Tuesday, April 14, 2009

The truth about HDHP

I signed up for the High Deductible Health Plan (HDHP) option at work, thinking it would be a good deal for me and my husband since we are both blessed with excellent health. The deductible is $2000/person or $4000/family. One of the benefits of the high deductible option is that “Preventative Adult Care”, “Preventative Well Woman Care” and “Preventative Mammograms” are covered at 100% with no deductible. Another benefit is that my company contributes to a Health Reimbursement Account (HRA) on my behalf ($1500 for employee plus one coverage). Sounds great so far, hunh?

According to the description of the plan, “When you enroll in the option, you'll receive a debit card that you can use to pay for eligible expenses as long as you have a balance in your HRA.” My first problem was that I never received a debit card so I did not have access to the funds. When I contacted our Human Resources department, they informed me that the verbiage in the plan description was incorrect. I would not receive a debit card. The funds would instead be administered by Aetna and could only be used for “covered” medical expenses, so any expenses that Aetna denied or over-the-counter expenses would have to come out of my own pocket. Annoying, but I could live with that.

The next obstacle is that there is apparently no such thing as “Preventative” care because Aetna pays almost everything out of my HRA account.

My husband went for a physical and the associated lab tests weren’t considered preventative. Aetna paid the charges from my HRA. Cha-Ching. He went back to have his cholesterol level checked so he could get a refill on his medication and that isn’t considered preventative either. Cha-Ching. That was last year. This year, he went to a new doctor (because our old doctor was no longer in the plan). I have him strict instructions to specify when he made the appointment that it was for his “annual physical”. The doctor’s office billed the insurance company for two visits, coded “99203 OFFICE/OUTPATIENT VISIT, NEW” and “99386 PREV VISIT, NEW”. Aetna paid the $135 for the “PREV VISIT” but took the $100 for the OFFICE/OUTPATIENT VISIT” from my HRA. Cha-Ching. Aetna’s response to my dispute? “Our records indicate that the claim was billed for a routine visit as well as a medical visit. If there were issues discussed during the routine visit that are medical in nature, the provider can bill for a routine visit and a medical visit.” Amazing.

My routine mammogram required a follow-up because the technician saw something that might indicate a problem. The follow-up mammogram showed that it was nothing, but because they “thought” there was a problem, it wasn’t considered preventative. Cha-Ching. Another chunk of change from the HRA.

And the most distasteful of all? Aetna doesn’t seem to think a colonoscopy is preventative either. Do they think I just went through all of that prep-work for the fun of it? Cha-Ching, Cha-Ching, Cha-Ching. There went the rest of the HRA and I still owe $1329.95. My dispute over this one is still outstanding. I can’t wait to hear what response they come up with for this one. 

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