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!