Archived Newsletters
Click on dates below for corresponding newsletter
| None at this time 4/2009 |
The "Archived Newsletter" site contains mostly outdated information. We have left it in intact to maintain an accurate historical context. Some of the information does remain accurate and important. Such as Workers Compensation and DROP plan. |
MIAMI
HEART |
| Miami Heart Institute has REFUSED to
negotiate with us for a discount. Remember, they are not in our network. If you use Miami
Heart for a non workers comp injury or illness it will be considered out of network. You
will be responsible for paying a $1000.00 deductible and 30% of the bill. There will be no
exceptions. Johns Eastern has advised me that illnesses that appear to be workers comp
will be paid by them initially but, if it later becomes apparent that the illness was not
heart related, they will decline to pay. If the initial visit yields a diagnosis that
would not be considered workers comp, and you need further medical studies, you must go to
an in- network facility for further testing to avoid out of pocket expenses. |
MOUNT SINAI MEDICAL CENTER |
| Mount Sinai Medical Center has
negotiated a 25% discount with us. The Trust will consider Mt. Sinai as an "in
network" hospital. You will be receiving additional information from our
administrator regarding procedures for using Mt.Sinai. |
PRESCRIPTIONS |
| Remember, our Rx plan
allows you to buy in 30 day or 90 day supplies. The same co-pays of five and fifteen
dollars apply. In other words, you get three times the medicine for the same price. You
should remember to order 90 day supplies for medicine you take forever, like thyroid or
non heart bill related high blood pressure. To order 30 day supplies, you simply present
your prescription at a participating pharmacy. To order 90 day supplies, you must either
have your Doctor fax the rx to RX America, or you can send it to them by mail. Your
medicine usually arrives within two weeks. Once they have the RX on file, renewals are
done by a phone call. (1-800-293-2202.) Remember: Do not to use your RX America card for
workers comp claims . |
IMPORTANT PLAN CHANGES |
| Since the Trust formed in
1990, health care costs have increased almost 40%, while prescription prices increased
35-40% in the past two years alone, and are expected to increase further. Health care
costs will increase another 10.5% this year alone. Remember, we went over nine years
before we instituted our first cost of living increase while during this same period we
substantially increased benefits. Our eye care plan and prescription plan are only two
examples. Over the past year the Trust paid out large amounts of funds due to a large number of unusual catastrophic illnesses. Coupled with the huge increase in health care costs as cited above, the Trust recently made some changes: a small rate increase of 3.5% with a small reduction in benefits. But our initial evaluation of these changes reflects that the savings will not offset the anticipated increases in costs. As a result additional changes will be mandatory. We are looking at putting those additional cost saving measures into effect in June. The most frequent question I am asked is "why do I pay so much for my insurance when xyz pays so little" First, our rates are in part based on 90% matching funds from the City. If the FOP negotiates with the City to pay higher rates, then that would off set our need to increase rates or cut benefits. More importantly, our rates reflect the costs of a plan with broad coverage and benefits not found in many employees plans. Also, as the number of our retires continues to grow, they will have a greater impact on the fund. The changes that the board makes now are designed to accomplish only one thing: to keep the plan solvent so that it is still here when we retire. Our fund will continue to cost less than city insurance, while our benefits are substantially better. The fact is, our plan is rich in benefits, and that costs money. The people at ASI who administer our plan as well as many others tell us that they would like to be on our plan because its better than the one they themselves have, and insurance is their business. Gary Kluger, Chairman |
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| Lab Bills |
| Members have been having problems with
Smith Kline Labs. The labs policy to send the bills to the members. There is a spot on the
bill that says "if you want us to bill your insurance company, fill this section out
and return." If you do not fill this section out and return it to SmithKline, they
will continue to bill YOU, and eventually turn the account over to collection. |
Billing problems |
| All billing problems should be
directed to our administrator, ASI (305-595-4040). Claudia Nagel, our office manager
should only be contacted when your dealing with ASI was unsuccessful. When calling Claudia
with a problem, please have ALL information about your claim and problem ready. |
Prescriptions |
| Some of our members continue to
receive their high blood pressure medications by using their RX America card. This is
strictly prohibited. RX America will soon be advised not to fill these RX's. Please
remember to use the City's insurer for Workers Comp prescriptions. |
Workers Comp |
| Remember, under workers comp
statutes, (State Law) you must see your workers comp physician yearly. Not a bad idea
anyway with high blood pressure or a cardio vascular problem. I f you don't, and lose your
workers comp coverage, the Trust WILL NOT cover you for your workers comp problem. |
Miscellaneous |
| Beech Street/Capp Care discarded its
affiliation with Dimensions network affective Jan. 28, 2000. Neither the Trust nor our
administrator ASI were notified. All Dimension physicians were given the option to join
the Beech Street network. Some did, some did not, many were already apart of it. It is
imperative to call the Beech Street Provider Network to verify that the physician you are
seeing is in the network. Providers are always leaving and being added to any network.
