Conference 7.286::digital

    Perhaps we should protest - have all our teeth yanked and eat soft
    veggies and soup.  It would save on dental and food bills and give
    Digital a recognizable appearance.  Imagine the publicity !
    
    Who volunteers to go 1st ?  I proposed this but cannot join the protest;
    I need my teeth for grinding as I tackle the 1992 tax return ;] 

    plus you only get $1000 worth of benefits a year.
    depending on how easy or difficult the crown is, you
    could eat up the $1000 quick.
    
    i've been there.  
    
    willie

    
    I just went through this with the dental plan for some work done
    for my wife.  The outside group is American Dental Examiners.  That
    is a group of dental experts who sell their services to a number
    of insurers.  They review the claim and render a recommendation to
    the JH dental plan.  In my wife's case they provided zero $ for a
    covered procedure.  Call 800-332-2060 and ask them to tell you
    the basis for the ADE recommendation.  If you disagree you can have
    your dentist resubmit the claim with additional information which
    is what I am doing.  If it comes back the same way and you still
    disagree there is an objection process that you can pursue through
    your PSA.
    
    fwiw,
    Steve
    

    Well, I had called JH Dental Plan back, and my revelation in .0 was
    their reply. Another consultnat in my office has had gum surgery, and
    he told me you can appeal till your teeth fall out, and DEC Dental 
    (aka-John Hancock) Claims will not budge.
    
    What really PO'd me was that the first CSR told me the payment was
    $196, but when I called back to inquire on the basis, the first CSR was
    out, so I asked the one who answered my call ( after a loooong wait in
    the rotary). My BIG MISTAKE, she read back the notes and said 'Oh, they
    only allowed for 1/3 the quadrant, not the full quadrant. So you only
    get $98, not 196..." At that point I wished I had not made the call.
    
    As I was writing this reply, I decided to call the original CSR back,
    and make sure that what I had been told was correct. This lady says
    "The last CSR you talked with made a mistake, you will get $195.60, and
    the check will be issued today. If we had missed today, it would be two
    more weeks, since we only cut checks for DEC twice a month". I am glad
    for two things: 1) That I am getting $195.60 rather than $98, and 2)
    That these folks aren't running a nuclear power plant. We'd be in big
    trouble.
    
    Anyway, I guess I will not file an appeal, since from what I can tell
    it's a waste of my time to do so. I did talk with our Personnel Rep. as
    (I am at a District Office) and related this sordid tale. She plans to
    take it up with some internal benefits group to see what can be done to
    improve things. No promises, but perhaps a start.
    
    GB ):-(

       Re .1
      Hah...there are a lot of us who--through no fault of our own--have
    already gone through THAT procedure!! But still, even dentures don't
    last forever, and when you have to replace those, you are talking
    around a grand-and-a-half if you have to replace the full thing...upper
    and lower... Last time I think I got $400.00 against a $1,200.00
    bill....and they have a 'rule' that you can't wear the out in less than
    5 years or you WILL be gumming everything... 
    
      The insurance business overall is one of the biggest scams ever
    invented...
    
      John McD

>>    For those of you who think our Dental benefits are excellent, beware.

	FWIW, I never thought our dental assistance plan was that great, no mind
	excellent.. (I say this after just spending ~$250 toward a crown I
	just had put in.)

					tight this month,

							mike

    I know where you are coming from.  I need a mouth guard to stop me from
    grinding my teeth at night.  Two different dentist in the last two
    years have given me the same diagnosis.  If the guard is not made soon
    within 3 to 5 years I will have only stubs for teeth.  
    
    Well, the one dentist called John Hancock.  They told him that they
    would not cover the guard at all.  He asked why.  They stated that it
    really wasn't necessary.  Well, the dentist said, "isn't better that we
    protect her teeth now instead of having to replace all of them later?" 
    JH's reply was, "well when it happens then we will cover it."
    
    Now the second dentist is fighting with them.  Who knows what will
    happen.
    
    Thank goodness that you are getting your check.
    
    Lillian

	This story goes on the stack. Evidence that suggests this company
	does not deliver what it promises. Evidence that if you were a
	customer, you would not be inclined to believe what Digital told
	you.

	It is becoming understood in enlightened organisations that being
	"customer oriented", although supremely desirable, is unattainable
	until the organisation first becomes "employee oriented". The point
	is that the customers don't see "the company". They see employees.
	The company's image is the sum of the employees' images. So the
	first step is to have happy, committed, employees who believe in
	what they are doing.

	"Imagine a company that delivers what it promises". Ken Olsen laid
	down the precepts that went into the "Corporate Philosophy" more
	thirty years ago. Profit came before growth, but before profit
	came honesty.

	Let's go back to being honest in everything we do!

	/Tom

    dejavu
    I've just had the same experience...cracked a tooth below the gum,
    had the "lengthening" procedure done, and am now getting ready to
    schedule the crown work.  The lengthening procedue was estimated
    at $600, and initial response was 50% coverage.  Well, I got the now
    famous letter the carrier sends to providers that states they are
    reviewing the case & will provide payment when that review is
    completed.  The provider of the surgery has not yet sent me a bill
    or anthing, and I believe his office is waiting for the carrier to
    complete the review.  I'll post my results just to see how things
    work out here.
    Mark
    

    Just a reminder on a couple of points:  DEC's dental coverage is only an 
    assistance plan.  John Hancock only administer the plan, AKA screw up the 
    forms and checks etc.  And, this is part of our reimbursement for working 
    at Digital, just as much as our salary, (something most people don't 
    remember) not a gift from the company as some seem to think. 
    
