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That’s typical for high deductible. I’d recommend creating an HSA and saving up for those costs tax-free. If you don’t go to the doctor that often, it’s often still cheaper to pay those costs + your insurance premiums than it would be to pay for a higher-priced insurance plan. If you find yourself going to a lot of doctor’s visits, you might want to reassess for next year and see if it’d be more cost efficient to go on a more expensive plan. In the meantime though, just set aside money for those costs and don’t stop going to the doctor if you need to.
I did this for each provided and what they told me I’d get billed was completely different from what I was actually billed. That’s why I feel like I was kind of cheated and feel powerless with this insurance stuff/my health 😢
Welcome to the wonderful world of for profit healthcare! If you have not met your deductible for the year (~$2,000) then insurance doesn’t pay for anything. The $250 charges are basically arbitrary. The insurance company didn’t pay for half of it; the “discount” is the negotiated rate between the doctor’s office and the insurance company. You owe whatever the negotiated rate is. There’s not a whole lot you can do other than complain and escalate. I’ve done this before and received a discount. I would definitely ask about the new patient fee bc that sounds like bs.
FWIW a HDHP makes sense for most people, but in some situations it doesn’t. I’m on a PPO plan with a $500 deductible because I was not blessed with good health genetically. Finding doctors and comparing costs is not worth the hassle for me. I did the math to compare what I spent on the PPO last year vs if I did the HDHP instead and it was about the same cost to me. The only benefit to a HDHP is having an HSA. But for me that financial benefit isn’t worth the stress.
Pro
high deductible means your insurance doesn’t help out much until you hit that deductible with your own money (out of pocket). it also sounds like you went to a specialist, so this type of assessment wouldn’t be part of some yearly well-being check so to me, it doesn’t sound too unreasonable.
maybe give your insurance provider a call and have them walk you through the billing
Pro
i got high deductible too, under the assumption that i probably won’t even be spending much money on medical visits other than the covered yearly assessments. im keeping high deductible so I can use the free HSA money to invest. But if you think you may be racking up a personal fee in medical expenses, maybe a medium tier would be better? I don’t really have too much advice other than what I know for myself :/
One thing i am always cautious of though is to talk about fees BEFORE going in for an appointment. that new patient fee is BS - sucks that they didn’t tell you on the phone
Chief
If you're on a high deductible, make sure to max out your HSA ($3500/ year individual).
Chief
Does PwC match? EY does not.
I’m a bit surprised your insurance company paid anything for these dermatology activities if you were below your deductible. Are you sure that this wasn’t your benefit for using an in-network provider? For example, if the dermatologist billed $250 but they have a contract with your insurance company to only charge $125 for the procedure, then your EOB will show an insurance adjustment of $125 but the insurance company didn’t pay anything, you just got the advantage of the insurance company’s negotiated rates. Make sure you go to an in network provider to get this benefit. If you go to an out of network provider, that can charge you anything they want. You could go to a lower deductible plan but look at the difference in those costs. At my company the lower cost plan costs more than the deductible difference.
If you were billed $250 for the office visit and $250 for the biopsy and your insurance company negotiated that to 125 and 125, that’s pretty fair. The insurance company has already negotiated for you. If you want to see a line item billing, look at your EOB, it will show each charge, the amount billed, the negotiate amount, the amount paid by insurance, and your responsibility. The point of high deductible insurance is that you take care of these “small charges” and insurance covers when you need surgery or hospitalization. You should use your HSA to save tax free to cover your deductible and co-pays. You could spend your time fighting this but this is a completely reasonable charge for a dermatology procedure and biopsy.
Call insurance to understand why they didn’t cover more and then call the clinic back and tell them you’re willing to pay half (assuming insurance doesn’t pay more). I’ve done this a few times at dermatologists and they typically accept.
Tell them they need to give you a line item bill of the cost of all the items.
Chief
First of all, a “new patient fee” is weird. I have never never been charged that. Some providers will make you be an existing patient before you see the doc for something like a biopsy, so you need an initial exam to be a patient— but you should have gotten something for that $250. So, the first thing here is you need to learn to ask questions at the office ahead of service— what do they charge, how do they bill, etc. You’ll get the hang of it.
Secondly, though these fees sound high, remember you are paying way less per month in deductibles than the alternative plan. Once you have some $ built up in HSA account these fees won’t seem so bad and won’t deter you from getting care. On a high deductible plan, your best move is to put the max into your HSA each month.
Chief
You have to make your own decisions, but the way I do it is map out a year of premiums in an excel sheet to compare the various options. Then I add in costs for treatment for my likely expenses and see what is cheaper.
Then I do the same analysis but with a “reasonable worst case” medical situation thrown in there. Could I manage that? Would it wipe me out?
Remember, you can always use something like care credit or well fargo health advantage to pay a big bill. And, you don’t have to pay that big bill at once. You only have to pay a small bit at a time in good faith to not be sent off to collections.
I have a family of 4 and a lot of complex health issues. I still choose the low premium/high deductible plan. Just food for thought. Don’t make a choice out of fear.
You should get a higher tier of insurance. Your reasoning for getting a high deductible plan has changed. In an earlier comment you just riddled off wanting to see 3 specialists. GI will be expensive as you can go down a rabbit hole easily.
Yes that’s normal for a specialist and for pretty much all plans until you hit a deductible. New patient fee is weird to me, sounds more doctor specific than standard practice
Rising Star
High deductible health plans assume you don’t go to the doctors frequently, and would rather have less money taken out of your paycheck each month, with the trade off being that you’ll paying more per doctors visit. You also can start an HSA that is direct deposited from your paycheck and then you can use that money tax free to pay for those more expensive drs visits as needed, and invest those funds if you don’t.
It's a numbers game, a higer deductible plan will be for people who rarely need medical care, to minimize annual spend on premiums and deductibles. Not a good fit for individuals or families that need Healthcare throughout the year, as you'll have to exhaust that deductible every year before coverage kicks in. With just a handful of visits per year the HDHP still makes sense, you'll have to forecast next year's needs, and then weigh each option against another.
Max out the HSA in all cases.
Most likely your plan didn’t pay anything since you haven’t hit your deductible, but what you saw on your bill was the “plan discount” (the special rates negotiated between your insurance company and the provider).
You’re almost always better off with a high-deductible health plan (HDHP) *and* an HSA where you contribute at least your deductible vs. a PPO/HMO. Obviously this depends somewhat on how much your employer contributes to your plan premiums.
Thanks for breaking that down!