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Hi all, here is my story. I had a HSA plan through my employer and went to see a family doc at Northeast Medical group in CT months ago for cold.  Nobody there knew how much to collect on the spot and so charged me $20 for copay. Now, 6 months later their billing department sent me a bill for $300+ as outpatient visit and I would have to pay $200+ for the visit after contractual discount.  So I called my insurance carrier(Bluecross/Blueshield) first and they said that is how high deductible HSA plan works where all the fees count toward deductible first.  I called the doc office again asking for their fee for cash/credit card rate and I was told it's only $90 flat for a visit. I also asked again for a quote with my insurance and they said they had no information on how much my portion of the fee would be.  This does not make sense to me: first of all, it's better to walk in there be seen there without this HSA plan and let them charge your credit card upfront. Secondly, how could you bill your customer/patient later without telling them how much it would be first? I understand that they need to file a claim and see how much the insurance covers but there must be a system to calculate patient's responsibility.  If I was told that the doc visit would cost me $200 I would have left that day.  Looks like I am going to suck it up pay the $200 this time.  I wonder how you finance gurus with HSA plan go find a doctor.  The moral of the story is to be persistent of asking for a quote upfront and to bargain hunt for a doctor that has a reasonable fee schedule for your health plan but what if they can't tell you that information right away. How can I find a doctor with this plan? Even though am in my early 30s and rarely have the need to see a doctor I want to know how to deal with this type of situation.

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Pay the 90
Enjoy the fact you put $s in your 2016 HSA

tl;dr

davidbeckham said:   first of all, it's better to walk in there be seen there without this HSA plan and let them charge your credit card upfront. Secondly, how could you bill your customer/patient later without telling them how much it would be first?
On the first sentence. That is not exactly true. Even though you have to pay for the total costs out of pocket, you really aren't. When they run through insurance you are only paying the contractual allowed amount. This, in many cases, is significantly lower than their fee and can also be lower than any cash-pa discount they give.

For the second sentence. Yes, unfortunately, that is how healthcare works. It is pretty difficult to estimate OOP costs on an HSA plan.

HSA plans only save money when you don't use them, or only use them for their freebies (preventative care).

Just pay the bill. This is how HSA plan works. I think it is slightly unusual that the cash rate is lower than the insurance rate - I look at my lab bills and I am really surprised how little they get paid. The only time I have seen situation similar to yours is when my son was on my plan and used a place which was not on the network. So may be the lesson learned is that when using out of networw, pay extra attention. Since u are healthy, you can pay cash - else you also have to look at how things contribute to your deductible. I recently had a $400 prescription filled on my account and since I had met the deductible, I only paid  $40 for it. If I had not met the deductible! it would have been cheaper to order it from a Canadian Pharmacy. And since I have met the deductible, I will make sure that I get a refill in late Dec that will cover me until March end.

Make sure that you are ultimately paying for this from a tax advantaged HSA account instead of cash account.

Thank you all for your input. I did make sure the doc was in network with the plan.

In the future if I call the hsa carrier on a specific provider with specific procedure code would they be able to tell me how much my out of pocket cost be beforehand? I always hear that collector writes off charges for many reasons . when is agency willing to settle a charge like writing off 50% of the bill.?

davidbeckham said:   Hi all, here is my story. I had a HSA plan through my employer and went to see a family doc at Northeast Medical group in CT months ago for cold. 
 

  This is getting better than visiting doctor for "fever in the middle of the night"

For a cold ?

Rufflesinc should be able to help you. Just file the claim under his name.

davidbeckham said:   In the future if I call the hsa carrier on a specific provider with specific procedure code would they be able to tell me how much my out of pocket cost be beforehand? I always hear that collector writes off charges for many reasons . when is agency willing to settle a charge like writing off 50% of the bill.?
  
Yea you got shafted.  Especially if your expected annual expenditure is below the HSA deductible amount.  Since in this case, they weren't even sure how much deductible to collect, I doubt they would know your cost beforehand.

I also have an HSA plan.  The same happens with pharmacies.  I ask them how much a drug would be without insurance first, and then how much it would be with my BCBS plan.  Oftentimes, the no insurance cash rate is cheaper so I just pay cash instead of using my insurance.  

