Anyone else have an HSA insurance plan?

Miscellaneous and Personal Stuff I Must Share
1

I’m tempted to put this into the pit, but I’ll try for experience feedback first.

My company switched to a United Healthcare HSA plan a few months ago to save on employee healthcare costs. The company and their outside benefits administrator did a good job of selling us on the plan, repeatedly hammering the plusses and downplaying the negatives. I certainly understand the reasons behind it, with insurance being what it is these days. But goddamn it’s been an aggravating and expensive experience so far.

Among the number of issues I’ve had:
General ignorance/lack of attention by medicals professionals as to what procedures and treatments are covered as preventative care vs. what I pay out of my pocket. For example, I’ve had two office visits miscoded by my doctor, resulting in me paying out of pocket for them. After the first time (which they refused to resubmit the claim) I discussed it with my MD. He ensured me that they would put the right ICD codes down to get the second visit covered. Well it happened again, and again they are refusing to resubmit. Fuckers! Tip -don’t ever use the term “wellness exam” in place of “physical”. They don’t understand.

Another problem: needless ordering of procedures/tests that I have to pay for until my deductible is met… a CT scan that was inconclusive and later declared unnecessary in a follow-up visit with a specialist. Lab work for the second time in 6 months, when the first one was perfectly normal. I hate to be chintzy when it comes to my health, but the financial pain is felt a lot more now so I feel like I have to rein in this type of frivolous behavior, or plan for it at least.

Finally: Of course I pay contracted rates on anything until my deductible is met. The problem is it’s a pain in the ass to find out what those contracted rates are. My medical provider can’t tell me. In the case of the CT scan, the same office (on different days) gave me 2 cost estimates of the same procedure that varied by over $700. And United Healthcare can’t tell me until a claim is submitted, even if I have the procedure code. They have a cost estimator on their website but it is so limited and vague, it’s fucking worthless. I have to go through my benefits administrator to find an estimated cost, which takes days –if they even bother to get back to me. Recently, I saw a specialist. I paid $240 out of pocket for the visit, which is what the office told me was my contracted rate. Now I see on the submitted claim that my out of pocket cost should have been $191. Of course the office wants to give me a credit rather than refund my overpayment…

One thing that was emphasized about the plan was that it made us more aware and accountable of our health care choices and costs. I’m trying but comply but it’s been frustrating. Anyone else have problems with their HSA?

2

I don’t have an HSA, but I have been a benefits administrator. This part here seems most likely to be BS. My recommendation is that your benefits administrator try to work more closely with the insurer (UHC) to get you employees access to usual, customary and reasonable rates and/or negotiated rates for at least a variety of common procedures. I know we did this for one of our dental plans that had really low reimbursements. This was somewhat helpful in reducing the sticker shock when the plan only covered 30% of what their high-end dentist was charging (and maybe 70% of what the guy working out of the back of his truck was charging…).

I expect that trying to get negotiated rates from your provider is a hopeless cause. Like trying to teach a pig to sing, wastes your time and annoys the pig. They probably work with a multitude of plans, even a multitude of UHC plans. I’m not 100% sure this is how it works, but I suspect the doctor’s office bills for what they usually charge, and UHC comes back and says, “no, we negotiated to only pay you this, remember?”

3

I am not only signing up for one next month or so, I helped my boss while he was working on setting it up. I am interested in hearing your problems. I have chosen the HSA100 with a 3800 deductible and UHC insurance.
It seems that you are paying a lot of stuff out of pocket, not out of your HSA, because if you had money in your HSA it wouldn’t actually be “out of pocket” right?

4

I’ve only been on the HSA plan (UHC Definity) since 7/1, so I haven’t accumulated more than a few hundred dollars in my HSA yet, certainly not enough to make a dent in the expenses incurred so far.

