T.R | Title | User | Personal Name | Date | Lines |
---|
4214.1 | Not an improvement for my family finances | CUPMK::HOBBS | | Wed Oct 25 1995 12:25 | 28 |
| Guess it depends on what you mean by improvement.
Yes, today's RC rates do not reflect rates charged by dentists
in the real world
BUT
to pay for the new RC rates, the benefits package I saw said
our cost would increase.
(Now, I can't remember if the package said it would increase
$3.50 or increase to $3.50, so let me use the best case.)
If the cost for family coverage is $3.50 per week, that's $182/year.
For each visit during the last few years, I have paid $7 above
the RC. For a family of 3, that means I pay the dentist $42 yearly.
The twice yearly visits cost $22, so if I did not have insurance I
would pay $132.
Now I have to pay $182/year for something that costs $132?
Is Digital contributing to the cost of dental benefits? How much?
If the RC covers the dentist charges, John Hancock realizes $50
from my contribution, more if the RC does not cover the total charge.
Not an improvement for my family finances ;-(
|
4214.2 | | CSC32::M_JILSON | Door handle to door handle | Wed Oct 25 1995 12:52 | 4 |
| re .1 That is the basic definition of insurance. Those that pay more in
insurance than what is spent cover those that spend more than what they
pay. If you believe you will always spend less than the insurance cost
then don't get the insurance (if that can be done).
|
4214.3 | Who's your dentist? | WMOIS::PINEAU_C | | Wed Oct 25 1995 12:52 | 10 |
| -.1
Who's your dentist?? I pay about $24.00 over the R&C rates for a
cleaning and check up visit - per person! That doesn't include x-rays.
With 6 in my household, I'm trilled to see that the R&C rates will
improve, even for a few dollars more a week.
For my family, it's about time....
Now, I wonder if they've increased the amount paid on braces??
|
4214.4 | Insurance is its own reward. | AXPBIZ::SWIERKOWSKIS | Now that we're organized, what's next? | Wed Oct 25 1995 13:04 | 22 |
| re: .1
> Now I have to pay $182/year for something that costs $132?
.
.
.
> Not an improvement for my family finances ;-(
I have to disagree with you. Insurance is not a product or a service; it's
a bet. The insurance company bets that I'll stay healthy and I bet that I'm
going to have expenses that exceed my premium (life insurance is a little more
interesting). One abcess and crown will easily put you ahead. You're lucky
that your family only needs normal maintenance, but chances are, you will
eventually need major demolition. That's when you reap the value of the
insurance.
To look at it in a different light -- I'm throwing car insurance down the
tubes every month -- I don't get anything for it, but I'm sure glad I have it
to protect my family's financial health. One major wreck and lawsuit is all
it would take.
SQ
|
4214.5 | | QUARK::LIONEL | Free advice is worth every cent | Wed Oct 25 1995 13:05 | 6 |
| The current R&C rates were set in 1987 - they are long overdue for an update.
The family coverage is going from $2.25/week to $3.50/week, an increase of
$65.00/yr. If the new R&C rates are really up to date, I'll recover that in
just one dental visit.
Steve
|
4214.6 | Warehouse Dental Club? ;-) | HSOSS1::HARDMAN | Digital. WE can make it happen! | Wed Oct 25 1995 14:33 | 12 |
| $22? Geez, I didn't think that ANY doctor or dentist would even let you
sit in the waiting room and read the magazines for that price! You've
got a bargain basement deal there.
In the last year or so, I've had to have one root canal and two
crowns. What a quick way to kiss $1,500 goodbye! Now they want to pull
all 4 of my wisdom teeth. So as of Jan 1, I'll up my HCRA to the max to
help defray some of the costs, then schedule an appointment to have 'em
yanked. :-(
Harry
|
4214.7 | What am I Buying ... What does it look like? | DASPHB::PBAXTER | Vmsmail: PENUTS::PBAXTER | Wed Oct 25 1995 15:38 | 16 |
|
In making this decision to stay in the family dental plan even
though it is going to cost me a little more...
** I would like to see what we are buying... **
I have been unsuccessful so far in trying to obtain what
o the current R&C schedule is
o what the new 1996 R&C schedule will be
I can do the delta on my typical services and then evaluate it.
Who's to say if the '1996 R&C schedule' really reflects 1996 costs?
|
4214.8 | No change to Ortho | CSEXP1::DEPUE | | Wed Oct 25 1995 16:37 | 2 |
| I called John Hancock to see if the ortho lifetime max was increased.