PrincipalMember said:   Make sure that you are ultimately paying for this from a tax advantaged HSA account instead of cash account.
  This is not the most tax efficient way. Best way is to max out your HSA every year, pay for the expenses out of savings (or monthly cash flow), keep the receipts forever, invest the HSA funds and then enjoy the triple tax advantage when you cash out down the road.

davidbeckham said:   In the future if I call the hsa carrier on a specific provider with specific procedure code would they be able to tell me how much my out of pocket cost be beforehand? I always hear that collector writes off charges for many reasons . when is agency willing to settle a charge like writing off 50% of the bill.?
You would think it is easy, but it is not that easy. You would need to have all of the codes, any modifiers, etc to know for sure.

If you did have everything, then yes, in theory, the insurer should be able to tell you the contracted amount. However, I doubt many would.

tennis8363 said:   davidbeckham said:   In the future if I call the hsa carrier on a specific provider with specific procedure code would they be able to tell me how much my out of pocket cost be beforehand? I always hear that collector writes off charges for many reasons . when is agency willing to settle a charge like writing off 50% of the bill.?
You would think it is easy, but it is not that easy. You would need to have all of the codes, any modifiers, etc to know for sure.

If you did have everything, then yes, in theory, the insurer should be able to tell you the contracted amount. However, I doubt many would.


So there is no way to avoid being screwed?

davidbeckham said:   
tennis8363 said:   
davidbeckham said:   In the future if I call the hsa carrier on a specific provider with specific procedure code would they be able to tell me how much my out of pocket cost be beforehand? I always hear that collector writes off charges for many reasons . when is agency willing to settle a charge like writing off 50% of the bill.?
You would think it is easy, but it is not that easy. You would need to have all of the codes, any modifiers, etc to know for sure.

If you did have everything, then yes, in theory, the insurer should be able to tell you the contracted amount. However, I doubt many would.


So there is no way to avoid being screwed?

  In what respect were you screwed? Maybe you are new to the US medical system. But ~$200 for an office visit is not unusual. 
Second, if you are going balk at this, perhaps HDHP is not for you. But recall that most plans (even non-HDHP) have a deductible and you will be responsible for 100% of the cost till the deductible is met.

If it's something simple like an office visit then the insurance co should be able to tell you with the CPT code what the charges would be. Once you start getting in-office tests done or more complex procedures, that's where it will be difficult.

If you choose to pay cash for a visit and not go through your insurance (which may or may not be less) then you aren't working towards paying your deductible and out of pocket max for the year with the insurance. For some people that may not matter, some will.

As the other poster said, $200 is not unusual for a new patient visit. Can be $300 for a specialist.

If you have an HSA plan, you need to be willing to do the leg work, collect CPT codes, compare cash vs insurance pay prices, etc. if you want to extract maximum value or just be willing to pay the difference. In theory you're saving on what your monthly charges would be on a non-HSA so a few extra bucks for a single visit shouldn't enrage you.

Why are you even going to a doctor for a cold. Don't you know there is no cure for it? You probably infected half the people in the waiting room as well as the staff. If you needed advice, a simple phone call would have been better.

fwuser12 said:   
davidbeckham said:   
tennis8363 said:   
davidbeckham said:   In the future if I call the hsa carrier on a specific provider with specific procedure code would they be able to tell me how much my out of pocket cost be beforehand? I always hear that collector writes off charges for many reasons . when is agency willing to settle a charge like writing off 50% of the bill.?
You would think it is easy, but it is not that easy. You would need to have all of the codes, any modifiers, etc to know for sure.

If you did have everything, then yes, in theory, the insurer should be able to tell you the contracted amount. However, I doubt many would.


So there is no way to avoid being screwed?

  In what respect were you screwed? Maybe you are new to the US medical system. But ~$200 for an office visit is not unusual. 
Second, if you are going balk at this, perhaps HDHP is not for you. But recall that most plans (even non-HDHP) have a deductible and you will be responsible for 100% of the cost till the deductible is met.

