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!
