Member Feedback by jennyyingdi

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                                                Member Feedback
                                                On 11/30/04 E-mail


E-mail message:

The Public Employees’ Benefit Board (PEBB) will be considering changes over the coming months that likely
will affect the healthcare benefits and delivery system available to members starting in 2006, providing better
value for our healthcare dollars. Facing the ongoing crisis in the healthcare system, the Board has formed a vision
of a new state of health for PEBB members statewide. The Board will soon solicit proposals from healthcare plans
and providers to carry out this vision starting in January 2006. Over the coming months, PEBB will be outlining
possible changes in its newsletter and Web site at http://oregon.gov/DAS/PEBB.

Because these benefits are an important part of your compensation, we want to make sure you are kept informed.
We will be using e-mail to help you link to the latest information.

In addition, PEBB wants to help you get the best possible value from the healthcare system by providing action
steps you can take. For example, this month’s newsletter includes articles on talking with your doctor to get the
best care during your short visits and on a new tobacco cessation benefit. You can read the newsletter online at
http://oregon.gov/DSA/PEBB/december04.shtml.

If you receive duplicate copies of this e-mail, please accept our apologies. If you wish to reply, please do not
select “reply,” because we won’t receive the response. Instead, please send responses to
inquiries.pebb@state.or.us. As you learn about the Board’s plans, please feel free to share feedback.


Responses are presented by topic.


Evidence-based Care

PEBB Vision

     *    Evidence-based treatment, formulary and other services - The new vision requires that patients receive
care based on the best available scientific knowledge. It should not vary illogically among clinicians or clinics or
regions. The focus will change dramatically to outcomes and results. This will improve care and reduce waste

Please direct me to additional information about what is actually meant in practice by this part of the vision.

Question: is the following part of the vision designed to reduce access to desired procedures, medications or other
types of care? Everyone is not the same and does not react in the same way to medications and procedures. Seems
like care might not be given unless scientific studies had shown a specific practice to be beneficial. I am
concerned that state employees will get reduced care options under this vision. Does that mean experimental
procedures or innovative care can not be tried by a physician with support by my health insurance system? I am
concerned that evidence-based may be used as a minimalist approach, denying needed health care to employees
and their families, and not helpful to our health care. Standardization of good procedures is good, but so is
constantly seeking new information...and there's not enough research dollars to go around. If something works,
prove it and standardize it, but in the meantime allow variation from the standard as needed or desired to
encourage innovation.

Also, will PEBB financially support use of fitness centers if employees and their families do in fact use them?
...also encouragement of exercise at work. This support of exercise might be better than unproven homeopathic
practices. Again, some variation may be useful, but follow up with scientific studies. If it helps, let all of us know.


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Thanks for any additional insights you can give me on just what is meant by "evidence-based." As you do, please
address my concerns below if you are able. I do appreciate what you are doing to improve the health of PEBB
members and their families and perhaps to set a model for how to improve the health of people more generally.
I am interested in how the "evidence-based" part of the new system being visualized will protect my and my
family's health if we find it doesn't work for us or if we find ourselves with a diagnosis at the edge of scientific
knowledge where there is not replicated scientific information ("evidence-based") as to how exactly to improve
one's health. Experience with one's own body and trying various controlled avenues for improvement could prove
helpful.

The term "evidence-based" sounds good, but I am sensitized to how things work out in practice. Let me tell you
why so you can understand why I bother to bring this up at all. In my field … in my opinion the term "science-
based" is misused a lot with disastrous impact on our environment and ultimately our economy. International
trade in plants and plant products is allowed unless "science-based" evidence showing harm is accepted by the
phytosanitary decision makers. To make it worse, it looks like they may be impacted by the short-term politics
and economics. Prior to the emphasis on trade and the international trade agreements, "science-based" evidence
was needed to allow imports (not to exclude imports as now). Our knowledge and experience with similar
invasive species is often not allowed to be transferred to new, potentially invasive species for which little data
exists. Consequently many new invasive insects, weeds and plant pathogens continue to move in international
trade, devastating landscapes, crops and forests. Once here, it is rare that it is possible to eradicate them. I hope
you see why the term evidence-based raises a red flag for me. I'm trying to find out if this is a cause for concern
with respect to health care plan development.

I agree that standardization of good procedures is a very good thing. Combining it with allowances for innovation
to look for even better ways is an even better thing. In all this, I believe we must be sensitive to how this plays
out in practice especially when we are dealing with situations at the limits of our knowledge and science. People's
biology varies and what may be "best practice" in general may not be helpful in a particular patient.

For example, the "best practice" of encouragement of whole grain cereals (my standard practice) could prove
harmful to a person who is gluten intolerant with celiac disease as are about 1 in 250 people of our descent. My
daughter who, unknown to both of us, had previously found herself in this situation recently pointed this out to
me.

Identifying best practices is a good thing, but allowing physicians and their patients to seek their best way should
also be acceptable under the PEBB health plan. Otherwise why have a doctor? Based on the blood tests, etc, a
computer program could tell me what is likely best to do...but it might not take the important nuances into
account. Maybe such a computer program might be helpful as a supplement to a doctor's presence and
assessment, but not good alone.

Thanks again for your work and any insight or help you could give me to understand what this general vision will
mean in practice to me and my family and others like us.

I was reading the newest PEBB newsletter and find the new buzzword "Evidence-Based Medicine" very
troubling. What this sounds like to me is that if your doctor can't find out what's wrong with you then your
insurance won't pay for any more care. I find this very frightening. Instead of that, why not start getting insurance
companies to start covering preventative maintenance types of care such as weight management programs. So
many of the insurance dollars spent are diseases and conditions directly related to being overweight. If the
insurance companies would pay for dieticians, exercise costs, etc., they would save millions on treatment.

