Top 10 Reasons Your HSA Does Not Match Your Deductible #2

2. Your medical claims have not been submitted to your insurance.

Just the other day, I went for a follow up appointment for an ankle fracture from a few months ago. While checking out, the billing representative for my physician asked me if I would like to go ahead and pay for today’s visit. Confused, I asked if she had already submitted the claim to my insurance for processing. She told me that since I have a high deductible plan, she could go ahead and see what the pay schedule is for the visit so that I could pay in full now, and they would submit the claim later. I kindly declined and explained that without having submitted my claim to my insurance and receiving confirmation of how much I would owe on an EOB statement, I would prefer that I not pay at this time.

This is not an uncommon scenario of how HSA accounts and medical deductible can become unbalanced. Since claims do not always process in the order of the dates of service (usually they just process in order of how they are received), I could meet my deductible before this claim is ever sent to my insurance and not owe anything out of pocket for my visit. Or the billing representative could mistype when submitting the claim, and my claim might never process and go to my deductible. Although I would have paid for a medical bill, if the claim never processes through my insurance, it will not be applied to my deductible.

For instance, let’s say that I started the year with $2000 in my HSA and a $2000 in network deductible. I have some claims totaling $1500, all of which process to my in network deductible, and I pay out of my HSA. I now have $500 in my HSA and left to meet with my deductible. Then, on a Monday, I slip and fall. I go to the emergency room and get x-rays. It’s a break. They submit my claims for processing to my insurance. On Wednesday, I go to an orthopedic specialist to get my new crutches, walking boots, and to check on the fracture. While checking out, the provider asks if I would like to go ahead and pay the $250 bill, which is the contracted rate with Anthem. They called and checked with my insurance, and I still owe $500 to my deductible. I decide I would rather pay now and use my HSA. Since this has not yet processed through my insurance, I now have $250 in my HSA and $500 to meet on my deductible. On Friday, my insurance processes my claims from the emergency room. They total $1000, so they pay $500 and apply $500 to complete my deductible. I receive the bill for $500, but I only have $500 in my HSA. The orthopedic specialist forgot to submit my claim, so now I have a $250 out of pocket expense to pay my emergency room bill until my orthopedic specialist can submit the claim, have it processed, get paid in full, and refund me the payment that I made during the visit.

Want to know to rest of the top 10 reasons your HSA does not match your deductible? Check out the McGohan Brabender checklist and look for upcoming and previous articles explaining the other reasons!

Top 10 Reasons Your HSA Does Not Match Your Deductible #3

3. You put a deposit down for a procedure and are owed money back.

The growing trend of consumer driven health care has meant changes for the benefits offered to employees (higher deductibles, HSAs, FSAs, and HRAs). Those significant changes have also meant changes for providers. Higher deductibles mean that many providers will not receive any payment from insurance companies if deductibles have not yet been met, as the responsibility will be on the patient. With procedures that can easily go above and beyond a member’s high deductible, some providers are beginning to require deposits to be put down before they will perform surgeries or other costly procedures for members with high deductible plans to ensure that they will receive payment. Some members choose to use their HSA funds to pay for these deposits, and if their claim processes so the member’s responsibility it less than the deposit they made, the member’s HSA and deductible will be un-even until the provider gives the member the refund that they are due.

For instance, let’s say that you have a $1000 deductible and start the year with $1000 in your HSA. You go to the hospital because you are having stomach pains. After a day of observation, you doctors have decided that you need surgery. The surgery is expensive, though, and to ensure that they receive payment, the surgeon requires that you pay a $500 deposit. You pay this out of your HSA, leaving you with $500 in your HSA and $1000 deductible to be met since no claims have been submitted yet.

Your claims from the hospital are submitted to the insurance first and total $1500. Your insurance processes this, applies $1000 to your deductible, and pays the remaining $500. Then, your surgeon submits her bill to your insurance for $10,000. Since you have already met your deductible and do not have any co-insurance due, this claim is paid in full by your insurance and you do not owe anything. However, you now receive a bill from the hospital for $1000 and only have $500 in your HSA. Everything has been done correctly by insurance, but now that your surgeon has received payment in full for your claim, you are owed $500 back from the deposit you put down. Once those funds have been returned to your HSA, you will have $1000 in your HSA and can pay in full your responsibility to the hospital for $1000.

