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!

Express Scripts and Walgreen's Contract

Recently, articles have begun to circulate regarding the negotiations of Walgreens and Express Scripts, the pharmacy provider network used by Anthem. Articles have included headlines such as Walgreens to Sever Ties With Express Scripts.

After contacting representatives from Express Scripts, McGohan Brabender has been told that:
This type of negotiation is common between pharmacy benefit managers and pharmacies. It's early in the process. There has been no change in our members' abilities to use their pharmacy benefits at Walgreens and Duane Reade pharmacies. The contract does not expire until January 1, 2012, giving the two parties several months to work out a solution. We are hopeful that Walgreen Co. and Express Scripts can soon reach a reasonable solution that meets our members' and customers' needs.

At this time, these negotiations should not effect the prescription benefits of an Express Scripts member going to a Walgreens pharmacy, but we will continue to communicate with our representatives and keep updates posted.

Trends in Benefits: HPV Testing Not Covered as Preventive

Healthcare reform has brought on many changes to the healthcare industry, and one of the benefits that has brought about significant confusion has been the coverage of preventive services in full.

Recently, our team has begun to see a trend of charges for women going for their annual exam with their OB/GYN. Upon investigation, everything has been coded as preventive for many of these exams, but the charges are coming from the lab. Though most of the labs run are coded and can be run through benefits as preventive, HPV screenings are not on the approved list for preventive coverage and are therefore not covered in full. Thus, members are finding that their exams, which they believed would be covered in full, are having some charges. We have seen this happen with multiple carriers, especially as physcians are beginning to make this screening a part of their protocol for annual exams.

So long as this screening remains off of the list of codes that must be covered in full for preventive services and physicians continue to make this a part of their protocol, members will most likely continue to see this charge during their annual exam.

UPDATE: Please see our article on new women's preventative services