High-deductible health insurance: filing a claim

[Parliament 14286]

So I got my gall bladder (RIP) took out a week ago.  An ER visit, organ removal and 2 nights in the hospital are gonna hit my insurance.  NBD there, as I have employer-provided BC/BS.  It's a high-deductible ($5k) plan and my HSA account has enough to cover it.  No problem there.

So help me out with the mechanics of all this.  I've never had a claim over $3k, and it's been a minute.  The hospital is gonna send a series of bills over the next few weeks.  They'll og go BC/BS of course, and I'll get copies.  Then what? BC/BS pays the bills and sends me a bill for my deductible? Then I pay it with this HSA debit card I have?  I have a hard time believing it is that easy.

 

TIA

[PilotsError 2317]

Narrator:  it’s not that easy. 
 

it will be an absolute nightmare.  
 

Good luck. 

[conVINCEd 21469]

Just wait a month or two.  None of it will make any sense.  

[BearSchlong 8109]

Do not pay the hospital until after all the claims have been processed.

Medical billing is make believe.

[Parliament 14286]

How long will all that take?  2 months, 3 months?

[royiv 9339]

6 hours ago, Parliament said:

So I got my gall bladder (RIP) took out a week ago.  An ER visit, organ removal and 2 nights in the hospital are gonna hit my insurance.  NBD there, as I have employer-provided BC/BS.  It's a high-deductible ($5k) plan and my HSA account has enough to cover it.  No problem there.

So help me out with the mechanics of all this.  I've never had a claim over $3k, and it's been a minute.  The hospital is gonna send a series of bills over the next few weeks.  They'll og go BC/BS of course, and I'll get copies.  Then what? BC/BS pays the bills and sends me a bill for my deductible? Then I pay it with this HSA debit card I have?  I have a hard time believing it is that easy.

 

TIA

Pretty much all this. This should be a straightforward claim. Would expect that you're done with it in 45-60 days. Keep in mind that in addition to the hospital submitting a claim on your behalf, you will also have professional bills from the ER doc, surgeon, anesthesiologist, radiologist, pathologist and maybe a hospitalist. Just make sure to keep up with the EOBs from BCBS. They make it pretty easy these days online. Don't settle up with anyone until everyone has been paid/adjudicated.

Edited May 29, 2023 by royiv
ETA: ER doc

[77horn 216]

From my experience, it'll take the hospital about 3 weeks to get a bill prepared.  You would think with modern ERP systems, they could tell you what you owe as of yesterday, but no.

And about the same for all the doctors (surgeon, anesthetist, etc.)  The bill will first be presented to your insurance.  Insurance will review it. They will decide what they'll pay.  They will send you an "Explanation of Benefits".  Each billing entity will then send you a bill for whatever is left that you owe.

Yeah, it's going to be a few months.

And don't be surprised to find that the original bill is for, say, $50,000; Insurance says, "as a preferred provider, our contract with you only allows $5,000."  (I mean, like, how can those 2 numbers be for the same scope of work?)

[Parliament 14286]

Should I worry about certain line items not being covered, and I'll hafta pay them out of pocket?

[conVINCEd 21469]

1 hour ago, Parliament said:

Should I worry about certain line items not being covered, and I'll hafta pay them out of pocket?

While this was a minor deal, relatively speaking, you will have an out of pocket maximum that is probably a little bit above your deductible.  That’s your worst case scenario.  Let BCBS and the hospital play pickle ball for a little bit, and then pay what you should once that’s settled.  The first bills you receive will be complete and total horseshit.

[BearSchlong 8109]

How long will all that take?  2 months, 3 months?

My dad died in an automobile accident on March 16 of ‘22 and we still haven’t received a final bill.

Dad was the most responsible guy I know. A few months prior to his death, he was in the hospital for a few weeks. One day an AR clerk showed up at his hospital bedside and said he needed to pay $22k immediately. So he pulled out his checkbook, right there in the hospital room. His Medicare out of pocket for that whole year was maxed at $7,500. When my stepmom found out what he did they talked and either stopped payment on the check, or called the billing office and threatened them with a lawsuit if they cashed it. I can’t remember which.

We never received another bill from that hospital.

I’m his executor and I have money set aside in an account for if/when the final bill shows up.

I’ve got more respect for meth dealers than medical billers at the moment, for other reasons that would derail the thread.

[Parliament 14286]

To be clear, my medical treatment was EXCELLENT.  From my first trip to urgent care, to being discharged from the hospital (sans the dead organ) was literally 46 hours.  I think that's pretty good.

If you have the means to pay (insurance or straight cash, homey) our medical system in the US is pretty good.  If you DON'T have the means, I bet it sucks pretty bad.  Just like everything else in the US.  It's a feature, not a bug.  (And I'm not defending at all.  

[royiv 9339]

1 hour ago, Parliament said:

Should I worry about certain line items not being covered, and I'll hafta pay them out of pocket?

No.

[tx 3 putt 77338]

Those bills will keep coming to the next 12 months (at a min)

[Guest]

I just laugh at the idea of $5K being a high deductible. 