Answer: "No" :^(
|
4214.9 | no inflation over 10 years | DASPHB::PBAXTER | Vmsmail: PENUTS::PBAXTER | Thu Oct 26 1995 11:10 | 6 |
| Re: -.1
I suppose that they don't believe that orthodontic(sp) costs didn't
go up over the last 10 years .....
yea sureeeee
|
4214.10 | | TUXEDO::STRUTT | Colin Strutt | Thu Oct 26 1995 12:00 | 14 |
| re: .6
> In the last year or so, I've had to have one root canal and two
> crowns. What a quick way to kiss $1,500 goodbye! Now they want to pull
> all 4 of my wisdom teeth. So as of Jan 1, I'll up my HCRA to the max to
> help defray some of the costs, then schedule an appointment to have 'em
> yanked. :-(
When I had my wisdom teeth extracted (a couple of years ago) they
charged some to my dental plan, and the rest to my medical plan - I
ended up paying nothing (at least - nobody ever sent me a bill).
The oral surgeon suggested this approach - and it suited me just fine.
colin
|
4214.11 | CAN'T GET $$ for opting out either! | AXPBIZ::WANNOOR | | Mon Oct 30 1995 14:10 | 11 |
|
- .10
wish my surgeon had suggested that!
the surgery cost me $600+ out of pocket (basically
JC covered about 40%!) - this was the bay area R&C rate!!!
I also need cleaning ideally once/qtr - no way JC covers those!
Even for one I pay out of pocket since JC prices are based
on IOWA prices!
|
4214.12 | What is reasonable and customary?????? | MROA::DUPUIS | | Mon Oct 30 1995 14:29 | 13 |
| Well, when I expessed my desire to see this information and was told I
couldn't they finally referred me to Paul Cornelius @MSO. I have sent
in a memo and am waiting for a response.
My concern is not that the rates are going up, although I would like to
know what is R+C today and how that will change after the first of the
year.....I just have a problem with someone telling me that they are
honoring a rate, but they won't tell me what that rate is. It's like
going to a mechanic for an estimate and they say they'll charge you
what ever is reasonable and customary....wouldn't you want to know what
that is?
Roberta
|
4214.13 | | QUARK::LIONEL | Free advice is worth every cent | Mon Oct 30 1995 15:17 | 7 |
| You can have your dentist submit a request for "pre-approval" of a procedure
and JH will tell them what the R&C is. The big problem is for people trying
to set up their HCRA amounts for next year - without knowing how close to
"real" the '96 R&C numbers are, there's no way to properly determine this
number.
Steve
|
4214.14 | | NWD002::BAYLEY::Randall_do | Software: Making Hardware Useful | Mon Oct 30 1995 15:37 | 10 |
| Of the "Reasonable and Customary" part of the reimburse-
ment, Hancock has really only been providing the "Custo-
mary" part - it's been their custom to pay about 50% of
what my dentist charges. Of course, any improvement
is an improvement, but I'd like to see what they think
are "Reasonable". I'm really tired of getting hosed by this
insurance which doesn't insure much.
With no other choice.....
|
4214.15 | 50%? you are lucky! | HELIX::SKALTSIS | Deb | Mon Oct 30 1995 16:53 | 5 |
| My dentist offers an "insurance" for $80 that has better covererage
than what we have. The catch is that is is only available to those
that don't have a dental plan offered by their employer.
Deb
|
4214.16 | I received a response.... | MROA::DUPUIS | | Tue Oct 31 1995 15:21 | 11 |
| Well, a very kind lady named Patty Haugh called me from John Hancock
and gave me all the information I needed. I asked for a number that
I could give my fellow coworkers who had questions and she told me
to have them call 1-800-332-2060 and that whoever answers the phone
would be able to provide some answers. She did want me to note that
the reasonable and customary charges "rates" that they have right now
are for 1995, the new rates will be available 1/1/96 and they MAY be
higher. You do need the area code of your dentist to receive accurate
information.
Roberta
|
4214.17 | | DECCXX::REINIG | This too shall change | Tue Oct 31 1995 16:05 | 9 |
| Of course, basing the rates on the area code of your dentist means that
you and your spouse can be reimbursed differently for the same
procedures, even if the two dentist charge the same amount. My spouse
and I got to different dentists because we each continue to go to the
dentist we went to before we got married. It would be better to base
the payment on where you live rather than where your dentist does
business.
August G. Reinig
|
4214.18 | Cost of doing business is what counts. | AXPBIZ::SWIERKOWSKIS | Now that we're organized, what's next? | Tue Oct 31 1995 17:37 | 18 |
| re .17
> Of course, basing the rates on the area code of your dentist means that
> you and your spouse can be reimbursed differently for the same
> procedures, even if the two dentist charge the same amount. My spouse
> and I got to different dentists because we each continue to go to the
> dentist we went to before we got married. It would be better to base
> the payment on where you live rather than where your dentist does
> business.
The charges from the dentist should be based on the cost of doing business
in the area where the dentist practices. I don't see how where you live
should have anything to do with it. I'm not saying we have great dental
insurance, but why should my premiums subsidize a dentist in an area that
has lower R & C charges?