Call for the latest information. It's your responsibility!. Remember, the Health Trust does not cover routine yearly physicals. Remember, it is your responsibility to find out if a procedure is covered. To verify benefits and coverage, call ASI. To verify a physician is in the network call Beech Street…. Gary Kluger, Chairman |
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Health Trust News Letter #3: 4/01/00
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| The Drop Plan |
Entering
the DROP plan does NOT alter your rights under workers comp. If you suffer from an on the
job injury or illness YOU ARE COVERED BY WORKERS COMP. This of course includes
hypertension. If you are diagnosed with hypertension after entering the DROP plan it is
still covered under workers comp. All prescriptions must be obtained from the workers comp
carrier. Do not use your RX America card. |
Mount Sinai |
| We now have a signed deal with Mount
Sinai for a 25% hospital discount and a 20% discount with Sinai doctors. As mentioned in
the January newsletter, Sinai will be considered as IN network. |
Miscellaneous |
| Since the merger of Beech Street and
Capp care, over 90% of the Dimension Doctors remained in the network. Remember, contact
Beech Street to get up to date verification for your doctors status within the network.
Even their web site is only updated monthly. (http://www.beechstreet.com/) ASI can be reached on the world wide web @ (http://www.adminserv.com/) at ASI's web site, you can check your claims pass word needed from them) check eligibility and print claim forms, plus more. |
The Trust IS NOT going bankrupt. The changes made in the last six months went along way towards stabilizing our debt. Additional changes probably will not be made until Oct. 01, 2000. The Health Trust is doing fine… Board of Directors |
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| SPD's
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| Health Trust News Letter #5: 09/01/00 Open Enrollment |
| The time for open enrollment is here. If you need to make changes in your
Health Trust status you have until September 22 to take care of it. City of Miami Beach Insurance Rates: Well, the numbers are in from the City, and they speak for themselves. The City, which already has higher rates and lower benefits than our Trust, is raising their PPO single person coverage from $74.55 bi-weekly to $98.97. Yes, that's a 32% increase. Family coverage is going from $183.04 to $242.98 bi-weekly, an increase of almost 33%. Though we anticipate the need for a premium increase this January it will be considerably less. We also hope to add some benefits at the same time. |
| Miami
Heart |
| Miami Heart is now owned by Mt. Sinai. Miami Heart closed its ER as of
Sept. 01. All ER cases now go to Mt. Sinai. We have not heard from the City where our
members are supposed to go for minor on duty problems, though we are hearing that the
Heart has also shut down occupational health. |
| Books |
If you have
not received your Beech Street/Capp Care provider books or our SPD's, please see Claudia
at the Health Trust office, or Sgt. Kluger. |
| Health Trust
Office |
| It looks like the Health Trust will be the first new tenant
in the PAL building. Besides obtaining more office space, our closer proximity to the
station should make it easier for our members to take care of their Health Trust needs. We
will advise when the office is opened at the PAL |
MISCELLANEOUS |
| As a general rule you should avoid paying your provider in
advance and then anticipate a refund from the Trust. Here is why: The provider is paid a
pre arranged discounted fee for their medical services. They may or may not pass this
discount on to you. The Health Trust will only reimburse the member at the discounted pre
arranged rate for the specific medical procedures you had. The differences in fee's can be
considerable. You would then have to request that your provider reimburse you for the
difference, which they may or may not want to do. Remember: Beech Street/Capp Care never gives insurance or benefit information. They will only tell you if a particular physician is in network or not. ASI provides benefit and coverage information. ASI will not provide information as to the network status of a physician. An approval from ASI is an approval of coverage under our plan, and not an approval for a or a confirmation that a particular physician is in the network. Board of Trustees |
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| Health Trust News Letter: 04/01/01 Beginning February 01, 2001 the Health Trust became one of the first tenants in the new PAL building. Feel free to drop by and see Claudia on Tuesdays and Thursdays for all your Health Trust needs. Beginning April first, the Trust will add yet another benefit. Prescription Birth Control methods will now be covered. Following some recent court decisions, pressure from some members of the Fund, and approval from our insurance consultant, the Trust decided to add this benefit. Preventing just one (1) un-wanted pregnancy will fund this benefit for almost two (2) years. Remember that when purchasing birth control pills, generics are less expensive for you and your fund. Also, tell your physician to write the prescription for a three (3) months supply with three (3) renewals. Prescriptions like this are valid for one (1) year. Remember to get your Birth Control Prescription by our three (3) month mail order option and not from month to month. THIS METHOD GIVES YOU A THREE MONTH SUPPLY FOR THE PRICE OF ONE MONTH. Prescriptions by our
three (3) month mail order option from PRECISIONRX
Just follow the linking icons to the Trust's site. Our first page contains our name, address and phone numbers as well as the names of the Board of Directors.
