Author Topic: HDHP  (Read 4454 times)

econberkeley

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HDHP
« on: January 22, 2016, 08:13:54 AM »
We have a HDHP insurance. My kids needs a small surgery and we were told about the options we have regarding where he can have the surgery. We only have three options and they are not the cheapest. It looks like I can not shop around for the best value surgery center because surgeon only works in three different locations. I thought I can shop around with HDHP, but I guess not. Also, do you think there is a chance they offer lower price if I pay cash instead of going through the insurance. I have to pay the whole thing though because I did not finish my deductible yet. Any advice is appreciated.

bacchi

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Re: HDHP
« Reply #1 on: January 22, 2016, 08:21:16 AM »
An HDHP has just as many restrictions as any other plan; it just has a higher deductible.

Yes, ask if they'll offer a discount for paying in full at the time of surgery.

v8rx7guy

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Re: HDHP
« Reply #2 on: January 22, 2016, 08:40:43 AM »
This is part of the "risk" of using a high deductible health plan: when health expenses come up, you're paying with your HSA until you hit that high deductible.  I always remind myself that I have have been saving on premiums all year, my company puts in money, and whatever I put in is tax free... so often that makes me feel better about health expenses while on an HDHP.  Now, granted, it's early in the year and if you're new to the plan your HSA is pretty depleted, so there is no doubt that could suck a bit.  But that's part of the "risk" you take when you apply for an HDHP

COlady

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Re: HDHP
« Reply #3 on: January 22, 2016, 09:21:39 AM »
This is part of the "risk" of using a high deductible health plan: when health expenses come up, you're paying with your HSA until you hit that high deductible.  I always remind myself that I have have been saving on premiums all year, my company puts in money, and whatever I put in is tax free... so often that makes me feel better about health expenses while on an HDHP.  Now, granted, it's early in the year and if you're new to the plan your HSA is pretty depleted, so there is no doubt that could suck a bit.  But that's part of the "risk" you take when you apply for an HDHP

OR HDHP is the only option at the company you work for. Sigh.

deragun

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Re: HDHP
« Reply #4 on: January 22, 2016, 11:28:19 AM »
If you have in-network and out-of-network coverage in your plan, then you should be able to go anywhere else and pay based on the out-of-network rules/rates (20% in network vs 40% out-of-network coinsurance on mine with 2x deductible amount for OON).

If you only get in-network coverage, then paying full out of pocket may be your only other option.  But even if you go that route I just wanted to point out that you don't have to pay for it with your HSA money if you can swing it.  You can pay from checking/savings/etc and leave the money in the HSA.  Just keep documentation of the charge and payment, and at any point in the future you can take that much money out of the HSA for free (no penalty or taxes).

Now that I have access to a HDHP/HSA myself this is my strategy.  Any medical cost is paid outside the HSA and builds up a stache that can be tapped at any time once FIRE for unexpected needs without effecting taxes.

Also, this still applies even if the charge is more than you have in the HSA at the time.  IE $5000 charge with only $1000 in the HSA at the time still means you can recoup $5000 at any point in the future once you have it in the HSA.
« Last Edit: January 22, 2016, 11:30:56 AM by deragun »

Jmoody10

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Re: HDHP
« Reply #5 on: January 22, 2016, 11:52:26 AM »
If you don't have an HSA, open one before paying for anything. As long as the HSA is opened before the payment, you can backpay your self from the HSA at a later date to get the tax advantages.

jorjor

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Re: HDHP
« Reply #6 on: January 22, 2016, 12:24:11 PM »
We have a HDHP insurance. My kids needs a small surgery and we were told about the options we have regarding where he can have the surgery. We only have three options and they are not the cheapest. It looks like I can not shop around for the best value surgery center because surgeon only works in three different locations. I thought I can shop around with HDHP, but I guess not.

You can shop around with an HDHP. You can find a different surgeon that would work at a best value surgery center. Unless that's the only surgeon in your network, which would be crappy and not a fault of HDHPs in general but a fault of that HDHP (and whichever regulator approved the HDHP for sale since it seems tough to meet network adequacy guidelines that way).

Also, do you think there is a chance they offer lower price if I pay cash instead of going through the insurance. I have to pay the whole thing though because I did not finish my deductible yet. Any advice is appreciated.

