Wednesday, June 25, 2014

Taking care of business

Image: http://images.askmen.com/sports/health_100/111_mens_health-flash.jpg

The Summer months often find us at the doctor's office, it's simply a matter of time (annual physical around birthdays or convenience as we are off work/school). This year, now that we are under a new, high deductible medical plan, with our deductible already met, we must take advantage of this "it's all free as long as you are in plan" situation. These past few weeks have found me at the pharmacy for RX in preparation for some upcoming procedures, the hospital for physical therapy for my shoulder (sadly, out of benefit, so this is costing me, but I have a plan-see previous post) with only one more appointment left next week, the gastroenterologist,  the dentist for a cleaning and later for some repair work, the orthodonist for a night guard retainer (apparently I am night grinding). This week will take me to the allergist for my annual check up and RX refills (do mail order-again freebie), the gynocologist. Next week is my hand surgery, and I know that 6 weeks later, I will start OT for my hand. Still already on the calendar as set appointments: my mammogram, colonoscopy, endoscopy (learned that the colonoscopy would only be covered (paid out) if I had met the deductible, and it costs over $4000! the endoscopy would not be covered either, unless the deductible was met. I am guessing that the charge for that is $2000. When I called insurance to check on my benefit plan, I asked if a letter of medical necessity was needed to cover the endoscopy. Nope-that is the policy. Thud! so, I know to plan those type of tests AFTER meeting a deductible for the year). I need to find a new Internist as my former one is now retired. I may also return to the dermatologist in this same time frame (prior to Sept 1). I also need to order some mail order refills before the magic Sept 1 date. Any out of pocket dental expenses or out of plan co insurance costs are covered through my remaining HSA funds, which ar about $1000.  DD is responsible to cover her OOP expenses. DS #1 struggles so I have agreed to cover his glasses (desperately needs new ones).

The kids are all under my plan as well. DS # 1 just had his physical and blood work. He needs to get to the dentist, eye doctor. DD needs to return to the dermotologist, get her annual physical (she's aged out of her pediatrician), the dentist. The twins have their annual physicals in July, the dentist already scheduled as well . DS # 4 broke his retainer within a few weeks (I agree that it mustn't have been soddered (sp?) well). Our choices were: $125 to repair it, $300 to move to an Exxex guard (like what I wear and what was originally recommended by the dentist to the orthodontist @@), which we intended to buy in a few months anyway. They agreed to order the Essex. I recall previously contacting my insurance about this (crappy dental and no orthodonture coverage)and learned that since we are in this golden situation (no deductible) it CAN be applied to durable medical goods, but the orthodontist is out of network, so reasonable and custumary applies (um-welcome to Fairfield county! everything is more expensive here), and there would be a $150 deductible applied. So, best case scenario is that 1/2 or $150 would be covered out of the $300. I'll take whatever I can get.

I hope to address all anticipated needs within the next few months. Effective 9/1, we have to "eat" $4000 before insurance will cover anything (exception being regular dental cleanings). I'll be in OT, special needs child also has services deemed  coverable expenses, so the meter will be running again. We should hit our deductible for the new plan year within 3 months. I've planned and set aside extra monies in my new plan year HSA to cover this and to leave a cushion. The following year, our deductible goes up to $6000, with my employer contributing $2000 as they have/will for the first 2 years of our current, 3 year contract. I highly doubt that that freebie money would continue under a new contract, so setting aside $5000 next year, and $6000 the following is the plan. Luckily, it's pre-tax monies, and it leaves with me, when I leave/retire.

It's all a game, in many aspects. Life circumstances has taught me how to plan it to my advantage.

4 comments:

Bargain Mom said...

Ah, the insurance juggle - I know it well. Our biggest bummer is our ins has decided to not cover the audiologist visits and annual tests for the oldest. They never covered the hearing aid costs at all. A huge drag on the HSA monies. But we have orthodontia coverage we won't need (wish I could swap it out)

CTMOM said...

Bargain, if you had a letter of medical necessity, could it be covered under "durable medical goods"? I've learned to ask/word the right questions.

DW said...

A $2K contribution from your employer? Sounds good ... I got $125 ...

CTMOM said...

Yes, moving from our old plan set up to this high deductible, saved them $800,000 right off the bat. So while they were generous with the $2000 per employee, it's short lived (I am pretty sure)and they are able to somehow write it off. Regardless, it's a great way to ease me, as the employee, into setting aside the additional $2000/year, although I am setting aside $3000 next year, and plan on doing $4000 the third year of our contract. Our deductible also jumps to $6000 in year 3. If my assumptions are correct, with our new contract (would cover years 4 thru 6), assuming no contribution from the employer, and a $6000 deductible, I'd need to set aside $6000 myself, starting year 4. Since I am pre-setting aside additional funds to ease the burdeon (and there is no risk of ever losing it like with a Flexible savings account), simply bumping my contributions NOW, will build up my account, and help ease the anticipated transition.
Year 1: ($4000 deductible) Employer: $2000, me: $2000
Yeare 2L ($4000 deductible)
Employer: $2000, me: $3000 (overage of $1000)
Year 3: ($6000 deductible)
Employer: $2000, me: $4000
Year 4: (Assume $6000 deductible)
Employer:$0 assumed, Me: $5000 (remember my $1000 overage)
Year 5: (assume $6000 deductible)
Employer: $0 assumed, me: $6000
Year 6: (assume $6000 deductible-although could increase!_
Employer: $0 assumed, me: MINIMALLY $6000, but would do more if the assumed deductibles are higher.

Bottom line, I want to continue to minimally have the deductible amount in my HSA. I am planning for the jump in another year. I suspect, if the litmus test was lunchtime work conversation in my dept, that few are aware of this, and if so, are planning for it.
We have obnoxious medical bills, long story short. I am playing the game.