  In my experience, most deductible's for non-HDHP are for major visits (planned surgeries, admitted hospital stays, having babies, etc.). Office visits, non-admitted ER visits, specialty office visits, and a limited number of PT visits are set copays and then you generally don't get a bill for anything else associated with those visits.  Most of the lab work is also covered with those associated office visits.  Prescriptions are also covered with a (hopefully small) co-pay which varies depending on the drug needed.

davidbeckham said:   I wonder how you finance gurus with HSA plan go find a doctor.  The moral of the story is to be persistent of asking for a quote upfront and to bargain hunt for a doctor that has a reasonable fee schedule for your health plan but what if they can't tell you that information right away. How can I find a doctor with this plan? Even though am in my early 30s and rarely have the need to see a doctor I want to know how to deal with this type of situation.
 

  
First off, $200+ for an office visit with a cold seems very high, I would expect about half that. You should ask for the CPT and ICD codes, do a something search to make sure that you are being billed for the correct services.

It is very difficult to find out what the negotiated rate for a service is in advance, even if you already know the codes. Online tools designed to provide the consumer with empowering information are patchwork at best, completely useless. This is ridiculous and there is no good reason for it except for that's just how the system has developed.

So what can you do? Not too much, really. For office visits, there is little variation in negotiated rate among providers; as you have learned, one option is to ask what the cash price is and pay that if you think it might be cheaper, though I have found that insurance is usually better or about the same. For major, planned procedures (surgery, imaging, etc.), you can press the providers to get you the prices but depending on the circumstances you may find that there's very little you can do about it. For example, you can have an MRI done wherever you want and can choose based on price, but for surgery you're going to have to use the facility and anesthesiologist your surgeon uses.

They billed me "new outpatient visit" for $272 with two strep tests for $30 each. All comes out with contractual discount is $224.  Does the new patient visit cost more than regular one? Nothing seems different.

I also had an HSA until a few weeks ago, and the cost for a "normal" visit to the doctor varied from free (annual physical) to $90 (consultation) to $180 (diagnosis, tests, etc).  The doctor is located in an expensive area of Washington DC, so your costs seem on the high side, but not out of the ordinary.

There are tax advantages to having an HSA account, but IMO it's not worth the effort.  It's difficult (if not impossible) for the average person to shop around for medical care.

faloun said:   
There are tax advantages to having an HSA account, but IMO it's not worth the effort.
 

  
Can you elaborate? I am really enjoying my HSA account - between tax deferral and growth, I have like 2X of my "taxed" money in the account even after paying for medical expenses from the account.

davidbeckham said:   They billed me "new outpatient visit" for $272 with two strep tests for $30 each. All comes out with contractual discount is $224.  Does the new patient visit cost more than regular one? Nothing seems different.
They have two CPT codes and different allowed rates. While this article says the insurance reimbursements are close, my experience has been a new patient visit is typically billed $150-$200 and an existing patient visit is around $100.

http://www.beckersasc.com/asc-coding-billing-and-collections/30-... 

By far the most common type of visit is a level 3.

PrincipalMember said:   Just pay the bill. This is how HSA plan works. I think it is slightly unusual that the cash rate is lower than the insurance rate - I look at my lab bills and I am really surprised how little they get paid. The only time I have seen situation similar to yours is when my son was on my plan and used a place which was not on the network. So may be the lesson learned is that when using out of networw, pay extra attention. Since u are healthy, you can pay cash - else you also have to look at how things contribute to your deductible. I recently had a $400 prescription filled on my account and since I had met the deductible, I only paid  $40 for it. If I had not met the deductible! it would have been cheaper to order it from a Canadian Pharmacy. And since I have met the deductible, I will make sure that I get a refill in late Dec that will cover me until March end.
  
DO NOT pay a bill just because it arrives to you and tells you to pay $x amount. Well, unless you want to live up to the statement of "A fool and their money are soon parted"

OP - Log on to your health insurance site and look for your Explanation of Benefits statements. Match up the EoB with your date of service, this is what will tell you how much you SHOULD pay based on your coverage. If there is no explanation of benefits, or if the amount doesn't match - tell both the insurance company and the doctor office to re-process it.

PrincipalMember said:   
faloun said:   
There are tax advantages to having an HSA account, but IMO it's not worth the effort.

  
Can you elaborate? I am really enjoying my HSA account - between tax deferral and growth, I have like 2X of my "taxed" money in the account even after paying for medical expenses from the account.

