THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Friday, April 5, 1996 TAG: 9604040151
SECTION: VIRGINIA BEACH BEACON PAGE: 06 EDITION: FINAL
TYPE: Letter
LENGTH: Long : 208 lines
Managed health care is managing not to pay for care when you need it and managing to keep the consumers uninformed. Employers and individuals need to be informed of their health insurance coverage so they can be knowledgeable shoppers.
The following are questions you can ask while shopping for your health insurance plan:
1. Can any provider willing to contract with your company do so?
2. What providers are no longer accepting patients and why?
3. How do I know if my provider leaves the plan or is no longer taking patients?
4. Are their incentives to providers to limit the amount and type of care?
5. How are providers chosen for the plan - i.e., board certified, fellowships?
6. What guarantee do I have that the providers in the plan remain state of the art?
7. Specifically, what diagnoses are exempt from the plans - i.e., AIDS?
8. Specifically, what procedures are not covered by your plan - i.e., bone marrow transplants?
9. When I get pre-authorization for surgery and procedures - i.e., MRI and physical therapy - does that guarantee payment?
10. What guarantee do I have that my insurance carrier will determine I have a pre-existing condition I didn't know about?
11. What happens to my coverage if I am geographically separated from my PPO/HMO?
12. How does experimental care become state of the art?
13. What is the definition of an emergency - i.e., fractures, chest pain?
14. What large teaching centers are part of the plan and how convenient are they to my home?
15. How quickly can I talk with a human when I call your pre-authorization number?
16. What assurance do I have that the person on the phone is qualified in answering my questions?
17. Does the insurance company have a book on the explanation of coverage that is understandable?
18. What is our formula for calculating usual and customary rates (UCR) - i.e., number of doctors surveyed?
19. Does the plan pay providers at a competitive rate to retain providers?
20. What portion of my health care premium goes to direct health care, research, etc.?
21. Are discounts given for healthy lifestyles - i.e., non-smokers?
22. What appeals process is available if I do not agree with the payments, policies and care received?
23. What paperwork and phone calls are necessary to see a specialist?
24. What is my mental health coverage? Will it cover the nervous breakdown I may get while I shop for health insurance?
M.J. Penney
Virginia Beach
As the region's major companies continue channeling their employees into HMOs, they would do well to consider how much of the premium dollar actually goes to providing health care.
Some recent studies indicate that administrative costs and the high compensation paid to executives in certain plans take up an inordinate amount of such premiums. For example, a survey by WEISS Ratings of Palm Beach Gardens, Fla., found that for Cigna Health Care of Virginia, only 71.5 cents per dollar of premium actually went to pay medical expenses. On the other hand, Aetna Heath Plans of New York spends 94.6 cents of every premium dollar on health care.
While some in the HMO industry might claim that their organizations bear both the administrative cost of the insurer and some of the administrative cost of provider, those purchasing health care for their employees through plans offered by Sentara, Blue Cross Blue Shield and Optimum Choice, would do well to ask how much of the premium dollar pays administrative costs and executive salaries.
Roger W. Lidman, M.D.
The Center for Arthritis
and Rheumatic Diseases, P.C. `Indefatigable' Dean deserves to be re-elected
In reference to Edward Bacon's March 15 letter on Councilman W.W. ``Billy'' Harrison's lack of responsiveness and accountability, and concerns about council operations in general, I'd like to add a few words.
My family and I, along with some of our neighbors from Red Mill Farms, attended several council sessions last summer regarding an issue of immediate concern. We, too, were appalled at Mr. Harrison's avowed lack of patience and concern for the ``details.'' However, attending City Council was a great opportunity to observe closely the approaches and attitudes of our elected representatives.
We came away mightily impressed with the patience and good common sense of a number of those who serve us. One of these is currently running for re-election.
Councilman Robert Dean demonstrated the amazing capacity to be constantly aware of the bigger picture while remaining cognizant of the details that create that larger whole. We found him to be an indefatigable worker, always available and responsive.
For Virginia Beach residents who share a genuine concern for future quality for future quality of life for our families and neighbors, it's critical that we be concerned, informed and involved voters. I came away from council chambers with a heightened sense of the sometimes excruciating impact local politics has on our lives.
Our involvement can put in place those who will truly serve the larger population. I'd like to recommend support for Robert Dean, serving not just Princess Anne Borough, but the City of Virginia Beach.
