Can my HDHP with HSA have a Copay for ER visits?

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We have a new insurance company this year and in looking at our benefits it seems we have a $300 copay for ER visits.  Having had a HDHP with no copays the last 6-7 years I'm unsure of how this worked.  Asked the CSR via chat and it seems I would need to pay that at my visit to the ER, it would be credited to the yearly OOP max (but not deductible) and not credited towards a bill at all.  I'm curious how this can be a qualifying HDHP plan allowing us to have an HSA under IRS 969 regulations.  This is a plan via my spouses work at a big company.

If it matters or helps the discussion, we have a family integrated deductible/OOP Max of 3800/7000 (in network).  

Any help/thoughts would be great.  

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Yes they can do that.

HDHP doesn't mean copays aren't allowed.

In fact the 696 regulation you mention talks about copays going towards OOP limit.

trekwars2000 said:   Asked the CSR via chat and it seems I would need to pay that at my visit to the ER, it would be credited to the yearly OOP max (but not deductible) and not credited towards a bill at all.
I don't get why it would qualify toward the max OOP but not the deductible. I wouldn't be surprised if the $300 co-pay does count toward your deductible (which in turn should count toward your max OOP).

My HDHP plan doesn't have a copay for ER visits, so I should get billed the negotiated (hopefully in-network) "insurance rate"  for the entire visit.  If the negotiated rate is higher than my annual deductible (or whatever amount of it I have left), I'm then responsible for whatever's left of my annual deductible plus any co-insurance (up to my maximum OOP, where the deductible counts toward the OOP).  If (or once) the max OOP gets reached, then "in-network" claims for the rest of the year become free.

TheDiggler said:   
trekwars2000 said:   Asked the CSR via chat and it seems I would need to pay that at my visit to the ER, it would be credited to the yearly OOP max (but not deductible) and not credited towards a bill at all.
I don't get why it would qualify toward the max OOP but not the deductible. I wouldn't be surprised if the $300 co-pay does count toward your deductible (which in turn should count toward your max OOP).
 

  
Insurance plans often designate certain services as not subject to the deductible; in these cases, the copay applies instead. Since the deductible has been bypassed and the insurer is paying out, that copay doesn't count towards the deductible. It still counts towards the out-of-pocket total.

trekwars2000 said:   and not credited towards a bill at all.
 

  
Not quite sure what they meant by this, it is part of the hospital bill. For example, the hospital bills $2000, of which $1000 is the insurance negotiated rate, you pay the $300 copay, the insurance company pays the remaining $700.

doveroftke said:   
trekwars2000 said:   and not credited towards a bill at all.
  
Not quite sure what they meant by this, it is part of the hospital bill. For example, the hospital bills $2000, of which $1000 is the insurance negotiated rate, you pay the $300 copay, the insurance company pays the remaining $700.

  I asked that exact example to the CSR and he said the copay did NOT apply to the overall bill.  I would still owe the $300 copay and then the $1000 negotiated rate.  That is why it sounded fishy.  I asked where the copay went and he said it only got credited to the OOP max.

trekwars2000 said:   
doveroftke said:   
trekwars2000 said:   and not credited towards a bill at all.
  
Not quite sure what they meant by this, it is part of the hospital bill. For example, the hospital bills $2000, of which $1000 is the insurance negotiated rate, you pay the $300 copay, the insurance company pays the remaining $700.

  I asked that exact example to the CSR and he said the copay did NOT apply to the overall bill.  I would still owe the $300 copay and then the $1000 negotiated rate.  That is why it sounded fishy.  I asked where the copay went and he said it only got credited to the OOP max.

  This doesnt make sense. Either the CSR was misinformed or there was some communication issue (e.g., not using the terminology correctly).
What the CSR says makes sense only if the insurance negotiated rate is $1,300.
ETA: Who do you pay the $300 to in your example? The hospital? But they already got $1,000 (either from you or the insurance), which is the negotiated rate. If $1,000 is the rate, how do they get to pocket $1,300?

fwuser12 said:   
trekwars2000 said:   
doveroftke said:   
trekwars2000 said:   and not credited towards a bill at all.
  
Not quite sure what they meant by this, it is part of the hospital bill. For example, the hospital bills $2000, of which $1000 is the insurance negotiated rate, you pay the $300 copay, the insurance company pays the remaining $700.

  I asked that exact example to the CSR and he said the copay did NOT apply to the overall bill.  I would still owe the $300 copay and then the $1000 negotiated rate.  That is why it sounded fishy.  I asked where the copay went and he said it only got credited to the OOP max.

  This doesnt make sense. Either the CSR was misinformed or there was some communication issue (e.g., not using the terminology correctly).
What the CSR says makes sense only if the insurance negotiated rate is $1,300.
ETA: Who do you pay the $300 to in your example? The hospital? But they already got $1,000 (either from you or the insurance), which is the negotiated rate. If $1,000 is the rate, how do they get to pocket $1,300?

  Agree 100% that it didn't make sense.  I even asked who I would pay the $300 to (hospital, ER doc, etc) and he said hospital.  He then said it was clear I did not like my coverage and I should take up any concerns with my HR dept. 

Perhaps he was just incorrect. 

trekwars2000 said:   
fwuser12 said:   
trekwars2000 said:   
doveroftke said:   
trekwars2000 said:   and not credited towards a bill at all.
  
Not quite sure what they meant by this, it is part of the hospital bill. For example, the hospital bills $2000, of which $1000 is the insurance negotiated rate, you pay the $300 copay, the insurance company pays the remaining $700.

  I asked that exact example to the CSR and he said the copay did NOT apply to the overall bill.  I would still owe the $300 copay and then the $1000 negotiated rate.  That is why it sounded fishy.  I asked where the copay went and he said it only got credited to the OOP max.

  This doesnt make sense. Either the CSR was misinformed or there was some communication issue (e.g., not using the terminology correctly).
What the CSR says makes sense only if the insurance negotiated rate is $1,300.
ETA: Who do you pay the $300 to in your example? The hospital? But they already got $1,000 (either from you or the insurance), which is the negotiated rate. If $1,000 is the rate, how do they get to pocket $1,300?

  Agree 100% that it didn't make sense.  I even asked who I would pay the $300 to (hospital, ER doc, etc) and he said hospital.  He then said it was clear I did not like my coverage and I should take up any concerns with my HR dept. 

Perhaps he was just incorrect. 
 

  
Have you gotten an EOB yet? That should clear things up.

No EOB. This didn't actually happen. I was just trying to figure out how the billing would work before it actually happens.

copay typically means a negotiated charge in lieu of the actual charge for a standard appointment ( insurance would then cover the rest ). So I would expect $300 to be the charge to you for the ER visit itself, while any tests etc. ran during the ER visit would be extra and subject to the deductible.

I would probably try calling back and talking to a different CSR.



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