GetHealthHelp

A Patient Advocate's View

About this analysis

I have done this type of analysis every year since 1995. Copies will be available at the Local and in the Health Line Doctors offices.

I hope it makes it clear that 50A.Empire MEP Indemnity is the best plan for single adults and families with children over 16. The 185.AetnaMEP PPO/Indemnity is best for families with young children. Most problems occur when members have chosen the HMO options.

I just started getting complaint calls from people who have the 838.HealthNet NY/CT coverage. They can’t find doctors who are familiar with the plan. I’ve met the reps from that company and they are usually offering their Medicare plan. I see that they also cover the NYC workers, so from what I can tell this is a scaled down model of the old GHI.

This year’s choices and the way that Hewitt presented their comparison, leads me to the conclusion that they are preparing for a national plan that offers Consumer Directed Health Coverage. The CWA National web site has a great explanation of how Consumer Directed Health Plans will affect the members.

October 8, 2007 Posted by | Uncategorized | Leave a comment

2008 Verizon Health Plan Comparative Analysis

2008 VERIZON HEALTH PLANS COMPARATIVE ANALYSIS

This analysis is to help you choose the right plan for your needs. The analysis is based on comments from Doctors and Patients made to GetHealthHelp.com. The plan details were taken from the 2007 & 2008 Benefits Renewal Worksheets, delivered by Hewitt. It is not meant as an endorsement or complaint about any plan.

Go online BEFORE October 30, 2007 to http://resources.hewitt.com/verizon or call 1-877-275-8947 ONLY if you want to change your plan selection from last year.

 

PLAN

 

50A.Empire MEP Indemnity

 

185. AetnaMEP PPO/Indemnity

 

814.Empire BCBS NY

 

21.Aetna

 HCN NY

 

847.Aetna HMO

 

822.HIP NY

 

838.HealthNet NY/CT

 

HOW DOCTORS & PATIENTS LIKE

 THIS PLAN

 

A+ BEST for Adults

Preventive Exams for children not covered

 

BEST, Some Problems Proving Medical Necessity

Well Baby In Network Only

 

 

Only doctors at participating hospitals will accept.

Bare Bones Coverage

 

Network Providers are

 good in this plan.

 

Only doctors at participating hospitals will accept.

Bare Bones Coverage

 

VERY GOOD for Preventive Services for children and women’s care.

 

Doctors compare this coverage to Medicare HMO’s. Small Network

 

 

CHANGES FROM

 LAST YEAR (2007)

 

Deductible raised from $200/500 to $250/625

Out Of Pocket max. increased to $700

 

 

Deductible raised from $200/500 to $250/625

Out of Pocket max. increased to $700

 

 

  $150 Hospital  co-pay

per admission added  

 

 

NONE

 

Replaces 803A. Aetna

  $150 Hospital  co-pay

per admission added

$50 emergency room

 

 

 $100 Hospital  co-pay

per admission added

 

 

 $150 Hospital  co-pay

per admission added

 

 

IN NETWORK

PRESCRIPTION

PLAN

 

Annual Out of Pocket

  max. raised to $300

70-85% covered with limits on co-pay

 

 

Annual Out of Pocket

  max. raised to $300

70-85% covered with limits on co-pay

 

 

 

In-Network Only

limited co-pays

 

 

70-85% covered with

 co-pay maximums

 

 

$5 co-pay 34 day supply

$10 mail order 90 days

 

Small co-pays for network and mail order generic & approved drugs. No Coverage for some drugs.

 

Small co-pays for network and mail order generic & approved drugs. No Coverage for some drugs

 

 

 

OUT OF NETWORK

PRESCRIPTION

PLAN

 

 

70-85% covered with same co-pay max as

 in-network except has a $50. deductible

 

 

 

70-85% covered with same co-pay max as

in-network except has a $50. deductible and patient pays then gets reimbursed

 

 

 

 

 

NONE

 

 

70-85% covered with same co-pay max as

 in-network except has a $50. deductible and patient pays then gets reimbursed

 

 

 

 

 

NONE

 

 

 

 

NONE

 

 

 

 

NONE

October 8, 2007 Posted by | Uncategorized | 1 Comment

2008 Verizon Health Plan Choices Analysis

 

CAN I USE MY

 OUT OF NETWORK DOCTOR & HOSPITAL

 

 

All doctors are covered

for 80% of office fee after deductible

 

All doctors are covered for 80% of office fee after deductible with some limits on fees

 

 

 

NO

 

70% covered after $250 deductible with limits on fees and procedures including hospital care

 

 

NO

 

 

NO

 

 

NO

 

ADVANTAGE OF USING IN NETWORK DOCTORS

 

 

Doctors agree to a fee schedule which may lower your out of pocket cost

 

Pay only a $15 co-pay

 for office visits

 

Requires PCP Selection

Limits out of pocket cost

 

No out of Pocket for In Network doctors visits $15 co-pay for specialists

 

Requires PCP Selection

Pay only a $10 co-pay

 for office visits

 

Pay only a $10 co-pay

for office visits.

 

Pay only a $10 co-pay

for office visits.

 

 

CHIROPRACTIC COVERAGE

 

Same as Medical Coverage Out-of-Network

In-Network agrees to managed care limits

 

 

80% covered fees after deductible for both In and Out of Network with  medical necessity and fees subject to limits

 

 

$10 co-pay

 

Limited number of visits both in and out of network Preauthorization and

 $1500 Annual Max.