I am looking to the future with a very skeptical eye after reading the last few PEBB newsletters.

I read the board's new vision plan to address the health care crisis. These certainly are challenging times for health
care providers, patients and the healthcare system. I am pleased to see that the board is addressing our options.

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The University of Oregon will be issuing a RFP for domestic and international students insurance that will include
Oregon State, so I certainly appreciate the issues you are attempting to address.



Most of the plan seemed self explanatory; however, I do have a couple of questions, thoughts or concerns:

1) "Evidence-based treatment, formulary and other services-The new vision requires that patients receive care
based on the best available scientific knowledge. It should not vary illogically among clinicians or clinics or
regions. The focus will change dramatically to outcomes and results. This will improve care and reduce waste."

The "best available scientific knowledge" does not always agree. Within most professions there are reasonable
differences of opinions in terms of findings, treatment or methodology. It is not uncommon that professionals
view the same "facts" and come to different conclusions or solutions.

So, how is "best" being determined? Who decides care? Who will be determining whether the physician's
treatment plan is acceptable?

Is the statement above suggesting that the treatment we have received to date is not "evidenced based"?

2) My other question concerns, "Realigned incentives-The system provides incentives to providers to align their
practice with system goals; it does not pay practitioners who continue to function as outliers."

What are "outliers"? Are we talking about non payment for services rendered, or are we talking about a reward
program?

Thank you for outlining your vision in advance, allowing us the opportunity to get clarification.

I strongly support the pro active, prevention oriented educational programs, health screenings, etc. Excellent!


Plan Design and Coverage


I just finished reading your current Newsletter and more specifically the section titled "The PEBB Vision." Items
number two and three struck me as significant and in line with an idea I have had floating around in my head that
I feel fits into these categories. State employees have recently been under some criticism over the issue of sick
leave. Aside from the negative perception held by many in our state, the issue of sick leave is far more complex
and may well be able to tie into the issue of health benefits.

One of the problems with our sick leave benefit is that while it is a contract employee benefit, it is fraught with
built-in inequities. The worst aspect of it is its fundamental basis of "Use it or lose it." Can any benefit be
considered equitable if it is unfairly applied? Is it fair that people who take better care of themselves are less able
to access the benefit than those who don't? Can it even be considered a benefit if one needs to sacrifice a good
work esthetic in order to utilize this so-called benefit to its fullest capacity?

I believe that these questions address only a few of the problems existing with the current sick leave benefit and
the policies surrounding its use. I also believe that the state, with just a little creativity, can not only correct
these problems but reduce the impact of the cost of healthcare benefits at the same time. Not only for current
active employees, but anyone who may serve any significant time as a state employee and moves on to other
employment, or retires.

I propose that the state adopt a policy similar to the one currently used by the Salem Keizer Transit District that
converts unused sick leave into a tax free medical savings account (MSA). In addition, I propose that this new

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program allow any employee who has accumulated over 240 hours of sick leave time the option of converting
some or all of any unused portion of sick leave beyond that limit into the MSA every year at benefit open
enrollment time. This would then provide for the investment and accumulation of interest and/or dividends into
the MSA.
Here are just some of the benefits to the employees and the state:
     A powerful incentive to reduce absenteeism, which would be a huge benefit to the state in general
        productivity as well as specific increase in customer service related issues.
     As with the issue above, a greater effort towards wellness. This would reduce health insurance claims and
        generally reduce, over time, the escalation rate of premiums.
     A potentially huge benefit to retirees with 20 or more years of service. A substantial MSA could
        eliminate the need for Medicare supplemental insurance.
     To a lesser degree it would help all employees who leave the state with five or more years of service.
     Last, but certainly not least, it would benefit all employees equally, regardless of family make up, age or
        general health. Sick leave could become a wellness incentive that we can all benefit from.

Hi. I just read below and briefly, I just don't understand why our health care options do not contain a choice with
a big deductible, like $1500 or $2500. So many people in the private sector have these now because it's cheaper.
We can budget to pay a few hundred dollars a year but we need catastrophic protection. Why do you refuse to
offer such an option? Thanks much.

A few quick suggestions to consider--or toss... (1) As suggested on KGW feature yesterday, support finding a
way to reward employees for good decision-making in terms of their health benefits and/or sick leave. But do this
without encouraging sick employees from coming to work! (2) In particular with regards to Kaiser, emphasize
continuity of care as opposed to assembly line medicine. The doctors frequently (at least for our family) don't
examine the charts closely enough the first time and prescribe medicines or durations of medicines which have
been specifically specified otherwise in the records. This often requires a follow-up visit. (3) This leads to
another suggestion. If you have to be seen for the same condition or problem within 24-hours of being seen by
another family practitioner (not a specialist), there should be no co-payment for the second visit. This happens to
us all the time. We have actually been told, "Well, I don't know. Let's get you in tomorrow to get the regular
doctor to look at you." This costs the employee more money and time, and demonstrates incompetent care by
Kaiser. No co-payment would encourage competent practice of medicine. (4) Increased coverage for braces
would be helpful, too!

I found the new PEBB vision to be quite interesting. I'm wondering when (or if) we'll ever get to the place where
we treat health insurance like car insurance. I think it makes perfect sense to conduct a risk assessment of each
applicant to determine the insurance group/rate they should have. If you are trying to keep yourself healthy,
shouldn't you be rewarded by having your rates reduced (you know - good driver's rate reduction)? A periodic
assessment of # of visits, type of visits, etc. would be conducted to see if a change in coverage would be
necessary.