Want to know to rest of the top 10 reasons your HSA does not match your deductible? Check out the McGohan Brabender checklist and look for upcoming and previous articles explaining the other reasons!

Top 10 Reasons Your HSA Does Not Match Your Deductible #4

4. You paid for prior year claims with this year’s funds

Deductibles can be set up in two ways: calendar year, which runs January 1^st to December 31^st each year, or plan year, which runs from the first day of a group’s renewal date to the day before that renewal date the next year (for instance, August 1^st to July 31^st each year). Any claims with dates of service within these time frames apply to those specific deductibles, and at the end of the deductible year, the deductible resets. Billing from providers can sometimes take months, though, and claims from the previous year (and last year’s deductible) can be paid for with the current year’s HSA funds, creating in equal amounts in your HSA and remaining current year deductible.

For instance, let’s say that you have a calendar year deductible of $1000. In December of 2010, you go to the doctor after you twist your ankle. You have x-rays to check for a break, but you are happy to report that the bones are all fine. The doctor sends the claim from your visit for $250 to your insurance for processing. Your insurance applies the first $200 to your deductible but pays the additional $50 because you have now met your 2010 deductible. This processing takes time, and your provider finally bills you in February 2011 for the $200. You started 2011 with $1000 in your HSA, so you use this money to pay for the bill. However, this money was applied to your 2010 deductible, so you now have $800 in your HSA and $1000 to meet on your 2011 deductible.

In March, you twist your ankle again. But this time you actually break it. You see your doctor, get x-rays, are sent to an orthopedic doctor, fit for a walking boot, and have to get crutches. Your claims total $1500 and are sent to your insurance to be processed. Your insurance applies the first $1000 to your 2011 deductible and covers the remaining $500 dollars. The doctors you saw send you a bill for $1000, but you only have $800 in your HSA since you paid for last year’s claim with this year’s funds. You use the $800 left in your account and must pay the remaining $200 out of pocket.

Want to know to rest of the top 10 reasons your HSA does not match your deductible? Check out the McGohan Brabender checklist and look for upcoming and previous articles explaining the other reasons!

Express Scripts and Walgreen's Contract

Recently, articles have begun to circulate regarding the negotiations of Walgreens and Express Scripts, the pharmacy provider network used by Anthem. Articles have included headlines such as Walgreens to Sever Ties With Express Scripts.

After contacting representatives from Express Scripts, McGohan Brabender has been told that:
This type of negotiation is common between pharmacy benefit managers and pharmacies. It's early in the process. There has been no change in our members' abilities to use their pharmacy benefits at Walgreens and Duane Reade pharmacies. The contract does not expire until January 1, 2012, giving the two parties several months to work out a solution. We are hopeful that Walgreen Co. and Express Scripts can soon reach a reasonable solution that meets our members' and customers' needs.

At this time, these negotiations should not effect the prescription benefits of an Express Scripts member going to a Walgreens pharmacy, but we will continue to communicate with our representatives and keep updates posted.

Top 10 Reasons Your HSA Does Not Match Your Deductible #5

5. You paid for vision or dental claims with your funds.

One of the growing trends in benefits is the offering of dental and vision benefits in addition to medical coverage. While medical coverage may pay for some very basic vision screenings, vision benefits can offer reimbursement for eyeglasses or dental can offset the cost of orthodontia. If you are on a high deductible health plan with an HSA, you can especially benefit from your tax free money by paying for dental and vision expenses out of your account. These bills are approved expenses by the IRS for your funds. However, while these claims will run through your dental or vision benefits and can be paid for with your HSA funds, they do not apply to your medical deductible and can create a discrepancy.

For instance, let’s say that you have a $2000 deductible and start out the year with $2000 in your HSA. In January, you go in to your primary care physician for your annual preventative physical. You have your workup, blood drawn, and basic vision screening. These claims are submitted to your medical insurance, which pays them in full because they are a part of your preventative care. You have no charges, and your deductible and HSA funds both stay at $2000. Your doctor suggests that it is time to get glasses, though, so you go to an optician after the appointment. They prescribe you glasses, and the claim for the appointment and glasses are submitted to your vision insurance. Of the $200 in charges, $150 are covered by the vision benefits. When you receive your $50 bill, you pay from your HSA. You now have $1950 in your HSA but still owe $2000 to your medical deductible.

