPBEAT::JFERGUSON | Judy Ferguson-SPS Business Support | Tue Feb 04 1992 16:18 | 6 |
| RE: .46
In your Digital phone book -- Personnel Department, Corporate/Us
Benefits Manager
|
1736.48 | Note to US. Benefits Mgr. | CIMNET::MCCALLION | | Wed Feb 05 1992 13:40 | 29 |
| This is my note to Peter Hawker: Did I give too much personal info,
just enough? Did I leave out anything?
Hello Peter,
I am writing you concerning the Dental Benefits being offered today by
Digital Equipment Corporation to its employees.
Several weeks ago my husband needed some emergency dental work and was
required to bring a large amount of money to the office before they
would treat him. We will need to come up with $354.00 prior to dental
surgey and that is just for the dentist. The reason for this upfront
money, I was told, was that Digital Employees had voted not to increase
the benefit amount for the Dental Plan and that Digital was using the
1987 rate scales. This is not the first Dental Office that has told me
this.
I did inform the Business Office Personnel that the Digital employees
do not vote on the benefits.
Do you forsee Digital bringing its Dental Assistance rates into
alignment with the industry in Fiscal Year 93 or in calendar year 1993?
I look forward to your response regarding this matter.
Sincerely,
Marie McCallion
Employee
|
1736.49 | My $.02 | PTOECA::MCELWEE | Opponent of Oppression | Thu Feb 06 1992 01:07 | 7 |
| Your note covers the basic problem, however I would like to suggest
that the words "reasonable and customary charges" (as mentioned in the
plan provisions) be referenced as being maligned with reality in 1992.
Please update us when you receive a response.
Phil
|
1736.50 | | NOTIME::SACKS | Gerald Sacks ZKO2-3/N30 DTN:381-2085 | Thu Feb 06 1992 09:26 | 6 |
| Could someone post an official description of the Dental Assistance Plan
that uses the term "reasonable and customary charge?" I thought the whole
purpose of the dental plan was to encourage preventive care. Preventive
care is reimbursed at higher rates than the serious stuff. There's also
an annual maximum benefit, which is arguably the inverse of the Digital
Medical Plan's out-of-pocket maximum.
|
1736.51 | Dentist Rejects Patient for lack of signature | SCARGO::LEVY_J | | Thu Feb 06 1992 16:06 | 6 |
| What would you think of a dentist who asks his patient to sign
a page full of sticker labels to be used on the John Hancock
reimbursement forms, and when refused, sent a letter two days latter
rejecting that person as a patient?
Sad but true.
|
1736.52 | | NOTIME::SACKS | Gerald Sacks ZKO2-3/N30 DTN:381-2085 | Thu Feb 06 1992 16:44 | 6 |
| re .-1:
There's something strange here. First, what's wrong with signing stickers?
If the dentist puts them on bogus bills, all you've got to do is tell JH
that they're being billed for services not rendered. Second, why didn't
the dentist simply refuse to accept the DEC dental insurance?
|
1736.53 | | VMSSPT::NICHOLS | conferences are like apple barrels | Thu Feb 06 1992 16:48 | 4 |
| each service provider probably feels the need to control what
administrivia he can in an attempt to gain mastery of a bunch of
probably incompatible insurance beurocracies.
Signing labels is his schtick, let him have it.
|
1736.54 | Here sign this.... | SCARGO::LEVY_J | | Fri Feb 07 1992 12:43 | 10 |
| The first thing I remember my Dad teaching me (when I was old
enough to "sign" something) was to NEVER sign ANYTHING in blank.
If your signature appears on something, to my mind, this means
that you have not only seen/read it, but approve of it. If I'm
not mistaken, the place on the insurance form that this "sticker"
would be stuck, says something to the effect that "I have read
and agree/approve...."
Sorry, I don't give signed blank checks to anyone either.
|
1736.55 | | VMSSG::NICHOLS | conferences are like apple barrels | Fri Feb 07 1992 12:48 | 2 |
| A record of the actual kind, amount, and dates of services rendered
are mailed to the patient when the check is mailed.
|
1736.56 | | NOTIME::SACKS | Gerald Sacks ZKO2-3/N30 DTN:381-2085 | Fri Feb 07 1992 12:55 | 2 |
| It's obvious to JH that the signed sticker was applied after the form was
filled out. If JH had a problem with this, they wouldn't allow the practice.
|
1736.57 | Managed Health Care | RICKS::PHIPPS | | Fri Feb 07 1992 12:58 | 14 |
| <<< Note 1736.55 by VMSSG::NICHOLS "conferences are like apple barrels" >>>
A record of the actual kind, amount, and dates of services rendered
are mailed to the patient when the check is mailed.
My last dental visit was a minor repair to a filling and didn't
require any local anesthetic. Never mind that it cost $61!
I did receive the JH paper saying what was paid and what not. Or was
it. I sent the dentist a check for the difference. That was weeks
ago. I just got a bill from the dentist for the part that JH said
they paid for Digital.
Oh well.
|
1736.58 | | FIGS::BANKS | Vice President in charge of VMSMail | Fri Feb 07 1992 13:21 | 10 |
| I'm not sure why signature availability is a problem.
My (not related to dental) health care provider gives me statements that say
"Signature on file" where my Jane Hancock would go (on the blank where it says
I authorize payment directly to the provider). Even though I've already paid
the bill, the balance due says "0.00", and I cross out the part that says
"Signature on file", JH still goes ahead and reimburses the HCP.
In other words, your signature on the form authorizing payment seems entirely
optional as far as JH is concerned.
|
1736.59 | I haven't used a form in years. . . | CAPNET::CROWTHER | Maxine 276-8226 | Fri Feb 07 1992 14:33 | 6 |
| Neither the dentist that I go to nor the dentist that my children
go to require a form at all. They are computerized, send off what ever
paperwork they send off the JH and we get back what JH paid. Then we
send off the difference to the dentist. We only pay at the time of
service for procedures where the prework form has been submitted to JH
and they tell the dentist what they will pay.
|
1736.60 | | TEMPE::MCAFOOS | Spiff readies his daring escape plan... | Fri Feb 07 1992 16:22 | 3 |
| re .59
Same here...
|
1736.61 | Same here..... | SIMAN::SERPAS | Albert J. Serpas | Fri Feb 07 1992 16:33 | 1 |
| The comment in .59 is EXACTLY how easy it works for me also.
|
1736.62 | Signature required at least once | SOLVIT::CORZINE | searching for the right questions | Thu Feb 13 1992 10:50 | 6 |
| My wife is a health care provider and does her own billing. My
understanding of how it works with most private insurers is that the
insurance company requires a signed form the first time the provider
bills the insurer for a particular patient. Thereafter, the
notation 'signature on file' (which I take to mean at the insurance
company), is sufficient.
|