/selfemployedobamacareinsuranceuser

Edited May 30, 2023 by FirstTimeCaller

[Texzilla58 4743]

The advice to pay zero until you know what all the charges are and your insurance is settled is correct.

What is your deductible? And what is your annual out of pocket max? Is your policy a PPO or a HMO? Is the ER and all providers in network? This is the beginning of the bullshit. It should be illegal to not disclose all this up front. So if you have a typical PPO let’s say your deductible is $4000, with an out of pocket of $7500. You’ll pay to whomever the balance remaining of your deductible will if you’ve had some claims this year. After that you’ll pay a portion of the bills, say it’s 20%, up to the out of pocket limit, then they cover everything else. So if the surgery and stay total $30k, you’re maybe responsible for $6k less your deductible less your out out pocket.

Example: I was told by my primary a few years back to head to the ER due to a weird chest upper abdomen pain on Christmas Eve. Went to Mansfield Methodist. Had BCBS silver PPO. No issues with the admitting folks. Was later informed with billing that only the ER was in network. Doctors there out of network. The ultrasound facility a separate entity and out of network. Though all in the same building. Raised hell with the hospital and all the providers and got shit fixed.

Your HR manager should be able to assist you with questions, as well as your insurance company. BCBS will work hard to hammer away any bogus charges and expenses. You will also be able to negotiate with all these various assholes once you get through all of it.

My wife is on Medicare with a top tier supplement plan and she’s had probably $400k of surgeries in three years and not paid a cent. I go on it in December.

[CooterBrown 18022]

Wait for all the bills. Then ask for itemized bills. Then offer 30% of what you owe. Tell them that’s all you can afford. They often take it.

[beer 3220]

oops

Edited June 6, 2023 by beer

[txhorns 2413]

You fuckers need better benefits through your work.  A proper benefits package and your cost would be minimal.

[EastHorn 281]

On 5/29/2023 at 8:27 PM, Parliament said:

To be clear, my medical treatment was EXCELLENT.  From my first trip to urgent care, to being discharged from the hospital (sans the dead organ) was literally 46 hours.  I think that's pretty good.

If you have the means to pay (insurance or straight cash, homey) our medical system in the US is pretty good.  If you DON'T have the means, I bet it sucks pretty bad.  Just like everything else in the US.  It's a feature, not a bug.  (And I'm not defending at all.  

I'm a doctor and I don't even know how the billing works.  Plus the few times I have needed and used healthcare my employer/hospital just doesn't bill insurance as a favor and dissolves the payment (technically illegal) and surgeon and anesthesiologist didn't ever bill me.  It's a broken system.  

[Parliament 14286]

Looks like the bills are flowing in now.  Screenshot from my BC/BS account.

Is that saying BC/BS gets a $34k (70%) off the top discount?  And it looks like I was wrong about my deductible being $5k.  $1800, with a $3k out of pocket max it looks?

[Parliament 14286]

UPDATE

Looks like the bills are done coming in.  $49,155.27 is what it costs for full-service organ removal in the US today, before discounts.  After discounts it's $11,628.95.

Question on the $3,000 deductible.  Is it automatically taken from my HSA?  Or do I need to click some boxes over at Fidelity?  Neither website is very clear.

 

[Updawg 2286]

There will be random bills from doctors etc that you never saw. Question everyone and everything

[Nice Guy Eddie 13522]

6 hours ago, Parliament said:

UPDATE

Looks like the bills are done coming in.  $49,155.27 is what it costs for full-service organ removal in the US today, before discounts.  After discounts it's $11,628.95.

Question on the $3,000 deductible.  Is it automatically taken from my HSA?  Or do I need to click some boxes over at Fidelity?  Neither website is very clear.

 

In my experience, HSAs don’t automatically pay for anything. I suppose there could be a plan that automatically pays for expenses but some people don’t want that. They keep it in the HSA and let it grow tax free. Save the health care bills and cash out at some later year.

[Texas Jeff 1945]

7 hours ago, Parliament said:

Question on the $3,000 deductible.  Is it automatically taken from my HSA?

No.

Most HSA's give you a debit card.  If you pay your bills for qualified expenses using the card, the money will come out of the HSA and pay the bills.

If you have a mix of investments and a cash account at the HSA, you may need to sell some of the investments to fund the cash account before you pay the bills.  Usually they will not automatically sell your HSA investments to cover the debit card, but they will drain the cash account.

You can also pay the bills yourself, and then ask for reimbursement from the HSA.  In that case, you will pay the bill, and then you will receive a check written to you from the HSA, or you can make an electronic transfer to your bank account.

Keep the receipt for the expense you paid for out of the HSA, maybe write "paid for using HSA" on it.  Make an envelope of expenses like this for this year, and keep them with your taxes.  At the end of the year, you are going to receive a tax form showing how much you withdrew from the HSA.  Should the tax man audit you, you may need to provide bills showing exactly what you spent the HSA money on, to prove it was a qualified expense.

And certainly don't take my advice for this, I am not an expert.  But I do have an HSA.

Edited October 31, 2023 by Texas Jeff