I'm getting gouged on prices for medical services when using my HSA plan. How to be billed fairly?
The big difference for me under the High deductible plan has been that instead of paying the co-pay, now I am now responsible for the negotiated rate until I reach the deductible limit. The HSA is only a way to funnel medical payments through a tax free account the insurance company and the doctor don't care about the HSA. If we go out-of-network, then I am responsible for the full rate, but they only count the negotiated rate as a credit against the out of pocket/deductible. This big difference makes it very important to pick a doctor in-network. For your example: I would have paid $50 under the PPO, but $200 under the high deducible plan. If I go out-of-network I would have to pay whatever the doctor want me to pay, but the insurance company would only credit me $200 against my deductible. I can pull the extra $350 from the HSA. It is hard to get good pricing information from some doctors, but the price difference for me has been so large that in-network is the only way to go. For prescriptions the high deductible plan has been worse, because we pay the full price with no discounts for the medicine, until we reach the plan deductible. That makes the cost of the prescriptions as much as 10x's more expensive. In fact the annual cost of our prescriptions all but guarantees that we hit the deductible each year. "I had an HSA for two or three years. I found very routinely that my insurance company had negotiated rates with in-network providers. So as I never hit the deductible, I always had to pay 100% of the negotiated rate, but it was still much less than the providers general rate. Sometimes dramatically so. Like I had some blood and urine tests done and the general rate was $450 but the negotiated rate was only $40. I had laser eye surgery and the general rate was something like $1500 but the negotiated rate was more like $500. Et cetera. Other times it was the same or trivially different, like routine office visits it made no difference. I found that I could call the insurance company and ask for the negotiated rate and they would tell me. When I asked the doctor or the hospital, they either couldn't tell me or they wouldn't. It's possible that the doctor's office doesn't really know what rates they've agreed to, they might have just signed some contract with the insurance company that says, yes, we'll accept whatever you give us. But either way, I had to go to the insurance company to find out. You'd think they'd just publish the list on a web site or something. After all, it's to the insurance company's advantage if you go to the cheapest provider. With a ""regular"" non-HSA plan, they're share of the total is less. Even with an HSA plan if you go to a cheaper provider you are less likely to hit the deductible. Yes, medical care in the U.S. is rather bizarre in that providers routinely expect you to commit to paying for their services before they will tell you the price. Can you imagine any other industry working this way? Can you imagine buying a car and the dealer saying, ""I have no idea what this car costs. If you like it, great, take it and drive it home, and in a few weeks we'll send you a bill. And of course whatever amount we put on that bill you are legally obligated to pay, but we refuse to tell you what that amount will be."" The American Medical Association used to have a policy that they considered it ""unethical"" for doctors to tell patients the price of treatment in advance. I don't know if they still do." First, as noted in the comments, you need to pay attention to your network providers.  If you are unable to pay exorbitant prices out of pocket, then find an in-network medical provider.  if you are unhappy with the in-network provider list (e.g. too distant or not specialists), then discuss switching to another plan or insurer with your employer or broker. Second, many providers will have out of pocket or uninsured price lists, often seen in outdated formats or disused binders.  Since you have asked for price lists and not been provided one, I would pursue it with the practice manager (or equivalent, or else a doctor) and ask if they have one.  It's possible that the clinic has an out of pocket price list but the front line staff is unaware of it and was never trained on it. Third, if you efforts to secure a price list fail, and you are especially committed to this specific provider, then I would consider engaging in a friendly by direct negotiation with the practice manager or other responsible person.  Person they will be amenable to creating a list of prices (if you are particularly proactive and aggressive, you could offer to find out of pocket price lists from other clinics nearby).  You could also flat out ask them to charge you a certain fee for office visits (if you do this, try to get some sort of offer or agreed price list in writing).  Most medical practices are uncomfortable asking patients for money, so that may mean flat refusal to negotiate but it may also mean surprising willingness to work with you.  This route is highly unpredictable before you go down it, and it's dependent on all sorts of things like the ownership structure, business model, and the personalities of the key people there. The easiest answer is to switch clinics.  This one sounds very unfriendly to HSA patients.