SQ
|
4214.19 | | DECCXX::REINIG | This too shall change | Wed Nov 01 1995 10:47 | 11 |
| Why should my wife and myself be reimbursed differently for the same
procedure done the same week by different dentist who charge the same
amount but one happens to work in the town north of me and the other in
the town south of me? This has happened to me. (Sort of makes it
difficult to price shop.)
Also, as my dentist says, he has to pay the same prices for dental
equipment as everyone else, yet he is somehow supposed to charge less
than dentists in other regions.
August
|
4214.20 | zip code, not area code.... | MROA::DUPUIS | | Wed Nov 01 1995 10:49 | 4 |
| In my last message, that should have said zip code, not area code....
Sorry,
Roberta
|
4214.21 | what about billing | CASDOC::CHARPENTIER | | Wed Nov 01 1995 11:27 | 4 |
| Sometimes the way a service is billed will make
a difference in the payment. I'd compare billing.
Dolores
|
4214.22 | | CXXC::REINIG | This too shall change | Wed Nov 01 1995 12:27 | 1 |
| Same codes.
|
4214.23 | delayed statements for international transferees | MILORD::BISHOP | Take hold of the life that is truly life | Thu Nov 02 1995 09:56 | 20 |
| Not dental specifically, but any medical signup for 1996.....
The benefits bulletin describing changes came a couple of weeks ago,
noting that our personalized statements should arrive by October 30th
and to contact Benefits Express if you didn't receive one.
Well, I haven't received mine. So I called Benefits Express. Turns out
that because I originally came to the U.S. on temporary relocation the
"system" thought I was ineligible. (I've been a permanent resident and
permanent US employee for seven years now :-). One of those glitches in
handing over to B.E., I guess.
This affects anyone who came in on international transfer. B.E. is
aware of the problem and will be sending out the personalized kits to
those affected by this time next week. So you should still have a week
in which to enroll before the 17th.
All I want it for is the PIN so I can re-enroll in HCRA.....sigh.....
- Richard.
|
4214.24 | | NOTIME::SACKS | Gerald Sacks ZKO2-3/N30 DTN:381-2085 | Thu Nov 02 1995 10:11 | 3 |
| > All I want it for is the PIN so I can re-enroll in HCRA.....sigh.....
I think the PIN's the same as your SAVE PIN.
|
4214.25 | | MILORD::BISHOP | Take hold of the life that is truly life | Thu Nov 02 1995 10:40 | 4 |
| yes but I couldn't find it so I thought "good, they're going to remind
me of it just when I need it".
hmph.
|
4214.26 | It's the TOTAL cost of doing business that counts. | AXPBIZ::SWIERKOWSKIS | Now that we're organized, what's next? | Thu Nov 02 1995 20:53 | 13 |
| re .19
> Also, as my dentist says, he has to pay the same prices for dental
> equipment as everyone else, yet he is somehow supposed to charge less
> than dentists in other regions.
Ah, but the cost of dental equipment is not the total cost of doing business.
Rents/mortgages, taxes, salaries and service costs will vary from town to town
and state to state. Of course in the state of California with our really
skewered property tax laws, the cost for a building will also vary widely
with how long the dentist has been in practice in the same location.
SQ
|
4214.27 | | BROKE::LAWLER | MUDHWK(TM) | Fri Nov 03 1995 07:29 | 13 |
|
> (paraphrased) But the cost of doing business varies from town to
> town
And in all cases is higher than it was in 1987 when the rates
were set...
IMHO, the failure to keep up with inflation in general swamps out
any 'local differences' in the reimbursement amounts.
-al
|
4214.28 | Is there a basis for R&C? | NQOS01::hornet.det.dec.com::comfort | | Fri Nov 03 1995 08:51 | 4 |
| I think it was a WSJ article a couple of years ago that said that a lot
of "reasonable and customary" policies didn't have any data to back
them up and were basically a way for insurance companies to make
sure they didn't pay out more than they had planned.
|
4214.29 | show me ONE provider | NPSS::NPSS::BADGER | Can DO! | Fri Nov 03 1995 11:39 | 6 |
|
I would suggest that *if* the term "reasonable and customary" were
used, then a list of doctors in my area who would accually DO the
work for the "reasonable and customary" price be available!
I really doubt that such a list does exist.
|
4214.30 | | REDZIN::COX | | Fri Nov 03 1995 12:49 | 6 |
| from someone who has a relative in the health care billing industry.....
"Reasonable and Customary" is just another way of saying "What the Market Will
Bear".