My problems? Well, I hit on most in my original OP, but in a nutshell:

[ul]Medical providers don’t really know what’s covered and what isn’t. “Preventative care”, which is covered 100% by my plan, appears to be a grey area for providers. My MD says routine visits are preventative and thusly covered (they’re not). His nurse says only physicals are considered preventative (likely true), but that they can’t submit a claim for a physical unless they do a prostate exam (not true –hey I had doody that day). If they submit an erroneous claim, they won’t redo it because they don’t want to be flagged for review by UHC.[/ul]

[ul]Needless ordering of tests & procedures by providers. I guess because of the nature of insurance today, providers don’t really know or care what treatments cost –they just frivolously order them as they always have (RE: my CT scan in my OP). Since most of the cost comes out of my pocket now, I’m learning to question these more and more.[/ul]

[ul]Contracted rates. Good luck finding out what something will cost beforehand. UHC’s online treatment estimator is very limited and vague. Calling UHC won’t help, even if you have the ICD codes. Your medical provider can’t tell you what the contracted rate is without submitting a claim. Because of this, providers will estimate in their favor and automatically collect the highest out of pocket amount from you for treatment. It’s then your problem to collect your overpayment.[/ul]

[ul]Contracted rates (again). UHC cheerleaders came to our office and really emphasized that we pay substantially discounted “contracted rates” for treatments & drugs. In fact, they led us to believe that we would typically pay about half of the full rate out of pocket. Well, some of the contracted rates/out of pockets are a joke. Here are actual examples of what I’ve paid:
Routine office visit: full rate $64, contracted $56
Specialist visit: full rate $268, contracted $191
CT scan: full rate $1238, contracted $978
30 day prescription for Zyrtec: full price $81, contracted $71[/ul]

[ul]HSA access. You have to use UHC’s captive bank, Exante, for your HSA. They have a full sheet of fees they’ll charge you if you’re not careful in how you use your account funds via debit or by filing claims. They charge $3/mo just to have the debit card. Yes, it pays interest, but until you build up a decent nest egg, the fees more than offset any interest earned. I’d prefer to have the ability to shop my HSA around for the best deal.[/ul]

I’m sure there’s more, and some of these issues may go away as HSA plans become more widespread and I become more familiar with managing my health care. For now, it’s been costly and aggravating.

5

I don’t believe that for a moment. That is, I don’t believe them…I fully believe they told you that.

The HSA belongs to you and has nothing to do with the insurance company.

6

Wow. Your post makes me so glad that we as a company bitched and pissed and moaned enough to make our employer decide not to go to an HSA (at least for now). When they tried to sell us on it, it was such a hard-sell technique that I was automatically leary. I was not impressed, even with the idea that th company was planning on putting $X into each employee’s HSA to start.

We have a couple of upper management here who are in treatment for cancer, for them an HSA would be more than worth it. For those of us who live hand-to-mouth, and only see the doctor for the rare issue, it is totally not worth it. If we are forced into an HSA next fiscal year, I will have to do something drastic, as I simply would not be able to make it under those conditions.

Good luck in getting squared away with it, I hope it comes out better for you soon!

7

This has a slight ring of insurance fraud to me. They can probably charge more for the wrongly coded procedure, particularly because you have to pay for it as opposed to it being covered by UHC. Resubmitting a correctly-coded claim will result in them getting less money. If it were me, I might consider threatening them with filing a fraud report with whatever medical board governs in your state and see if they aren’t suddenly willing to cooperate with you on filing a legitimate claim with your insurer.

Good luck!

ETA: Oh, and find new doctors, ASAP!

8

I don’t believe they’re actively committing fraud (although the probable tendency is to always bill the highest amount possible), I think it’s more because of ignorance/stubbornness/laziness. Take the case of my physical. Nurse says she can’t code it as a physical because I refused a prostate exam. My benefits administrator says that’s not a disqualifier. Nurse is reluctant to rebill because of aforementioned ignorance/stubbornness/laziness. I’m still fighting that one, but I will get more threatening if they don’t come around. Under my previous insurance plan I just paid an ofice copay and the provider/insurance worked out the actual settlement. Just another example of HSA plan in action…

9

I guess I’m just dense because I don’t see the drawback, Litoris. It seems that someone that goes to the doc very rarely would benefit. Using round numbers, obviously, I can pay $200 a month for insurance or I can put $100 a month into an HSA. That money will build up and collect 5%. If I only go to the doctor 3 times a year, at $200 a pop, I will spen $600 this year at the doctor, but will have put my $1200 into an account tax-free that is making compound interest. So wouldn’t the ones that don’t go to the doc make out better? Plus me, since I have chosen to cut my contribution to $100 instead of the after-tax $200 I would be paying for insurance.

