Conference 7.286::digital

    Before you jump on the HMO bandwagon, be aware that they probably
    do not cover dental, and they probably don't cover any TMJ-related
    expenses (Healthsource New Hampshire does not).  However, John Hancock
    Medical Plan does provide coverage for TMJ-related expenses.  
    
    BTW, there is already a note on this topic in this conference. 
    Do a DIR/TITLE for the listing.
    
    Mark.

    re "if John Hancock continues to digress".
    
    I think we need to give credit where credit is really due.  Somebody
    correct me if I'm wrong, but what I've been told over the past month
    in some dental hassles is that JH is only the *administrator* of
    Digital's medical/dental policies.  Digital pays JH for the service
    of being that administrator.  No money ever leaves JH's pockets
    when claims are made, it all comes directly out of Digital's pockets.
    
    Now the question:  I agree with what you said, but *who* is really
    digressing on the dental/medical policies??
    
    Jon

I have HMO coverage.  My "normal" dental care still comes from John
Hancock.  Oral surgury (as for an impacted wisdom tooth) is covered
by my HMO, however.

Better read the fine print.

Martin.

    re .2
    
    The checks I receive for dental expenses are JH checks NOT DECs.
    The dentist deals with JH not DEC.
    
    /tb/
    

    
    RE -1
    
    Isn't that "administering"?
    
    

    re .4
    
    The checks are from John Hancock, but the money is in fact Digitals.
    
    They have J.H. handle all administrative details, and handle the
    money issuing things. But it is in fact Digital's money.
    
    
    Not sure exactly how it really works, but it is true.

    My last statement from JH (they sent a payment to the Dr.) had
    a line on it to the effect that the payment was supplied by DEC
    and sent by them.
    
    		Alfred

    
    	I think the point here is when did the policy change, not who
    is paying, though I do thank my insurance plan coverage...
    
    	When did they switch the policy from 100% at a predetermined
    payment plan, (customary fee), to a 60% - 80% of the same customary
    fee. Note that now the coverage is 60%- 80% of the predetermined
    fee, not what the dentist actually charges.
    
    	This considerably lessens the coverage. I would rather keep
    the old payment schedule @100% and have "them" (DEC or JH) increase
    my weekly deductions.
    

    
    Try calling the RISK MANAGEMENT group located at AKO1-3.
    You can ask to speak to the person who is responsible for
    John Handcock.  Then ask him your questions, and let us know the
    answer.

    Not only did I ask the same questions about coverage but I actually
    spoke to Laura Stevens (from JH). After venting my frustrations
    about the changes we agreed to a complete 5 year audit of bills
    paid and denied by the dental plan for both my wife and I ( Both
    DEC employees for the last 11 years).
    
    After an extensive amount of research we agreed that in some cases
    JH overpaid and in some cases I should have been re-imbursed more.
    
    Net/net JH returned about $357.98 for the both of us  (dental)
    
    We then requested an audit of our complete 11 years worth of medical
    
    Net/net JH returned about $258.45.
    
    
    Through all of this Laura was very helpful ..... who's next

    This issue was discussed, relatively recently, in note 254 of this
    conference.
    
    Re: .8
    
    Please see my note 254.37.  The old coverage was a percentage (less
    than 100%) of a predetermined fee; if your dentist charged less
    than the fee, then your effective coverage could go up to a maximum
    of 100%.  The new coverage is a percentage of the actual charge,
    up to a maximum based on the customary fee.  
    
    The effect of these changes depends on how your dentist's charges
    compare to the predetermined maximum customary charge.  It can work
    both ways, and in my case, has.  I have gotten better coverage this
    year than last for a cleaning, and worse coverage for a filling
    (the filling work was somewhat complicated, so I'm not surprised
    the dentist charged so much more than the customary fee).  I'm going
    back in a couple of weeks for some simpler fillings, and I'll expect
    the coverage to be better for those (since the dentist's charges
    will be less).  (No, my teeth aren't rotting away; I'm having a
    number of fairly old plastic fillings replaced.)
    
    The new policy went into effect 1 Jan 87.  There was a notice about
    it last fall.
    
       Gary

    what is John Hancock's policy regarding double coverage i.e. if this is
    your primary insurance company and then you have say coverage thru
    your spouse with a different insurer, what is the procedure to claim 
    expenses incurred?
    
    thanks,
    
    - Rajesh

re: .12

There will be what is known as 'coordination of benefits'.  The patient files
first with whoever he/she has insurance coverage.  If that doesn't cover the
entire bill, the patient then files with the other insurance company.  In the
case of dependents, the 'birthday rule' is applied to determine which insurance
must be used first.  For example, say spouse A was born on 3/27.  (The year
is not used in the birthday rule).  Spouse B was born on 8/2.  The birthday
rule says that the insurance of the spouse whose birthday comes first in
the calander year (Spouse A on 3/27, in this case) is filed against first.
The birthday of the dependent has absolutely nothing to do with this.

So, I was born in April, and my wife in September, so all insurance claims
for our daughter are filed against my insurance first.  This applies to both
medical and dental claims.

Bob

re .13:

What if husband and wife have the same birthday?

re: .14

That's a good one.  I'll have to ask my wife who is in this silly business.

Bob