Dave
|
4214.31 | | NETCAD::SHERMAN | Steve NETCAD::Sherman DTN 226-6992, LKG2-A/R05 pole AA2 | Mon Nov 06 1995 10:09 | 27 |
| "Reasonable and customary" is a term that belongs to the health
insurance folks. They get to define it as they see fit. It is
misleading in that it implies some relevance to what customers or
service providers would consider reasonable and customary. Obviously,
when you get socked with a bill that exceeds the "reasonable and
customary" numbers, your response may be to approach your service
provider and ask why. I've done this. My service provider gave me
plenty of documentation that amply demonstrated why their service
rates were reasonable and customary. It's easy to prove that what you
and I think of as reasonable and customary is in stark contrast with
what the insurance folks define as "reasonable and customary." We can
go to service providers to get the hardcopy proof!
I think we'll see pigs fly before we see the insurance industry use a
definition of "reasonable and customary" that is in line with how
service providers and clients would define it. And, while we await the
sky-high hams I expect we'll see a round of new phrases from health
insurers for the compensation to be expected. All of it designed to
mislead as well as the carefully phrased "reasonable and customary" has
worked. I think the fact is that this bit of jargon has worked very
successfully for the health insurance industry.
I *would* like Digital to push for a bit more honesty with use of such
phrases from employee benefit providers. I'd also like to see sausages
fly through my window and onto my breakfast plate each morning.
Steve
|
4214.32 | If my take is correct... | SHRCTR::SCHILTON | Press any key..no,no,not that one! | Mon Nov 06 1995 10:45 | 18 |
| It's my understanding that folks are out there, consulting firms,
research firms, whatever you want to call them, gathering this
data all the time, day in, day out. They compile this data and
insurance companies buy it. Companies, like Digital, when they
negotiate a contract with an insurance company decide how often
they want updated "reasonable & customary" data. The less often
they want it, the cheaper the cost to the company.
Thus, it's my understanding that Digital decides how often they
want to update their reasonable & customary list. If they want
to keep the cost of the dental benefit low(er), they buy the
new(er) information less frequently from the insurance company.
In employees' eyes, Digital seems to be damned if they do, damned
if they don't, with regard to this benefit.
Sue
|
4214.33 | | PADC::KOLLING | Karen | Mon Nov 06 1995 11:18 | 24 |
| Awhile back I got a call from a couple of folks associated
with Benefits, apparently because I'd sent a brief message
to BP's secretary, suggesting that the strings about health
benefits be brought to his attention. Here's what one of them
subsequently emailed me about the reasonable & customary
question; he said it was okay to say it came from "U.S. Benefits."
(I also asked about the sky-high HMO and HMO-Elect charges
in Dallas that were mentioned in another note, and he said they
are "reviewing the Dallas issue.") Here's his r&c message:
If they call the Hancock service center (1-800-dec-2060) and explain
what it is they are attempting to do, I have been told they will be
help
through an "estimate" of what the R@C numbers are likely to be. The
cannot take this to the bank because:
1) the r@c numbers are not set yet
2) they are "guessing" on both treatment and cost, unless they have
submitted a pre-treatment estimate
Again, they can help, but if people areexpecting specifics and
guarantees, it is not going to happen.
|
4214.34 | | plugh.ibg.ljo.dec.com::needle | Money talks. Mine says "Good-Bye!" | Mon Nov 06 1995 11:34 | 14 |
| >> If they call the Hancock service center (1-800-dec-2060) and explain
>> what it is they are attempting to do, I have been told they will be
>> help
>> through an "estimate" of what the R@C numbers are likely to be. The
>> cannot take this to the bank because:
Has anyone had any luck with this? All I get at Hancock is someone telling
me that the only way to get this information is from my PSA at Digital.
Naturally, Digital tells me that I need to call Hancock. Time's running
out and I still haven't got the information I need to make an informed
decision on whether to stay with the dental plan. The harder I try, the
further away I get from obtaining meaningful data.
j.
|
4214.35 | | ROWLET::AINSLEY | Less than 150 kts. is TOO slow! | Mon Nov 06 1995 11:37 | 7 |
| re: .33 and the 'Dallas issue'
We received revised cost amounts for the HMO and HMO-elect in the past
few days, I'll try to put them in the other topic. Thanks for asking
about it.
Bob
|
4214.36 | | REGENT::LASKO | Tim - C&P Printer Systems Engineering | Mon Nov 06 1995 12:23 | 13 |
| Re: .34
Does the left hand know what the right hand is doing? I called the
Hancock number (after chatting with a B.E. drone) and spoke with a
pleasant person who gave me a few quick prices after some discussion of
what I wanted. I did get a few specific R&C costs* based on my
dentist's ZIP code that were higher than what they pay out today but
she didn't say these were estimates. I was gathering more receipts over
the weekend and intended to call this week to get more data.
