Planning a Procedure on a High Deductible Health Plan

A High-Deductible Health Plan (HDHP) is a plan with a higher deductible than a traditional health insurance plan. The monthly premium is usually lower, but you pay more healthcare costs yourself before the insurance company starts to pay its share.

Planning a procedure on an HDHP can be very affordable because you can use funds from your Health Savings Account (HSA). This type of account is unique to HDHPs and allows you to pay for certain medical expenses with money that has not been taxed by the federal government. You are eligible to reserve $3,450 annually (pre-tax) for an individual and $6,900 (pre-tax) for a family to pay for qualified medical expenses, including your deductible.
 

Factors to Consider When Planning a Healthcare Procedure on a HDHP

There are several pieces of information that you must obtain before scheduling your procedure. An HDHP allows you to direct your own healthcare, and this begins with careful planning. Three important considerations are the cost of your procedure, the quality ratings of your provider and the timing of your procedure.

The Cost of Your Procedure

Because you are responsible for costs for covered healthcare services until you reach your deductible, you should comparison shop if you elect to have a non-emergency procedure. Many health insurance websites provide information on where to find in-network services. Some even offer cost-estimator tools that give the price you would pay to various providers for a specific service. One of the benefits of an HDHP is that out-of-pocket expenses are the negotiated rate between the healthcare provider and insurance company, not the market rate. This can bring significant savings.

To obtain accurate pricing, ask your physician’s billing office for the Current Procedure Terminology (CPT) code for your procedure. You will want to call your insurance company for detailed information about your out-of-pocket responsibility.

Remember that many preventive tests and screenings are covered at 100 percent. You may be able to find a list of covered preventive procedures on your health insurance provider’s website, but call Member Services to confirm before scheduling.

The Quality Ratings of Your Provider

Quality can vary just as much as price, so do your research to find independent ratings of physicians and facilities you are considering. Be open with doctors about your goals of balancing cost with quality of care. Often, doctors may offer solutions for less expensive tests, services, procedures or prescriptions. This may help you in your final decisions.

The Timing of Your Procedure

Timing is also an important consideration. If you anticipate needing an expensive procedure that approaches or exceeds your deductible, schedule it early in the year, if possible. After you have met your deductible, your plan will pay for 100 percent of covered services for the rest of the year. This is where HDHPs can work in your favor, so plan expensive procedures carefully.

Questions to Ask Your Insurance Provider to Determine Procedure Costs on an HDHP

To begin using your healthcare dollars more efficiently under your HDHP, refer to this guide the next time you schedule a procedure:

  • Call your insurance company and say, “I am considering having ________________ procedure. The CPT code is ________. Can you verify whether this is a preventive service at no charge or whether I will be responsible for paying the negotiated rate?”
  • If the procedure is not a preventive service, ask, “How much have I already paid toward my individual/family deductible?”
  • Now, you should ask about in-network doctors. If you have already chosen your doctor, you can ask, “Would you please verify that Dr. ____________ [your preferred doctor] is in-network?” If you do not have a preferred doctor, you may ask for a list of a few doctors in your surrounding area who are in-network and their corresponding contact information.
  • The next step is to inquire about in-network facilities by asking, “Where does Dr. ________________ perform this procedure? Is _________________ [your preferred location] an in-network facility?” Some doctors have privileges at several hospitals and/or ambulatory surgery centers (ASCs), so you will want to choose the most economical location. Often, an ASC is more reasonably priced.
  • Ask, “Are there other specialists that will be billing for this procedure such as an anesthesiologist, radiologist or physical therapist?” Gather as much information as you can to plan ahead.
  • If your procedure requires a hospital stay, ask, “How much should I expect my bill from the hospital to be? Is there a daily charge?”
  • You should now contact and interview doctors if you have not yet made your selection.
  • After you choose a doctor and a facility, check the balance of your HSA. If you have not set aside enough funds through HSA, ask your doctor’s billing office or facility billing office about a payment plan.