 In February when you trip and fall because you weren’t wearing your glasses, you are rushed to the emergency room where you have x-rays and are fitted for a cast. The claims total $3500. $2000 are applied to your deductible, and your medical insurance pays $1500. You are responsible for the $2000 that went to your deductible, but since you only have $1950 left in your deductible, you must pay $50 out of pocket to make up for your vision claim.

Want to know to rest of the top 10 reasons your HSA does not match your deductible? Check out the McGohan Brabender checklist and look for upcoming and previous articles explaining the other reasons!

Top 10 Reasons Your HSA Does Not Match Your Deductible #6

6. You paid for non-covered benefits with your funds

While an HSA is a bank account, it is a very special account because it is funded with tax-exempt dollars. That means that these funds can only be spent of IRS declared qualified expenses. While this certainly includes medical claims that area applied to your deductible, this money can also be used to pay for such expenses as acupuncture and over the counter medications (so long as you have a prescription on file). However, in many cases these expenses are not eligible to be applied to your medical deductible. While you can pay for them with your HSA funds, you will end up with less money in your HSA than you must have to meet your deductible.

For instance, let’s say that you have a $1500 deductible and start the year with $1500 in your HSA. Since you have seasonal allergies, your physician has suggested that you get some Allegra in April. Although this is now an over the counter medication and cannot be run through your medical insurance, because the physician has written you a prescription, you are able to pay the $20 charges with your HSA funds. You now have $1480 in your HSA and $1500 left to meet on your deductible. When you have a bad fall on a run in May and break your ankle, you x-rays, casting, and crutches total claims of $1600. You insurance applies the first $1500 to you deducible and pays the remaining $100. You are responsible for the $1500, but you only have $1480 in your HSA. You may pay up to $1480 out of your HSA, but you will need to pay $20 out of pocket to meet you deductible.

Want to know to rest of the top 10 reasons your HSA does not match your deductible? Check out the McGohan Brabender checklist and look for upcoming and previous articles explaining the other reasons!

Top 10 Reasons Your HSA Does Not Match Your Deductible #7

7. You went to an out of network provider

Most plans do not just have one medical deductible. In fact, most break up deductibles into two categories: in-network and out-of-network. In-network typically refers to those providers that have been approved by the insurance company to meet their standards of care and agreed to accept the contracted rates the insurance carrier pays on specific procedures and not balance bill the patient. Out-of-network providers are those who have not agreed to accept the contracted rates of the insurance carrier. Therefore, while the claim may run through your insurance (and insurance may even pay on the claim) and a portion may be applied to your out-of-network deductible, the provider is able to balance bill you for the remainder of the claim. While you are allowed to pay this amount using your HSA funds, there will now be a discrepancy between your HSA funds and your remaining deductible.

For instance, let’s say that you have a $1000 in-network deductible, a $2000 out-of-network deductible, and you put $1000 in your HSA account to start the year. You go to your physician for a sore throat, and after your appointment, the doctor sends in the claim. However, this doctor is an out-of-network provider on your insurance plan. He bills $100 for your appointment and tests. The insurance company receives this claim, and they apply $60 to your out-of-network deductible, leaving you with up to $1000 to meet on your in-network deductible and $1940 on your out-of-network deductible. You will now receive a bill from the doctor for the full $100 since they are allowed to bill you above what the insurance company as they are not contracted with them on your plan. You pay this out of your HSA, leaving you with $900 in your account (although you still have more to meet on either your in or out of network deductibles). Had you gone to an in-network physician for your sore throat, the doctor could have billed the same $100, been required to accept the $60 contracted rate, and you would have only been billed $60. Then you would have only had to pay $60 out of your HSA, and you would have $960 left in your account and $960 left to meet on your in-network deductible.

Want to know to rest of the top 10 reasons your HSA does not match your deductible? Check out the McGohan Brabender checklist and look for upcoming and previous articles explaining the other reasons!

Also, make sure to check out our links to help you find in-network providers on your plan!

Pregnant? Check out United Healthcare's Healthy Pregnancy Program!

Pregnancy can be one of the most exciting time of a woman’s – and couple’s – life. At the same time, it can also be a time full of questions, concerns and confusion regarding medical care, the options available, and what steps should be taken to ensure a healthy baby and mother.

In order to make this process easier, United Healthcare has created a site healthy-pregnancy.com that can be accessed by anyone as well as a program for expectant mothers on their plan.

