Anyone Make a Claim, with Individual High Deductible Health Insurance Policy?

[John Galt III]

Well, I just clicked the submit button on my application to Capital Blue Cross for a HDHP (high deductible healthcare plan).

It has emergency room coverage at only $100 per visit with no deductible and no coinsurance. Hopefully I won't ever use it, but...

I was just wondering if anyone here has used a HDHP individual policy, to access emergency room care (or any other care, actually) , and if the coverage was what you had expected.


Thanks!

[stargazer08]

I have. Was a very smooth process. I had 2 emergency room visits for migraines and a couple of doctor visits.

The doctor visit was the most troublesome because they want their money up front but had no clue how much my bill would be. I over paid and I had a heck of a time getting that overpayment back. I think I was one of their first HDHP customers.

Now they're on board with how the process works. They bill insurance, get the discount rate amount and bill me for that.

[MooreBonds]

Have had an individual HDHP since HSAs first came out a number of years ago.

My first 'claim' was when I had a little head pains from really loosing my temper for the 2nd time in my life (family issues...sigh ). Went to my primary care physician about 2 days later, who figured it was nothing, but recommended I get an mRI just to be safe. She suggested a local hospital.

I then asked her how much it would cost, or if there were cheaper places around (since I had never had a medical procedure before, and had no idea what kind of cost ranges there were for an mRI). She looked at me like I just asked her who won Wimbledon in 1973 ("well why the hell should I care?")

After I reminded her that I had a HDHP and that I would be paying for it out of pocket, she still didn't really care if that may have been the best/most cost-effective place. It's not like I still had throbbing pains in my head -it was just really a one-time thing that went away after a few minutes, so it was just a safety check and wasn't an emergency.

I double checked my plan and the hospital was "in network", but still worried about the stories of "I went in for a procedure, and it turned out Dr. X and nurse Y were in network, but the anesthesiologist/radiologist/et. al. turned out to be out-of-network, etc.".

Ended up being all in-network. "List price" for the mRI was $3,300, but my network/plan price was $1,100. They still run everything through insurance before you get the bill (because at the time of service, they don't know and don't care what your deductible is, just what your co-pay is)...so I didn't have to pay for anything until they billed me at the network rate a few weeks later.

So, bottom line is, it (should) work just like any other insurance plan, low deductible or high - give them your card at time of service, they bill it to your plan, you get the EOB from your insurance company 3 weeks later, and a bill from the provider a few weeks after that.

Since you cover the first $X for the HDHP, it's a good idea to know ahead of time which ERs in the area are in your network, just in case. It's true that any emergency room is "in network" in true life-is-on-the-line situations, but some times an ER visit isn't for truly life critical trips, so just an extra 2-3 minutes could mean the difference between a $2,000 bill and a $8,000 bill.

[zinger1457]

My first HDHP/HSA policy in ER was with Aetna and I selected the lowest cost plan available at the time, which didn't include doctors office visits except for the annual physical checkup. My health is good and my thinking was that if I did have to visit the doctor I would just pay the standard insurance company negotiated rate for an office visit from my HSA account. Wrong thinking!!! It was a fairly cheap ($75) lesson learned but the insurance company said I only qualify for their negotiated rate for those items covered in my policy.

[grasshopper]

One thing you need to watch for too is lab work, if lab work is done at a hospital sometimes the procedure isn't coded right. My physicians group can do lab work on the premises, but BCBS only covers LabCorp and one other company. Also what you don't know can cost you, I had a biopsy done and was lucky LabCorp did the slice and dice, but not the pathologist reading. $1500 paid total by BCBS, $750 paid by grasshopper for the reading( would have cost $1500 without BCBS. Who knew, you always think your doc is looking out for you.

[John Galt III]

Quote:

Originally Posted by stargazer08 I have. Was a very smooth process. I had 2 emergency room visits for migraines and a couple of doctor visits. The doctor visit was the most troublesome because they want their money up front but had no clue how much my bill would be. I over paid and I had a heck of a time getting that overpayment back. I think I was one of their first HDHP customers. Now they're on board with how the process works. They bill insurance, get the discount rate amount and bill me for that.

Stargazer,

Thanks. For the emergency room visits, you had no surprise charges?
DId you pay a flat fee for each ER visit, and no more?

My plan specifies $100 for an ER visit, so I am assuming I would pay only $100 no matter how many doctors looked at me in the ER and how many xrays, etc were done in the ER.



JGIII