This is a little bit (okay - a lot) tongue in cheek, but I'm a big proponent of a healthy life style. It bothers me (and
many other state employees I know) that our health care costs are impacted by those that don't take care of
themselves (by smoking, being overweight, not exercising). And there's no incentive or penalty to change.

Thanks for letting me vent. Sounds like you've got lots of "fun" things ahead. Keep up the good work!

Contribution


Just wondering as I had heard a "rumor"....I heard that PEBB plans on the STATE not putting in as much to pay
for our Health benefits. We are suppose to be getting our raises back…but it was said that that raise we will never
see as it will have to go to pay for our Health benefits. Can you tell me if this is true or not? Thanks


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The best bang for our buck is to give the money to the employees and let them decide what to do with it. If you
continue to "feed" the existing health care system (and that includes even if "adjustments" are made to the system)
it will continue to escalate out of control and continue to spiral into a downward return of benefits. Ending the
system and allowing the employees to make their own health care decisions is the best option.

Tobacco Cessation/Incentives


Dear Sir(s),

I just read the PEBB Benefits update letter regarding the forthcoming changes that will affect our health benefits
beginning in 2006.

I have one question:

If there is an "ongoing crisis in the healthcare system" how can the PEBB board justify the use of healthcare
dollars to fund a tobacco cessation benefit?

More to the point, why should the majority of us suffer diminished health care coverage at the expense of those
who decided to pursue an obviously unhealthy activity?

I would like to see our health care benefits supply basic good health care. I do not need an expert Web site to
view. During Oregon’s struggle with budgets we added partners which increased the pay outs. I wish we would
quit adding individual items such as smoking cessation we all know somebody pays somewhere this stuff isn’t
free. I believe for families that we need to have basic health care provided. Families with children are paying the
price for all this extra life style enhanced benefits.

We need benefits that cover us here in Medford where the hospital technicians are not on any provider list, going
to the hospital here is costly and we pay the higher price. This benefit would help everyone in the family not just
a smoker. It’s nice to have all the fringe benefits but not at the cost of our everyday needed health care. Insurance
companies are dressing up these packages and selling us a bill of goods that we do not need. I would rather see a
basic health care package for less than one with fringe benefits added. Health care has become so expensive and
we can’t save everyone from their everyday choice habits.
                                                                                                       

Other


How about addressing the issue of increasing prescription costs by not reducing access to needed prescriptions
(for some) but by reducing the cost of the prescriptions in the first place? Stopping advertisements of prescribed
drugs would save millions (perhaps even billions) of dollars and would reduce requests of doctors by patients for
inappropriate prescriptions. At least the Oregon legislature could do this for our state; it would be a start.

It seems the real drain is the insurance businesses, not the doctors. The patients and employers also need to step
up to the plate to improve the health of employees and their families.

Thanks for any help you can give me.
                                                                                                     
Hello -
I have just read the online version of PEBB's Vision for 2007. I am seriously concerned that PEBB's new vision
will force me to have only one alternative in healthcare, that being to receive my health care services through the
highly INFERIOR care that is offered by Kaiser Permanente. I do not wish to be forced to accept inferior
healthcare service.
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Blue Cross Blue Shield allows me the freedom to choose my own healthcare provider. It also gives me the
freedom of easily choosing a different provider if I am not satisfied with the care of the current provider. I can
also choose to be treated in a hospital where the best treatment and care is offered. For example, St. Vincent
Hospital in Portland, Oregon offers an exceptional Women's Health care system for breast cancer patients --
starting from screening all the way through treatment. The same cannot be said for the Oregon Kaiser
Permanente system.


Hi -
Quite a few million Americans and many thousands of Oregonians believe that health care should be paid for in
full for all by either the employer or the government, as a basic human need. Is PEBB working toward this in any
way? Look forward to your response. Thank you.


Dear Pebb,
Thank you for your email about keeping us informed of the healthcare plans process. My only feedback is that
you keep the emails short. We will read them if they are not long. Thanks.




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                                                 Member Feedback
                                                 On 01/04/05 E-mail


E-mail message:

A message from the Public Employees' Benefit Board (PEBB):

Did you know that if you're diagnosed with breast cancer in Medford, you're more than twice as likely to get a
mastectomy than someone who lives in Yakima? And that the rate of back surgery in Bend is more than six times
the rate of the same surgery in New York?

PEBB is asking medical plans and providers to address the topic of unexplained geographic variations and other
quality issues in their responses to the Board's request for proposals. The Board is encouraging them to provide
better value for all of our healthcare dollars.

As consumers, we can also take steps to get better value. Find out what you can do in this month's newsletter,
online at http://oregon.gov/DAS/PEBB/january05.shtml. Topics include geographic variations in care, cost and
effectiveness of prescription drugs, and services to address low back pain. And find out the latest on PEBB's RFP
for medical benefits to start in January 2006.

The Benefit Board wants to hear from you. Please send feedback to inquiries.pebb@state.or.us.

(If you received a duplicate copy of this e-mail, we apologize and will work to ensure it does not reoccur.)

Responses are presented by topic of the response.


Bariatric Surgery/Obesity

One of the issues that I find very interesting is how persons who live in Northern Oregon and have access to
Kaiser insurance are eligible for bariatric surgery services, which are, to my knowledge, covered by Kaiser, and
yet persons who live in rural areas and are not eligible for Kaiser are not covered for such services. As a person
who has Blue Cross/Blue Shield, which has a total exclusion for such services, and a person who has numerous
health issues, including diabetes, GERD, neuropathy in my feet, etc that could be resolved through bariatric
surgery, for which I am medically qualified, I am excluded from this as an option because I live in a rural area and
cannot access Kaiser medical coverage. A medical coverage provider that provides the rural communities with
coverages and exclusions that are comparable to others living in Metropolitan areas with options for their
insurance would be more equitable. After reading several websites regarding bariatric surgery exclusions, I have
become aware that other State employees in rural areas have expressed this same view and frustration.