At healthy-pregnancy.com, you can utilize tools such as a due date calculator, week by week baby growth explanations, fitness and nutritional tips, descriptions of the types of delivery available to women, and resources such as an appointment tracker and links to sites that can help you know more about the care your planned hospital offers. Make sure to check out the birth plan checklist (which is printable) so that you can easily communicate your birth plan to your entire labor and delivery team.

The program that United Healthcare has created also provides additional resources to their members. By enrolling for the Healthy Pregnancy Program during the first 33 weeks of their pregnancy, expectant mothers are given access to 24-hour toll-free access to experienced pregnancy and childbirth nurses, educational materials and resources, as well as one-on-one support. Currently, over 41,500 high-risk pregnancies has been identified and supported by the nurses of this program, helping expectant mothers to be more informed throughout their pregnancy.

Top 10 Reasons Your HSA Does Not Match Your Deductible #8

8. Some of your claims were adjusted after you paid the bills

The processing of medical claims is not always a simple or quick process, and sometimes insurance carriers require additional information in order to process a claim. During this reprocessing time, providers may choose to rebill a member for the balance of the bill. Should this be reprocessed, additional funds may be applied to your deductible but the amount owed may also be lessened. Then, the provider would owe the member a refund, and their HSA and deductible would not match up.

For instance, let’s say that someone goes to the doctor. They have a $1500 deductible and have $1500 in their HSA. While at the doctor, they have their annual preventative visit, an eye exam, and their allergy shot. The provider then sends their bill to the insurance carrier for the visit: $50 for the visit, $25 for the eye exam, and $25 for the allergy shot. Based on the bill coding, the insurance provider covers in full the contracted rate of the visit, covers in full the contracted rate of the preventative eye exam, and asks for additional information on the allergy shot (but does not pay anything towards that part of the claim). In the meantime, the provider bills the member for the $25 allergy shot that the insurance carrier has not yet paid. Although the member’s explanation of benefits shows that the allergy shot has not been covered, they go ahead and pay the $25 out of their HSA to the provider. Then, the insurance carrier receives the additional requested information from the provider. With this information, they are able to process the claim for the allergy shot, adjust to the contracted rate of $10, and apply that $10 to the member’s deductible, leaving them with $1490 left to meet. However, the member has already paid $25 to the provider and only have $1475 in their HSA. The member must now request that the provider refund the $15 to their HSA in order to have this corrected or they will continue to have uneven HSA and deductible balances.

Want to know to rest of the top 10 reasons your HSA does not match your deductible? Check out the McGohan Brabender checklist and look for upcoming and previous articles explaining the other reasons!

Top 10 Reasons Your HSA Does Not Match Your Deductible #9

9. Your HSA account has maintenance fees assessed

It is important to remember that although your HSA is unique in how your are allowed to spend the money it is still a bank account. Just like other bank accounts that you might have, your HSA bank may assess monthly or quarterly fees or deduct funds when you ask for paper statements or a replacement card. Should you only start with just enough funds in your account to meet you deductible but you account charges a quarterly maintenance fee, you may end up a few dollars short in your account to pay for your deductible our of your HSA.

For instance, if you have a $3000 calendar year deductible and put exactly $3000 in your HSA at the beginning of the year, you have just enough funds to cover your deductible. Let's say that you have a claim in February for $2000. This applies to your deductible, and you pay for it in full out of your HSA. You still have $1000 in your HSA and have $1000 left to meet for your deductible. Then in March, your HSA bank deducts $5 for your quarterly maintenance fee. You now have $995 in your HSA, but you still owe $1000 to meet your deductible because that $5 charge was not a medical claim. So when you have a $2000 claim in April, $1000 will apply to your deductible and the insurance provider will cover the additional $1000. You can pay for up to $995 of the $1000 applied to your deductible out of your HSA, but you will still have to pay $5 out of your pocket to meet the deductible. It is important to remember that you will also still be responsible for the $5 quarterly fee in June, September, and December. If you do not have enough funds in your account to cover these charges, you may also be responsible for overdraft fees, because at the end of the day, an HSA is still a bank account.

Want to know to rest of the top 10 reasons your HSA does not match your deductible? Check out the McGohan Brabender checklist and look for upcoming and previous articles explaining the other reasons!