  
Yeah - I have and HSA and no employer, so I contribute the full amount - we've gotten our HSA's up to about $30,000, invested in high yield bond funds at the moment.  Have no plans to cash out until I'm 65 - it's just another IRA.  If you have the money to pay the bill, the worst thing you can do is use the HSA.  Worst case, if we ever need the money, we can go back and reimburse for all the things we've paid cash for, first year of the HSA was a $7000 baby. 

faloun said:   I also had an HSA until a few weeks ago, and the cost for a "normal" visit to the doctor varied from free (annual physical) to $90 (consultation) to $180 (diagnosis, tests, etc).  The doctor is located in an expensive area of Washington DC, so your costs seem on the high side, but not out of the ordinary.

There are tax advantages to having an HSA account, but IMO it's not worth the effort.  It's difficult (if not impossible) for the average person to shop around for medical care.

 You are forgetting the other important benefit of an HDHP: lower premium. Of course, it is suitable for healthy people who dont have any chronic conditions and usually dont have a need to visit a doctor on a regular/frequent basis. Each one has to make that decision based on their health and the premium difference between non-HDHP and HDHP (among other things).

Sadly, the short version is that our medical system is a scam, where they refuse to provide the price of the service until after you've already used the service. So they don't want to let us shop around, compare prices, you know, all the things that actually make capitalism work.

davidbeckham said:   They billed me "new outpatient visit" for $272 with two strep tests for $30 each. All comes out with contractual discount is $224.  Does the new patient visit cost more than regular one? Nothing seems different.
  Yes there are different codes for new and established patient.  A new patient would/should include more time spent to establish patient history.

An established patient that have not been back within 3 years will be considered a new patient.

tennis8363 said:   
PrincipalMember said:   Make sure that you are ultimately paying for this from a tax advantaged HSA account instead of cash account.
  This is not the most tax efficient way. Best way is to max out your HSA every year, pay for the expenses out of savings (or monthly cash flow), keep the receipts forever, invest the HSA funds and then enjoy the triple tax advantage when you cash out down the road.

  Can you easily cash out forever?

fwuser12 said:   
davidbeckham said:   
tennis8363 said:   
davidbeckham said:   In the future if I call the hsa carrier on a specific provider with specific procedure code would they be able to tell me how much my out of pocket cost be beforehand? I always hear that collector writes off charges for many reasons . when is agency willing to settle a charge like writing off 50% of the bill.?
You would think it is easy, but it is not that easy. You would need to have all of the codes, any modifiers, etc to know for sure.

If you did have everything, then yes, in theory, the insurer should be able to tell you the contracted amount. However, I doubt many would.


So there is no way to avoid being screwed?

  In what respect were you screwed? Maybe you are new to the US medical system. But ~$200 for an office visit is not unusual. 
Second, if you are going balk at this, perhaps HDHP is not for you. But recall that most plans (even non-HDHP) have a deductible and you will be responsible for 100% of the cost till the deductible is met.

  He was screwed because their cash rate is $90.  The strep tests were probably extra, meaning he's being billed about $70 more than he would've paid as a cash customer.

I'd call up the doctor and have them delete your insurance info.  That should restore the cash rates.  You can still send the bill in to your insurance so it counts against your deductible.

I am told almost daily that healthcare is all fixed and it is Utopia for all....why so many problems...isnt everything " FREE"

Glitch99 said:   
fwuser12 said:   
davidbeckham said:   
tennis8363 said:   
davidbeckham said:   In the future if I call the hsa carrier on a specific provider with specific procedure code would they be able to tell me how much my out of pocket cost be beforehand? I always hear that collector writes off charges for many reasons . when is agency willing to settle a charge like writing off 50% of the bill.?
You would think it is easy, but it is not that easy. You would need to have all of the codes, any modifiers, etc to know for sure.

If you did have everything, then yes, in theory, the insurer should be able to tell you the contracted amount. However, I doubt many would.


So there is no way to avoid being screwed?

  In what respect were you screwed? Maybe you are new to the US medical system. But ~$200 for an office visit is not unusual. 
Second, if you are going balk at this, perhaps HDHP is not for you. But recall that most plans (even non-HDHP) have a deductible and you will be responsible for 100% of the cost till the deductible is met.

