Author Topic: HDHP question  (Read 1590 times)

slappy

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HDHP question
« on: February 15, 2016, 06:56:52 AM »
I switched to a HDHP this year, and from what I understand, my deductable is $3k, after which the insurance will pay 90% of costs, until I hit my max OOP of $4k.  My husband goes to a therapist weekly and I'm due to have a baby in September, so that $4k will come pretty fast. 

But I have a really wierd question. It seems like in addition to the therapy and the baby, any other medical care would be covered at 100% (assuming in network) because our OOP max will be hit.  So for example, if I started going to the chiropractor every week or two, we would hit the max OOP sooner, but from then on everything would be covered. It almost seems like the chiro care (or anything else) would be "free" in the sense that it would be covered after we meet our OOP Max. 

Does that sound right? Am I missing something? I've called the insurance company, but they don't seem to have any answers.  Does my understanding of the situation seem correct?

GrOW

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Re: HDHP question
« Reply #1 on: February 15, 2016, 07:05:39 AM »
Scary that the insurance company did not have answers. It may be that you are using different terminology/language and so it seems that both sides are on different pages.

Try this:

Build a sheet or list or table that helps you visualize your plan thresholds. Start at $0 and work up to you deductible being careful to include individual vs family deductibles if they are different. Then work up to OOP max again being careful to include any individual vs family differences. Include both your % and the insurance company's % for each 'tier' that your table includes.

This should help you visualize it easily and should also allow you to quickly switch from 'your view' to the 'insurance company's view' should that help your discussion.

A super simple table (well I am skipping actually formatting a table)could be:

$ Range  Your%  Their %
$0-$3,000 100% 0%
$3,001-$4,000 90% 10%
$4,000+ 0% 100%

**Of huge importance - note that dollar range is dollars paid by you and not claims dollars. If your obligation in the 2nd tier is 10%, it will take $10,000 of claims for you to pay the $1,000 needed to move to the 3rd tier for OOP max coverage.


Two quick additional thoughts:
1. Max your HSA, if you are not already on track to do that
2. Call your employer HR company. They have people that are experienced middlemen between their employee and the insurance company. They can help you speak the same language.

Good luck with your research and best wishes on the new baby in a few months.
« Last Edit: February 15, 2016, 07:07:55 AM by Redcedar »

slappy

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Re: HDHP question
« Reply #2 on: February 15, 2016, 07:10:27 AM »
Thank you! :)

Part of the insurance company's confusion was my husband's therapy.  First they transferred me to the mental/behavioral health department. Then they transferred me to the billing/claims department. It seems that they didn't understand how the therapy played into the situation. 

I'll try the HR people and see if they can help.  The way I'm understanding it, for people with high healthcare expenses, it almost seems to good to be true to have the $4k max OOP. 

GrOW

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Re: HDHP question
« Reply #3 on: February 15, 2016, 07:18:23 AM »

Part of the insurance company's confusion was my husband's therapy.  First they transferred me to the mental/behavioral health department. Then they transferred me to the billing/claims department. It seems that they didn't understand how the therapy played into the situation. 

If you have recent claims for this exact therapy, your insurance company should be able to grab the necessary diagnosis and billing codes from those past claims and tell you exactly how it is handled under your current policy. If he was on a different plan when he last had therapy, try to log into that plan and print out an EOB, explanation of benefits, where you can find those codes and provide them to your current insurance company. Last option, call the doctor/provider and ask for the codes that they applied to your husband's last therapy bill.

You are right that some services can be seen as falling into a few different groups. Get the diagnosis and billing codes and you should be able to quickly clear things up.

slappy

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Re: HDHP question
« Reply #4 on: February 15, 2016, 07:19:59 AM »
Good idea! Thank you! He started early last year, and we had a $20 copay on that plan. Now we have to pay $89 (every week!) until we hit the deductible. 

I can definitely get the EOB. That should help a lot.