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INDICATIONS FOR TOTAL BODY SCANS |
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| From Palo Alto Medical
Foundation Advertisements for 'Full Body Scans,' or total-body CT or CAT scans (Computer Axial Tomography), are seen in the newspaper and heard on the radio everyday. The ads claim that a CT scan is like a report card for one's body and can offer peace of mind or potentially save a life. PAMF is waiting for results of current studies to show if total-body CT scans benefit patients. "the issue is the lack of any data about improvement in health outcomes because of routine CT scanning on asymptomatic people," PAMF family physician Meg Durbin said. Radiation exposure is also a concern. But PAMF physicians and organizations such as the American Cancer Society, the U.S. Food and Drug Administration and the American College of Radiology question the use of CT scanning for healthy, asymptomatic patients. In a procedure that takes approximately 15 minutes, an X-ray machine housed in a large, doughnut-shaped device rotates around a person's body taking X-ray "slices." A computer program then reconstructs a 3-D body image from these scans. "Today, patients have a greater interest in maintaining their health and using advanced technology to diagnose and treat illnesses," said Meg Durbin, M.D., family practitioner and assistant medical director of Health Plans at PAMF. "But with full-body CT scans, the issue is the lack of any data about improvement in health outcomes because of routine CT scanning on asymptomatic people," she added. According to Harvey Neiman, M.D., chairman of the Board of Chancellors of the American College of Radiology, "To do a whole-body CT scan over 10 years ago would have taken an hour, so it was, from a business standpoint, not feasible." Today, rapid CT scans are possible due to enhancements in computer and X-ray technology. This makes for an attractive business model for entrepreneurs, who are able to scan large numbers of people to pay for the overhead of the equipment, and thus turn CT scanning into a profitable business venture. According to The Arizona Republic, San Jose-based AmeriScan charges $960 for a full-body scan. Full-body scans are not typically covered by insurance, so most patients pay the cost of the scan out of their own pockets. One major problem with CT scanning is the number of false-positive indicators, according to PAMF radiologist Solon Finkelstein. "Take the example of lungs," he said. "Most people have some nodules in their lungs. Most are benign and not cancerous. They are often the result of old disease, such as a scar from an old infection. The CT scan is not finding things that are not there but finding things that may not be significant." "The many false-positive results produced by total-body CT scans can lead to tremendous anxiety and unnecessary operations and testing," Mary Hufty M.D., chair of the PAMF Prevention Guidelines Committee, added. "If patients have specific complaints, we have many tools available to us - without full-body scans - to evaluate those complaints." Additionally, a negative result from a scan may prevent patients from following their recommended preventive health care guidelines. "Patients may receive false assurances and fail to complete needed evaluations and treatment if a total-body CT scan produces a normal result," Dr. Hufty said. "Many things can be amiss that are not shown on a CT scan, such as infectious, hematological, metabolic or endocrine abnormalities. "A negative total-body CT scan does not provide a reason to feel reassured, and a positive CT scan does not provide information that has been shown to improve life expectancy or quality of life," she added. Radiation exposure is also a concern. According to the National Radiological Protection Board, a CT full-body scan delivers an equivalent effective dose of radiation equivalent to 500 chest X-rays, and a mammogram is equivalent to about 8.5 chest X-rays. Currently, PAMF does not offer full-body scans, preferring to minimize X-ray exposure to a specific area in question. "While the benefit of whole-body scans is in doubt, there is no doubt about the fact that the study gives radiation to the area scanned," said Dr. Finkelstein. "We're waiting for the results of studies now underway to show if there is real benefit to justify the radiation." To date, there have been no published studies indicating that full-body CT scanning prolongs lives. PAMF doctors recommend staying with proven procedures. "It's very important that patients undergo preventive tests that have been proven to benefit them. These include stool tests for blood with a sigmoidoscopy or colonoscopy for people over 50, and Pap smear testing for cervical-cancer prevention and detection," said Dr. Hufty. From Rush North Shore Medical Center A Reasonable Approach to Total Body Scanning One of the latest innovations in medical technology is a non-invasive, computed tomography scan that some claim can detect early signs of not only heart disease and lung cancer, but also tumors, stones and cysts in internal organs, aneurysms, joint disease and osteoporosis, and uterine, ovarian and prostate disease. "A full-body scan can save your life," promoters argue, calling it a "revolution in preventive medicine."