Posts filed under ‘medical’

Insurance Renewal Time: Our Deductible Resets to $3000

laptop and stethoscope

Our insurance plan will renew on December 1st, which unfortunately means that the clock will also reset on our deductible. With a high deductible insurance plan my husband and I will have to shell out $3000 before our insurance kicks in any money for doctors visits or prescriptions.

This is only the second year we’ve subscribed to one of these plans and due to a series of unforeseen medical issues it is the first time we actually met our deductible. Unfortunately we paid $2600, (last year’s deductible), before the insurance company threw in a dime.

Since we’ve already paid the maximum amount this year I’m looking to see what other medical expenses I can squeeze in before year’s end. My first goal is to fill all of our prescriptions prior to December 1st. According to my pharmacist I can renew prescriptions after 75% of the medication has been used. I have two prescriptions to refill. One of them is eligible for renewal just two days before my deductible resets! I actually scheduled a calendar alert to remind me on the day I am eligible.

I plan to get the most bang for my buck by transferring those prescriptions to a different pharmacy. We have three pharmacies within a mile or two of our home, so it doesn’t really matter which I choose. I’ll earn two $25 gift cards just for making the switch. One of the prescriptions cost $25, so that extra money is kind of a wash. The other one doesn’t cost us anything so using the prescription transfer is kind of like earning free money.

As far as doctors are concerned I’m hopeful that my husband’s medical issues won’t require too many follow-up appointments. If we hadn’t already met the deductible his last visit to the podiatrist would have cost us $910! Luckily his next appointment falls a week or two before December 1st and he’s already feeling better from just one visit, which is really great news!

My son also needs a follow-up appointment to the pediatrician. He may actually need two visits and although I can squeeze one in early next week I’m not sure if I’ll be able to fit in another one before the looming deadline. According to the last explanation of benefits a similar appointment will cost us at least $140.

I miss the days of $250 an $500 deductibles, but I don’t miss the higher monthly premiums that come from selecting those options. I keep reminding myself that even if we do pay the entire $3000 deductible again next year we’ll still pay less than we would for a more traditional plan. It doesn’t make me feel a whole lot better, but it’s something.

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November 5, 2014 at 5:13 PM 3 comments

Insurance Options: HSA, HMO or PPO

piggy bank

I sat down this weekend to review our insurance options for next year. As owners of a small company my husband and I spend a ridiculous amount of money on insurance premiums each month. I don’t miss much about my working days, but I do miss the benefit of employer provided insurance. In 2011, (the last year I was gainfully employed), I paid less than $2000 in premiums for an entire year’s worth of insurance! My employer paid $8,725. These days we are on the hook for the entire $10,000 to $18,000 bill!

Our options for next year include three different plans; a PPO, an HMO and a high deductible HSA plan. The breakdown is as follows:

Type of Plan Monthly Premium
PPO $1,541.71
HMO $1,082.90
HSA $843.07

These numbers are quite specific to our little family of three. The premium is based on each of our ages, so I know that the PPO plan costs $611.94 for me, $615.89 for my husband and $313.88 for my son.

The difference in premiums is quite substantial. The PPO plan costs $698.64 more than the HSA plan per month and $8,383.68 per year.

Type of Plan Yearly Premium
PPO $18,500.52
HMO $12,994.80
HSA $10,116.84

Of course the premium calculation is not the only factor to consider. The breakdown of deductible costs are as follows:

Type of Plan Deductible
PPO $500
HMO $0
HSA $3000

Comparing medical plans is like comparing apples to oranges. To better even the score I added deductibles to the yearly premium totals. In the worst case scenario, (like this year), we will pay the entire deductible before our insurance kicks in.

Type of Plan Yearly Premium + Deductible
PPO $19,000.52
HMO $12,994.80
HSA $13,116.84

As you can see the HMO plan is the cheapest overall option, but I am not a fan of HMO plans. I’ve experienced my fair share of medical issues and I know how difficult it can be to navigate the health care system when troubles abound. I have no desire to wait around for doctor referrals when I am in pain or in need of care. Especially not to save $122.04 a year.

After ruling out the HMO I tried to break down the costs of the PPO and High Deductible plan even further. There are definitely more upfront costs with the high deductible plan. For example, I would owe a $30 copay for medical treatments like allergy shots, physical therapy, and acupuncture. The same goes for x-rays, lab work and other diagnostic procedures. If we experienced a truly horrible year we could easily pay hundreds to thousands of dollars for these services. The maximum out of pocket costs for the HSA plan are $8,000, which means I could pay a total of $5,000 more after meeting the yearly $3,000 deductible.