    I thought I would avoid the anxiety around how much my bridge work
    would cost by getting a pre-work extimate.  Twelve weeks later the people
    reviewing the treatment gave me a figure, unfortunately, in the mean 
    time Digital changed the plan and the percentage that would be
    reimbursed and I landed up $1200 in the red.
 
    I don't like the way DEC quietly whittles away the benefits.  Would it
    be too much to expect them to be above board and honest?  If I
    didn't keep the booklet they send out at the end of the year, outlining
    the upcoming health care choices I would be hard put to notice what had
    been lost, until I tried to get treatment.  By the way, it also pays to 
    keep your eye on the Orange Book.  It's suprising how many of our 
    personnel policies have changed lately.
    
    

                    <<< Note 2440.7 by GRANPA::LIROBERTS >>>
                                -< MOUTH GUARD >-

>    I know where you are coming from.  I need a mouth guard to stop me from
>    grinding my teeth at night.  Two different dentist in the last two
>    years have given me the same diagnosis.  If the guard is not made soon
>    within 3 to 5 years I will have only stubs for teeth.  
    
>    Well, the one dentist called John Hancock.  They told him that they
>    would not cover the guard at all.  He asked why.  They stated that it
>    really wasn't necessary.  Well, the dentist said, "isn't better that we
>    protect her teeth now instead of having to replace all of them later?" 
>    JH's reply was, "well when it happens then we will cover it."
    
>    Now the second dentist is fighting with them.  Who knows what will
>    happen.
>    
>    Thank goodness that you are getting your check.
    
>    Lillian

Lillian,

I understand where you are coming from  regarding the night guard.
I have had two of them made so far,

I don't remember all the figures, but I do remember that I had to pay
a portion.

My got covered in part because I have TMJ, and they did consider it under
that. I think there is a life time amount set though for anything they
pay related to a TMJ problem.

If you are not aware, TMJ is a condition, atleast with me that makes it
very painful to keep my mouth open very long for any kind of dental work
because the jaws start aching, etc.

I had also broken a tooth and the night guard was to keep me from doing
that again from the clenching.

Again, it got covered because it was submitted under the TMJ problem.

Sorry, I don't  have the details or figures.

I also feel that I end up paying atleast 1/3 of my dental bills out of
my pocket.
					Sue...

    
    	re -1
    
    	I also have TMJ and JH told me they don't cover TMJ appliances
    	only if you have JH MEDICAL will they cover part of it under
    	medical not dental.  I fought with them for awhile over this
    	and the only thing that's happened is my dentist dropped his
    	price for the guard..which I will have to pay for myself.
    	I was told by JH to check my "benefits book" I looked it
    	up and sure enough under dental (section 4) its says under
    	Plan does not cover charges for: its has TMJ listed.
    
    	

>                    <<< Note 2440.12 by AKOCOA::JBOURQUE >>>
>                          -< TMJ- medical not dental >-

    
>    	re -1
    
>    	I also have TMJ and JH told me they don't cover TMJ appliances
>    	only if you have JH MEDICAL will they cover part of it under
>    	medical not dental.  I fought with them for awhile over this
>    	and the only thing that's happened is my dentist dropped his
>    	price for the guard..which I will have to pay for myself.
>    	I was told by JH to check my "benefits book" I looked it
>    	up and sure enough under dental (section 4) its says under
>    	Plan does not cover charges for: its has TMJ listed.
    
 You are right, now I remember that is what happened with mine
It was covered under the medical, but it was covered in part.

						Sue...
   	

Another problem I have had is that I pay the bill, and the dental
office submits it to them as PATIENT PAID BILL

Still they send the check to the dental office

I get the statement and have to wait for them to get the check
to send to me.

Do they read the forms ??

					Sue...

<Another problem I have had is that I pay the bill, and the dental
<office submits it to them as PATIENT PAID BILL

<Still they send the check to the dental office

<I get the statement and have to wait for them to get the check
<to send to me.

You have to put in BIG RED letters that you've already paid the bill and
you expect JH to reimburse you, the patient. That has worked for me in the
past for dental and medical bills. 

    re: .2
    
    >plus you only get $1000 worth of benefits a year.
    >depending on how easy or difficult the crown is, you
    >could eat up the $1000 quick.
    
    That $1000 benefit can not be realized.The plan, as designed,
    would require one to have 33 teeth filled and 33 teeth extracted
    to max out.
    
    
    Mike

    re .14 and .7(?) - Mouth guards
    
    My husband just got one of these, to stop him from grinding his teeth.
    The charge was $199.  The covered benefit was $0.  JH says they will
    only cover them if the patient gets them 6 months before or after
    dental surgery.  (Don't ask me how they know he's not going to have
    surgery in the future!)
    
    re .16 - the $1000 benefit
    
    Yes, it can be realized.  My husband had alot of work done in one
    year, and went over the max by a few hundred $$.  Naturally, JH
    wouldn't pay anything above the $1000, which really aggravated me,
    since I pay for family coverage and no one else in the family had used
    up anY benefits that year.  (I know, that's not JH's fault, but i
    thought it would have been nice if they'd taken that into account).
    
    In general -
    I really worry about the caliber of people handling the claims.  My
    husband had his own dental insurance for about 2 months, in 1990.  JH
    has been handling claims for him ever since, and there have been alot.
    But recently they decided not to pay a $290 claim unless we provided
    evidence that the other insurance was no longer in effect.  SO I sent
    them what they needed.  A month later, they asked me for it AGAIN.  so
    I sent it again.  A few weeks later, they paid the claim.  A few weeks
    after that, they AGAIN sent me a request for the info about the other
    insurance, stating that they wouldn't pay the claim until I provided
    it!  Not only had i provided the info twice, but they'd already paid
    it!  It was then that I was convinced I was dealing with idiots.
    It's scary.....
    