Thank you for that information. However, I am still not sure, for persons such as myself, if it is not cost effective
to have bariatric surgery available on a case by case basis. Should someone look at my medical history, and the
amount of money that PEBB has paid out for my medical issues related to morbid obesity, as well as money for
dieticians and medically administered diets that have failed, I'm sure that the costs paid for me in the last two
years alone far exceed 19k; I myself have paid approximately 4000 out of pocket in 2004 alone for prescriptions,
evaluations, ultrasounds, blood tests, lab tests, emergency room visits, etc. My suggestion, I guess, would be to
look at each case individually, assess the cost/benefit of providing the coverage for that particular person based
upon how much they have cost the State with their existing medical conditions, and make denials/acceptances on
such a basis, rather than having a blanket exclusion. There are some people who do not have health related issues
who are obese and would, in my opinion, not be worth the cost of the surgery. Their medical history would
indicate as such. However, for persons such as myself with diabetes, neuropathy, gerd, gallbladder problems,
infertility, etc, and for which my doctor has clearly stated time and time again that bariatric surgery could resolve
virtually all of my health issues and that this is the only long term solution, it may be beneficial in the long run for

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PEBB to cover this procedure. The cost that the State has paid alone also doesn't include missed work time and
missed production time for the agency based upon absences for doctors' appointments, as well as illness. I also
find it somewhat interesting that the federal government has determined that the cost/benefit of covering bariatric
surgery is sufficient to include it now as a Medicare covered practice. I would be lying if I said it isn't somewhat
frustrating that my tax dollars pay for others to have a life saving surgery, but I myself cannot, but ah, such is life.
It is my hope, in the near future, that PEBB will re evaluate their total exclusion of bariatric surgery and instead
consider it on a case by case basis based upon a thorough review of each individual's total cost for medical care
versus the cost for the surgery and follow up. If I could make any suggestion, that would be it.

If, in the future, there are further pilot projects to assess the benefits of bariatric surgery, I would definitely be
willing to be a participant!

Again, thank you so much for your detailed response to my inquiry. It is very insightful and I very much
appreciate the time you took in responding!

Regence BCBS of Oregon is the hardest in the nation to get approval for this from, not to mention any nutritional
or weight loss help. It saves lives and will save money in the end avoiding the aftermath of diseases like Sleep
Apnea, High Blood Pressure and all of the effects of Obesity.

I have been told you would rather see me die than pay for weight loss surgery that will save my life and allow me
to walk normally. Any other information is moot. Does is occur to you that surgeries occur where the money to
pay for it is and that is the factor, not geography. When I die please do not equate it to my living in Southern
Oregon, equate it to your refusal to help me live. Honestly, are you really think we are that ignorant.

I would just like to say that I think it is terrible and unfair that RBCBS won't pay for the gastric bypass surgery if
it is medically necessary or recommended by a physician. I think the surgery would save RBCBS a lot of money
in the long run if you take into consideration all the other diseases/problems caused by obesity such as diabetes,
sleep apnea, high blood pressure etc. The cost of treating these conditions over the years would surely outweigh
the cost of a one time surgery. And that isn't even taking in to consideration the complications caused by those
illnesses. I hope you consider paying for the gastric bypass surgery soon as I think it will help save many lives
and avoid complications associated with obesity and other obesity related diseases.

I am wondering why gastric bypass, which was once covered by our medical insurance, is no longer covered. Is
there anyway to protest the exclusion if it is deemed to be more medically prudent to have the procedure done
than not?


Plan Design and Coverage


Why doesn't PEBB care about obesity? Why don't you provide coverage for dietician. Obesity is one of the major
causes of heart attacks. Hummmmm seems like a problem to me that needs addressed.

I myself struggle with this problem and it is not because I do not eat right and because I don't exercise. I do. I am
told that I need to join Weight Watchers but I don't have the funds to cover that and my insurance does not
provide coverage for dietician, therefore, I have to suffer with being over weight.

I know this may sound very "off the wall" but I wonder if there is any federal monies out there that could be
passed through to the states, specifically the state of Oregon, for state workers who work and/or live in the
Umatilla area, or Pendleton; in other words, downwind or upwind of Hanford.

I was born in 1948, lived in Umatilla as a child, played outside like all the other children, while Hanford was
conducting all those "tests" letting clouds go up into the atmosphere and drift over the sparsly populated cities and
counties of eastern Oregon. Many of those children of the late 40's and early 50's who lived in the area at the time

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of the "tests" have developed various types of cancers, or have died. State workers who are exposed to the
munitions dump with chemical waste leaking; state workers on the road crews, or other agriculture employees, for
example, may have serious health problems that only occur in this region of the country. Perhaps there is some
federal and/or grant monies that PEBB could apply for to determine this and, depending upon the outcome of the
study or studies, health care could be geared to unusual incidents of cancer.

This is just a thought. Toss at will! I just happen to be one of the children of the late 40's and early 50's from that
region, but I haven't (fortunately) developed any large scale cancers, but I did have a brush with breast cancer
which was cured (I am cancer free today), I don't have any cancer but I am considered a "downwinder" and I do
"glow in the dark" thanks to Hanford! I really don't glow in the dark, but I am glad that I can laugh about it, from
my own personal experience, but I think there may be others out there who may have gained knowledge and/or
better health care had their health situations been recognized as unique to Oregon.