Maybe. The rate the insurer pays is already negotiated by the insurance company and heavily discounted from the charged rate in most instances. You might find that you can do better on your own, but maybe not.

charis

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Re: HDHP
« Reply #7 on: January 22, 2016, 12:40:22 PM »
The full out of pocket cost of the medical care will likely be higher than the negotiated rate you'd have to pay through your HDHP, possibly twice as much.  I would really look into this before you try to swing a lower cash rate. 

I have a HDHP.   My doctor sends a claim to my insurance for $500.  My insurance calculates my rate as a HDHP member to be $250.  If it's preventative care, I pay $0 on that claim.  If it is not preventative and I haven't met my deductible yet, I pay $250. 

Even if I worked out a 10% cash discount with the doctor's office, that doesn't make up for going through insurance.  Plus it wouldn't count toward my deductible.


charis

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Re: HDHP
« Reply #8 on: January 22, 2016, 12:42:54 PM »
If you don't have an HSA, open one before paying for anything. As long as the HSA is opened before the payment, you can backpay your self from the HSA at a later date to get the tax advantages.

I don't think this is accurate.  I don't believe you can reimburse yourself for medical expenses incurred prior to the date you opened the HSA.

Merrie

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Re: HDHP
« Reply #9 on: January 22, 2016, 01:05:19 PM »
The full out of pocket cost of the medical care will likely be higher than the negotiated rate you'd have to pay through your HDHP, possibly twice as much.  I would really look into this before you try to swing a lower cash rate. 

I have a HDHP.   My doctor sends a claim to my insurance for $500.  My insurance calculates my rate as a HDHP member to be $250.  If it's preventative care, I pay $0 on that claim.  If it is not preventative and I haven't met my deductible yet, I pay $250. 

Even if I worked out a 10% cash discount with the doctor's office, that doesn't make up for going through insurance.  Plus it wouldn't count toward my deductible.

Seconding this! Even while in your deductible, you'll pay the negotiated rate. Also, you may be able to get a price break on THAT rate. Example: when I had my son, after getting the bills for his portion of the fees and mine, I called the department at the hospital that had sent the bills and asked if there was any price break available. There would have been a hardship discount available if we'd been less than 400% of the poverty level, but we aren't. Even so, they offered a 25% discount to pay the bill in full, which I did since we had set aside extra money for this expense.

relena

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Re: HDHP
« Reply #10 on: January 22, 2016, 02:14:16 PM »
does your insurance have a number you can call to find the cheapest person who can do the surgery? many insurance companies offer this free benefit but a lot of people don't realize that it is available to them.

Altons Bobs

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Re: HDHP
« Reply #11 on: January 22, 2016, 02:14:39 PM »
You can definitely shop around and ask the different providers (doctors and surgery centers) how much they would charge if you pay cash.

I had to have an MRI done, with my insurance (HSA plan also), they wanted to charge $900+, I asked what happened if they didn't file the claim and that I paid cash, they said it would be $350.  So with insurance $900+ which is the network negotiated rate, with no insurance $350.  I said I'd take the $350.  I paid for it from my Health Savings Account but it did not go into my deductible even though they were in network, but because it was cash pay, I got a much bigger break.  Providers purposely jack up the prices because insurance would pay, but they charge less for cash pay patients.  Not only this, years ago, same story, on another service.  Always ask about the cash pay price if you want to pay less.  I even called my insurance company to complain about this, they said those were the prices they signed in contract with the providers, they couldn't charge less.

You have to have an HSA already opened, you don't have to fully fund it first, but it has to be opened first, and then have the surgery, and then fund it and reimburse yourself.

Whatever you have leftover in your HSA when you turn 65, if you want to take it out for NON-Medical use, you have to pay tax on it like a traditional IRA.  A PP is wrong on this.  If you use it to pay for IRS approved medical expenses, then no tax, or if you use it to pay for Medicare Part A and Part B, no tax.

MDM

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Re: HDHP
« Reply #12 on: January 22, 2016, 03:07:05 PM »
If you don't have an HSA, open one before paying for anything. As long as the HSA is opened before the payment, you can backpay your self from the HSA at a later date to get the tax advantages.
I don't think this is accurate.  I don't believe you can reimburse yourself for medical expenses incurred prior to the date you opened the HSA.

jezebel is correct.  It is not the payment date but the date the expense was incurred that must be compared with the date the HSA was first funded.

As a fine point, in some states "opening" an HSA is sufficient.  In many (most?), however, one must not only "open" the HSA but put some money (even $1 will suffice) into it before state law (and thus the IRS) will consider the HSA actually opened.