  He was screwed because their cash rate is $90.  The strep tests were probably extra, meaning he's being billed about $70 more than he would've paid as a cash customer.

I'd call up the doctor and have them delete your insurance info.  That should restore the cash rates.  You can still send the bill in to your insurance so it counts against your deductible.
 

  Nothing stopped OP from calling before the appointment for a cash rate (no insurance).

He is peeved mainly about the ~$200: (a) he did not expect it to be that high --- this fee is not unusual in the US (b) because of his deductible he will be responsible for it after the insurance "discount"  --- OP should have known this when he opted for HDHP and (c) had he known the cost, he may not have visited the doc --- ask upfront and get the upfront cash rate.

tgersinthewhhouse said:   I am told almost daily that healthcare is all fixed and it is Utopia for all....why so many problems...isnt everything " FREE"
  It will be after taxes.

bobley said:   
tennis8363 said:   
PrincipalMember said:   Make sure that you are ultimately paying for this from a tax advantaged HSA account instead of cash account.
  This is not the most tax efficient way. Best way is to max out your HSA every year, pay for the expenses out of savings (or monthly cash flow), keep the receipts forever, invest the HSA funds and then enjoy the triple tax advantage when you cash out down the road.

  Can you easily cash out forever?

  Yes, I just keep the receipts and bills for anything medical (even over the counter meds, condoms etc). Right now, we have about 25K in the HSA and $2.5K in receipts. I will continue to hold the receipts and cash them out as part of my tax-free early retirement funds in about 15 years.

fwuser12 said:   
Glitch99 said:   
fwuser12 said:   
davidbeckham said:   
tennis8363 said:   
davidbeckham said:   In the future if I call the hsa carrier on a specific provider with specific procedure code would they be able to tell me how much my out of pocket cost be beforehand? I always hear that collector writes off charges for many reasons . when is agency willing to settle a charge like writing off 50% of the bill.?
You would think it is easy, but it is not that easy. You would need to have all of the codes, any modifiers, etc to know for sure.

If you did have everything, then yes, in theory, the insurer should be able to tell you the contracted amount. However, I doubt many would.


So there is no way to avoid being screwed?

  In what respect were you screwed? Maybe you are new to the US medical system. But ~$200 for an office visit is not unusual. 
Second, if you are going balk at this, perhaps HDHP is not for you. But recall that most plans (even non-HDHP) have a deductible and you will be responsible for 100% of the cost till the deductible is met.

  He was screwed because their cash rate is $90.  The strep tests were probably extra, meaning he's being billed about $70 more than he would've paid as a cash customer.

I'd call up the doctor and have them delete your insurance info.  That should restore the cash rates.  You can still send the bill in to your insurance so it counts against your deductible.

  Nothing stopped OP from calling before the appointment for a cash rate (no insurance).

He is peeved mainly about the ~$200: (a) he did not expect it to be that high --- this fee is not unusual in the US (b) because of his deductible he will be responsible for it after the insurance "discount"  --- OP should have known this when he opted for HDHP and (c) had he known the cost, he may not have visited the doc --- ask upfront and get the upfront cash rate.

 The problem is that most Americans who sign up for an HSA don't have the first idea about how they actually work. They simply see a cheaper premium, sign up and then are shocked when the first bills from MD visits come.

People don't want to know either. I used to manage an HR department at a healthcare facility, we offered a PPO and HSA and no matter how much education we would throw at people, the questions and anger would start in about February when the first bills came in. One would also think that people in healthcare might have a slightly better understanding. Nope.

Be happy that the doctor and the lab was in-network! Balance-billing by out-of-network providers adds a whole new dimension to the medical payment issue.

For example, the in-network doctor could have sent those strep tests to an out-of-network lab, and you would never have known. Then, the lab would bill you $400 per test instead of $30, and you would have no recourse since there is no contractual rate.

Every time you go to the doctor, you're rolling the dice as to what charges you will get hit with. You really can't determine them ahead of time. The medical system is simply broken. The only thing you can do is to have insurance with a reputable carrier, and try to get one with a good network. If it's through work, ask your colleagues for their experiences with doctors, and pick a PCP based on that.