Even in these times. I did it with a crown and a root canal.

The easy way for Digital to handle the Dental bills would be
to just pay the bill until you reach the $1000.00 Maximum and
then let you the patient pick up the rest.  If you don't use
all of the money, Digital makes out.  In the meantime, they don't
have to pay for teh examiners and could probably reduce the cost
for John Hancock or maybe bring it in house.  Save Money, make 
employees happy, what a concept.

Larry

    re. 16
    
    i have experienced the maxing out of the $1000, so i know
    it is doable.
    
    did you know that dental will only pay for two cleanings
    a year, regardless of whether you reach the $1000.
    so besides the $1000 max, there are also rules around
    the number of 'cleanings' they will pay for.  it wouldn't
    surprise me if they limited the number of tooth extractions
    also.
    
    smiley

    Since I recently filled out a dental JH form, I noticed that to get
    patient reimbursement, you need to attach a paid receipt to the bill -
    else it automatically goes to the dentist.
    
    

    
    Re: .17
    
    > Yes, it can be realized.  My husband had a lot of work done in one
    > year, and went over the max by a few hundred $$.  Naturally, JH
    > wouldn't pay anything above the $1000, which really aggravated me,
    > since I pay for family coverage and no one else in the family had used
    > up any benefits that year.  (I know, that's not JH's fault, but i
    > thought it would have been nice if they'd taken that into account).
    
    There is a very good reason why they should not do this.  Let me
    relate a little story.  Back around 1974 when I worked the insurance
    business, Blue Cross petitioned the State of MA for a rate increase
    because their reserves had fallen dangerously low.  After investigation,
    it became clear that BC had been paying all legitimate claims *and*
    a significant number of other claims that they found were cheaper to
    pay than to properly research and reject.  In effect, they paid
    benefits to people who weren't entitled to them and wanted to go back
    to *all* their customers for a rate increase to pay for it.  Not a
    good idea.  Their rate increase was not approved and shouldn't have
    been.
    
    Steve

    i don't have the reimbursement issue.
    my dentist bills me the delta between his charge and
    what the insurance will pay.  they bill the insurance
    company for the amount that insurance will pay. 
    they seem to be very up what will be paid by the insurer.
    
    i would dread having to pay the dentist and then deal with
    the insurance company reimbursement.  :-(
    
    willie

Re: 19

>    did you know that dental will only pay for two cleanings
>    a year, regardless of whether you reach the $1000.
>    so besides the $1000 max, there are also rules around
>    the number of 'cleanings' they will pay for. 

I believe there are also rules around when the cleanings have to 
occur.  Woe to the patient who goes in earlier than 6 months from 
the last cleaning.  Even one day earlier.

>	  Woe to the patient who goes in earlier than 6 months from 
>the last cleaning.  Even one day earlier.
    
    They have resolution in the micro-fortnight range, forget days.
    
    This string repeats a common theme if I may paraphrase: "You're not
    paying more, you're getting less."
    
    Phil

    re .17
    
    I'm sorry to say that it is a sorry fact of life these days to have
    to deal with totally incompetent "idiots". "Idiots" is as you would
    put it, I just refer to them as "lemmings". Society in the great old
    U S of A is spewing them out at great quantities. The next time I
    go an entire day without encountering a "lemming" devoid of any trace
    of common sense I will be sure to let you know.
    
    Some may think that this entry should be in soapbox or some other
    conference. Not really, considering this conference is about working
    at Digital... Have I got stories to tell, nah I won't take up anymore
    of your time. 8-)
    
    Jim C.

>     Since I recently filled out a dental JH form, I noticed that to get
>     patient reimbursement, you need to attach a paid receipt to the bill -
>     else it automatically goes to the dentist.
    
    Supposedly, this is all you need do.  But, if you don't write in big
    red letters that you've already paid the bill and the money is to come
    to you, they send it to the dentist.
    
                                    August G. Reinig
    

>    Supposedly, this is all you need do.  But, if you don't write in big
>    red letters that you've already paid the bill and the money is to come
>    to you, they send it to the dentist.
    
                                    August G. Reinig
>    

I think some of the bills are now faxed in, I think my dentist office
does that now. It is not as easy to put all the flashing lights or
whatever it takes to get their attention.

I did resolve my medical bills by getting a BIG stamp made, it says

	REIMBURSE EMPLOYEE
	 BILL IS PAID

It is about six inches long and I use Red Ink Pad

But that only works with forms I send in, many places now have
generic forms that are accepted my most insurance companies and don't
even use our forms anymore. When they send them in , we can't control it.

					Sue...

    re: .25
    
    I heard a great term that describes 'those kind of people'
    (idiots,lemmings, etc.) and it's "conscientious incompetence". They
    have no clue as to what they're doing or how they're supposed to do it
    but by jove, no one's going to change the way they're doing it!

    I'm looking at my most recent paystub.  I pay nothing for my coverage
    and $2.25 a week for my wife.  There is no additional charge if I had
    additional family members if I remember correctly.  So the operative
    question becomes, what do you want for nothing????
    