It seems even in the very worst case scenario the HSA plan is a better deal. After accounting for deductibles the difference between the HSA and PPO plan is $5,883.68, which means even in the very worst case scenario I will save $883.68 by choosing the HSA plan.

The high deductible plan also allows me to save $6,650 per year in a tax advantaged account, which means some of my dollars will be spent before tax further boosting my overall savings.

What do you think? Am I missing something important? Is there something else I should consider when choosing between these plans?

October 12, 2014 at 5:55 PM Leave a comment

A Happy Medical Bill Update

Medicine Bottle

I appealed my unexpectedly high out of town medical bill and received notification that a portion of my $875 bill will be covered after all. Since the facility is out of network I am responsible for 20% coinsurance on the total, which amounts to $175. I also owe the negotiated rate, ($165.59), for a $268 doctor’s bill.

Rather than paying $1148 I now appear to owe only $340.59. (I say appear to owe because the Explanation of Benefits have not been finalized yet.)

Readers of this blog may remember that I was contemplating the decision to drive twelve hours roundtrip to avoid paying out-of-network prices. I would have paid roughly $80 in gas plus a $30 copay to drive north, which means staying put only cost me $230.59 more and a whole lot less hassle and headaches.

Yay!

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October 10, 2014 at 5:17 PM 4 comments

That Out-of-Town Medical Bill Gets Bigger!

medicine

Last month, after much contemplation, I decided to remain in North Carolina rather than driving over two hundred and sixty miles back to Maryland for an unexpected medical test.

I was all set to pay a higher price for that procedure and called in advance to receive a quote. Unfortunately, on the day of the scan the hospital could not confirm the quoted price.

My original $550 estimate went right out the window. It was too late to choose a different facility, (the test had to be performed within a specific time frame), so I proceeded without any idea of what I might actually owe.

Well the first bills have arrived and my final cost is twice the original estimate! The quoted $550 procedure was correct, but an additional and completely unexpected charge of $330 was included in my bill along with an additional doctor’s bill of $268. The ugly total; a whooping $1148!

On top of that my insurance company has denied the claim due to lack of preauthorization. I knew that I would pay the out-of-pocket total but I hoped that out-of-network rates would apply and that the final payment would be added to my yearly deductible. As of now, no such luck.

For those wondering I did ask the doctor’s office requesting the exam to seek preauthorization from the insurance company a week before the test was scheduled. They called twice and were told on both occasions that preauthorization was not necessary. So my only recourse is to appeal the denial and hope that the claim is reprocessed.

Despite this rather hefty medical bill I am still happy with my decision to stay in North Carolina on the day of the test. My family was in town with me that week and I did not tell them about the scan. I don’t like them to worry necessarily. If I had gone home I inevitably would have told them or lied to them about my need to return to Maryland.

It would have been a six hour drive each way, which would have been a twelve hour round trip, not including the time at the doctor’s office getting scanned or a twelve hour drive plus an overnight stay in Maryland away from my family.

If the outcome was poor I would have spent six hours driving alone contemplating those results, which would have made for a rather somber and depressing ride.

I am certainly not happy paying over $1100 for a procedure that should have cost nothing more than a $30 copay. I am still hopeful that the claim can be properly appealed and that the final cost will be closer to five or six hundred dollars.

It was certainly not the frugal choice, but if I choose the frugal options all along the way, then every once in awhile I should get to select an option that makes sense in ways that aren’t financial. At least that’s what I’m telling myself to help me feel better.

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September 7, 2014 at 11:01 AM Leave a comment

A Follow Up to That $440 Question

Needle

I decided to spend the extra money to avoid the twelve hour round trip drive from our vacation spot to my doctor’s home office. I’m frugal enough in other aspects of my life to weather the $440 bill. Unfortunately, when I arrived at the hospital the clinical staff could not confirm the cost of my test. I was told that my initial estimate was probably correct, but that the hospital could not provide the exact cost. Apparently the hospital farms out their billing processes to a third party who could not be reached to provide an estimate either.

I asked if I could receive the total cost and pay cash up front and in advance to receive a discount, but since they couldn’t provide a price they had no way of making this happen. So I have no idea if the bill will be larger or smaller than the $550 I was originally quoted. This gets a little scary when it comes to medical procedures because something that should cost $550 may very well end up costing me $3000.

At that exact moment in time I had no choice but to move forward with the test. I could not reschedule a test closer to home within the necessary time frame required by my doctor.

When my doctor received the results of the exam they told me I would need to have it repeated. While the test revealed a number of items the doctors were looking for, it was inconclusive about one specific issue.

A commenter on my blog asked if the test might need to be repeated and while I knew it was a slim chance I nearly laughed out loud when the nurse told me they only trust their own technicians.