* I asked for real simple things: an adult prohphylaxis and the "routine
exam". I wanted my receipts to get their codewords for other things
I typically run into.
|
4214.37 | Why use a high price data collecting firm | DECCXX::REINIG | This too shall change | Mon Nov 06 1995 12:57 | 7 |
| Just how difficult is it to collect this data? The insurance company
has people continually submitting bills with the actual cost. A little
bit of adding and division should give the average cost for a zip code.
Use whatever multiplier you want on the average to get the price you
want to say is "reasonable and customary".
August G. Reinig
|
4214.38 | omSome | PCBUOA::RIPLEY | | Sun Nov 26 1995 12:02 | 18 |
|
I used to have my teeth cleaned every 6 months just as
allowed by the dental plan. Then I noticed that my
cleaning person was charging $49 per cleaning. I thought
that was too high so I now go only once per year and
I seem to get along ok. Under the current rates, the
plan is paying $29 of the $49 and I am paying the $20
difference. I am looking forward to 1/1/96 to see what
effect the upgrading of the 10 year old "reasonable and
customary" estimates will be like. This is the easiest
measure because teeth cleaning is a consistant cost that
we can anticipate. In reality, under currenct thinking that
"Preventive" measures should be encouraged, teeth cleaning
for me falls in this category and should be encouraged by
good payout for those who do this on a regular basis.
My 10 cents worth!
|
4214.39 | Well it is now 1996 | AD::MCGEE | At this point, we don't know. | Thu Feb 01 1996 00:33 | 19 |
| Now that it is 1996 my wife is going to have a
Scaling procedure done. In 1995 we found out that
DEC covered $66 of $250 per side of the mouth.
A lousy 26%.
And now?
DEC covers $88 of $250.
A slightly better 35%.
We will have to shell out $324.00 for this
procedure.
Not at all a happy camper.
Lets see here, now in http:\\www.hp.com there denetal plan says.....
|
4214.40 | | NUBOAT::HEBERT | Captain Bligh | Thu Feb 01 1996 08:22 | 18 |
| I don't consider our Dental Plan as much of a benefit at all. I've come
to just not expect much of it.
Last year my dentist personally called our dental plan office, to discuss
a procedure that my wife needed. She spent a lot of time on the phone
with them, working her way up the chain to someone who (allegedly) was in
a decision-making position. They told her (the dentist) to go ahead,
everything was okay. When we submitted the paperwork the claim was
denied. The dentist called them back and was told "we were in error"
-- and the decision was irrevocable. The cost to me was in four figures.
Insurance coverage that represents a fraction of the regionally normal
rates is apparently all we can expect.
Given the present relationship between management and labor, it won't
improve soon. Take it or leave it.
Art
|
4214.41 | | GRANPA::MWANNEMACHER | be nice, be happy | Thu Feb 01 1996 08:26 | 7 |
|
That's tough, Art. A reinforcemetn to me and I hope to the rest of us.
Get it in writing.
Mike
|
4214.42 | wisdom teeth policy | NOTAPC::SEGER | This space intentionally left blank | Thu Feb 01 1996 08:54 | 9 |
| when my daughter's orthodontist said she needed her wisdom teeth extracted (he
could seen them coming in crooked in the x-rays), I had some interesting
conversations over it with our HMO. bottom line, we got zip.
now if we were willing to wait for them to get impacted/infected (as we were
assured they would if we waited), we could then have had her admitted to a
hospital and the HMO would pick up the tab (less the $3).
-mark
|
4214.43 | More comparisons, please. | NWTIMA::STAMPGR | | Thu Feb 01 1996 10:18 | 9 |
| I'd love to see some more comparative examples of coverage increases
over last year. They did raise our contribution by 44.5%, after all,
with the explanation that we would see increased assistance.
I see the lifetime for orthodontics is still $1000.
Disappointing plan (better than nothing?).
Greg
|
4214.44 | Right - better than nothing! | SHRCTR::SCHILTON | Press any key..no,no,not that one! | Thu Feb 01 1996 11:14 | 12 |
| My one experience since the dental benefit was "improved" has been
positive. For the last 4 or 5 years I've had to pay about $17-19
towards the price of my cleaning & X-rays (because the reasonable
'n customary list hadn't been updated).
I went to the dentist on Jan 6... and I only have to pay $4 towards
the cost. For $.50/wk, I like it. Sure, I'm losing $26/yr in weekly
premiums, but if that pays for more frequent updates to the R'nC list,
I'm happy.
And it'll help *now* with the cavity to be filled & another cleaning
later in the year.
|
4214.45 | Crown Work - big change in payments | LANDO::JBENNETT | | Mon Feb 05 1996 09:09 | 8 |
| In December my dentist told me that I had cracked a large
old filling on a back molar and needed a crown. The estimate
for the work was a little over $500. The estimated benefit
payment in December was $260 (about 50%). In January, I asked
for a restatement of the estimate benefit. It was $400, so I
had to pay $120.