    Sure there are better plans out there.  Do you want dental plan choices
    like our fun with health care each fall?  There's a number in the DEC
    phone book on who to talk to about benefits.  Call them and suggest it. 
    Chances are, to get good coverage you are looking at $30 a week. 
    Certainly if you know you are going to need a lot of work, its probably
    worth paying for it.  But would you want DEC to only offer a $30 a week
    plan.
    
    Gather signatures of people who want the choice.  If DEC won't respond,
    then work directly with an insurance company.  You should be able to
    get a group plan written up.
    
    DEC does review reasonable and customary if they get enough complaints. 
    I had to do that a couple of years ago with my dentist.  
    
    Its unfortunate when you are caught by surprise by an accident.  But we
    don't really pay for the plan.  Expecting major benefits from it is a
    mistake.
    
    	Dave

    How can you say that we want something for nothing?  Dental insurence
    is compnnsation, and we have every right to up to $1000 value for your
    service per year.  If you are getting less than full service you
    have every right to complain.  It is not a gift but a right that we
    have earned.                  

    My purpose in writing the base note was to give a 'heads-up' about the
    fact that our benefit coverage has fallen behind the times. 
    
    I don't believe that basing the 'reasonable and customary charges' 
    threshold on 1986/1987 data is beneficial to Digital or to the 
    employee. The company should try to stay current with what it costs to 
    have services rendered, lest employees' health needs suffer because 
    they can't afford to make up the difference. And believe me, I asked 
    the questions about having the tooth extracted vs the required work 
    ( and subsequent costs...) associated with saving the tooth. I decided 
    to do what it took to make up the difference. I can afford it now, but 
    what happens in 2-3 years when costs have escalated another 50% and our 
    benefits yardstick is still measuring 1986/1987 costs ? Would you let a 
    dentist who would do gum surgery and bone removal at $60/tooth work in 
    your mouth ? I bet not, but that's what the Dental plan says is 
    reasonable and customary. I asked the JH rep the same thing and she 
    didn't have an answer.
    
    Personally, I'd be willing to pay a few more bucks a week ( perhaps not
    the $30 as some have suggested...) to have the coverage stay current. I 
    have my entire family of four covered, and I'm glad to have it. I'm just 
    sad to see it fall behind the times and be less of a benefit than it used 
    to be. I guess we're not in Kansas anymore...
    
    George :-(
    

    i went did my normal 6 months dental checkup and the pill came to
    $170 !  almost died when i saw it, they said they had to do 2 x-rays
    for check up, i came all clean health with no problems too and the nice
    nurse even told me iam doing great and i should keep up the good work and 
    all but still $170 for normal check up is too much i think, they list the
    things they done on the pill offcourse but they say it in doctors talk
    and they expect us normal people to understand it too.

    the medical cost is going out of control i think.

    \bye
    \nasser

    if all they did was 2 xrays and, perhaps, a cleaning for $170, you
    might want to check around with other dentists for comparisons
    
    it sounds like they were, indeed, cleaning up
    
    do some research, and reduce the bite from digital's insurance budget
    
    dave

    
    And is it really necessary to get your teeth checked every 6 months?  I
    go once a year, this, I think, is sufficient.
    
    
    
    Mike

I guess it depends upon your teeth, but I go every 6 months to get the crud
cleaned out from between my teeth that flossing can't get.

Bob - who wore braces and got crooked teeth again

    >And is it really necessary to get your teeth checked every 6 months?  I
    >go once a year, this, I think, is sufficient.
    
    It really depends on the individual.  Some people might not have to go
    very often; but in my case, having to fight a constant battle against
    plaque, I basically need to go *four* times a year.  I pay for the
    additional two times out of my own pocket.
    
    -- Mike

    my dentist recommends a CLEANING every six months.
    checkups (the dentist, as opposed to a hygienist) looking
    into your mouth, happen once a year.
    people who are prone to gum disease may get cleanings every
    three months.
    there is no hard and fast rule.  if you dentist says once
    a year is fine, go with it.  
    this could be a pay me now ($50 every six months for a cleaning)
    or pay me later ($500 for gum surgery very two years) situation.
    
    I view cleanings and checkups as preventive maintenance.
    
    :- )

    
    plus there is nothing like that FRESH out of the dentist office
    feeling!

    and please remember, a healthy DECeeee is a happy DECeeee, and a happy
    DECeee is a productive DECeee ! 

    \bye
    \nasser

    nasser,
    
    you are so funny!  you should have your own notes file.
    
    a fan
    
    willie

    
    Yes he really shoul have his own notesfile so he wouldn't end up
    trashing all the others.
    
    
    I brush and floss the ole teeth regularly, I must say that the new
    baking soda toothpaste makes my teeth feel dentist fresh.
    
    
    
    Mike

    
    Before everyone goes ballistic...RE: -1 the first part :')
    
    
    
    Mike

    RE: .40 (baking soda toothpaste)
    
    FWIW: if it feels good, great.  But my dentist says that the baking
    soda pastes don't actually DO anything more than the standard pastes.
    He suggests using anything you like, as long as it has flouride.
    
    This is critical when you have kids.  The best toothpaste is the one
    they'll use.  My kids can't stand the baking soda crap (and I don't
    blame 'em; I think it's vile too).
    
    So, keep your (and Digital's) dental costs down by getting toothpaste
    that will be properly used, not avoided.
    