 I do have a little feedback if you don't mind me using this forum. As I approach Retirement, I am quickly finding
out the limited medical and dental programs, keeping cost in mind, available for the state retired persons. Seems
to me that after contributing thousands and thousands of dollars in healthcare premiums, and not many of us even
using the benefits, there would be a more serious and dedicated effort to protect and care for ALL of the state's
employees once reaching retirement age. Since I have contributed something like $600.00 to $750.00 per month,
that equates to $7200.00 to $9000.00 per year. If I work for 25 years I have contributed from $180,000.00 to
$225,000.00 upon retirement. Maybe I haven't even used any of the medical or dental benefits, at all! The state of
Oregon and PEBB needs to take a more serious look at using some of this cash flow and helping it's own
employees with healthcare after retirement. How about coming up with a program that allows full medical and
dental coverage for all employees with 20 or more years of service with a much reduced monthly cost? Like
$300.00 per month until we die? Just a thought and I thought you wanted to hear more than just warm and fuzzy
things. There are a lot of old time employees that are left in the dark. Thank you, gh :-)

Good day,

If you ever sit around a table with employees and bring up the topic of Willamette Dental, you will hear a
collective, ugh! It is amazing to me the amount of employees who have had poor care, who have been told they
have to wait days or travel to Portland when in Albany to handle emergencies, who have to wait outrage time
periods to get appointments, who have had to go back for repeated visits for the same issue or to have one
dentist's work repaired by another dentist.

In addition, this provider knows their phone center is not only difficult to deal with, but they do not transmit what
the client wants to tell their local office. The office manager of my branch has repeatedly told me, after I have
mentioned the heavy handedness of the operators, she hears complaints about "them" all of the time.

I too fall within the category of having to have one dentist repair an others work, and I am lucky, I like my dental
team. However I am the minority.

So I ask these questions for those whom do not read their e-mails. Why do we not have more of a selection of
dental providers or why is Willamette not held accountable and get away with this?

Hi,

I am writing in response to your request for feedback.

These are extremely difficult times when dealing with health insurance. My sincere gratitude goes out to you in
managing this for PEBB members.

PLEASE change the policy of the 60% opt-out rate to an opt-out rate of 100%.



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The incredible power of the internet allows individuals to join in with huge groups of people to obtain very good
rates on top quality health insurance. It is very easy for a PEBB member to obtain a higher level of health
insurance over the internet rather than going through PEBB.

Please stop forcing us, (by not allowing a 100% opt-out) into the PEBB system and allow us to search out and
find a health insurance tailored to our specific needs.

Thanks,

FYI:

My physician diagnosed me as having "dysmetabolic syndrome x" (pre-diabetes/borderline diabetes). He
prescribed nutritional counseling from a diabetes-oriented dietician and group classes for me to help prevent my
getting diabetes. My Regence-Blue Cross plan refused to pay for them. They will pay for diabetes treatment,
medicine, and accessories if I do get diabetes. They refused to pay for information, etc. to help me not get
diabetes!

Last night I had a wonderfully informative hour of counseling from the special diabetes-oriented dietician, which
my physician prescribed. I'm paying the $101.00 or so cost myself. I need the information. I don't want diabetes.

The group classes of three sessions cost $600.00. They are very valuable. My daughter-in-law has diabetes. She
raves about how helpful the classes are. She says they are pre-diabetic people in the classes, as well as those who
already have diabetes. Of course, their insurance plans pay for them to attend. It's glaringly obvious that they have
more sensible insurance plans than mine regarding preventative measures.

Everyone I tell this to (including two dieticians, family members, and a nurse) says it's crazy that Regence Blue
Cross won't pay for information to prevent an insured from getting diabetes. They pay only if you do get diabetes
(possibly because you didn't get the preventive information in the first place?). Wouldn't that cost Regence Blue
Cross more money in the long run? I might still get diabetes, but at least I'll be way ahead of how to responsibly
manage my care. And who knows? I just might not get diabetes, with last night's information working for me.

I'd sure like to take the group classes too. But I don't have the $600.00 for them. And Regence Blue Cross refuses
to pay.

There's a lot I like about Regence Blue Cross. I can select the health care providers I want. I'm not limited. This is
extremely important to me. However, Regence Blue Cross is way behind the times regarding preventive
measures. It's like they are living in the past, and not up to date on how vitally crucial preventative measures are!

Many thanks for reviewing insurance companies and coverage. I thought the above might be useful in your
considerations of the matter.

As long as hospital administrators and health care insurance executives make high six and seven figure salaries,
and as long as there is no restraint mechanism on medical care consumption, insurance costs will continue to rise
at a rate greater than inflation.

Americans are overweight, over medicated, and over expectant of what medical care to which they are "entitled".
Benefit plans are set up to meet the needs of those with life-styles known to increase medical costs instead of
rewarding those with healthy life styles.

With the exception of better newsletters, I don't see this changing.




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Just an FYI to add to your areas of concern.

I have had four people close to me diagnosed with throat cancer in the last year. Three of them have recently died
and one is very ill and doctors say there is nothing more they can do for him. Two of the people that passed
away, never smoked a cigarette in their life. My sister had breast cancer, however, she has survived it with
several surgeries and a mastectomy. These people all lived in the Columbia Gorge Area most of their lives, from
Hood River, Oregon to Goldendale, Washington.

Could there be a possible link to the Aluminum Plants in The Dalles and Goldendale? I wonder how many others
in this area have the same disease (Cancer). Also folks should know that cancer thrives on sugar, and that is what
the doctors want to give these folks... Ensure is made up of so much sugar no wonder these people go so fast.