Yea right! This is some communist propaganda if I have ever seen it!  No rational person would ever want someone else to be making decisions as personal as health care for them. Get out of here with these ignorant socialist lies.  No questions asked; people want health care decisions to be made between them (the patient) and the doctor, it is a fact. In all practical honesty, no one wants those types of decisions made by some pampered disconnected bureaucrat miles away. Anyone who argues otherwise is not being honest with themselves.  The plain reality of health care in America is that it is a protected and dark market where no one actually gets to see the cost of services. All we need legislatures to do is make insurers and health service providers publish price sheets and cost lists to the general public and we all will get to watch costs for everyone across the socioeconomic landscape plummet to unprecedented lows.   Fuck the Republicans for letting the insurance companies continue to write these disasters of legislation that they call a repeal bill. Equally, fuck the Democrats for letting the insurance companies give us the complete, failure by design, that is the ACA. Both of these shit-wings embedded with wilful bureaucratic incompetence need to just give us a fucking price listing for services and medications and get the fuck out of our way! "Former financial analyst here, happy to help you. First off, you are right to not be entirely trusting of advisors and attorneys. They are usually trustworthy, but not always. And when you are new to this, the untrustworthy ones have a habit of reaching you first - you're their target market. I'll give you a little breakdown of how to plan, and a starting investment. First, figure out your future expenses. A LOT of that money may go to medical bills or associated care - don't forget the costs of modifications and customizations to items so you can have a better quality of life. Cars can be retrofit to assist you with a wheelchair, you can build a chair lift into a staircase, things like that which will be important for mobility - all depending on the lingering medical conditions. Mobility and independence will be critically important for you. Your past expenses are the best predictor of future expenses, so filter out the one-time legal and medical costs and use those to predict. Second, for investing there is a simple route to get into the stock market, and hopefully you will hear it a lot: Exchange Traded Funds (ETFs). You'll hear ""The S&P 500 increased by 80 points today..."" on the news; the S&P is a combination of 500 different stocks and is used to gauge the market overall. You can buy an exchange traded fund as a stock, and it's an investment in all those components. There's an ETF for almost anything, but the most popular ones are for those big indexes. I would suggest putting a few hundred thousand into an S&P 500 indexed ETF (do it at maybe $10,000 per month, so you spread the money out and ensure you don't buy at a market peak), and then let it sit there for many years. You can buy stocks through online brokerages like Scottrade or ETrade, and they make it fairly easy - they even have local offices that you can visit for help. Stocks are the easiest way to invest. Once you've done this, you can also open a IRA (a type of retirement account with special tax benefits) and contribute several thousand dollars to it per year. I'll be happy to give more advice if/when you need it, but there are a number of good books for beginning investors that can explain it better than I. I would suggest that you avoid real estate, especially if you expect to move overseas, as it is significantly more complicated and has maintenance costs and taxes." "There is a lot misinformation in this thread that I'd like to clear up. In fact, you're more than welcomed to PM me if you wish to see any backup to the statements I'm about to make.   First, I'd like to say that as an Uber/Lyft driver, the experience has been nothing short of exhilarating. I normally work in the L.A. and O.C. areas of So. Cal and the amount of interesting, super successful, and wonderful people I meet on a daily basis is off the charts. It's as if I'm some sort of talk show host on wheels.   Initially, I applied for Lyft, as the social and community angle of its service intrigued the hell out of me. I'm an outgoing guy and I'm also an artist of some type who receives a royalty check only once a month. Instead of doing kickstarters and begging for money, I thought doing Lyft would be a great idea instead. So far my customers have been nothing short of an inspiration. Anyway, after passing a background check, a driving test with my mentor, a driving record check, alongside submitting all my documentation (license, registration, insurance) , and a quick vehicle inspection (my car is rather new and in great condition) I was hired quickly.   That same day I decided to get to work quickly, see how the whole system works. As soon as I got to the destination I wanted to get to I got my first call on my phone within 5 minutes. I use my GPS and rush to pick my customer up (while obeying all traffic laws, of course). After a couple of minutes of chit chat I come to find out my first Lyft customer ever is an Uber recruiter. She likes my car and my approach so she hands me a Uber logo'd black bag with an iPhone, a car charger, and a mount. I asked her if this means I have to work exclusively for Uber, she says, ""Nope.""  My eyes then light up like some medieval lights in the sky, chicken little for the peasantry, ancient aliens approved phenomena when I realize I'll have access to both customer bases just one week removed from not being able to pay my phone bill.   After submitting a background check, a driving record check, and pretty much all the stuff Lyft asked for, I was driving for both Uber and Lyft a week after I was hired for Lyft.   The good news for you the consumer is that both companies are being cut throat because they want your money! There's never been a better time to hitch a ride on the cheap. Both companies have thrown millions of dollars over the past couple of months through social media,  driver bonuses, and other venues, so you're able to get a free ride or a deep discount off a long ride.  