    -- Russ

    i just to also point to my fellow DECeees something important, the
    dentist told me to use NON-ALCOHOLIC mouth gargel wash, he said you got
    to be careful with the ones out there because most have alcohol in
    them and some DECeees might not react well to it and they might not
    no that as they use it.

    i went ahead and bought a bottle of NON-ALCOHOLIC ones, they are hard
    to find because they are just coming out, but if you ask the 
    pharmacists they'll tell where you can find one.

    i been using lestireen all my life stright out of the bottle too and 
    i did not know who strong it is but i stopped it now and started
    to use this non-alcholic one, i never thought this stuff has alcohol in it 
    before now !

    i just wanted to point to this just in case some DECeees did not know 
    about it.
    if you are not sure please always check with your personal physicians or 
    consult your dentiest.

    \bye
    \nasser

    RE: .42 Actually it (baking soda) helps in the prevention of gum
    disease.  The BS toothpaste has fluoride it it.  I agree with the idea
    of getting one (with fluoride) that the kids like for them, they brush
    longer.
    
    
    
    Mike

.39	You missed one, an Unhappy DECeee writes many notes in the
	DIGITAL note file ;-}

.41	You've been using Listerine� all your life.  Is that why
	you're such a sour puss (no offense intended, I couldn't
	resist the pun;-)

Alcohol content of Listerine.  When Listerine came out with the
mint flavor, if you checked the ingredients, you would of noticed
that the alcohol content was less then the old stuff.  The regular
had an alcohol content of 29%, the Mint is 24%.  Seems that using
a mouthwash with a percentage of alcohol greater then 25% increased
the users likelyhood for getting oral cancer.  I will be looking
for non-alcoholic mouthwashes.

Larry

    if 25% alcohol listerine causes oral cancer,
    what does scotch, gin, bourbon, etc. do?
    i have never heard liquor connected to oral
    cancer before.
    so the worst thing you can do is get dolled up to go out,
    gargle with your highly alcoholic mouthwash, go to a bar
    and drink booze, and smoke cigarettes.
    
    :- (

    
    If I remember correctly, alcohol can cause throat and/or mouth cancer
    although I believe that throat cancer is most common.
    
    
    Mike

    re: .44
    
    I believe my dentist was challenging the notion that it actually DOES
    fight gum disease in any significant way.  He, likewise, didn't think
    there was much behind the "tartar control" claims of many brands as well.
    
    Note as well that chewing gum now claims to fight various mouth
    ailments by virtue of the fact of that it causes you to salivate.  It's
    apparently true to certain extent, but the hype seems to extend well past
    the point of significance.
    
    -- Russ

Frankly, I don't swish my Glen Livett around in my mouth.  I let it 
pass slowly over the tounge in small quantities.

It may also have something to do with the fact that one tends to 
use mouthwash after one has brushed and flossed, opening all those
little pockets that my dentist keeps telling me are too big, and 
thereby allowing the Mouthwash to get to the root of the problem.

Larry

    In my High School days I worked in a Pharmacy. On Sundays, when the
    liquor stores were closed, people would buy mouthwash to drink. Anything
    for a buzz I guess. It didn't happen often but when it did I sure
    felt quite sad that someone could get to that point. The pharmacy
    by the way was not in an urban community but rather in a well to
    do suburb of Boston. The "medicines" that some of these well to
    do folks had scripts for were quite sad as well but those are stories
    for another time. Money sure doesn't buy happiness as I saw first hand.
    
    Jim C.
    
    

      > Anything for a buzz I guess. 
      > The "medicines" that some of these well to do folks had scripts 
      > for were quite sad as well but those are stories
 
      Yeah, just ask Kitty Dukakis.
    
    
        
        
    

Thanks,

Bob - Co-moderator DIGITAL

Maybe Digital should provide a mouthwash allowance, nothing 
makes a worse impression on a new customer then a bad case
of Bad Breath ;-}

Larry

Bob - We haven't strayed as far as other topics have strayed,
at least we are still in the mouth!!

    TOM'S OF MAINE puts out an alcohol-free mouthwash!!!

I have to agree with .29 to a large extent. At two and a quarter a week for
family dental coverage, I figure anything that's covered/paid by the plan 
above and beyond the $65 that it costs me annually is a benefit. It may
not be as much of a benefit as I'd like it to be, but I'm still ahead.

Compare to Medical Plan 2. Without a catastrophic illness, a serious
chronic problem or an emergency requiring hospitalization, it's highly
unlikely that you ever get back what you put into it each year. The
Dental plan is a bargain in that light.

-Jack

    
    Re: .29
    
    > So the operative question becomes, what do you want for nothing????
    
    I don't deny that the premium is cheap and that I should not expect
    big benefits from the dental program, *BUT* I do expect that for the
    money I pay that the plan will deliver what it says it will for that
    money.  In my current experience they are not.
    
    My wife, because her teeth were neglected when she was a child, has
    full upper and lower dental appliances and she is only 41.  Her
    dentist, and a second she consulted for another opinion, told her that
    her dental appliance is eroding the bone in her lower jaw and at the
    current rate the erosion will leave her unable to wear any appliance
    within just a few years. She was faced with still being in her 40's
    and being toothless without being able to do anything about it.  I
    expect you can imagine how that felt.
    
    The dentist told her that dental implants would work for her since they
    suspend the appliance on top of posts implanted in the bone and would
    therefore not erode the bone further, but the implants require
    substantial bone to support them and would need to be done before the
    bone erodes beyond that point.  She has begun the implant process.
    
    The implants are covered by the dental plan, but since it is a
    "significant service" (their words not mine) they have the claim
    automatically reviewed by an independent agency which reviews dental
    claims to see whether the work is necessary.
    
    They have totally denied the claim.  We'd have been happy with the
    60% or reasonable and customary which I am sure is far less than 
    the $2000 the dentist charge for two implants, but we got nothing.
    Zero.  If my wife's case is not "necessary", I'd sure like to see what
    they think is.
    
