High Deductible Health Insurance Plan
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Anonymous
If the hospital is in network with your insurance, you still get to pay the same “agreed to rate” that your insurance pays. You don’t pay more. If a procedure/test is $1200, but your insurer agrees to pay $800, you would only pay the $800 on an HDHP as long as you stay in network. |
Anonymous
This. Even with chronic health issues we do much better with our HDHP. We know we’re going to pay the full deductible in the first few months of each year, and we plan accordingly. |
Anonymous
It's a horrible system and I am surprised people aren't protesting in the streets for this, if they only realize how we are getting ripped off and having such poor quality healthcare. I had high deductible plans my entire life, also bought personal insurance as self employed and through employers. PPO plans, which is what I prefer are pricey and quality of service you get from providers is terrible. You have flexibility to choose any provider though and you don't need approvals (which is the reason for PPO, because, unfortunately, I find quality of care to be terrible and need ability to switch quickly). You basically pay twice, because your premiums are high, your deductible is high and if you are reasonably healthy you are just overpaying for very mediocre care that shouldn't cost nearly as much as you are paying for it. You only come out ahead when you hit your max out of pocket (many thousands of dollars) because of some surgery you need or giving birth or anything major and catastrophic. Sorry, OP, I lived in this world for decades. If you are embarking on this journey now, welcome to hell. |
Anonymous
The funny joke is that if you ask what discounted cash price is for the test/procedure it can cost you less than what you pay towards your deductible based on the "negotiated" discount of your insurance plan. If it costs more, it's only a little bit more which is still not going to justify paying expensive premiums. It's basically a very expensive catastrophic insurance plan. Overinflated prices shown on your bill are complete racket and not what they would charge to a cash patient. This happened to me personally and there are many social media videos on this with people going through their medical bills and comparing discounts provided by insurance with the cash patient discounts medical providers give you. |
Anonymous
| We do high deductible. It seems like it can’t be cheaper but it is, because the premiums are so expensive. We do the math every few years based on typical visits, prescriptions etc. One thing to be aware is that you might be locked into using just one pharmacy for your prescriptions, and they might be quite expansive. Aetna for example forces people to use CVS. I don’t think it should be legal but that’s what happens. Also get used to paying over 5k or more if someone needs the ER. |
Anonymous
Yes, this year I’m hoping we wouldn’t reach our deductible and I’m going to be asking for cash prices for urgent care visits (stitches etc). I already know from past experience that they’re cheaper. Once I had to pay 600 for stitches and follow up to get them removed (300x2)… when it would have been 150 for cash pay with free stitches removal!! I had to complain for hours about that because they had originally told me it would be free to get them removed but the person telling me that didn’t realize my insurance. Very annoying. It’s basically catastrophic coverage like someone said. |
Anonymous
We paid nothing for regular annual physicals for the entire family and also once a year OBGYN exam and a mammogram. I think colonoscopy after a certain age is covered too, but I am not sure, because I did mine after we already met our deductible. I think they heavily discount colonoscopy after a certain age if done according to the approved schedule. But every other appt and scan and minor procedure is out of pocket and goes to your deductible. This means urgent care and minute clinic for kids. Our bills are usually around 200 per kid to go to urgent care for a strep test and antibiotics. Our bill for pneumonia xray and antibiotics was about 300 per kid. You will need to budget for all these appointments and also this makes you ration care and not run to the doctors for any reason. Frankly, this caused some tension between me and my spouse who is rather cheap when it comes to this because he thinks that I am running to the urgent care with my kids too many times wasting money (we rarely meet our deductible, so it's all out of pocket). |
Anonymous
It is, which means you have to really weigh how you are getting your care and ask for prices beforehand and also learn some hacks to cheaper out of pocket expenses. It's just a piece of mind really for you to have full coverage in case of anything terrible happening, but for regular care high deductible plans aren't economical or easy to use, putting extra stress on people having to ration. My advice is to get a list of urgent cares that provide services like xrays, stiches for deep cuts, splints for fractures (before you go to the ortho), etc. Basically, do everything you can to avoid going to the ER because hospital bills are truly atrocious and a minor visit to the ER will get you well on your way to meeting your deductible. What costs 300-500 in urgent care can easily cost a few thousand in a hospital ER, I kid you not, plus the wait. Strategy is this: If your kid gets a minor ortho injury, go to urgent care with an xray machine, call beforehand to make sure they have people who can take care of it and if needed do the temp splint. Then make an appt to the regular ortho the next day (keep calling the list of providers, should be many if you have a PPO plan), and it will get charged a lot less than ER ortho. Of course, in many cases ER is the best solution if it's something serious but make sure it's in your network, and avoid ambulance by all means!!! That's the biggest rip off. Use your car to drive your kid to the ER. If you get a deep cut, the same, find an urgent care that can do stiches, then make an appt with a plastic surgeon to fix it if unsightly. If your kid is coughing too much after a flu, get an urgent care with xray and make sure it's not pneumonia. When you go to the doctors, go to specialists right away, don't waste time on GP appts, which aren't free and where you won't get the right type of tests. Seek second opinions if you are unhappy with the current provider, because switching providers with PPO is easy. Ask for prices before hand because sometimes they do tests or procedures in the office. My ENT clinic uses 2 types of scopes and one is much cheaper than another and has the same result. Welcome to the life of sh** healthcare, my friends. |
Anonymous
| When you buy your plan make sure you can afford premium and the full cost of max out of care expenses (deductible + copay) per year. Then you should be ok. |
Anonymous
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When you need a surgery or a procedure make sure all providers are in network, which means anesthesiologist too, because they will send you a separate bill. Usually a clinic doing the procedure will make sure to disclose this, and if any of their providers are out of network they will settle with you for whatever your insurance pays. the hospital to get this reversed and covered. Last year I had a colonoscopy where their staff anesthesiologist in network was out of office and they got a replacement one who was out of network. They did disclose this beforehand and told me the doctor will take whatever my insurance pays and won't bill me extra, but scary bills get sent automatically. I received a bill for 10K and sorted it out quickly by signing over the check insurance sends for out of network providers. But sometimes they don't disclose.. this happened to me many years ago with a diff insurance plan when I gave birth to my first kid and received a huge bill my insurance rejected. It took a year of constant back and forth to fix it. |
Anonymous
| Has anyone done a specialist visit at Children’s recently? We just did a consult that took max 10 minutes and was charged $375 through our HDHP. No tests were done either. I’ve had other specialist visits but those were more in the $175 range. |
Anonymous
| If you're in DC area, I bet deductible will exceed any reimbursements you could receive for out of network. no way. go for PPO with lowest deductible |
Anonymous
| We saved a ton of money on a high deductible plan. We did the math - a lot of math. We figured out that it would be nearly impossible for us to spend more on the other plan, no matter what happened. Do the math. Imagine the worst case scenarios, do the calculations, and see if the plan will save you money. It worked out even better for us than we thought it would. We are a family of three, no major health problems. |
Anonymous
| and just stay in network |
Anonymous
Not even close. We’ve been on a HDHP for at least 10 years and our out of pocket expenses have never even come close to the amount we’ve saved in premiums. Plus we’ve gotten to max our HSA and leave it untouched for years. Win win! |