Just my 2 cents worth,

I would like to have a broader choice of medical providers. if I have
to pay extra for providence or a similar provider I would prefer that to kaiser or blue cross. maybe others would
too. (this is not OHP) please give us more choices. let us make the choice!

thank you


I am very concerned with the number of health care providers that are going off of the preferred provider
program. In the last two years, I have been in the position of changing health care providers twice and incurring
more out of pocket expenses.
Both my dentist -- of 10 years -- and our eye-care specialist of 5 years, have opted off of this plan. Their offices
tell me they do this because the compensation is not good. Most recently, I made an eye appointment for my
teenage daughter and was not informed by the office that they no longer were a preferred provider AND they
would not even wait to receive their money from VSP -- I had to pay all expenses up front that day -- a whopping
$400. When I got reimbursed from the insurance company, I received a letter telling me how much I would have
saved by using a VSP preferred provider practitioner. Given that I was not informed of this change until I had
already taken time off work to get there, it made it very difficult for me to make an informed decision.
When health care providers will not even trust that they will receive their reimbursement in a timely manner, and
require that the patient pay all costs up front, that is a huge and unnecessary problem. It makes me wonder what
our medical benefits are paying for.
It is not enough to simply state that we should be using a preferred provider. There are great benefits from being
with the same health care provider -- who knows my history and how best to treat me. At this rate, I will have to
bounce around repeatedly trying to find doctors that want to stay on this plan and definitely losing something in
the long run. PEBB should be very concerned about the number of doctors that are coming off the plan and why.
i would hate to see Oregon's health coverage & services being dropped to the LOWEST common denominator.....
while cost of services is a concern to all of us, the quality and access to needed services is a HIGH priority....
please do not hamstring our service or providers from dispensing a quality service that preserves the high standard
of living we are paying for..... thank you.

We have lost 3 specialists over the last 2 years that our family was seeing here in Eugene. I don't think any of
them left the plan voluntarily. There has been no replacements. We have had to make appointments to another
specialist in Salem.

Our present medical provider is unable to retain or recruit specialists to Eugene. If this is a common or
reoccurring problem and you think it would be helpful to pursue and need specifics, please reply.

Very little of my $5,000 a year or so health insurance is spent on my health. I try to be proactive, excluding an
occasional sporting injury or such.



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But. . . . .If I need a crown, I am going to have to pay half of the cost of the crown! That's half of $800, more or
less. That is what our current contract specifies with whatever dental provider we are signed up with. Wow! Sure
would be nice to get back to some reasonable fees for crowns, and bridges. State employees don't have that much
money sitting around in their monthly paychecks.

I would like to give some input to the PEBB Benefit Board regarding selecting the future medical provider. Please
forward this to all concerned.

I have been very dissatisfied with Vision Service Plan. It is difficult to make a claim, or to even get a claim form.
Of course, I realize it is any insurance company's standard procedure to dodge or deny claims..... it generates pure
profit. I did not have any trouble when Blue Cross/Blue Shield managed the vision plan. But now I am limited to
one claim per year. If I want to see my ophthalmologist and then buy my glasses at Costco, I will get reimbursed
for only one charge.

It is even worse for people that wear contacts. Most people buy replacement contacts quarterly, but Vision One
forces them to buy a years supply, or as much as their annual benefit allows. If you go to a VSP network doctor
you can buy contacts more frequently, but you are basically forced to buy glasses or contacts from whoever gives
you the eye exam. The cost for the glasses or contacts is usually higher and your benefits are used up earlier than
necessary.

Please, when you award the contract, make sure Vision Service Plan is not a sub-contractor or provider. Thank
you.

To Whom It May Concern,

I enjoyed reading the information regarding health information web sites in the recent online newsletter. I applaud
the attitude that patients need to seek information from other sources besides their physicians regarding their own
health care. I endorse physicians having to be accountable for controlling cost.

However, I am a bit wary of "managed care" because I've seen first hand its negative impact on patient care and
health. Having worked in hospitals as an RN I've been pulled away from patient care by an insurance company
representative asking for an explanation as to why a certain patient is still hospitalized. There's pressure from
insurance companies to discharge patients from hospitals before they are ready to leave. Especially the elderly are
then readmitted a week to ten days later, often sicker than during their first admission. Insurance companies
practicing medicine is a real phenomena that is happening in health care today, the public needs to become aware
of this. Trained physicians are no longer being allowed to use their professional judgment to determine their
patient's treatment plan.

Physicians must also practice "defensive medicine" because of litigation. Ordering expensive tests that may be
unnecessary is a back lash to patients frequently suing because they were misdiagnosed or not diagnosed quickly.

The changes that will have to occur in health care in order for it to be accessible to a greater number of people
will no doubt be interesting in the years to come. I hope that the answer is not at the expense of society's most
weak, the elderly, the poor and children.

I have questions that were not addressed during the open enrollment period regarding the non-rollover Flexible
Spending accounts. If an employee is not clairvoyant enough to accurately guess how much out of pocket medical
costs that they will pay during the following year, and they over-guesstimate, where does the "lost" income go?
To ODOT? To the State of Oregon? To "Best Choice"?

The purpose of the FSA is to allow an employee to deduct medical expenses up to $5000 annually from before tax
income. Why not just change the federal tax forms to allow every worker in the United States to deduct the first
$5000 of out of pocket legitimate, documented, medical expenses from their taxable income, regardless of income


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                                                                                                        BD attach. 13
level or whether or not other deductions are itemized, and exclusive of the personal exemption? The "Best
Choice" middlemen could then be eliminated, too. Or would that just be too simple?