GrOW

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Re: HDHP
« Reply #13 on: January 22, 2016, 04:05:59 PM »
Check your insurance company's website for a cost estimator or similar name. Castlight is a common provider of this info so if you see that you are also in the right area. Check cost of different surgeons in your area.

As others have said, open an hsa today and fund it via ach from your checking account for a small dollar amount pronto.

econberkeley

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Re: HDHP
« Reply #14 on: January 23, 2016, 05:43:57 AM »
Great tips. Thank you all.

My wife called our insurance company and asked about the facility fees for the in network surgery centers. The funny thing is that she couldn't give my wife prices. This is the exact words she told my wife: "this is a lost cause".  They don't know the negotiated rates, but somehow they can send the bill with the negotiated rates:-)
It is very hard to shop for healthcare if the system is not set up for this. Who has the time to go though all the hassle calling insurance companies, getting medical codes for procedures and get the prices from every provider? It is too complicated and time consuming. Health costs will keep skyrocketing because of this nonsense.

By the way, I already have an HSA account, but we already had a big health expense couple of weeks ago and it wiped out our HSA balance. I will pay with my credit card and later on recoup that charge paying out of my HSA balance. This is better than using HSA card because I can get 2% cash back:-) Thank you for the tip.

My kid's doctor is the one going to operate on my kid. I think it will get complicated if I use another surgeon since he wouldn't know his situation. He would probably want to see my kid before operating on him. This could mean an expensive doctor visit so I don't know if it is worthwhile to go that route.  I will definitely ask about the cash rate.

charis

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Re: HDHP
« Reply #15 on: January 23, 2016, 07:40:11 AM »
Great tips. Thank you all.

My wife called our insurance company and asked about the facility fees for the in network surgery centers. The funny thing is that she couldn't give my wife prices. This is the exact words she told my wife: "this is a lost cause".  They don't know the negotiated rates, but somehow they can send the bill with the negotiated rates:-)
It is very hard to shop for healthcare if the system is not set up for this. Who has the time to go though all the hassle calling insurance companies, getting medical codes for procedures and get the prices from every provider? It is too complicated and time consuming. Health costs will keep skyrocketing because of this nonsense.

The lack of information is exactly why my friend recently went back to a co-pay plan ("I know I might be paying more but I don't have time to/can't figure out what anything will actually cost on the HDHP").

They send you a bill with the negotiated rates AFTER submitting the claim to your insurance company.   That's how they know.

ender

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Re: HDHP
« Reply #16 on: January 23, 2016, 09:21:29 AM »
Great tips. Thank you all.

My wife called our insurance company and asked about the facility fees for the in network surgery centers. The funny thing is that she couldn't give my wife prices. This is the exact words she told my wife: "this is a lost cause".  They don't know the negotiated rates, but somehow they can send the bill with the negotiated rates:-)
It is very hard to shop for healthcare if the system is not set up for this. Who has the time to go though all the hassle calling insurance companies, getting medical codes for procedures and get the prices from every provider? It is too complicated and time consuming. Health costs will keep skyrocketing because of this nonsense.

The lack of information is exactly why my friend recently went back to a co-pay plan ("I know I might be paying more but I don't have time to/can't figure out what anything will actually cost on the HDHP").

They send you a bill with the negotiated rates AFTER submitting the claim to your insurance company.   That's how they know.

This is how I occasionally feel, too.

It's frustrating to no end how with an HDHP I need to spend so many hours researching things that the people you talk to at insurance companies/medical providers don't even know the answers to. It's so annoying that it's so obscure/opaque.

ETBen

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Re: HDHP
« Reply #17 on: January 23, 2016, 09:34:19 AM »
The reason they can't give you the negotiated rates is that its per claim. The one surgery may have 20 different claims submitted (it isn't a flat rate). So she won't know all of what they would submit for reimbursement.

RedefinedHappiness

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Re: HDHP
« Reply #18 on: January 23, 2016, 09:38:38 AM »
One word of caution. When using an out of network doctor, you could pay more than just the 40% coinsurance. The 40% is typically based on a set rate for the particular procedure. Then they will balance bill you for the remainder.

Extreme example. Out of network doctor rate for procedure is $5000. Set rate by insurance company is $2000. You have out of network coinsurance of 40%. They will charge you 40% of 2000 PLUS $3000 (5000-2000).

Aside - we can blame this on insurance company, but you can also blame on the doctor who decides his services are worth 2.5 times normal price in market.