John
|
4214.46 | NOT happy with new dental policy | TALLIS::NELSON | It's not the years it's the mileage! | Fri May 31 1996 11:15 | 30 |
|
I wasn't happy about being FORCED into a dental plan that I had no input towards
(apparently some group of folks was polled about this, but I wasn't one of
them). However, I decided to wait and see what the difference was.
Now I know -- I'm paying *more*. What gets me the most is it was explicitly
stated more would be covered. Not much more, if you ask me. For this extra
money, I would think that all of a routine cleaning would be covered -- this
is preventive maintenance guys! Small change. But I find out only $7 more
is covered. I have good teeth, so all I ever have is two routine visits a
year.
Last year I paid $19 for each visit, for a total of $38. THIS year I'm paying
$26 for the new premium, and an additional $12 per visit, for a total of $50
per year. LIke the commercial states, "Where's my SAVINGS?!" Sure, it's only
$12 more per year but that's not the point -- the point is I was told I'd be
saving more.
I would like to see this policy changed such that those folks that want this
extra coverage can opt for it, but those of us who don't can take the old
plan. At the very least, this whole thing should have been labelled as it
really is -- a way to pass more cost to US.
Brian
|
4214.47 | I saw improvement | NYAAPS::CORBISHLEY | David Corbishley 323-4376 | Thu Jun 06 1996 09:59 | 7 |
| Unlike the last noter, I did see improvement in what I pay. All of my
exam, cleaning, x-rays were covered this time. A first in my 19 years
at Digital. As schedules are based on a geography, an individual
dentist could charge more or less that the schedule amount. In
otherwords, your mileage may vary...
David
|
4214.48 | Ortho coverage? | PHXSS1::HEISER | maranatha! | Wed Sep 11 1996 13:23 | 5 |
| Any new on orthodontics being raised from $1000 for next year? How
about alternate dental plans with better ortho coverage?
thanks,
Mike
|
4214.49 | | PHXSS1::HEISER | maranatha! | Fri Sep 27 1996 15:21 | 5 |
4214.50 | | DECCXX::WIBECAN | Get a state on it | Fri Sep 27 1996 15:24 | 6 |
4214.51 | | CSC32::M_EVANS | be the village | Fri Sep 27 1996 16:48 | 4 |
4214.52 | I wouldn't complain... | KYOSS1::FEDOR | Leo | Fri Sep 27 1996 17:10 | 12 |
4214.53 | Changes for 1997? | ASABET::MACGILLIVARY | | Thu Feb 06 1997 11:59 | 13 |
| Has anyone heard of any changes to the 1997 Dental benefits? This
week my Dentist asked if there had been a change for this year
because since the first of January, the percentage they have
received back from the Insurance is definately less than last
year for the same procedures, which of course means more $$
out of our pockets.
He was very surprised, especially since they were increased in 1996.
I told him I had not read of any changes for this year, but I must
admit, I did not read through the benefits book as yet.
|
4214.54 | 70% in my case | PASTA::MENNE | | Thu Feb 06 1997 12:19 | 9 |
| I submitted my dentists proposal for work that I need done.
It took John Handcock at least 2 month to do the job and
send me the paper work indicating what % of each procedure
they would cover. 70% was by far the most prevalent number,
if not the only number. Some % may have been higher or lower,
I really haven't looked it over closely because I can't afford
to have much of the work done.
Mike
|
4214.55 | increased coverage this year | DZIGN::HABER | Jeff Haber..SBS IM&T Consultant..223-5535 | Thu Feb 06 1997 13:03 | 7 |
| Actually the dental benefits were supposed to go up this year because
they refreshed the table that is used to drive the 'normal and
customary' charges for the first time in (I think) four years. I
believe I've seen a HIGHER amount covered so far this year. Of course
your mileage may vary...
/jeff
|
4214.56 | | TLE::REAGAN | All of this chaos makes perfect sense | Thu Feb 06 1997 13:14 | 7 |
| Yes, my understanding is that dental covers more this year, but your
weekly deduction is also slightly higher.
VTX BENEFITS_US is out of business and the benefits book isn't on the
Web yet...
-John
|
4214.57 | I have no complaints | SHRCTR::SCHILTON | Sacred cows make the best hamburger | Thu Feb 06 1997 13:16 | 10 |
| I don't know specifics about changes to the benefit provided,
but I was pleasantly surprised to find that my dentist was
being paid the entire amount by JH and I wouldn't have to kick
in anything. (This was for a $35 cleaning and $53 X-rays done
on Jan 14).
And, as always, the benefit explanation sheet (or whatever they call
it) was out to me within 2 weeks of my visit to the dentist.
Sue
|
4214.58 | call JH for exact amounts | LINGER::PINEAU | | Thu Feb 06 1997 13:24 | 16 |
| JH will now pay 100% of the customary and reasonable charge set by JH
for your area. I believe this is only for preventative work.