Bad Sam - I assume you chose the Preventive Care Option (or whatever it’s called)? One of the benefits to me was that I didn’t have to deal with filing claims. I put money in the HSA. It’s mine through Exante. I go to the doc. I pay at the door when I am done. So I don’t see where the insurance company comes into play if you have not yet met your deductible. Is it because you are paying out of pocket instead of using the HSA debit card and want to apply the doc charges towards the deductible?

I would also be interested in hearing about the “other fees” because although I do have the $3 a month fee here, I don’t have any others listed except for the start up fee, which is something like $10.

Thanks for all the info.

10

Currently in the second year of this type of insurance and I have experienced many of the same problems. In my case my employer provided a $1000 account balance, while I paid monthly premiums that were significantly less than I’d paid for the prior coverage (a PPO).

It’s very frustrating both having no idea of the incurred cost, nor even any accurate idea of how much money is left in our account; it has taken weeks (in one case, literally months) for some claims to be processed and appear on my account page on the insurer’s website.

As in the OP’s case, my company pushed hard to encourage employees to switch to this plan, emphasizing the overall cost savings and ease of use. But if one of the selling points is ostensibly that it’s supposed to (in a sense) cut out the middleman and allow the insured to make informed decisions about the healthcare they want to pay for, it really hasn’t shaken out that way because there’s no practical way to find out what you’re going to be paying before you consent to treatment. Is there any other industry in which you can neither cost-compare ahead of time, nor get the service provider to tell you directly what they charge for a service? (And why is this considered acceptable in health care?)

As ShelliBean suggested, it’s a good health plan for people who never get sick. It reminds me of the Monty Python sketch in which the Reverend Morrison is talking with the insurance claim adjuster, Mr. Devious:

REV. MORRISON: But my car was hit by a lorry standing in the garage and you refuse to pay my claim.
DEVIOUS: Well, Reverend Morrison in your policy… <gets up and starts rooting through a filing cabinet. Finds papers in a coat in the cabinet>… in your policy. Its states quite clearly that no claim you make will be paid.
REV. MORRISON: Oh dear.
DEVIOUS: You plucked for our ‘never pay policy,’ which if you never claim is very worthwhile, but you uh had to claim, and there it is.

In a few months I may be completely uninsured. Ironically, this will be something of a relief, as I’ll at least know for sure where I stand.

11

It’s been several months since this came up, but I did the math, but based on my life, I fall into that group for whom an HSA is a huge waste of money and a headache.

The basic issues are as follows: Because of the few ongoing conditions I have, I have to have regular bloodwork. Under regular insurance (RI) this costs me nothing, as it is covered bloodwork and my doctor orders it when needed, I don’t even have a copay for an office visit. Under the HSA, I would have to pay for it out of pocket at $150/pop. I have this bloodwork done about twice a year. Not a big expense, if paid OOP, but why would I want that? It would totally negate the “savings” of the different plan cost. (FWIW, I have had to have this bloodwork done 4 times so far this year due to my thyroid acting wonky – we have to keep it in check or it goes way bad, way quickly – that’s $600 that I would have paid OOP, but the RI has covered.)

There is a monthly fee for the HSA plan, just like an insurance premium, and on top of that, I would have to put money into the HSA to pay for my medical services. This is what irked me the most – at least the money I pay towards RI premiums does something.

With RI, once I meet my personal deductible of $500 for the year, my stuff is paid at 100%, with an HSA, I would have to meet the full family deductible of $1500/year. That’s $1K more OOP than with RI.