    You can be sure I am not through with them.  
    
    Steve
    

I checked with Corporate about the statement in .0 that 1986 rates are used.
While I don't doubt that the note writer was told this, it did seem hard to
believe (which many of you said).  I guess its not a lot better, but not
quite so bad.

On the low rate of what you actually get paid vs. the cost, welcome to health care
in the '90's.

    re .56
    
    I fully understand your frustration.  My wife has TMJ.  Our dental plan
    covers none of it.  Our medical plan has a $1500 lifetime max if you
    picked up John Hancock or HMO elect.  That money is long since gone.  I
    think it stinks, but that's the policy.  
    
    I'd like to see us have better dental coverage.  I'd be willing to pay
    for it.  In the meantime, for $65 I get two cleanings and so does my
    wife.  This is much more than the amount I put in.
    
    Do fight them for your claim.  Insurance companies go out of their way
    to make things tough.  Its an easy way to screen out false claims.  You
    may even need a lawyer.  Don't be bashful.  The TV ambulance chasers
    are right, sometimes you do need a lawyer to fight for you.  Contact
    the Mass Bar Association.  They can get you names of reputable lawyers
    in your area who practice in the health care space.
    
    	Dave

    
    Re: .58
    
    > Do fight them for your claim.
    
    You can bet I will!  They are going to wish they never heard of
    me.  This is only one of the issues.  The reason my wife has lost
    her teeth is that she was a severely abused and neglected child.
    She regularly goes to therapy to help her recover from that.  She
    experiences flashbacks which are triggered by present events and
    has been hospitalized twice in the last year and a half for it.
    She has over six years built up enough trust (trust is a BIG issue
    for victims of childhood abuse) in her therapist to begin to really
    achieve the recovery she wants so badly and now the mental health
    agency (AGCA) for Healthsource is refusing to pay her therapist because
    her case isn't "acute".  Just 10 minutes ago, I got a call from her in
    tears, that one of her patients (she is an RN) had taken a swing at
    her.  The entire unit rushed in on hearing the commotion; they got the
    social worker up to the unit immediately; they were all fussing over
    the patient; AND NO ONE ASKED MY WIFE IF SHE WAS OK.  Just such an
    incident like this, which could happen to anyone at any time, could
    trigger a dissociative flashback that could put her back in the
    hospital AND HER NEED IS NOT ACUTE.  I am so mad that I could chew
    nails!!!
    
    I myself was once hospitalized after a car accident and the insurance
    company tried to screw me out of $8000 flatly denying that they
    owed more, BUT I HAD READ THE POLICY.  It wasn't until I quoted
    from the policy and threatened to haul their butts into court that
    they budged and did it leaving me with the feeling that they knew
    it all along, but waited to see if I would bitch.
    
    They won't hear the last from me until they pay or they wish they
    had.
    
    Steve
    

    RE: -.57
    
    I was told this by the John Hancock CSR when I called to see what would
    be covered BEFORE I had the surgery performed. I gave the EXACT
    procedure number, which she looked up. When she replied that the
    program provided a payment benefit of $490.00 based on the Zip Code of
    the doctor, I asked her how that benefit was determined, considering my
    peridontist was charging $650 for the procedure. She responded that the
    benefits were based on '86-87 rates, and furthermore, Digital had no
    intention of updating the rates to a more current level. Then I got the 
    typical party line about JH only being a screening agency...
    
    Now, I didn't take the time to call Corporate. When I have tried to
    call them in the past, I either got a recorder or a run around about my
    inquiry. Besides, I didn't have a lot of time to spend on this. I am
    trying to save my job, and this would not have been productive to that
    end. At least we are only a couple of years behind...
    
    George 

    > program provided a payment benefit of $490.00 based on the Zip Code of
    > the doctor, I asked her how that benefit was determined, considering my
    
    Note, they base it on the Zip Code of the doctor, not of the patient.
    So, all we have to do in convince our doctors to get a P.O. box in
    some very expensive place, say perhaps Berverly Hills?  
    
                                    August G. Reinig

    I have a different problem with the dental insurance people.  My
    dentist sent in a pre-work estimate for removing an abcessed tooth and
    replacing with a "Michigan bridge."  That's a little bridge with one
    tooth on it.  The sides of the bridge are wings that are cemented to
    the teeth on either side of the baddie.  He cannot save this tooth
    because it abcessed close to 20 years ago and I've had surgery on it
    twice.  The estimate was sent in March 9 and I received notice  May 7
    that they were sending the claim to ADE.  ADE sent me a notice May 14
    that they need more information from the dentist.  He doesn't really
    understand what they want -- it appears they want more xrays.  
    
    Meanwhile, I have an abcessed tooth in my mouth that is draining. That
    claim has evidently been sitting in some JH office for two months while
    the tooth drains.  When I called JH, I was told that the dentist
    mustn't have sent in further info when asked, but he was never asked or
    contacted in any way.
    
    Now, I see from this note that after waiting all this time, I'll get so
    little reimbursement that it isn't worth it.  My husband said that the
    longer they wait, the more they save. He also said that JH (DEC) won't
    pay anything that the work is worth.  I didn't believe him then, but
    now I do.