By having an unusable FSA as a supposed benefit, the result for me personally is that I will feel gypped every
single time that I have an out of pocket medical expense during 2005. It will be the same as paying a sales tax
equivalent to the top federal and state income tax rates, just because I didn't have the foresight back in October to
predict that the medical expense would occur a year later. And you know how much we Oregonians hate
regressive sales taxes. If you can't fix the FSA's to carry a balance from year to year, then the FSA is worse than
useless.

Why are there no Preferred Provider Orthopedic Surgeons in Eugene, Oregon.


Geographic Variations


The patient should have the final say in what treatment is best for him or her. She should be able to get second
opinions, and select the doctor and method of treatment for such things as breast cancer. The insurance company
should not dictate the treatment to only be cost effective.

Per the question :
Did you know that if you're diagnosed with breast cancer in Medford, you're more than twice as likely to get a
mastectomy than someone who lives in Yakima? And that the rate of back surgery in Bend is more than six times
the rate of the same surgery in New York?

I would like to know the likelihood of death or complications due to breast cancer in Medford versus the
likelihood of death or complications due to breast cancer in Yakima. What about the complications from the back
injury in Bend versus the complications from the back injury in New York. If our health care is better here, then it
is worth it. If not, by all means, look to change.

Just because they do more of the surgery here than there does not mean it is a bad thing. If breast cancer in
Yakima kills twice as many people than die of it in Medford, the masectomy is a good thing.

If you live in New York does that mean you have to suffer from back pain because NY Dr.s are reluctant to
surgically correct problems? Just comparing numbers may not be the best thing for PEBB members. Remember
the old addage that figures lie and liars figure!

We also need to understand that not making use of available resources does not always reduce costs. Often times
trying to save pennies ends up costing dollars.

Just a little feedback!!!

Dear PEBB,

These statements:

"Did you know that if you're diagnosed with breast cancer in Medford, you're more than twice as likely to get a
mastectomy than someone who lives in Yakima? And that the rate of back surgery in Bend is more than six times
the rate of the same surgery in New York?

PEBB is asking medical plans and providers to address the topic of unexplained geographic variations and other
quality issues in their responses to the Board's request for proposals." concern me. Differences do not equal
"good" or "bad" health care.
Perhaps the surgeons in Medford are saving lives. Perhaps Bend is ahead of the curve, and those back surgeries

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                                                                                                           BD attach. 13
have created a better quality of life and less pain and suffering. Perhaps New York refuses or delays necessary
surgery in the interest of saving money. What has been described here is not the whole picture.

That PEBB is focused on measuring numbers of procedures, and not patient outcome, is VERY, VERY
concerning. I've seen too many instances of providers not instituting a therapy or not referring to a specialist
because of the cost, only to see the patient suffer over a long period of time before appropriate care is finally
rendered. Most times the patient gives up and works around the system to receive the necessary care, saving the
plan's money and increasing costs for the patient.

Choosing a health plan that limits procedures may, or may not, be in our best interest for quality health care.
Please think carefully when following numbers instead of patient's needs.

Very interesting information! I've always believed that you need to shop around for the "best" value, I didn't know
that it included medical procedures.

It isn't good, but it seems logical that different geographical areas tend to provide different service. It's all about
"people" and what their agenda is. If the head doctor, or hospital administrator advises certain rules, then
everyone follows along.

I think it's very important that we've almost entirely done away with HMOs. They allowed way too much control
by the insurance company. And doctors are only people, and their knowledge and service should not be taken for
granted. Consumers should always ask questions, and seek other opinions.

I appreciate that you shared this knowledge.

Thank you.

A geographic comparison of C-sections also would be of interest.

Hi,
My initial question is how many other factors are considered, besides geography. I'm pretty sure that a Logger, in
Bend, is at a higher potential risk for a back related injury than a Subway Engineer from New York. So the
geography issue means nothing unless maybe the women in Medford live closer to some sort of Toxic waste or
Radiation, etc.... Without the cross reference that the Public Health Department is priveleged to be aware of, I am
not swayed by the data that the insurance company has to provide. There are more factors than data provided.

I also know about UPS and Intel companies insurance information. An initial difference is in Dental -
(Orthodontia) UPS provides $2000 for Orthodontia, and Intel provides $1500. PEBB is only $1000.

This is an initial example of cross referenced data that needs to be considered. I'm not positive; but I would expect
to find that both of these companies have a larger employee number than the PEBB. This is my initial input for
now. Thanks,

We probably get better health care here in Oregon than they do in New York and other places. I have heard lots of
folks who have moved here from out of state rave about Oregon's health insurance. It appears like the insurance
dollars go toward care here instead of lining the insurance agencies pockets!

My comment would be that just because something is unexplained doesn't necessarily mean it isn't so. The
surgeries referred to below could be at variance among different areas around the country due differences in risk
management and preferences of the physicians/healthcare organizations. However, I understand that Oregon has
the highest rate of stroke of any state in the country. I don't think an explanation has been offered, but it's difficult
to attribute that to decision-making by physicians or healthcare organizations. Or is it?



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                                                                                                           BD attach. 13
I have a suggestion for medical providers which is to not assume they know what is wrong but to give a thouough
examination for the money spent on an office visit. I was taking to another state employee who went to the doctor
three times, one of those times to a specialist who told her what she had without examining her. Her pain was so
severe she purchased three visits and was told each time what she had. She was sent to lots of physical therapy
which did no good and cost everyone a fortune. She was then directed to another specialist who examined her,
took x-rays and did further tests based on the results of the x-ray.
Turns out she has a serious condition which requires surgery to the spine. PEBB and my friend paid out a great
deal of money to get some advice she could have gotten from a stranger on the street corner and the first value
both PEBB and her got for their money was the last doctor. We have all had that happen and it is very expensive,
let alone dangerous. Thank you for asking for my opinion as I was bothered by the extra pain and expense my
friend had to go through because someone assumed they knew it all.

