Conference 7.286::digital

    
    
    Hummm... My benefits booklet did inform me of the copayment change. 
    They did not however point it out.  I noticed it said $5 and knew that
    it had been $3.  So they must have known in my area at least that the
    copayment was being increased.  Not surprising that some did not have
    the change listed though.  If I were in your shoes I would be a little
    upset too.  
    
    Ken
    

    re: -.1
    
    My HMO is Harvard Community Health Plan and it clearly the benefits
    book clearly shows $3 copayment for Office visits.
    
    What if I am hospitalized for some reason, is it possible for my HMO to
    say to me "Sorry Mr. Carbaugh, but effective January 1, 1993
    hospitalization coverage dropped from 100% to 80%"?  Are my labs and
    X-rays still covered at 100%?  As far as I'm concerned, I can't trust
    ANY of the information in the booklet now.
    
    Ken

    	Have you brought this to the attention of your personnel rep?
    
    	You are correct in questioning what other benefits/costs have
    	changed.  Have personnel find out for you now, rahter than you
    	having to find out when you need coverage.
    
    	Digital should work this out with the HMO.	

    RE -.2
    
    My HMO is also Harvard...
    
    I visited my Dr. Monday for my periodic physical, the co-pay was the
    expected $3.  And I do know that this is the Harvard Co-pay, as a
    small computer entry glitch forced the receptionist to call the
    Harvard office for verification of my coverage...
    
    My recommendation is to revisit this with your local office, and if
    you cannot resolve it there, a call to Harvard member service should
    take care of it.
    
    BTW all lab fees, etc. are still 100% as stated in the benefits book.
    
    
    					Jesse

    This may turn out to be an administrator screw up. I belong to HCHP
    and my wife has brought our daughters in a couple of times already
    this year, ear infections, coughs, and the co pay has been $3.00.
    This was at the Medford center.
    
    Harvard has a number of their own facilities. They also are affiliated
    with a number of Medical Centers. My Doctor is associated with General
    Medical Associates. This group accepts people from different health
    groups not just HCHP. Different health groups have different co pays.
    Perhaps the admin person didn't have the proper information. Please
    look into this further. 
    
    Jim C.
    

Also-

The same HMO may have different co-pays depending on what company you work
for... thus some other company plan may have went from $3 to $5 and someone
at the doctor's office may have assumed that it applied to all members of
that HMO.

Lee

    Here's an update to .0:
    
    It turns out that Pentucket Medical Associates overcharged me.  I
    called the HCHP Member Advisor and checked with my Personnel Office and
    confirmed my $3 copayment.  Two different receptionists at PMA informed
    me in a matter of fact way that my copayment had gone up to $5.
    
    I have contacted the PMA office and they are reimbursing me for the
    overcharges.  
    
    Thanks for all of the advice - I guess some further investigation was
    in order.
    
    Ken

    this happened to me tuesday at Fallon....I just switched to them from
    CMHC.....My Daughter, who is 9yrs old, needed her yearly eye exam and
    I had planned to only pay $2 but was informed at the desk I owed $50.
    well I told the lady I didn't have $50 and I was very sure I was
    covered for the $2 co-payment.....She said she would bill me ! when I
    got home I call the 800 # to double check on this, and after a few
    minutes on the phone with a very nice woman named April,she assured me
    that a mistake had happened and when I got the bill I was to send it to
    her with the $2 co-payment and she would clear up the problem.
    
    
    so I guess the best thing to do is know your coverage and question any
    difference on the spot...
    
    Chris

    I experienced a similar problem as .0.  The medical center I go to
    (associated with Harvard Community) on two separate occasions charged
    my wife a $5 copay.  On my most recent visit I questioned the medical
    center on the practice and after checking with their office agreed that
    they had overcharged us and upon presenting the reciepts would
    reimburse us.
    
    LDS

When the HMOs started, they each had the same benefits to all members.  In
the last couple of years, they have started negotiating with employers to get
their business.

I belong to Fallon through my husband's Commonwealth of Mass coverage.  It is
completely different from what everyone else has.  But the Fallon Clinics have
it in their computers, so most visits go smoothly.  But if you have something
unusual, you might have to call several people until you get the right answer!

Elaine

      1. I just recently switched from one HMO to Fallon/U-Mass.  I was told
         how lucky I was to be working for Digital because my co-payment would
         only be $2 instead of $5.  I thought that was for doctor visits.

      2. Then recently, I had to get a prescription filled, but I had not
         yet gotten my card in the mail, so I called Patient Relations at
         Fallon Clinic.  I was told that I could get the prescription filled
         without a card because I was in the computer, and my co-payment
         would be $2.  I told the woman I though the prescription co-payment
         was $5, but she said no, it was $2 because I worked at Digital.
         So I was happy, but still wondered what the truth was.

      3. When I went to get the medicine, I had $2 ready, but was told that the 
         co-payment was $5.  I was willing to pay the $5, but was confused by
         the inconsistency of information.  She said I had to pay $5, she
         could not help it if someone told me $2, and if I wanted I could call
         patient relations.  

So I did step 2 all over again.  So now I have names to use when I talk to the 
manager to get the correct information.  Of course the manager has not been 
available to take or return my call.  I did call personnel to see if there
was something they could do, but was told that I had to call my HMO for
any further information.

Since the medicine would have cost me $87, $5 is pretty good, so I should be
happy.  But I just want correct information.  Can someone else who has Fallon
tell me what their co-payment is?

Thanks.

    
    I have Fallon Clinic.  The doctor visits are $2 and the prescriptions
    just went from $2 to $5.  I'm not sure about Fallon/U-Mass.
    
    -Steve