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1.I don't understand the part of the bill when it state the amount under the provider's responsibility and the amount allowed?
For example,the charge is $1,050 USD,then the provider's responsibility is $237.00ish USD,then the amount allowed is $838.00ish USD and the co-pay is $45 USD.
Then,the individual out of pocket is about $2,773 USD out of $3,000 USD!
2.Should I get a health savings account and what should I consider about before applying for it?
1.I don't understand the part of the bill when it state the amount under the provider's responsibility and the amount allowed?
For example,the charge is $1,050 USD,then the provider's responsibility is $237.00ish USD,then the amount allowed is $838.00ish USD and the co-pay is $45 USD.
Then,the individual out of pocket is about $2,773 USD out of $3,000 USD!
2.Should I get a health savings account and what should I consider about before applying for it?
Sight unseen, I'm going to venture a guess:
Billed amount - $1,050
Allowed amount - the amount the insurance company is going to pay your provider for this procedure according to the contract your provided signed with the insurance company. If this is a PPO, this is all he is allowed to bill for the entire procedure, including your portion. This is the $838. The balance of $212 is what your provider agreed as a discount to be passed on to you.
If your bill says the provider responsibility is $237, then you are responsible for $601. I truly doubt this. I think you got it backwards...I think your responsibility is $237 and the provider's is $601 (which they will get paid by the insurance company). This makes more sense in an 80/20 split.
If you have already paid a co-pay of $45 when you went to the doctor, you only need to pay $237 - $45 = $192 to the provider, assuming I am correct that you got the responsibilities backwards.
You have effectively paid the full $237 toward your deductible, which also contributes to your maximum out of pocket of $3000. After you have made all of these co-pays for all other procedures and they all reach $3000, everything you go for is paid at 100%.
1.I don't understand the part of the bill when it state the amount under the provider's responsibility and the amount allowed?
For example,the charge is $1,050 USD,then the provider's responsibility is $237.00ish USD,then the amount allowed is $838.00ish USD and the co-pay is $45 USD.
Then,the individual out of pocket is about $2,773 USD out of $3,000 USD!
2.Should I get a health savings account and what should I consider about before applying for it?
First, never send any money to a doctor until you receive a bill from them. Your EOB (Estimate of Benefits) statement that you receive is not a bill, and should say so.
Second, what the previous poster said sounds correct to me. If you don't understand it, call your insurance company and a representative will explain it to you. If they can't, ask for a manager to explain it to you. Do not call the doctor's office. They will most likely explain it correctly, but you should deal with the insurance people first. When you receive your bill from the doctor, it should match what your EOB said. Then if you have further questions, contact the doctors office.
Regarding a health savings account, it is a good idea for tax savings. The only problem is if you don't use the money, you lose it. There have been attempts to change the law about this but I haven't heard anything being passed yet. Therefore, you do not want to overestimate your health spending. Your premiums can not be used towards this. Think of copays, deductables, co-insurance amounts for doctors, hospitals, prescriptions. I usually calculate what office visits we know we'll have, what maintenance drugs we use, and go just a little bit over. You never know...my husband ended up having emergency surgery in February, so we've pretty much exhausted our account already...but I'd rather have our spending go a little over than lose my money!
Regarding a health savings account, it is a good idea for tax savings. The only problem is if you don't use the money, you lose it. There have been attempts to change the law about this but I haven't heard anything being passed yet. Therefore, you do not want to overestimate your health spending. Your premiums can not be used towards this. Think of copays, deductables, co-insurance amounts for doctors, hospitals, prescriptions. I usually calculate what office visits we know we'll have, what maintenance drugs we use, and go just a little bit over. You never know...my husband ended up having emergency surgery in February, so we've pretty much exhausted our account already...but I'd rather have our spending go a little over than lose my money!
A Health Savings Account is not the same as a Flexible Savings Account. You don't lose the former if you don't use it, unlike the latter. You can take the former with you even if you leave your employer. You have to have a High Deductible Plan to get an HSA; you don't need that with an FSA.
What is a co-pay,a deductible,and a co-insurance exactly?
Deductible - the first x amount of dollars you would be responsible for of any charges before your insurance would start to pay.
Co-pay - an amount usually for office visits due to the provider at the time of the visit. This amount would reduce your liability to the provider.
Co-insurance - the sharing arrangement based on your coverage that you and the provider have for each procedure; the amount after your deductible is met is subject to coinsurance, commonly 80/20, 60/40, 50/50
Example: You have a policy with a deductible of $2,500, a $25 co-pay for doctor's visit, $35 for specialist, $60 for Urgent Care, $100 for Emergency Room visits; Rx contributing to the deductible (not always the case)
You go visit Dr. No to have your cholesterol levels checked. Dr. No is an internal medicine doctor, and has been seeing you as an established patient. You see Dr. No and he sends you to lab for bloodwork.
Here's your bill:
Dr. No's bill to Insurance Co. for visit - $160
Contracted amount payable for visit (per contract of Dr. No with Insurance) - $140
You pay $25 at the get-go to Dr. No (co-pay)
Lab - $250; negotiated lab - $180
Because you have not satisfied your deductible, you will owe:
Dr. No - $140-$25= $115
Lab - $180
Total - $295
$295 goes toward your $2500 deductible. You will be liable for $2,205 more before coinsurance applies.
If in the above scenario, you have satisfied your deductible you will owe the following:
Dr. No = 20% of $140 = $28 less the $25 co-pay means you owe Dr. No $3. Insurance pays Dr. No $112 (80% of $140)
So,the co-pay doesn't even apply to the deductible,am I right? Since,you stated that it reduces your liability to the provider because it would takes longer for you to use up all of your deductible.
A Health Savings Account is not the same as a Flexible Savings Account. You don't lose the former if you don't use it, unlike the latter. You can take the former with you even if you leave your employer. You have to have a High Deductible Plan to get an HSA; you don't need that with an FSA.
My apologies; the co-pay counts towards the deductible.
In most FSA's, you can claim against money you have not yet contributed provided the amount is within your annual election. For example, you elected to contribute $100 per pay period toward an FSA starting on January 1, 2009 for a total annual contribution of $2,600. On January 15th you had to have a root canal in the amount of $1,200. You can claim this entire amount against your FSA and may be reimbursed for the entire amount, even if you have not contributed that amount yet. So far, all my employers have "advanced" the funds to me. If you over contribute and don't use it, you lose it to your employer.
Conversely, in an HSA, you can only claim against the balance of what you have so far contributed. So in this example, you would not be reimbursed out of your HSA until you have made 12 contributions of $100. You would have to advance this amount and submit a reimbursement form. However, whatever you contribute is yours to take with you, even if you leave your employer. There are also differences in what is covered in each. If you are not in a position to advance large payments, take the FSA, but be careful not to over contribute since you would lose whatever you don't use.
The lower the deductible, the higher the premium. The choice of a health plan and the accompanying FSA/HSA will depend on your particular health condition or plans for elective procedures during the year.
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