If you really insist, I could see if I still had the paperwork where I did the math to see which was better, but you could just trust me, that for those of us with ongoing issues who have to see the doctor now and then, but not all the time, an HSA is the worst possible option. An HSA is great if you either a) only see the doctor once a year and have no possibility of anything happening to you, or b) have a major illness and can afford all of the OOP upfront. Neither of these situations apply to me.

12

I’m not picking on you Litoris, but you mention several things I would like to respond to. There seems to be a bit of confusion throughout this thread on what an insurance plan with the HSA option is.

The monthly fee is an insurance premium. When you have a plan with the HSA option you are paying for a deductible plan that meets the IRS’ criteria that qualifies you to open an HSA (Health Savings Account) through your bank. The insurance plan works the same as any insurance that carries a deductible. When you say ‘regular insurance’ I take it you mean a co-pay plan or a plan with a smaller deductible.

As to the HSA itself, you do not have to put money in the account or even open one, you merely have the option to do so.

If the premium difference between the two plans is at or greater than $83.33 per month, you are still saving money on the higher deductible plan. Of course if your employer pays 100% of your premium, this doesn’t apply.

In your particular case, the higher deductible plan may not have been worth it, but that would make you part of a very small group. For the vast majority of people the higher deductible plan is more cost effective. I would say close to 90% of the plans I sell these days have the HSA option and I have yet to see it be cheaper in the long run to go with a different plan. I’m sorry to hear it ended up costing you more, but that is not true for most people.

13

Part of the reason the plan was so worthwhile to me was because I do not have regular, ongoing health issues and need insurance for the catastrophies only (hit by a car, brain cancer, what-have-you). It has been to my benefit to pay out of pocket when I need it rather than pay every month for a regular insurance whether I need to utilize it or not. This way I am paying pre-tax every month and putting it into a 5% interest account that I get back (this is not use-it-or-lose-it). Part of what I am feeling dense about is the online account checking and posting from the insurance companies. Are you saying that you can’t regularly check your balance like a bank website? Also I am still interested in problems with the HSA. This month my boss is being the test rodent for us and I want to know what “catch” to watch for because right now it looks like it’s more beneficial to me and I don’t want to jump in blind.

Finally - Vinyl Turnip, I am wondering if the reason I have had different experiences at doc offices are because I am going for very routine stuff? I’m not trying to ask your business, but are you getting problems from the regular doctor’s office or some kind of specialist? Because I’ve been on a cash basis for a while and at the beginning of the relationship I state that I will pay cash upon exit and want to know up front what tests, x-rays visits will cost etc and they have been very obliging. A couple of doctors actually work with me to find the most cost effective treatments and the office staff have told me specifically what to ask for when I call so I get coded correctly.
I have not, however, been unlucky enough to get stuck in a position of “have this blood test or die and we’ll tell you how much later.”

14

Argh, I had a response typed up and the browser went nuts and ate it, so I will try again.

Pick away, I typed my response rather hurriedly and it was a bit unclear as to my actual level of understanding of the differences between the 2 options. Reading it, I might consider myself a dumbshit, if I didn’t think I knew better :smiley:

Ok. First thing – as for the premiums for RI vs HSA. With RI, I pay a copay for each visit and then only 80% of the bill for things that fall outside of “regular office visits” – my doctor visits are almost always “regular office visits,” so it only costs me $25/pop to see my doctor (the copay). With HSA, I would have to pay the monthly premiums, and then the full amount (or the contracted charge, which IIRC was only a $20 savings from my doctor’s regular charge) for the office visits. This is why the HSA seems idiotic for me. Already, if I have to go to the doctor 4 times per year, I am paying $100 under RI or $216 (my dr.'s regular fee is $74/visit, so I am assuming my memory is correct at it being $20 less for the contracted rates) for the HSA. We’re not even talking about my bloodwork, which would cost me nothing under RI, and $600 under HSA (maybe a little less with the contracted rates, but still in excess of the $0 I would pay under RI).

The difference in premiums was about $30/month. Absolutely not worth it in my case.

This is what I am saying – I fall into the group for whom an HSA is not a good option. I have to have regular bloodwork, but no major issues that would cause me to really ever meet the deductible or be able to use the plan effectively. Fortunately for me, the company decided against an HSA at this time. I am unsure what actions I will take if/when they force us into an HSA.

