Saturday, November 16, 2013

The reality of living with a high deductible medical insurance plan and a health savings account

My new, high deductible ($4000 for me and the kids under the "family" plan)medical insurance started July 1 and will run through the end of June before starting the new, fiscal year. During that time, although preventative care is covered at 100% (annual physicals, well woman care, flu shots) all illness related charges, medications, most tests etc are expenses incurred by us until we hit the deductible ($4000). One perk of this new plan is that my employer will contribute $2000 (and I can match up to an additional $4500) per year into a Health Savings account, which are tax free funds that accrue until my retirement, when they are taxed. Meanwhile, the $ in the HSA is used to pay for the aforementioned, not yet covered until I hit my deductible, medical expenses. Another benefit is no longer having to keep track of co-pays for visits, simply show my insurance card, wait until the billing is processed my insurance  and either the medical cost is paid by the insurance company or I have a medical debt obligation to meet, until I hit that magic $4000 in expenses, which we quickly did this past Summer, especially as I was in physical therapy post surgery. I was able to work out interest free payments to the hospital to reimburse them monthly for the rehab therapy I received. I am depositing $200/month into my HSA and paying the hospital off the same amount monthly until the obligation is met. Fine. No impact on our budget. Caveat is to stay "in plan" with providers as there is a discounted rate and no paper work. Go outside of network, there is a deductible, and there is no in plan, reduced rate. You would be lucky to get 80% back.

Fast forward, and an orthopedist has me taking mega doses of Advil twice/day to help me with hip tendonitis. I am to be on this mega dose for 2 weeks. Concern is that this will impact my GERD so I placed a call in to my gastro MD. Yes-take the (generic) Advil BUT you MUST be on Prevacid. I compared prices (generic version at small town, local pharmacy was $35! close to $50 something for the name brand) so I didn't get it there while I was picking up a RX for another ailment. (free BTW as we hit the deductible). So, today, my errands included a stop at my least favorite store (I was in the area thankfully as I plan my errands to conserve fuel) for $12 and change. This is one OTC medication that I CAN use my HSA for, so I paid for it, using some of the funds that my employer placed into this account-bottom line, free to me, no impact on my budget.

I also placed a call into my Allergy-Asthma-Immunologist who I saw in early October for my annual visit, and a concern over a lingering cough from a recent cold. He felt it was GERD flaring up, advised me to take a month of Prevacid, see what happens and call if the cough remains. Still coughing, and I use RX nasal sprays to combat allergies so just what is this? Calling avoids a MD visit and he simply called in a generic antibiotic, suspecting that this is a sinus infection just lingering, causing post nasal drip and therefor the cough. If the meds don't help after a week, I am to call again and see him for a visit. Fine. The bulk of my MD's follow this protocol, saving me time and ultimately $. Again, we hit the deductible, the RX cost me $0.

I also am a very compliant patient. I see some of the best MD's in the country, I am fortunate, as well as selective. I resent the practice of forcing a patient to see a PA before seeing the MD. While I understand that this can free up the MD's time to see more patients, the insurance company pays the same amount regardless of who I see in the practice. I recently had a follow up visit with an orthopedist I know very well, after having a MRI. In walks the nice PA. Great guy, well educated, personable. I politely, yet firmly, insisted on speaking with my DOCTOR who I saw just the week before. I am paying to see HIM, not the PA. Bottom line, I remain assertive when it comes to my medical care. So while the PA gave me the "update" on the MRI results as well as some possible treatments, I insisted on speaking with the orthopedist, who I am paying to consult with me on my medical care.  When I called my gastro MD yesterday, I spoke with the nurse and explained that the orthopedist asked me to consult with the gastro Doc before starting the course of Advil. She got back to me a while later, told me what to do and mentioned that it's been a while since I saw gastro guy (been focusing on orthopedic issues the past few years) and would I make an appointment? Sure, she patched me through to scheduling, who insisted that I first see the PA. I explained that the last time they did that in this practice, I had to insist while at the appointment, to see my gastro MD as the advice of the PA was totally opposite what the MD had me doing. She complied, the MD came in and confirmed that I should continue doing as he had been advising me to. @@ Sigh. Apparently that PA is "no longer associated with the practice" but there is a new one. Hmmm . .I made an upcoming appointment, but have absolutely no reservations about asking to see the DOCTOR who is the one who said to come in and see HIM. Anyway . .

 I am addressing medical concerns as cost effectively as possible:
-using in plan facilities, doctors
-selecting generic meds,both prescriptive as well as over the counter
-using mail order for our maintenance meds and being sure to renew them just prior to the end of June to max out this "freebie"
-making medical appointments now (before the June end of fiscal year) to address medical ailments, especially what I would characterize as "less serious/urgent" such as an appointment with the dermatologist. I do have some dermatological concerns which will be covered in full by insurance, including medications. I will also have some treatments of a more cosmetic nature. Getting costs ahead of time, and knowing what they will be, will guide my ability to use the funds in the HSA to cover these additional charges. I am able to deposit lump sums, if needed, into my HSA to cover these extra costs (up to an additional $2500/year) I will once again start July 1 with $2000 from my employer. Any charges beyond that cost for upcoming procedures/therapy/meds this Summer, will be worked out for a payment plan starting Sept.
-besides the orthopedic issues I am addressing, the next 6 months will find me at the dermatologist, dentist, gastroenterologist, a new internist (yet to be determined as my former one is now retired) for a physical, my gynocologist, as well as handling some routine medical tests such as mammography, colonosccopy now that I've hit the magic 50. I am also anticipating additional surgery on my hand, come Spring, which will be again followed by weeks of OT at the rehab center. Knowing this, I can anticipate once again, quickly maxing out the $4000 deductible in the Summer of '14, thereby placing us in the position we are in now, with medical expenses being fully covered, if in plan.

It's been an interesting ride so far, a definate adjustment but I think I've got a good handle on it.


DW said...

It sounds like you're doing quite well with it ... and the contribution from your employer helps a lot, I'm sure.
A question, is the $4k a deductable or your out of pocket costs. My HD plan has a deductable, but when I reach that, it's an 80/20 payment until I hit the out-of-pocket max ... then everything is covered 100%

CTMOM said...

THe $4000 is a deductible-we have to incurr $4000 (not including well woman care or annual physicals which are all covered 100% if in plan). Once we hit that deductible, then the rest is covered @ 100% unless out of plan, where there is 80/20 of reasonable and customary. We are in an expensive area, so reasonable and customary is hard to bargain with when EOB's don't cover it all.