Oct 7, 2009

With an HSA Account, When Do You See the Doctor?

One of the selling points of HSAs (Health Savings Accounts) to the American Public is that you get to take control of your healthcare. That is, if you need a doctor, you pay for the doctor, but only until you hit your high deductible. The insurance plan, then, is more affordable -- because if you don't need a doctor, you're not going to go see one.

But then, the issue arises that people don't go in to get screened for problems that might be small now, but could be worse later. Additionally, besides worrying about your health, you also have to deal with countless confused billing departments who don't understand why you need to know how everything is coded (preventative care (yearly checkup, etc) is covered 100%, at least on my plan, whereas diagnostic and everything else goes to the deductible.)

I went for an annual physical and received a lab form for blood work. Before getting this lab work done I called my insurance company just to check on costs. I found out that while my annual physical was "free," the lab work - which should be free if part of the annual physical - would not be covered because a few tests that the doctor asked for were diagnostic. Even though the form had both the preventative and diagnostic codes on it, if the diagnostic code was present, I was informed that most likely the insurance would bill me for the entire lab tests (and lab tests aren't cheap.) Of course, had I not called, I would have just gone to get my tests and received a surprise bill.

Even with this information, it's not clear what's covered and what isn't. Ultimately, I still do better with an HSA than PPO-style plan because my company puts in $100 / month and I have a $1500 deductible. If I were to go with the other plan it would be $30 per month, plus I wouldn't get the $100. So $130/month or $1560 / year would be the total loss of money just for going with the co-pay plan instead of the HSA. Now, with the HSA deductible, if I were to hit it, everything after $1500 would be covered (I think.) I haven't spent any of it yet, and with the year coming to a close I'm tempted not to.

I went to a Ob-Gyn yesterday and showed her the paperwork for my blood test ordered by my regular doctor. She looked it over and said that she was going to get me most of the tests anyway. It turns out the two "diagnostic" tests were things I didn't really need anyway -- they were really basic tests to see if I have PCOS -- which we already know. So she said those tests were pointless. She gave me a new lab form with just the preventative code on it. At the appointment in addition to my regular check up (covered) she also did an ultrasound to check on the cysts in my ovaries. While I didn't feel comfortable asking her how much it would cost to view my ovaries via xray while she was about to stick some high-tech device into my vagina, that's what I was thinking. And after the appointment was over and I was talking to my obgyn in her office, I asked about the coding of the ultrasound and she said it wasn't preventative since we know I have PCOS. (Well, I think it would have been diagnostic anyway, even if we didn't know.) The cost? I'm still not sure. It could be $100, it could be $300. Which is really ok, that $900 extra I've made this year that's in my HSA account will go towards it.

Without a 401k at my job, I like to think of my HSA account as my supplemental retirement account to my Roth IRA (which I max out every year.) So it's kind of a pain to dip into it.

It looks like I'll be dipping into it even more now. I developed a really bad pain on the top of my right foot, and there is definitely something hard like a bone where all the soreness is. Made an appointment with a podiatrist for this afternoon, which, for just a consultation, will be around $150. And finding out that much information in advance was a pain in and of itself. The doctor's office told me to call billing. Billing said they had to call the doctor's office, then call me back. I got my answer, but I'm not even sure it's accurate. And then, a consultation usually leads to other costs - diagnostic testing, therapy, drugs, surgery. If they're just going to look at you and say "put some ice on it and don't run for a week" then why bother going in the first place?

I think next year I'm going to switch to the basic PPO plan. Even if it costs more. This way I'll actually go to the doctor when I need to, and not have to be paranoid about costs.

At least now I have insurance. As many of you know for a long time I struggled with getting insurance -- I was denied by 3 different insurance companies due to pre-existing conditions of irregular periods and depression. About a year ago I was hired full time to a job with insurance. I now know that working freelance / being self employed is NOT an option for me. So much for living in a free country.


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