If you have a cold, just stay home.

canoeguy1 said:   For example, the in-network doctor could have sent those strep tests to an out-of-network lab, and you would never have known. Then, the lab would bill you $400 per test instead of $30, and you would have no recourse since there is no contractual rate.

 

  That used to be covered by PPOs.  Of course, my company got rid of PPO last year and said the EPO provided everything at same coverage level.  And we got a letter a couple months ago that they were changing it so not in-network ordered tests from any out-of-network provider are subject to out-of-network deductibles and coverage instead.  The employer-contribution amount for the health plan went down ~10% year over year, I guess that's all that matters to them since most won't pay attention to that and it allows a hidden pay-cut across the board.

Bend3r said:   
canoeguy1 said:   For example, the in-network doctor could have sent those strep tests to an out-of-network lab, and you would never have known. Then, the lab would bill you $400 per test instead of $30, and you would have no recourse since there is no contractual rate.

 

  That used to be covered by PPOs.  Of course, my company got rid of PPO last year and said the EPO provided everything at same coverage level.  And we got a letter a couple months ago that they were changing it so not in-network ordered tests from any out-of-network provider are subject to out-of-network deductibles and coverage instead.  The employer-contribution amount for the health plan went down ~10% year over year, I guess that's all that matters to them since most won't pay attention to that and it allows a hidden pay-cut across the board.

  It gets even more interesting if you have a narrow network plan, and need to go to the hospital. Every group in the hospital, from radiologists to physicians, to lab technicians, may or may not take your insurance. Nobody will be able to tell you whether they do or not. WIth an EPO, your chances go up dramatically that you are balance-billed out the wazoo by all sorts of out-of-network providers.

When that happens, your insurance will pay only a fraction of the bill. After the Sky-high deductible is fulfilled, as well as your copay, they will only pay "reasonable and customary" costs. So if the doctor charges $2000, and the insurance thinks that $100 is 'reasonable' (they decide what is reasonable!), you're stuck with a $1900 bill.

Narrow-network insurance isn't really insurance at all, since it rarely pays out.

Skipping 40 Messages...
redmed said:   
EradicateSpam said:   
tennis8363 said:     This is not the most tax efficient way. Best way is to max out your HSA every year, pay for the expenses out of savings (or monthly cash flow), keep the receipts forever, invest the HSA funds and then enjoy the triple tax advantage when you cash out down the road.
  
It depends.  If you have a large HSA that gives you the ability to invest your money with returns that exceed management fees by a good margin, then yes.  However, many employer-funded HSA's give you few choices.  We switched to a HDP plan with an employer-funded HSA (to which we can add funds) on 7/1 (but were presented with another option and a second enrollment period with benefits starting 9/1 so we're leaving) with the ONLY option being a 0.4% savings account.  Once you switch plans, they charge $3 per month.  The math is simple, it takes quite a bit to beat that fee.  

I found years ago when also having an HSA option that it would take years and significant contributions to overcome fees where there were investment options.  After that year we switched plans to a non-HDP, and I've been draining the HSA as fast as I can, against a $3 per month fee.  I put my money into maxing my retirement accounts with good investments, then non-retirement with also good investments.

Most people have no clue.

If you have a employer funded HSA fine.  That's free money reduce the the fee's as best you can.  But if you can invest your own money, find a place with a HSA that have no fee's.  I have mine in my Credit Union.  In fact I use Credit Unions for most of my banking.  Stuff as much as you can into your HSA and let it grow.  When you get on Medicare you can no longer fund your HSA but the HSA will become very Handy in your post 70 1/2 years.  Pack your IRA's when your working to get tax savings but be sure you start draining the IRA into Roth's at every tax advantage you get.  Usually in your post working (low income) years before you start collecting Social Security.  Delay collecting Social Security as long as you can.  Use the years before collecting Social Security to move funds from your regular IRA into Roth IRA's.  The goal is to take advantage of every tax savings opportunity you can before you reach 70 1/2.  At 70 1/2 the government decrees how much you have to withdraw from your IRA.  If you have a large amount in your IRA  at 70 1/2 you have lost most of your financial (tax) options.  There are many tax traps waiting for you in your later years when you have built up a temping nest egg and the government is looking for income.

  This is just worthy of repeating...



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