Controlling the Cost of Healthcare – for the Employer

The cost of healthcare seems to always be on the rise, both for employees and their employers. Various plans have been introduced throughout the years to help control these costs – from front end deductibles to high deductible/HSA plans. Recently, United Healthcare and McGohan Brabender partnered to launch a new, innovative program and product to help employers earn significant trend and rate adjustments for their renewals call Bend the Trend.

The easiest way to understand how the program works is to break the program down into Years 1 and 2.

Year 1 establishes the foundation for the Bend the Trend Program at the employer level. To "get on the field to play," employers agree to some basic strategic commitments in the following categories: wellness, optimal plan components, outcomes-based plan design, diabetes prevention/control. Don't worry, it sounds a lot more complicated than it actually is -- and chances are good that you're probably already doing some of it or all of it already. If you are an existing UHC customer, you can go ahead and start at year 2.

For meeting each employer strategic commitment, points are awarded Click Here to Download PDF Chart . The more commitments you meet, the more points you earn. Thus, the greater the premium discounts.

Beginning with your Year 1 start date, the Year 2 clock begins ticking. Now we need your employees to get involved. Do you remember those four strategic buckets we started with at the employer level? Well, we take those same four buckets and add some employee activities to them. Some are very simple, and others may require a little more effort – but that's ok. Our goal is to get your employees to own their health care plan…not rent it!

Just as with the employer commitment, employees earn points. Some of the points are awarded for participation while others are based on outcomes.

At the end of Year 1, your Year 2 rate adjustments are determined. This is done by adding up your earned Year 1 and Year 2 points. The greater your points, the greater your rate adjustment.

Want to know more about this program? Check out the Bend the Trend website for a potential financial impact calculator, wellVibe trailer, and a contact form!

Top 5: Ways to Control the Cost of Healthcare #5

5. Get pre-authorizations or predeterminations of

benefits done when necessary

Pre-authorizations are prior approval from an insurance carrier for a procedure. These are not guarantees that the claim that comes in will be covered, but it is a statement that the insurer intends to cover the service. Many non-emergency medical procedures and services require a pre-authorization, and it is important to ask your physician if a prior-authorization is needed before a procedure. Most physicians will be generally aware of procedures requiring a pre-authorization, and they will call into the insurance carrier for review. Without a pre-authorization, some claims that might have been covered will be denied. If you want to be certain that a procedure does or does not require a pre-authorization, you can always get the procedure coding from your provider and call them in to your insurance carrier to verify.

Predeterminations of benefits are similar to pre-authorizations, but they are not required. Often, they are done for procedures in which a provider must prove that a patient meets medical criteria for a procedure before it can be performed. For instance, treatment of varicose veins is often denied as not medically necessary. However, if a physician does a predetermination of benefits with the insurance carrier and can provide documentation proving that the member meets the medical criteria, the procedure could be covered.

While it is always important to consider your health and the advice of your physician first, you can also help to control the cost of your healthcare by ensuring that the necessary steps (such as getting a pre-authorization or predetermination of benefits) are taken before any major procedure.

For more ways to control your healthcare costs, check out our Top 5: Ways to Control the Cost of Healthcare and check back often for articles explaining further each of these examples.

Top 5: Ways to Control the Cost of Healthcare #4

4. Ensure that your lab work is being completed by an in-network/participating lab

Just like in network providers, it is important to utilize in network (or participating) labs in order to receive the highest benefit from your medical coverage. Just like going to an out of network provider, using an out of network lab can result in higher costs, balance billing, and claims going towards a higher, out of network deductible.

For instance, let’s say that you have the following benefits and have already met your in network deductible for the year.

Covered Benefits	Network	Non-Network
Deductible (single/family)	$500/$1000	$1000/$2000
Out of Pocket Limit (single/family)	$3000/$6000	$6000/$12000
Preventive Care Services Services include but are not limited to: Routine exams, pelvic exams, pap testing, PSA tests, immunizations, annual diabetic, eye exam, vision and hearing screenings ·         Physician Home and Office Visits (PCP/SCP) ·         Other Outpatient services @ Hospital/Alternative care facility	$25/$50 20%	40% 40%

You go to your physician for your annual preventative visit. You have run a check on your insurance carrier’s website, and you confirm that your physician is in network. During your annual preventative exam, your physician runs some bloodwork and sends it off to their lab. Your physician’s bill processes through insurance, and since you have already met your in network deductible, you only owe a $25 copay.

However, your lab work was sent to an out of network lab. They bill $100. The contracted rate for these services is $50, and your insurance carrier applies this to your out of network deductible, which you have not yet met. Since the lab is not contracted, they are able to balance bill, and you are responsible for $100.