Karen Waller
Virginia Beach Vote NO on referendum
Voters of Virginia Beach, you will have only 57 candidates from whom to choose in the upcoming May elections. Do you know enough about 12 of these people (five for City Council and seven for the School Board) to cast an informed and judicious vote?
If you feel frustrated by our voting process, go to the polls and cast a NO vote to referendum number 1, which will be on the ballot. This will mean saying NO to the present system of everyone voting for everyone, with no councilman or School Board member accountable for his or her actions and votes to the actual district which they supposedly represent. We need some members at-large certainly, but we also need representatives who are elected and answerable to their own districts.
Virginia Beach is the largest city in Virginia and now needs to be governed as such, with residents having meaningful representation by voting for their own district members as well as the mayor and three at-large councilmen.
Doreen Steuteville
Virginia Beach Don't confuse candidates
In the March 10 Beacon you printed copies of the School Board members' resignation letters. Among them was the letter of Karen O'Brien. In the text of her letter was a statement that ``an announced candidate for the Lynnhaven Borough seat has attempted to intimidate and threaten me (Ms. O'Brien) if I (Ms. O'Brien) chose to run for election.'' Later, she refers to this individual as ``an angry man.'' Those statements, combined with a review of the candidate list for the Lynnhaven Borough, published elsewhere in the same Beacon issue, narrow the identity of the person cited in Ms. O'Brien's resignation letter to me and the other male candidate.
I am writing to state, unequivocally, that I am not the person Ms. O'Brien describes in her letter.
The controversy created in Ms. O'Brien's letter unless clarified, threatens to smother my campaign before it even begins. I am sure that there was no intention to harm my chances at election since Ms. O'Brien resigned before I filed to be on the ballot, and I am equally certain that Ms. O'Brien would confirm that she was writing about someone else, if asked.
Miguel J. ``Mike'' Arsuaga
Virginia Beach Neighbors grateful for help
On Feb. 2, the day of all the ice and snow, we lost our beloved pet, Roxy. My brother Terry was taking her on one of her many walks. Apparently some of the heavy limbs of a tree fell near her and she bolted running scared. Suddenly she was gone.
We immediately began searching. Since that time we have canvassed the neighborhood, distributed hundreds of fliers, ran ads in the paper, talked to anyone who would listen and visited the Animal Control and SPCA regularly.
Although we are heartbroken that our dog has not been found, we have had our faith in our fellow man deepened. Our local community, Shadowlawn Heights, rallied behind us. As the word spread we were amazed at the involvement of neighbors all around us.
One neighbor called the children on his block together and had them on the lookout for Roxy. Our mail carrier, Brenda, became very involved. She told everyone including local teachers who in turn told the schoolchildren. Local businessmen took up our cause. Wes at Smokehouse Deli, Sid at Lowe's Auto Repair, Beach Hardware and San Antonio Sam's all got involved.
Although we received no calls from our ads that were concrete, we were heartened by the many people who called about dogs they had seen resembling Roxy or just to let us know how concerned they were for us. Just the other day our neighbor was walking a miniature schnauzer that very much resembled Roxy. She said she was stopped twice by women in cars driving by and questioned, ``Is that your dog?''
Our whole family is still heartsick over Roxy's loss but are enriched by the concern of friends and even neighbors, most of whom we do not know personally.
Gloria and Paulette Hughes
Tony Adams and Terry Nixon
Virginia Beach Cox gymnast is an inspiration
Congratulations go to Lee Tolliver on his outstanding article (Feb. 28 Beacon) on Trish Feltz, the Cox High School senior gymnast and cheerleader who survived her bout with cancer. Trish is not only an inspiration to her friends and classmates, but to all of us.
Walter C. Kraemer
Virginia Beach Call amphitheater what it is
The other foot is about to drop on the Virginia Beach amphitheater. In a recent interview, the operator of the new project said ``another important task is obtaining a corporate name to be attached to the facility to give it a distinctive identity.''
How has this corporate sellout been successfully hidden until two months before its grand opening? The name of the facility should be the Virginia Beach Amphitheater. The taxpayers donated city land and have underwritten $17 million dollars for the facility. We were told this project should be built to help identify and promote Virginia Beach not a foreign automobile or some other inane product.
If the city wants to sell the name of this public project, the price should be $17 million dollars.
Brad Shoehan
Virginia Beach by CNB