Several years ago I had some minor surgery and when I went to see the surgeon for the follow up appointment he
shook my hand and said thanks for doing business with me. I was so impressed.

When I read about the breast cancer - I understand. I was diagnosed in Coos Bay - had a mastectomy by my
choice. I did not feel I could physically and emotionally undertake the six weeks of radiation that went with a
lumpectomy when the round trip distance daily would be 180 miles. When making the choices, you need to look
at other factors that contribute to the decision. Many people in rural counties go to places like Medford and they
make the decision like I did. I had the mastectomy and I am done and can go on with my life. It was the right one
for me.

Thanks. Regarding geographic problems, I work in downtown Portland. I wish Kaiser had a clinic/pharmacy
within walking distance of the LRT system. Presently I must drive 30 minutes each way (longer during rush hour)
to the clinic.

Small towns (Yakima, Medford) represent too small a sample to generalise upon (review the scientific method,
with particular respect to size of sample, which is the heart of every objective consideration). You can't compare
Bend (Oregon) and New York under any circumstances, especially not for the cost-nature of back surgery (lifting
heavy timber vs. heavy books). How about a more intelligent approach. Year after year you give us no choice
(one provider) for medical care, resulting in no competition to motivate that one provider to lower costs. For 80%
of what you pay them, I'll get my own insurance and manage my own medical care, as will enough other
employees to persuade Blue Cross to lower its fees for fear of losing the massive subscription base you offer it
without incentive to change.

Don't e-mail me any more of your "updates," unless they show some genuine sign of intelligence.

The word is "recur," not "reoccur."


Other


I agreed that we need our $ to be spend for our care, not the physicians packets. I 'm tired that you can't talk to
your physician for more than one illness. They tell you that you need another appointment. If your P.C.P. is out,
they tell you got to the ER. You go to your physician sick, there is never anything wrong, however, you end up at
the ER four times for the same illnes that your P.C.P. did not found. Sorry, if I'm frustated with my medical
coverage or plan. Thank you for giving the opportunity to voice our concerns.

I was about to take the online health survey to assess my health status, but I was stunned to see that login requires
my releasing my Social Security number.

As an investigator, it is rather disturbing that you require this critical piece of info. Why not just date of birth and
agency number? Or the last 4 digits of the SS number?

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Thank you for your reply,

 I am a breast cancer survivor. I have been through MANY surgeries and medical procedures since my cancer
occurrence in September of 2000 including a bilateral breast reconstruction.
On October 15, 2004 I received one of the final, final procedures that is necessary for my breast reconstructive
surgery. The final procedure is a process where you have the newly constructed aureoles tattooed.
Sounds very strange, but without the tattooing, your new breasts look pretty funny.
Dr. (Name) was my cosmetic surgeon and I loved him (he did a fabulous job). You may be surprised to learn that
my cosmetic surgeon does not perform the service of tattooing. (Sarcasm) In fact, none of the local cosmetic
surgeons provide such a service. I had to pay the $300 out of my pocket to the cosmetic tattoo artist that was
recommended by my Doctor.
I submitted a letter from my Doctor, a letter from the technician who performed the service and a letter from
myself explaining why it was necessary for me to have this procedure and that there were no "Preferred
Providers" available to provide this service to me. I received the pat response from Blue Cross...ineligible
expenses due to the Non Preferred Provider status.
In frustration I picked up the phone and called Blue Cross and asked if my letters were even reviewed. I was
helped by a Representative named: (Name) (Phone Number: 503-412-5534). She said she would review the letters
and my account. Within an hour she called me back and explained that she had checked with her supervisor and
that they would make the exception and pay the claim!!
Just wanted you to hear about a GREAT experience!
Thank you for being there for us as a representative to our issues!


Lifestyle/Incentives


Given that obesity, diabetes and heart disease are running rampant in our society as well as cancer and other
"lifestyle" diseases - I would love to see an exercise incentive as part of our health benefits. When I worked in
another state, the health insurance came with an option where the insurance co. would contribute to the cost of
health club memberships with various health clubs around the state participating.
Each month paid for was based on an attendance log where a person had to average 4 times per week of exercise
to have assistance with the next month's membership. It also had incentives at various exercise level such as being
able to win water bottles, caps, sock, various athletic gear, bags etc. It was a great option and would help with
medical cost related to all the above conditions.

Dear PEBB:

On the topic of lower back pain.....I have been a member of the YMCA in Salem now for ten years. I have found
that strengthening my abdominal muscles has almost eliminated my prior problems with lower back pain. Marion
County pays (or at least they did a few years back) for it's employees to have their strength evaluated and for a
personal trainer to establish a program for improving overall health through regular resistance training and
exercise. Why doesn't PEBB do something similar. Isn't prevention worth much more than a cure? And isn't value
what we're looking for in health care? Think about it. I had to pay $50 out of my own pocket to save hundreds of
$ in doctor's visits and pain medication. Also, the $45 I pay every month to the Y saves PEBB hundreds of dollars
every year. Why can't PEBB offer some incentives; i.e. money, to support those of us trying to stay healthy and
out of the doctor's office. I suggest a subsidy of $15 a month towards health club membership contingent on the
member actually going at least 2X a week on a yearly average (that takes into account vacations, illness, etc.). The
Y records each visit I make; they could easily provide PEBB with a yearly report showing my visits.




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