If you haven't tried both services, now's the time. Don't want to risk getting a DUI just for driving down a couple of blocks to your favorite bar this weekend? You'll probably be able to get a free ride there (if you scour gently for specials) and pay between $7-13 for the trip back. Better than getting your car impounded, losing your license, and paying $10,000+ in penalties and court fees, eh? You have no idea how many poor saps I take to and from work who can't drive because they just got a D.U.I., and who are now plunking $25-35 per ride just to get to where they gotta go.     **INSURANCE**  As for insurance, both companies have given me supplemental insurance. I have full coverage on my car for when I'm off the clock (which was required at time of hiring, btw). So here's how the insurance for Lyft and Uber works.   [For Lyft](http://i.imgur.com/mc6hanN.jpg)   When App is turned on (on the way to pick up client) -or- ""Contingent Liability""   1. * up to $50k/person (bodily injury)  1. * up to $100k/accident (bodily injury)  1. * up to $25k/accident (Property damage)   When you pick up client(s) in the car and you're on your way to the destination.   Excessive liability &amp; UM/UIM  1. Up to $1,000,000/occurence  Contingent Collision &amp; Comprehensive   1. up to $50,000/accident  ($2500 deductible)   [For UberX](http://i.imgur.com/k9kIvzB.png)   When App is turned on (on the way to pick up client) -or- ""Contingent Liability""  1. up to $50k/person (bodily injury) 1. up to $100k/accident (bodily injury) 1. up to $25k/accident (Property damage)   When you pick up client(s) in the car and you're on your way to the destination.  Excessive liability &amp; UM/UIM  Up to $1,000,000/occurence  Contingent Collision &amp; Comprehensive  up to $50,000/accident ($1000 deductible)  Other than the deductible, as you can see both plans are pretty much the same. Which in my opinion, should be more than enough.   **SERVICES &amp; EXPECTATIONS**  Both apps are easy to use and within 5-10 minutes (sometimes much sooner, there've been many times where I get a call and the customer is on the sidewalk a few feet from where I was parked waiting for my next call). Both passengers and drivers adhere to a rating system. As of today, if either driver or passenger fail to maintain a rating of 4.6 and above they risk being booted from using the app. So it's important that drivers know what the hell they are doing (like being courteous, respectful, professional, clean, and know how to use a GPS while driving accurately and safely and/or knowing their routes instinctively) and passengers should also be polite, respectful, communicative (very important since drivers aren't psychics). Also, don't be so drunk that you either pass out or throw up in the back and make sure that if your bring your friends along for the ride, that they adhere to the code of conduct expected of passengers. I've run into numerous instances where an otherwise perfect passenger gets dinged for their drunk and/or rude friends.    Also, as a driver, for your insurance to work, don't EVER end a drive early because you made a wrong turn or were late for a pick up. You're risking an insurance hiccup in the event of an incident, and passengers should also make sure that their driver has their app online throughout the entire trip, as well as making sure the driver's pic of him/her and his/her car match the profile you see on the app.   As for safety, I've yet to hear from a passenger they felt they were ever in immediate danger. Did they get a creepy vibe from one of their drivers? Sure, not everyone is a social butterfly, and there has been an inundation of ex-cab drivers going over to Uber (which is good, cause' the service is getting pro drivers with experience, but could prove detrimental, since they're gonna have a hard time competing with Lyft on the charisma side of things).   However, I've already numerous accounts from young women in Hollywood who are now refusing to call for a yellow cab or taxis on Hollywood Blvd and Sunset and the surrounding areas due to unwelcome sexual advances by drivers looking to take advantage of their sometimes solitary and inebriated drive home. It's heartwarming and great to hear whenever you drop one of these young women off at their places and they thank you for being both professional, courteous, welcoming, and above all else, trustworthy, all while paying a fraction of the cost of what a cab would normally run at that time of night.   **MY PERSONAL EXPERIENCE (IN SUMMARY)**  I'm literally having the time of my life. My other job requires me to interact with humanity, pick its brain, and then express those experiences to everyone else in an invigorating, positive, and inspirational manner. What better way to do it--while earning some decent money--than driving around for Uber and Lyft.   These services are, without a doubt, revolutionary, and are being used and employed by both young and old, men and women, struggling students, and strategically utilized by incredibly wealthy and successful Hollywood types and investment bankers. It's cheap, reliable, and very fun too. It's also bringing back the long lost art of human interaction and conversation back into our daily lives.   So far, so good, and it breaks my heart whenever I hear misinformation and astroturfing about these services throughout the internet, and I'm supremely angered as to how certain municipalities are colluding with taxi cab lobbies to prevent Uber and Lyft and other ride-share services from competing fairly at a time where cities are desperate to ease congestion, reduce DUI's, and make sure their citizens are happy and are left with more money in their pocketbooks." "I also talked to the IRS yesterday to get a few of my own questions answered, and I asked a few of these while I was at it (as I didn't know the answers for sure either, even after reading IRS pub 969). To answer your specific questions: I would, however, like to confirm a few things: You are allowed to have multiple HSA accounts. My company forces me to   use a specific bank if they are going to be make contributions.   