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Conference 7.286::digital

Title:	The Digital way of working

Moderator:	QUARK::LIONELON

Created:	Fri Feb 14 1986
Last Modified:	Fri Jun 06 1997
Last Successful Update:	Fri Jun 06 1997
Number of topics:	5321
Total number of notes:	139771

1705.0. "Tufts HMO in central MA" by FRIGID::MBROWN () Fri Dec 27 1991 13:22

	This will be of interest to Tufts HMO members in central
	MA, and possibly elsewhere. 

	I have just learned of a new limitation in access to private 
	health care in the Worcester, MA area.  You can forget about 
	many specialists listed in the enrollment literature.

	Specialists must belong to the same IPA as the primary care 
	physician.  I believe this is not new.  The catch is that the 
	rules for belonging to an IPA may change.
	
	My primary care physician is associated with Memorial/Hahnemann -
	Medical Center of Central Mass.  Effective Jan 1, specialists will
	have to be on "active staff" to belong to that IPA.  That means the
	doctor must be on the teaching staff of the hospital, and perform
	90% of his work there.  

	Tufts, of course, says it's the hospital, not Tufts;  it sounds
	pretty cozy to me.

	This isn't right.  Before switching to Tufts I confirmed that all 
	the doctors we wanted were in the plan.  Now, the rules have changed
	after the fact.

	If you're interested:

		Tufts member relations: (617) 466-9410.	
		US Benefits, DEC         dtn  223-9202


	Mike

T.R	Title	User	Personal Name	Date	Lines
1705.1		BTOVT::SOBECKY_J	Still searching for the savant...	`Fri Dec 27 1991 14:55`	12
	It sounds like you definitely got the shaft...you made a decision based on printed material, and found out later that those choices were no longer valid. Have you talked to personnel? How will this affect you if you now want to switch to another plan, now that your specialist isn't available under the Tufts plan? Last I heard, switching plans can only be done once a year unless extenuating and well- defined circumstances occur... John
1705.2		DOBRA::MCGOVERN		`Fri Dec 27 1991 15:28`	4
	Raise hell. MM
1705.3	The packrat wins...	MAY21::PSMITH	Peter H. Smith,MLO5-5/E71,223-4663,ESB	`Mon Dec 30 1991 10:18`	6
	I'm not too surprised that the "marketing literature" was different from the "rule book". Whenever you change plans, especially _to_ an HMO, save all the printed information which you based your decision on. It may be the only ammunition you have!
1705.4	Please clarify !!	NECSC::DWORSACK		`Mon Dec 30 1991 15:03`	8
	RE: .0 / Specialists must belong to the same IPA as the primary care / physician. I believe this is not new. The catch is that the / rules for belonging to an IPA may change. What is IPA??
1705.5	BAIT AND SWITCH?	DELNI::GASKELL		`Tue Dec 31 1991 13:00`	8
	Sounds like a classic Bait and Switch. Try doing something about it? Best of luck buddy--I've been trying with HCHP for years to get the services I am paying for. FYI - When you have to visit your HMO, it's best to take a WELL person with you to act as an advocate for your rights. I can stand up for myself when well, but when sick I'm a marshmallow. I strongly suggest you take backup with you. It works for me!
1705.6	re .4	FRIGID::MBROWN		`Mon Jan 06 1992 07:18`	1
	IPA is for Independent Practitioners Association.