Fillings, caps, crowns, etc will probably follow something different. You
should call your dentist and get the code numbers for the work you plan
to have done and then call JH. They will give you the dollar amounts
they will pay. I did this for my January visit. I only paid $3.00 out
of pocket instead of my usual $15.00. So I was happy.
I'll be make some more calls for pricing since my 3 kids all have
appointments in a couple of weeks. It's a pain, but I would rather
know prior to going to the dentist what I will be paying. Last year
the dentist owed me over $40.00 because "they" estimated what they
would get paid by JH. It took the dentist 2 months to cut me a check.
So now, I'll tell them what I'll be paying.
Chris
|
4214.59 | Coverage improved for me! | ACISS2::GAUS | | Thu Feb 06 1997 13:36 | 5 |
| I'll second what was reported in .57. For the first time EVER, my
cleaning and checkup was covered 100%. It was an unexpected surprise.
Since I still go to my childhood dentist in the middle of nowhere (with
his zip code from some rural, poverty-stricken county), who knows what
"reasonable and customary" figures JH cooks up.
|
4214.60 | | BSS::DSMITH | RATDOGS DON'T BITE | Thu Feb 06 1997 14:08 | 12 |
|
From the "benefits" book
100% for diagnostic and preventive work
70% for basic restorative work
60% for major restorative work
50% for various forms of orthodontic work
Dave
|
4214.61 | Still only $1000 max per year | SUBSYS::DONADT | | Fri Feb 07 1997 08:10 | 5 |
| The biggest problem with our Dental Insurance is that they never raise
the $1000 maximum payment per family member per year. Our plan is good
for preventive maintenance, but is very poor for anything else.
Ray
|
4214.62 | could be a lot better | USCTR1::RIDGE | Steve Ridge @297-6529 | Fri Feb 07 1997 16:38 | 20 |
| Our plan is also not very good when it comes to taking care of your
kids teeth. I have two children and both have needed braces.
My recent experiences with dental costs:
Dentist's Charge Insurance Covered
Braces for child #1 $2200 $1000
Braces for child #2 $2500 $1000
Root Canal (mine) $ 780 $ 430
Cap (mine) $ 650 $ 350
I usually use up my alloted $1000 every year as does my wife. There
is a lot of room for improvement with this plan. To offset the gap
between the actual cost and the insurance coverage I take advantage of
the HCRA. So I actually get a 30% (approx) suppliment from the Feds.
Steve
|
4214.63 | ...and you're COMPLAINING?? | BSS::BRUNO | A new day | Fri Feb 07 1997 17:44 | 12 |
|
The hard truth of the matter is that this is still insurance, the
basic concept of which is not geared toward people who use their full
benefit every year (yikes! I can't even imagine doing that).
If you do use your full benefit every year, you are getting FAR
more out of the plan than the vast majority of us.
Try to imagine people with auto insurance who wreck their cars
every year...
Greg
|
4214.64 | | USPS::FPRUSS | Frank Pruss, 202-232-7347 | Fri Feb 07 1997 18:22 | 7 |
|
/////
======================= ?
FJP
|
4214.65 | Son, daddy will get these straight for you.. | SMURF::PSH | Per Hamnqvist, UNIX/ATM | Fri Feb 07 1997 20:40 | 11 |
| | /////
| ======================= ?
With braces is probably more like
||||
||
===================||
||
||||
|
4214.66 | Some things at JH don't change | DECWET::LENOX | Johanna Maarit is walking before 10 months! | Mon Feb 10 1997 15:31 | 12 |
|
Last time I had major dental work JH slowed the process of payment
down by requesting more information from the endodontist, who
probably deserved the hassle. This month it asked my dentist for
more information about a cap, when the dentist's office is expert
at getting all needed information to any insurer (it does speed up
the payments from insurers). And I thought having cracks in teeth
was torture, ha!
They did cover more of my basic cleaning and x-ray charges. Of
course that means more comes out of the $1000/person limit that
hasn't gone up with inflation.
|
4214.67 | more please! | USCTR1::RIDGE | Steve Ridge @297-6529 | Mon Feb 10 1997 16:49 | 7 |
| re: .63
Or looking at it a different way...
If auto insurance only paid for approx 50% of any insurance
claim, you'd have to say that the insurance coverage is inadequate.
I would gladly pay more for better coverage, if I had the option.
|
4214.68 | | REGENT::POWERS | | Tue Feb 11 1997 09:30 | 25 |
| > <<< Note 4214.67 by USCTR1::RIDGE "Steve Ridge @297-6529" >>>
> -< more please! >-
>
> re: .63
>
> Or looking at it a different way...
> If auto insurance only paid for approx 50% of any insurance
> claim, you'd have to say that the insurance coverage is inadequate.