* Total body scanning has recently made its appearance in the Chicago area, as mobile units traverse the country with heavy advertising campaigns. What's more, permanent diagnostic centers are setting up shop in Illinois. Consumers are spending up to $1,000 for a comprehensive scan. Their hopes include detecting potentially life-threatening diseases in their earliest stages, or better yet, being given a clean bill of health. But the mainstream medical community is far from embracing the full-body scan. Dr. Leonard Berlin, Chair of the Department of Radiology at Rush North Shore Medical Center, advises patients to think things through and take a reasonable approach to total body scanning. "My position is this: One of extreme caution," Berlin states. While it's a personal decision, Berlin reminds patients that these types of scans will probably not be covered by insurance, and he stresses that tests can cost much more than just dollars in the long run. Both positive and negative tests can be problematic, Berlin explains. The False Positive First, up to 20 percent of patients who undergo a full-body scan (actually a scan of the neck and torso areas) are told they have "abnormalities," Berlin explains. "That's an astonishing figure," he says. The problem is, the vast majority of these abnormalities turn out to be nothing. For example, in one patient, a scan performed at a screening center showed an abnormality in the lungs that probably was a scar, but nevertheless, additional studies were recommended. After costly follow-up tests, the doctors found nothing and determined the spot was indeed merely a scar. "It was an enormous cost not only in dollars, but also in anxiety," Berlin explains. The False Negative In the case of the false negative, "They do the study, they find nothing, and six months later the patient may find out he or she has cancer," Berlin explains. The false negative could be due to human or technological error, in which case the diagnosis is simply missed. But also missing in the full-body scan is an important part of most CT scans, the administration of contrast media, also referred to as "dye," where an intravenous dye is injected into the patient, increasing the sensitivity of the scanning. "Certain tumors will not show up without the dye," Berlin stresses. "These full-body screening scans do not include the use of contrast media. Why? Because there can be reactions. ...People are being misled by overpromotion and advertising. Just take a look at the disclaimers on the scan results." It's true. A list of disclaimers generally accompanies the printout of full-body scan results. One warns of the fact that contrast media is not used, but the importance of this factor is not thoroughly explained. "In rare cases, people can incur a serious reaction to the contrast media, and in very rare cases, can even die," Berlin states. A mobile scanning unit or other diagnostic center may not have resources to appropriately deal with complications, or they may not want to assume the risk, so they simply don't use the dye. |
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| 04/05/04 As you are all aware by now, Claudia Nagel, our office manager, retired effective March 19, 2004. One of the many important functions done by Claudia was to act as liaison between the Fund, and ASI our health plan administrator and RX America our prescription company. ASI is taking on some of the functions previously performed by Claudia, however, at this time we do not have a liaison. During this time, and until we find a proper replacement, you may notify me directly of any problems or difficulties that you may be having. As in the past your first remedy is to deal directly with the medical and prescription plan administrators. As a reminder, their phone numbers are: ASI, 305-595-4040 (medical administrator) and RX America , 1-800-770-8014 (prescription plan). Feel free to contact me for any problems or questions. As always, I will do my best to assist you. The best way to contact me is via email at gbkworf@bellsouth.net I check my email many times daily, and generally you will have an answer to your problem within one (1) business day. You may call me via cell phone for emergencies only at 954-663-3796. Gary Kluger (Chairman) |
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