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HDHCP & HSA ?'s
Old 10-31-2013, 11:23 AM   #1
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HDHCP & HSA ?'s

It's open enrollment time at my j*b again. Not complaining, actually quite appreciative to have a job with health insurance, among other benefits.

Right now we have a rich (and expensive) PPO plan through United Healthcare.

I'm about 4 years, 229 days and 12 hours to retirement (but who's counting) and am thinking that starting an Healthcare Savings Account (HSA) and chucking all we can into it for the next 4 years probably makes good tax sense for us.

DH was diagnosed with cancer 5 years back, so that always weighs on my mind, even though he's about to be declared "cancer free" (fingers crossed).

That's the background, here's my question: The High Deductible Health Care Plan (HDHCP) offered through my employer is through Aetna. We tried a non-HDHCP Aetna plan about 7 years ago, and it was kind of a nightmare. We had a 20% deductible on everything, but it always seemed Aetna was disallowing charges because they were above Reasonable & Customary, or the ER doctor in a small town who treated my son was "out-of-plan", etc. I think we used up our FSA money before June that year, and still hadn't met our deductible with them due to all their fine print rules.

Anyone else have any experiences to share with their HDHCP and/or Aetna?

And, we can also have an HSA AND a Limited Purpose Flexible Spending Account at the same time. It took me a while to get it, but I think I understand it now.

Too many acronyms!!!!
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Old 10-31-2013, 11:26 AM   #2
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I had an HSA with Aetna HDHP through ex-Megacorp until April, and I really didn't remember having any more problems with it than any other health plan in terms of getting them to pay up. Others may, and will, have varying mileage.
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Old 10-31-2013, 12:28 PM   #3
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We have an HSA w/HDHCP. $6k deductible I believe. We enjoy the flexibility, tax savings, and insurance negotiated provider rates. We don't max it out, but do get the full employer match. Would put it third in line for filling each year behind 401k and ira's.

Never had an issue with the provider. This year the IRS asked to look at our 2011 receipts, as we had considerable health expenses that year. One letter back and the issue was resolved in my favor.
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Old 10-31-2013, 01:01 PM   #4
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Originally Posted by SumDay View Post
Anyone else have any experiences to share with their HDHCP and/or Aetna?
Aetna has been handling the insurance program through DH's Megacorp for several years (this is a self-funded plan for Megacorp).

It has gone fairly well. My main issue has been that Aetna is inconsistent in how it processes out of network claim. My kids regularly see an out of network provider and there are recurring charges that are always the same amount.

So, let's say the charge is $150. Note this charge is for the same thing from the same provider every time.

Aetna determines the allowable amount for the $150. The thing is that the amount deemed allowable varies widely and can even vary in the same EOB. It might be $150 very rarely or $75 or $95 or $115. There is just no predicting what it will be.

Early on DH would call Aetna when we would get an EOB where the variance was there. Aetna would agree that this didn't make sense and would then redo the determinations of the allowable amount (usually picking a middle ground number). However, this determination would never "stick" when we reported the charges the next month. It would be back to being varying amounts.

Also, occasionally they would refuse to allow anything on a charge saying that they needed information as to the education and qualifications of the out of network provider. OK. Fine. Except....they had previously allowed charges for this same provider many times before.

Basically, it often seemed like they would start anew with each invoice we sent them and no one ever looked to see what they had previously allowed for that provider for the same service for the same patient. That seems really inefficient to me but that seems to be how they do it.

Oh, the most annoying thing dealt with the invoices we received from the provider. We would often receive an invoice from the out of network provider showing the amount charged. Then the provider would run our credit card and provide a separate statement showing the amount paid by us. I would submit both of these to Aetna. This totally flummoxed Aetna. They refused to pay the charges saying that both the charge to use and the payment had to be shown on the same piece of paper. So, I had to go back to the provider and get the statements redone to show the charge and the payment on the same page. Finally, Aetna paid (this took forever to resolve so I'm condensing all of this quite a bit).
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Old 10-31-2013, 02:07 PM   #5
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Originally Posted by SumDay View Post
That's the background, here's my question: The High Deductible Health Care Plan (HDHCP) offered through my employer is through Aetna. We tried a non-HDHCP Aetna plan about 7 years ago, and it was kind of a nightmare. We had a 20% deductible on everything, but it always seemed Aetna was disallowing charges because they were above Reasonable & Customary, or the ER doctor in a small town who treated my son was "out-of-plan", etc. I think we used up our FSA money before June that year, and still hadn't met our deductible with them due to all their fine print rules.
We have had Aetna for a few years now. We have a plan with $0 deductible and 10% coinsurance (but it will change next year). We have been careful to stay within the plan network, and our doctors have been careful to check that labs and referrals stay in network as well. We have had no problems since in-plan providers all have negotiated prices with Aetna. We haven't had to use any out of network providers.

Our plan pays only 50% of "reasonable and customary" charges for out of network providers. So if an out of network provider charges us $1000 and Aetna says "reasonable and customary" is $200, Aetna will reimburse us 50% of $200, $100. We would then be on the hook for the other $900. In network, Aetna may have a negotiated price of $180 of which we would owe 10%, $18. That's why we're careful to stay in the network.

We do go out of network with our dental insurance. We get charged an extra $1 once in a while when the dentist's charges are that bit more than "reasonable and customary", but otherwise have full coverage. Dental insurance has usually been easier to deal with out of network.
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Old 10-31-2013, 05:26 PM   #6
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Quote:
Originally Posted by SumDay View Post

That's the background, here's my question: The High Deductible Health Care Plan (HDHCP) offered through my employer is through Aetna. We tried a non-HDHCP Aetna plan about 7 years ago, and it was kind of a nightmare. We had a 20% deductible on everything, but it always seemed Aetna was disallowing charges because they were above Reasonable & Customary, or the ER doctor in a small town who treated my son was "out-of-plan", etc. I think we used up our FSA money before June that year, and still hadn't met our deductible with them due to all their fine print rules.

Anyone else have any experiences to share with their HDHCP and/or Aetna?
Whenever you go out of network you have this problem with "reasonable and customary" charge, and all the insurers do this. If you get an ACA compliant policy, however, emergency care must be treated as "in network" even if the ER you are using is not in the network.
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