> I would gladly pay more for better coverage, if I had the option.
Insurance is very good at covering catastrophic or near-catastrophic
losses that occur infrequently or at irregular times.
When one knows that one will incur regular, significant charges/losses
for something, one should set up a sinking fund or be prepared
to pay as one goes.
As medical and dental expenses have become more expensive and more routine,
they don't fit the standard "insurance" model.
Preventative and diagnostic care is vital and necessary, but shouldn't
be covered by "insurance." (Which isn't to say it shouldn't be an employee
benefit or government entitlement or whatever, nor is it to say that it should.)
The theory of insurance is a deeply philosophical matter, really.
- tom]
|
4214.69 | Don't tell the dentist.... | GLRMAI::HICKOX | N1KTX | Wed Feb 12 1997 07:44 | 8 |
|
As of my last visit, JH is covering more (HCRA covers the difference)
than in the previous year.
The only problem is that you know when the dentists realize this they
will raise their rates and we'll all be in the same position again.
Mark
|
4214.70 | | NQOS01::nqsrv236.nqo.dec.com::Workbench | | Wed Feb 12 1997 08:33 | 7 |
| I'm not that worried about my dentist raising his
prices. He has told me in the past that of all the
insurance programs he works with, John Hancock is
the only one that didn't pay his fees under "reasonable
and customary."
BC
|
4214.71 | JH no longer the dental coverage contact? | REGENT::POWERS | | Fri May 30 1997 09:54 | 10 |
| Is it true that John Hancock is no longer servicing the Digital dental
benefit plan?
I got a letter at home a couple of weeks ago that said that someone else
had taken over the business and that the address to submit claims
would change (or had changed as of March 1?).
Am I on track, or have I just invented a new rumor to fill out
the dental plan improvements thread?
- tom]
|
4214.72 | I think its a fact | hndymn.zko.dec.com::MCCARTHY | A Quinn Martin Production | Fri May 30 1997 09:56 | 6 |
| I got the same letter. It said "next time you go, give this new address to the
dentist to submit the claims to."
It also said that the 800 number had not changed.
bjm
|
4214.73 | UNICARE/John Handcock | alfras1_port41.alf.dec.com::MCCRAW | | Fri May 30 1997 10:08 | 7 |
| Well I just submitted several claims last month to the old
address and they came back fine. The one thing I noticed
is that the return address on the envelope had the name
UNICARE/John Handcock. It looks like JH must have created
a separate company to manage these claims.
Pete
|
4214.74 | | CPCOD::CODY | | Fri May 30 1997 10:46 | 6 |
| UNICARE is located in Dallas and they are buying the claims business
for Digital that John Hancock is doing now, this applies to the medical
plans also. The 800 number is the same but I believe the claims will
be sent to Dallas sometime in the future.
|
4214.75 | | TLE::REAGAN | All of this chaos makes perfect sense | Fri May 30 1997 11:56 | 10 |
| The 1-800 number was switched to Dallas several weeks ago. I called
regarding a claim and got somebody with a southern accent. I asked
and, yes, she was in Dallas. Apparently, when UNICARE bought the
claims people, they were offered to relocate to anywhere else in
the country that UNICARE had offices (I skeptically thought to myself,
"Yeah, anywhere else as long as its Dallas..."). She told me that
the people in Braintree got good packages but most of them turned
down the relocation offer to "live on the beach".
-John
|
4214.76 | | NOTIME::SACKS | Gerald Sacks ZKO2-3/N30 DTN:381-2085 | Fri May 30 1997 12:45 | 1 |
| Um, what beach is that?
|
4214.77 | | NPSS::MDLYONS | Michael D. Lyons DTN 226-6943 | Fri May 30 1997 14:29 | 4 |
| Why, I imagine it's the world famous Wollaston beach, home to the
Wollaston Yacht Club.
MDL
|
4214.78 | | axel.zko.dec.com::FOLEY | Rebel without a Clue | Fri May 30 1997 15:11 | 5 |
|
The start of the Irish Riviera.
mike
|
4214.79 | | smurf.zk3.dec.com::PBECK | Paul Beck | Fri May 30 1997 15:16 | 3 |
| > The start of the Irish Riviera.
Erin go Buick?
|
4214.80 | Claim forms now go to TX | NQOS01::d7syo1-2.syo.dec.com::Workbench | | Fri May 30 1997 16:50 | 6 |
| I called the 1-800-DEC-2060 number yesterday because I had some dental claims
to file. I likewise got the same Southern accent representative and was told
to send them to an address in Richardson, Texas.
Larry
|
4214.81 | | TLE::REAGAN | All of this chaos makes perfect sense | Mon Jun 02 1997 11:54 | 4 |
| You can still use existing claim forms. They will be forwarded by
the post office.
-John
|