I guess my major issue is that I can’t see paying premiums for “contracted rates” that are still higher than I would pay if I just had no insurance and went to the local health department. Yes, I know I couldn’t go to the local health department for major stuff, but then again, I would still be screwed on OOP expenses unless I had a lot of major stuff.

Breaking the math down:
Regular Insurance:
monthly premium = $200 x 12 months = $2400
bloodwork = $0 copay x 4 times = $0
regular office visits = $25 copay x 4 visits = $100
total cost = $2500

HSA:
monthly premium = $170 x 12 months = $2040
bloodwork = $100 (assuming a very generous contract rate) x 4 = $400
regular office visits = $54 x 4 visits = $216
total cost = $2656

15

Shellibean, I’ll try to answer your questions as best as I can. Just remember, I’m fairly new on an HSA plan and came here seeking answers myself.
Here are the Exante fees I have:

Maintenance: $3/mo
ATM withdrawal: $1.50 per transaction
Check order fee: $10 for 25
ACH transfer: $5
Wire transfer: $20
Withdrawal/distribution: $10 (this is what you pay when you try to reimburse yourself for OOP expenses)
Overdraft: $25
Excess contribution refund fee: $20 (when you put more in than the IRS allows)
Insufficient funds: $15
Stop payment: $15
Research: $10/hr.
Copy of receipts: $25
Statement copy: $10
Account closure fee: $2

Admittedly, most are typical bank fees, but you can’t get around these by using an outside bank, which really peeves me. I’m not surprised you didn’t know about these. We didn’t either until the day came to sign up for the plan. And it appears they fed you the 5% interest line too. Well, newsflash –it’s 4%. Granted 1% doesn’t sound like much but it’s 20% less than they led you to believe and just another example of how (I feel) UHC downplays/misleads the negatives of HSA’s.

As for online account access, I can check that anytime via UHC’s website, which is a plus. Contributions also seem to go in right away as well.

The plan is worthwhile to those who rarely go to the doctor, or to those who routinely exceed the annual out of pocket deductible. Most people fall into the middle and will likely pay more out of pocket on an HSA. If you have a sudden health issue then it’s going to cost you. For example in my case, two doctor visits, one specialist visit, and a CT scan were all related to an enlarged prostate that showed up in the last few months. For all the treatment I received related to that issue, I paid $1170 out of pocket, not including a $77/mo. ongoing related prescription drug. That hurt, since I don’t yet have enough money in my HSA to cover these. Under my old plan, I would have paid about $150 OOP (I do realize my company would have offset some of that difference through higher premiums paid under the old plan). The secret to having a viable HSA appears to be either really sick or never sick at all.

Unless your HSA plan is different, one thing you’re not considering here is that you’re supposed to get a reduced contracted rate on treatment. Sure, it’s easy enough for them to give you a full price quote up front; but you shouldn’t have to pay the regular full price, or at least my plan doesn’t require that. The problem is, the provider probably doesn’t know what the contracted rate is at the time of service, so they’ll just estimate and usually charge you a higher amount. Example: If the visit should cost $50 OOP contracted rate, they might charge you $90 just to cover themselves. So then you have to hassle with getting your overpayment back. Meanwhile, your provider still submits a claim to insurance because how else will they know if you’ve satisfied your deductible or not. But… since the provider can’t (or won’t) find out ahead of time what the contracted rate is, they’ll submit a claim for a full amount. With UHC, you can check your claims online; so far this is only way I’ve been able to determine what the actual contracted rates are (after the fact). So you see why it’s so frustrating?

UHC made it sound so simple and painless when they sold us on the plan, the reality has been different and disappointing. Everybody seems to benefit more but the end user.

16

Just wanted to say thank you for the information. One thing I will definitely talk to them about is the 4% vs 5%. Like you said, 1% isn’t huge, but a lie is a lie.

17

PS - I did some copy and pasting of our conversation so now my boss knows that I am ShelliBean. I so smaaaart.