Had you requested that your physician send your lab work to an in network lab (which you can find a listing by doing an search on your insurance carrier’s site), then the lab work would have been adjusted to the contracted rate of $50, of which you would have only been responsible for 20% (or $10 – a difference of $100 for you).

For more ways to control your healthcare costs, check out our Top 5: Ways to Control the Cost of Healthcare and check back often for articles explaining further each of these examples.

Top 5: Ways to Control the Cost of Healthcare #3

3. Opt for generic or lower cost drug alternatives when available

Many factors play into the costs of prescription medications: cost of ingredients, costs of research and development, patents, etc. Often, brand name prescriptions have an initial higher cost for healthcare consumers to offset the cost of developing the medications during the window of time when their patent allows for the company to have control over the distribution of the medication. After this time, other companies can create generic alternatives to the brand names.

As the US Food and Drug Administration states:

Generic drugs are important options that allow greater access to health care for all Americans. They are copies of brand-name drugs and are the same as those brand name drugs in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.

Health care professionals and consumers can be assured that FDA approved generic drug products have met the same rigid standards as the innovator drug. All generic drugs approved by FDA have the same high quality, strength, purity and stability as brand-name drugs. And, the generic manufacturing, packaging, and testing sites must pass the same quality standards as those of brand name drugs.

Since the companies creating the generic medications do not have to invest as significantly in the research and development of the medication, they can sometimes offer it at a discount rate.
While your primary decision on medications should be the advice of your physician, opting for generic or lower cost drug alternatives is another way to control the cost of your healthcare, and you can ask your provider about your options.

For more ways to control your healthcare costs, check out our Top 5: Ways to Control the Cost of Healthcare and check back often for articles explaining further each of these examples.

Top 5: Ways to Control the Cost of Healthcare #2

2. Choose the right care facility (Primary Care Physician vs. Urgent Care vs. Emergency Room)

There are lots of options when it comes to where you go to receive health care services, and those options have different purposes as well as different financial implications.

Duke Health offers the following explanation of when to use each type of health care service:

Primary Care Provider

Unless you are experiencing a life-threatening emergency, primary care centers are the best places to start. Primary care providers are physicians who deliver basic care for common illnesses. They are your first stop for most undiagnosed health concerns.

You should visit a primary care center for illnesses such as colds, flu, and sore throats; minor injuries, aches, and pains; or routine health exams. You can schedule appointments with primary care providers during the week, and they are available by phone anytime for advice about health problems.

Urgent Care Center

If your primary care physician is not available and you need quick medical attention for a non-life-threatening problem, visit an urgent care center. Urgent care centers have similar resources to primary care facilities, but they provide comprehensive quality care on a walk-in basis with extended hours.

Go to an urgent care center when you need immediate medical attention or have non-emergency health concerns after hours. Examples include ear infections, sprains, simple cuts and burns, and eye injuries.

Emergency Department

Life-threatening emergencies and late-night trauma require an immediate visit to the hospital. Emergency rooms offer inpatient care, emergency services, trauma services, and more. Emergency clinicians are able to recognize, diagnose, and make recommendations for a wide array of medical issues.

Call 911 or drive to the emergency department at your nearest hospital whenever conditions cause severe symptoms and/or put your health at serious risk. Examples include heart attacks, poisoning, severe bleeding, and broken bones.

While life threatening emergencies require a visit to the emergency room, other illnesses or injuries do not and can offer significantly lower cost options for care.

For instance, let’s say that your benefits are as follows and you have already met your deductible year to date:

Top 5: Ways to Control the Cost of Healthcare #1

1. Utilize in-network/participating providers with your plan

Most insurance carriers create ‘in-network’ or ‘participating’ provider groups for their plans. These are providers that meet certain criteria and contract through the carrier to accept certain pay rates for their services. By going to an in-network or participating provider, you can help to control your healthcare costs and ensure that you are getting the highest possible benefit for your care.

For instance, if a provider is in-network for your plan and they bill $100 for an office visit but your insurance carrier has a contracted rate of $75, you will only be billed for $75, which will be applied to your deductible. However, if you were to go to a provider for the exact same service and they bill $100 but are out of network you will still owe $100 because they are not contract to accept the $75 rate. Additionally, only $75 will go towards your deductible. This is called balance billing, and if there is no agreement between the insurance carrier and the provider, the physician is allowed to bill you whatever amount they choose to charge.