However, I would like to move this money to a higher-risk/higher-yield   account. You are allowed to withdraw money to reimburse any past payments that   were made after the HSA is opened – perhaps years later. This would   allow me to accumulate interest on the money and then get reimbursed   later. You can transfer money between HSAs, etc. and the money will still   cover any payments since the first HSA was opened? I am currently unmarried and without children. An HSA can be made to   pay for any dependent or spouse medical bills as well. I am currently   signed up with an HSA that is marked as ""individual"" or something. I   assume that once I get married, I should have no issues using this   money from the past on my wife and kids? Note that I am not a certified tax professional and you should not rely on this information for your own tax decisions, but should investigate or contact the IRS yourself." CrimsonX did a great job highlighting the primary pros and cons of HSAs, so I won't go into detail there. However, I did want to point out another pro - HSAs are (or can be) easy to manage. You said: Is this a better way to approach health care costs instead of itemizing health care expenses on yearly federal taxes? I'm not sure which company you are looking at establishing your HSA with, but with mine I have a debit card that I use when paying for medical care and then at the end of the year I get a 1099-SA that provides the amount of money spent on qualified purchases that calendar year. Yes, there are a few extra boxes I need to fill in for my 1040 come tax time, but I don't need to itemize my healthcare costs over the year. It really is pretty simple and straightforward. Also, one con that is worth noting is that you become much more sensitive to healthcare costs due to the high deductible healthcare plan an HSA requires. For example, in all the years we've had an HSA we've not yet met our deductible, which means we pay out of pocket for any non-routine doctor visits. (The health insurer pays 100% of routine visits, like my wife's annual, well-baby check ups for the little one, and so on.) So, when you're feeling really sick and think a doctor's visit would be warranted, you have to make a decision: After being faced with this decision a time or two you will start to envy those who have just a $20 copay! Of course, that's just an emotional con. Each year I run the numbers on how much we spent per year on out of pocket plus premiums and compare it to what it would cost in premiums for an HMO-type plan, and the HSA plan always comes ahead. (In part because we are a pretty healthy family and I work for myself so do not get to enjoy group discount rates.) But I thought it worth mentioning because there are certainly times when I know I need to see a doctor or specialist and I cringe because I know I am going to be slapped with a big bill in the not too distant future! "My gym has a habit of randomly increasing our monthly payment with a $20 ""Special Fee"" a couple times a year.   This charge was not initiated until after I signed up, and signed authorization for a set monthly fee. The agreement I signed included no wording of this fee, so I have not given them permission to charge me this fee. I also have received no type of notification of this fee prior to it being charged to my credit card on file.   This seems very illegal to me. Am I right? What course of action might I have to get this stopped?" I'm a business law student, so medical stuff isn't really my specialty. I'll share with you what I know though. First, as to the legality, I'm not aware of anything making it illegal for them to consider their business with you concluded. Absent any contract between you and the doctor, it seems to me that you agreed to pay them in cash. If I was the business, I'd assume our business had been concluded as well. As for any contracts between the insurance company and the doctor's office, as far as I know, that's between them. That wouldn't give you standing to sue the doctor. I'm unfamiliar with a patient submitting insurance claims, but if that's something you are allowed to do with your insurance company and all you need is more information, submit a request for your medical records to the doctor. Under United States law, your medical records are yours. You have a right to receive a copy of them. Keep in mind though that the doctor's office may charge you a small copying fee to cover expenses they incur while making a copy for you. As far as complaining, I would suggest your local Better Business Bureau. Each state generally has a medical board which oversees doctors. You might lodge a complaint with them as well. I hope this helps. Keep in mind that I'm not an attorney. This is not legal advice. This is only what I personally would do if I were in your situation. You can and should consult an attorney who is licensed to practice law in your particular jurisdiction. If you do not presently have an HSA-compatible insurance plan, you cannot legally add money to your HSA. You can still withdraw, but you can't add. So basically your choice are to let the money sit there and be nibbled away by the monthly fees, to withdraw it anyway and pay the tax penalty, or to spend it on whatever medical expenses you do have. I have no idea what your expenses are, how good your present insurance is and how often you and any dependents see a doctor or get prescriptions. If you used it for ALL uncovered expenses, how long would it take to use it up?