    
    Re: .63
    
    I had a similar problem with regard to my wife's dental implants.
    They wanted more information.  I called JH and specifically asked
    what additional information they wanted.  I then personally conveyed
    this information to my wife's oral surgeon.  They paid the claim
    after getting the additional information.  I was irritated that I
    had to take this into my own hands and do their job for them, but
    it was worth $900 to us!
    
    fwiw,
    Steve
    

    I just got an interesting phone call from my dentist's office.  I had
    an overlay (essentially a crown).  My dentist decided to work on that
    tooth as it had also chipped.  JH just sent a memo second-guessing the
    dentist's professional judgement (and my previous dentist's
    professional opinion, but JH may not know that) and casting doubts as
    to whether or not they'll pay.  
    
    
                                     Kurt

    

This is getting ridiculous.

I'm getting tired of the dishonesty inherent in the way that Digital
has set up the Dental Plan.

If they only want to pay 50% or whatever, fine.  Be upfront with it.

But saying that you pay 70% (or whatever it is) of the bill, and then
actually paying 70% of what it would have cost 10 years ago is 
dishonest.

Who should I be talking to about this?
How do I get in contact with Corporate Benefits, or whoever decided it
would be a good idea to not reset "Reasonable & Customary" for a decade...

Kevin

    
    
    	The dental rates are as of 1986 I believe.  The mileage for
    	auto's is in the same category.  US Government just went to
    	.30/mile and we are still at .225.  That's the way it is and
    	of course noone likes it and it won't be changed till we "turn
    	around" whatever that means...  Best grin and bear it...

    
         ...but don't grin too widely.  Your bad teeth will show.  True,
    the "100% covered" label on the statement is a major slap in the face,
    adding insult to injury after having to come up with the lion's share
    of the bill.
    
         ...but hey, it's great motivation to brush and floss!
    
                                      Greg 

    
    I too am affected by TMJ disfunction.  In my case, it brings on
    headaches and all over body aches.  My health insurance is willing
    to prescribe muscle relaxants, anti-depressants (no idea why), send me
    to a physical therapist, and so on.  All of this costs more than the
    $200 that a bite guard would cost.  But they will not cover that.  And
    neither will JH unless within 6 months of dental surgery.
    
    To top it off, I'm covered by 2 dental plans.  My husbands plan covers
    me at no additional cost to him and they actually cover 100% of
    cleanings.  Only thing is, I have to submit to JH first, then to
    Delta Dental.  It took 11 months for my last bill to clear!  And if you
    think JH is screwed up... I think it is the entire Dental insurance
    industry.  My husband recently had a cleaning and they sent mail
    refusing to pay his claim because he is "covered under another policy". 
    Well he isn't!  Its me that has two coverages.  I didn't get dental
    coverage for him!
    
    I must say, however, overall, I'm quite pleased with our health
    insurance (Harvard), with the exception of this TMJ thing...
    
    Karen

Well don't feel too bad at least it's covered 50%, my wife just got diagnosed
with TMJ.  Since I was pushed two years ago to move to an HMO but have to keep
John Hancocks Dental insurance I ran into this catch-22...  According to the
HMO TMJ is considered a "dental" problem and is covered by their dental
insurance.  John H. says it's a "medical" problem and it's covered under their
medical insurance.  Well you guessed it, we are not covered.  When I called the
benefits people, I started explaining my problem she cut me off with a "yup,
you arn't covered".  I replyed back that since she seemed to know what I was
asking she must hear it a lot, "oh yes, all the time".  When I asked that
didn't they see a problem here, was told that I should have read the benefits
package better and should have seen that TMJ wasn't covered, after all I had
the "choice to say with John Hancock" and it was my decision...   She did say
that I could keep track of all the bills and when it was done I could file an
appeal with the corperate benefit office and they would review my case and
"maybe" pay for part or all of it...   Since it has already been about $800.00
and far from over I guess that's my only chance, fat that it maybe...

just blowing off some steam,

thanks,
dale

Sorry, but my note a few back may have been misinterpereted.

Yes, I was blowing off some steam, after finding out that I owe
my dentist hundreds of dollars for my wife's crown.

My primary purpose, however, was to stop whining and try to start
some change.  Things seem to be starting to loosen up.  Maybe if enough
of us voiced our concern about this in a constructive manner
(this does NOT mean things like "Hey, when are you jerks going to start
paying your fair share of my dental bills???")

Maybe, just maybe, things will get changed.

Keeping silent (to upper management) is sure to keep things the same.

So, my question is: to whom (and how) should I address my concerns?

    I dunno, but when you find out where to complain, let us know.  My
    spouse got stuck with a several hundred dollar dental bill recently after
    John Hancock paid their 70%-of-what-this-cost-many-years-ago piece of
    it.   Ouch.
    
    /Charlotte

I agree that the dental benefits, particular in the US are way behind
both the costs involved and the level of coverage of other companies.

I think that the even the $1000 dollar is a joke; you probably need 
to spend $10k in 70 different procedures to get the whole $1k, because
the only cover x% of this, Y% of that and one cleaning per 12 months.

I would even settle if John Hancock would provide a mechanism where 
we could contribute something and get broader coverage. I know people
that have had thousands of dollars in dental bills (in US), myself 
included and it would certainly have been worth it to me to have paid
some insurance coverage, that could have saved me all that money.

The other problem, which is a worldwide problem is that all insurance
and social systems use a baseline thats for the most basic of service at 
the lowest costs and they will only cover that cost ONCE.  

So if someone gets a cap thats cheap it only last a few years, but
you can't claim for having it replaced a 2nd time. If one goes for
say porcelain over gold, which can last 10-20 years, insurance companies
won't pay anything towards it.

Its definitely a lousy dental coverage ... but then its not great in any
country.