Also, some plans are set up to have different deductibles for in and out of network claims. For instance, your benefits summary might look like this:

Covered Benefits	Network	Non-Network
Deductible Family coverage requires the family deductible to be met before coinsurance applies. The single deductible does not apply to family coverage. Network and Non-Network deductibles are combined.	$1000 individual $2000 family	$2000 individual $4000 family
Out of Pocket Maximum	$1000 individual $2000 family	$2000 individual $4000 family

Let’s say that these are your benefits and you go to an in network emergency room because you are having chest pains. After the visit, testing, and discharge, you are billed $3000. You provider adjusts this to their contracted rates for your services to $2000. Since you have individual coverage and no coinsurance after your deductible, you will owe $1000 to meet your deductible, $1000 will be paid by the insurance carrier, and $1000 will be a contracted write off for the emergency room. However, had that emergency room been an out of network facility and you were billed $3000, the insurance company would have applied the full $2000 of the contracted rate to your higher out of network deductible. Since this facility is not contractually obligated to accept their pay rate for the services, you will owe to full $3000.

In order to make sure that you are going to a participating provider, it is best to call the number on the back of your ID card or search your carrier’s directory for participating providers on your plan. If you are asking your provider, it is important to specifically ask whether or not they are contracted with your insurance carrier on your specific plan.

For more ways to control your healthcare costs, check out our Top 5: Ways to Control the Cost of Healthcare and check back often for articles explaining further each of these examples.

Top 5: Ways to Control the Cost of Healthcare

Healthcare can be expensive, whether you are on a high deductible health plan with an HSA, a PPO, or some other health care plan. As many plans are becoming consumer driven, it is important as a consumer to understand how to control the costs of your care.

While not every option works best for every person, the top five ways to control the cost of your health care are:

1.    Utilize in-network/participating providers with your plan

2.    Choose the right care facility (Primary Care Physician vs. Urgent Care vs. Emergency Room)

3.    Opt for generic or lower cost drug alternatives when available

4.    Ensure that your lab work is being completed by an in-network/participating lab

5.    Get pre-authorizations or predeterminations of benefits done when necessary

Check back to our blog often over the next few weeks for articles explaining how each of these options can help in controlling the cost of your care. Also, download our Top 5 Ways to Control the Cost of Healthcare checklist!

Top 10 Reasons Your HSA Does Not Match Your Deductible #1

1. Your prescriptions have not be submitted to your insurance

One of the most common reasons that HSA accounts do not match up with medical deductibles is because a prescription has not been run through the insurance (and therefore not applied to the deductible) but paid for with HSA funds. Whether a pharmacy has old insurance information, offer a cheaper generic alternative that is not submitted through insurance, or confuse running an HAS card (that has the insurance emblem on it) as running the charges through insurance, our team is seeing this as a common reason that deductibles and HSA accounts become uneven.

For instance, let’s say that you have a $1500 deductible and start the year with $1500 in your HSA account. You fall ill one evening and go to the hospital. The hospital examines and treats you, releasing you the next morning with even medication for a week. However, you have instructions to go get more medication once you are out. The hospital submits the claim for your visit and medication, and it processes towards your in network deductible for $1400.  You go to pick up your prescription, which your pharmacist tells you will cost $150. You pay with your HSA funds, leaving you with $1350 in your account, and go on your way. The next week, you receive the bill for the hospital stay. The bill is for $1400, but you only have $1350 in your account. It seems that your new pharmacist forgot to run your prescription through your insurance, leaving you with uneven HSA funds and deductible.

You go to the pharmacy and ask the pharmacist to reprocess your prescription through your insurance. They resubmit it, and find that you only owed $100 to meet your deductible. They refund the extra $50 to your account, leaving you with $1400 in your HSA. You are now able to pay for your hospital bill in full and have met your $1500 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!

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!

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!

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!

Closing an HSA account

HSA accounts are a wonderful tool for member with high deductible plans. They allow members to save tax free money to contribute towards their healthcare costs and can help them to keep track of their deductibles.

It is important to remember that HSAs are bank accounts, though. Just like a bank account, no one other than the account holder can make changes or requests for this account. So should the account holder run out of funds or switch to a PPO plan and decide to close the account to avoid any monthly fees, etc., the member must call and make this request themselves.

Should you need to make changes to your HSA account, you can contact your bank with the following information:

Fifth Third HSA
for support: 888.350.5353

ACS | Mellon Bank
for support: 877.472.4200
after hours support: 800.264.5578

Turnaround Times

When it comes to turnaround time with carriers, issues are able to be resolved more quickly when you have all of the information ready before it is sent in. Time is often wasted with carriers going back and forth between groups or our team asking for additional information.

To expedite your process, follow these important tips: