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!