The day after I return from vacation I will drive to the doctors office for a repeat scan. At least I know I’ll only owe a $30 co-pay this time around. I am a bit terrified that this last scan is going to cost me an inordinate amount of money!

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August 17, 2014 at 4:37 PM 2 comments

What Would You Do? Drive 12 Hours to Save $440?

piggy bank

My doctor wants me to undergo a specific medical test. I am currently out of town and didn’t plan to return for at least three weeks. If I seek medical attention while I’m away all services will be priced out-of-network, which means I will pay full price. We are not even close to meeting our $4000 out-of-network deductible for the year.

The estimate for the procedure is roughly $550. In order to use my in-network services I need to drive over six hours home and another six hours back. That’s twelve hours of driving I did not intend to incur.

I initially planned to make the long drive, but after further consideration I’m just not so sure. I’ll need to drive a total of twelve hours alone. I would probably drive home the night before the test, drive to the test that morning and then drive back to the beach. I’ve done this before, but twelve hours in the car alone is quite exhausting.

If I make the drive home I’ll owe a $30 co-pay plus at least $80 in gas expenses. That makes a $440 difference between using an in-network provider versus a local out-of-network provider. (I’ve already met my in-network deductible for the year.)

So what do you think? Should I make the long haul back to my in-network doctor and save myself $440 or should I suck up the cost, stay at the beach and keep in my mind that I have plenty of money saved to pay this bill, even though I absolutely hate to pay that much money unnecessarily?

Honestly I cannot decide what to do and for those that are wondering I cannot delay the timing of the test. It must be performed during the three weeks that I am scheduled to be away.

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August 9, 2014 at 11:56 AM 8 comments

I Have No Idea What I Owe

Medical Bills

For over a decade I bought my health insurance through my employer. I paid a couple hundred dollars a month for a PPO plan and my company subsidized the rest. That insurance plan seemed to cover everything. If I needed to visit an acupuncturist, chiropractor or any type of specialist I paid a small co-pay and very little else. I paid a few hundred dollars for this care and my employer picked up the rest of the tab. I had no idea how valuable that benefit until 2011 when I was laid off.

When my job ended I opted to use COBRA for a year. My son was born a few days prior to the layoff and I wanted solid insurance in case anything should happen. Thankfully we never needed our insurance that year, but we continued to pay a $1500 monthly bill nonetheless.

Shortly before my COBRA coverage was set to expire we switched to a high deductible insurance plan. Even with the high deductible we still pay over a thousand dollars a month. The new insurance plan seems to cover a lot less than the old one. Acupuncture and chiropractic work are no longer included a long with a whole host of other treatments.

I understand that I no longer have access to the rolls royce of insurance plans, but I am amazed by how little the plan covers given that I pay only a few hundred dollars less. The most troublesome part of my new insurance plan is the amount of time it takes them to process claims. My previous insurer would process claims within a matter of days. The new one takes months. I am still waiting on claims from February to be finalized.

Between February and now I visited a multitude of doctors in hopes of curing my antibiotic induced neuropathy. I have a general idea how much my appointments and tests cost, but I have absolutely no idea what I will actually owe. I have to wait to see how the insurance company’s negotiated charges impact the bottom line. I have a $2600 family deductible and at this point I would assume I already owe that entire amount. Though it would certainly be nice to receive an Explanation of Benefits (EOB) detailing that fact.

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May 2, 2014 at 6:31 PM 5 comments

Free Money in my FSA Account

I found another silver lining in my company’s decision to lay me off. I’ll actually get a few hundred free dollars from my FSA account. My FSA account is pre-funded so I am able to spend the entire amount at any point in time throughout the year.


I have roughly $1,000 remaining in my account, but the entire amount will be utilized to cover the costs of copays and hospital bills related to the birth of my son. Since all of these expenses were incurred prior to my lay off date I can expense them all through the FSA plan.

Normally I would make contributions to the account with every paycheck, but this year I’ll be laid off before I can make the final four payments. I contribute roughly $160 each pay period to FSA, which means I’ll forgo paying the remaining $640.

If I hadn’t used all of the funds before my termination date I could have extended my FSA account through a COBRA plan, but I’d have to pay to continue with post tax dollars, which defies the purpose of using an account like this in the first place.

Luckily I used all of my medical dollars well in advance of my termination date, so I am able to use the entire pre-funded amount without having to contribute all of the money.

November 3, 2011 at 2:00 AM Leave a comment

Cost of a Hospital Delivery: $2,140.73

A quick search on the website of my health insurance provider estimated the costs of a vaginal hospital birth at $13,193. The average cost for a cesarean delivery is listed as $18,308. That’s actually a lot less than I would have predicted, but a lot more than I’d like to pay.