 

 

Only limited in-network coverage with

 managed care  limits

 

 

Limited number of visits

in-network $10 co-pay

 

 

Limited number of visits

in-network $10 co-pay

 

 

OUT PATIENT MENTAL HEALTH

 

Good Plan Most Providers Accept In- Out Network

 

Good Plan Most Providers Accept In-Out Network

 

Approved Services

in-network $10 co-pay

 

Authorization Required

$15 in network 50% out

 

Approved Services

in-network $10 co-pay

 

60 visits limit

in-network $10 co-pay

 

Approved Services

in-network $10 co-pay

© Caryn Isaacs, Health Care Policy Analyst   October 2007     š PatientAdvocate@GetHealthHelp.com     É 718-612-2360    7 GetHealthHelp.com

October 8, 2007 Posted by | Uncategorized | Leave a comment

About this analysis

This analysis is to help you choose the right plan for your needs. The analysis is based on comments from Doctors and Patients made to GetHealthHelp.com. The plan details were taken from the 2007 & 2008 Benefits Renewal Worksheets, delivered by Hewitt.

It is not meant as an endorsement or complaint about any plan.

Go online BEFORE October 30, 2007 to http://resources.hewitt.com/verizon or call 1-877-275-8947 ONLY if you want to change your plan selection from last year.

 

If you have further questions or comments; call GetHealthHelp.com at 718-612-2360

Caryn Isaacs, Health Care Policy Analyst

110 Wall St., 11th Floor

New York, NY 10005

October 8, 2007 Posted by | Uncategorized | Leave a comment

Plan Analysis Continued

 

 

ADVANTAGE OF USING IN NETWORK DOCTORS

 

 

Doctors agree to a fee schedule which may lower your out of pocket cost

 

Pay only a $15 co-pay

 for office visits

 

Requires PCP Selection

Limits out of pocket cost

 

No out of Pocket for In Network doctors visits $15 co-pay for specialists

 

Requires PCP Selection

Pay only a $10 co-pay

 for office visits

 

Pay only a $10 co-pay

for office visits.

 

Pay only a $10 co-pay

for office visits.

 

 

CHIROPRACTIC COVERAGE

 

Same as Medical Coverage Out-of-Network

In-Network agrees to managed care limits

 

 

80% covered fees after deductible for both In and Out of Network with  medical necessity and fees subject to limits

 

 

$10 co-pay

 

Limited number of visits both in and out of network  Preauthorization and

 $1500 Annual Max.

 

 

Only limited in-network coverage with

 managed care  limits

 

 

Limited number of visits

in-network $10 co-pay

 

 

Limited number of visits

in-network $10 co-pay

 

 

OUT PATIENT MENTAL HEALTH

 

Good Plan Most Providers Accept In- Out Network

 

Good Plan Most Providers Accept In-Out Network

 

Approved Services

in-network $10 co-pay

 

Authorization Required

$15 in network 50% out

 

Approved Services

in-network $10 co-pay

 

60 visits limit

in-network $10 co-pay

 

Approved Services

in-network $10 co-pay

October 8, 2007 Posted by | Uncategorized | Leave a comment

Open Enrollment is Oct.17-30, 2007

 

 

PLAN

 

50A.Empire MEP Indemnity

 

185. AetnaMEP PPO/Indemnity

 

814.Empire BCBS NY

 

21.Aetna

 HCN NY

 

847.Aetna HMO

 

822.HIP NY

 

838.HealthNet NY/CT

 

HOW DOCTORS & PATIENTS LIKE

 THIS PLAN

 

A+ BEST for Adults

Preventive Exams for children not covered

 

BEST, Some Problems Proving Medical Necessity

Well Baby In Network Only

 

 

Only doctors at participating hospitals will accept.

Bare Bones Coverage

 

Network Providers are

 good in this plan.

 

Only doctors at participating hospitals will accept.

Bare Bones Coverage

 

VERY GOOD for Preventive Services for children and women’s care.

 

Doctors compare this coverage to Medicare HMO’s. Small Network

 

 

CHANGES FROM

 LAST YEAR (2007)

 

Deductible raised from $200/500 to $250/625

Out Of Pocket max. increased to $700

 

 

Deductible raised from $200/500 to $250/625

Out of Pocket max. increased to $700

 

 

  $150 Hospital  co-pay

per admission added  

 

 

NONE

 

Replaces 803A. Aetna

  $150 Hospital  co-pay

per admission added

$50 emergency room

 

 

 $100 Hospital  co-pay

per admission added

 

 

 $150 Hospital  co-pay

per admission added

 

 

IN NETWORK

PRESCRIPTION

PLAN

 

Annual Out of Pocket

  max. raised to $300

70-85% covered with limits on co-pay

 

 

Annual Out of Pocket

  max. raised to $300

70-85% covered with limits on co-pay

 

 

 

In-Network Only

limited co-pays

 

 

70-85% covered with

 co-pay maximums

 

 

$5 co-pay 34 day supply

$10 mail order 90 days

 

Small co-pays for network and mail order generic & approved drugs. No Coverage for some drugs.

 

Small co-pays for network and mail order generic & approved drugs. No Coverage for some drugs

 

 

 

OUT OF NETWORK

PRESCRIPTION

PLAN

 

 

70-85% covered with same co-pay max as

 in-network except has a $50. deductible

 

 

 

70-85% covered with same co-pay max as

in-network except has a $50. deductible and patient pays then gets reimbursed

 

 

 

 

 

NONE

 

 

70-85% covered with same co-pay max as

 in-network except has a $50. deductible and patient pays then gets reimbursed

 

 

 

 

 

NONE

 

 

 

 

NONE

 

 

 

 

NONE

October 8, 2007 Posted by | Uncategorized | Leave a comment