    To the person asking where/what to do about the catch-22 of neither
    paying for the TMJ.  Here is what I am told.  Keep all bills and once
    everything (!) is done make copies of all bills and copies of all the
    insurance information that talks about TMJ.  In other words make a copy
    of the pages of the John Hancock insurance dental book that TMJ isn't
    covered and a copy of the pages stateing the same thing from your HMO. 
    Send all this infomation and your explanation on why you think you
    should get an exception (again!!) to US Benefits @MS02-1/D2.  They will
    then CONSIDER your request...
    
    I would think that you wouldn't hold your breath on this?....;-)
    
    dale
                 

    
    There must be some kind of cost saving whipcracking going on. I got a
    letter from John Hancock this morning to say that their consultants had
    determined that the insurance will not pay *anything* on a $1100 bill
    for two crowns.
    
    Apparently, the dentist forgot to take an xray just before doing the
    procedure, and the xray that he took two months ago is unacceptable.  I
    guess somewhere in the small print it says they can decline to pay on
    technicalities like this.
    
    
    
    

    Yep - this is why you are encouraged to have the dentist submit a
    request in advance for details on what will be covered for expensive
    procedures.
    
    				Steve

>>    Yep - this is why you are encouraged to have the dentist submit a
>>    request in advance for details on what will be covered for expensive
>>    procedures.

My previous dentist always did this - that way I didn't end up with "sticker
shock" when I got the bill for the 'left over' amount.  

I've heard complaints about the amount of coverage for 9 years now (ever since
I joined Digital), (and I agree with them!).

bjm

It may be slim comfort, but note that Health Care Reimbursement Account
deductions can be used to cover dental copayments, so you can at least 
be paying your share with tax-free dollars.

- tom]

    Wait until you have an accident that involves dental work....There must
    be another bit of fine print that says "No accident coverage" because
    there isn't any.
    
    I sent mail to the PSN with suggestions of what I would like to see in
    changes to the dental plan.  My lone mail won't do it, but if others do
    the same, hopefully there is time before next open enrollment to
    renegotiate the coverages. 
    
    karenm
    

I think it's worth mentioning that while the base rates haven't gone up
in ages, neither has the premium.

>I think that the even the $1000 dollar is a joke; you probably need 
>to spend $10k in 70 different procedures to get the whole $1k, because
>the only cover x% of this, Y% of that and one cleaning per 12 months.

They cover one cleaning every six months, which is what dentists recommend.

>>>They cover one cleaning every six months, which is what dentists recommend.


No they don't.  I used to be in a six month rotation, and found that they don't.
Annuals only.  Now if you're cross insured, then the dentist can bill one plan
for the first, and another for the second.

I just called JH.  The guy said "Cleanings and exams, you're allowed to have
two in any twelve consecutive months."  That's an exact quote.

    Hmmm.  My husband just went for his six month cleaning and they 
    wouldn't pay for it saying that the visits were too frequent.
    
    Pam

    re: .83
    
    I understand they are very picky about timing.  Go 1 day too early, and
    they will deny the claim.
    
    Bob

    Correct; note that "12 months" doesn't mean "calender year";
    
    They take the date of service, look back twelve monthes, and if 
    you've had two within that period, don't pay the claim.
    
    Dave

    I schedule my cleanings six months plus one day apart; as stated
    earlier, less than six months, and they'll disallow the claim.
    
    					andrew

  Your dental office should know how to work with the system.  I have to have
my teeth cleaned three times a year, which means I have to pay for one of 
them.  The staff is great at making sure everything comes out right.  They are
also really good at arguing with JH and some refusals have been reversed.

			SQ

PS.  I'm not saying I'm HAPPY with the coverage; they just paid less than 
half the cost of my new crown.

So with the Digital medical plan costing three digits of dollars
a week, is there anyone still signed up for it?

   erik

    
    re -.1
    
    I am on the digital medical plan and it does NOT cost me three digits
    a week. The reason being is my zip code is rural enough to miss most
    HMO plans, if not all.
    
    -Mike Z.

94*, Bay Area, although I'm curious if past history affects
your premium as well. I don't have a big family either,
it's just my wife and me. We don't want to stay on
the digital medical plan, at these rates.

   erik

    When I was on international assignment the better of the two Digital
    plans was costing me about $7.00/week. When I came back to MA it would
    have been over $30, who knows what it is now.  I still get 70% Digital
    coverage through the HMO elect option.  So for $7.50/week I get an HMO
    and if I don't like the way the HMO is going to deal with something, I
    can use the Digital coverage.  I think the max out of pocket with the
    elect is $3000/year. While $3000 is a large sum, but if I ever needed
    some major surgery I would what to choose my own doctors.

    -Bruce
     

It's very hard to come up with a situation in which DMP would cost less than
using HMO Elect and _always_ going outside the HMO.

    your dentist office should do the billing.  It usually goes to JH
    first, then whatever they don't pay, the balance goes to the other
    dental insurance carrier.
    
    Yes, you need to tell JH you have other dental insurance.

    
    
    Both my hisband & I are covered by two plans, both family.  The rules
    are as follows:  
    
    Me who works at DEC has JH.
    Husband has DELTA Dental.
    
    My dental work is billed to my primary insurance (JH) first, then to
    my secondary (DELTA).
    Husband is billed to his primary (DELTA) and then to his secondary
    (JH).
    
    For children, birth dates of both parents are looked at.  Because my
    birthday is in January, Tom's (husband) is in March, the kids dental
    work is billed to their primary (JH) based upon my earlier birth date,
    and secondary to DElTA.
    
    Then we pay the difference.