Now that I’ve picked a doctor and hospital I called my health insurance provider in the hopes of attaining a better estimate of the cost of child birth. While they couldn’t provide any estimates on the cost of coverage, (they said every hospital, procedure and doctor would have different pricing), they did tell me that I would be responsible for 15% of all expenses and they would cover the other 85%.



The representative I spoke to reviewed my medical history/insurance usage so far this year and let me know that I’ve met the deductible and a small portion of my coinsurance. Based on the information on file she said I should not expect to pay more than $2,140.73 out of pocket.


It just so happens that I have $2,552.42 remaining in my FSA account, which means that our pre-tax estimate this year was right on target. I’ll have a bunch of co-pays and other expenses between now and the time I deliver. I will also have a bunch more after the little one arrives, but I bet the FSA will cover almost all of our medical expenses this year.


I deferred $4,000 into my FSA at the beginning of the year in the hopes that I would get pregnant this year, but of course you just never know. It’s crazy to think that this little miracle happened and that we estimated the total cost of care so perfectly.

August 18, 2011 at 1:30 PM 3 comments

Perseverance Helps Pay Off My Medical Bill

Two hours before undergoing a medical procedure in January I was informed that the hospital refused to bill my insurance carrier directly. In essence, I was told that I would be responsible for paying the bills because the procedure is deemed experimental. Before any medical care could be administered I was asked to pay $1000 to the hospital and doctors. I was also asked to sign documents agreeing to be billed for the remainder. My husband asked me to forgo the procedure until we could work out the billing issues, but I had already put off the procedure for over a year and I simply couldn’t bear the thought of waiting any longer.

I have written about the trials and tribulations of that horrific day in the hospital on a number of occasions. To this day it amazes me that I went forwarded with the procedure. At that exact moment in time I had absolutely no idea how much I would owe the doctors. What I did know was that I had lived with an unbearable amount of pain for much too long and that a possible cure sat five feet away behind a curtain.

A few weeks after the procedure took place bills began to flow in from the hospital. In total I owed $5,904.66. Prior to the procedure I was informed that my self-pay status prevented the hospital from billing my insurance carrier directly. However, I was assured that I would be able to submit the claims myself. I’ve visited a lot of out-of-network providers who require me to submit my own claims, so I am used to this process. It is a bit inconvenient, but it’s typically not too terrible.

When I received the first bill I called the hospital and asked for the procedure and diagnostic codes required to submit a claim. A billing representative informed me that my self-pay status prevented the retrieval of those codes and that without those codes I could not submit a claim to my insurance company. I explained what I had been told on the day of my procedure but the representative assured me that the system would not provide the codes I needed. I talked to a number of representatives and managers over the next four months, each provided me with the same information.

I was furious. Although I agreed to self-pay it was my understanding that I could still submit a claim to my insurance company. Now I would be forced to pay the entire amount without any reimbursement from my insurance carrier. Fed up with the billing department I wrote a letter to the patient relations coordinator at the hospital. Days later the coordinator offered to assist me. That first conversation occurred in April.

The patient relations coordinator wasn’t able to help me, but she did put me in contact with a number of individuals in the billing department. I had been paying the hospital bill on a monthly installment plan and I explained that I would continue to pay the bill even after they provided the claim information. Day after day I sent emails to those individuals asking for assistance. Day after day they assured me that they could not help me.

Finally a few weeks ago I had a break through with one of the employees in billing. Although she would not send me the claim information she did agree to submit a claim to the insurance company. Yesterday my insurance company received and processed the claim. They paid $604 of a $789 bill. Unfortunately, the procedure was broken up into multiple claims so I must now ask the billing department to submit additional claims for the other procedures.

In the mean time I also asked for itemized bills and found that I was charged over 60 minutes for a procedure that lasted less than 10 minutes. Apparently the hospital charges patients for the amount of time spent in the pain clinic, not the amount of time taken for the procedure. In my case, I spent an additional 50 minutes in the clinic as my husband continued to deal with the billing debacle. Since the billing issues were not our fault I contacted the pain clinic and asked them to review the bill. After review the bill was reduced by 52 minutes or roughly $1300.

Between the $1300 billing error and the $604 in processed claims I’ve saved myself over $1900. Although it has been more than eight months since this procedure I am afraid to say these billing issues are still not over. It has been so long since the procedure that my claims are now fully paid. That means my insurance company will pay the hospital and I will receive a refund only after the hospital receives the insurance payment. I also need the hospital to submit additional claims to my insurance company.

After eight months of waiting and working with the hospital I am elated to have made progress on this issue, but I am saddened by the amount of time and energy it has taken me to seek a partial resolution. When you are sick or in pain the last thing you want to do is fight and argue about financial issues.

September 12, 2008 at 3:00 AM 1 comment

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