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!