Everyone has his or her own unique situation…we get that.
Here are a few “what ifs” to help you understand how to navigate through the health care system.
What happens if I go to my preventive care screening and the doctor says to do “X,Y,Z” in addition to my preventive exam?
Always ask your doctor why something is needed and how much it will cost if it’s not listed as preventive care. If you’re still not sure if something is covered as preventive, call your health plan — the number is also on the back of your ID card.
What if I need to visit the doctor because I think I have strep throat or I hurt my back?
When getting non-preventive services, you have to pay the full cost of the service until you meet your deductible and then coinsurance kicks in. This is when the health accounts help you pay for services during the year – you can use the money in those accounts to reduce your deductible amount.
What if my doctor says I need expensive surgery? How will I pay?
First, always ask your doctor if there are other alternatives, or get a second opinion. If it’s decided that surgery is the best option, here’s an example of how payment would break down. This example is for an individual employee in the Health Fund with a Health Savings Account (HSA).
John needs knee surgery to treat a torn meniscus. This year, John enrolled in the Health Fund plan and contributes money into a Health Savings Account (HSA) but realizes he may not have enough saved to cover the cost of this surgical procedure. He’s concerned about how much he has to pay out-of-pocket, so he contacts his health plan, UnitedHealthcare, to estimate costs.
Based on the estimate (as shown below), John will receive a bill from his provider for approximately $1,801.40. Because he met his medical deductible, UnitedHealthcare will pay 90% of the cost of care. (Bonus! John’s coinsurance is only 10% because he used a designated provider, which saved him over $300).
If John has enough money saved, he can use his HSA to pay for the total out-of-pocket expense that he is responsible for. If John needs more time to pay, he can contact his provider to set up a payment plan and use his HSA to pay monthly until the balance is paid in full.
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