Oh Sh*t. I’m 26.
It’s New Year’s Day and 2023 brought some added challenges. I turned 26 six months ago, and I’ve found myself stumbling through the complexities of health insurance and enduring insane medical bills ever since. I’m now on my own insurance, deciphering complex accounts and limits. It’s late, and my living room is illuminated by the blue light of the Cigna Insurance Medical Claims page. The zillions of doctor's visits I originally believed would be no cost to me (hello?? In-network??) are tidily laid out before me under "Patient Responsible," adding up to over $1500 in unexpected charges.
My jaw, once attached to the rest of my face, is now on the floor.
The nuances between HSA, HCSA, FSA, and MRA spending accounts leave my head spinning, and I've got $500 of my OWN pre-tax funds that vanished at midnight with no means to settle the payments. How?? Lordy. While I try to make sense of it all, I’ll update this post with the insights I gather along the way. For now, it’s still in progress. Here’s what I’ve got so far:
Phrases to know
“Submit a claim”
A claim is a request that you or your medical provider sends to your insurance company to pay for a percentage/all of your medical visit/service. The percentage paid is based on a variety of factors, including the specifics of your policy, how much you’ve already put toward your deductible, whether the provider is in or out-of-network, etc.
“Can you bill to my insurance first?”
This is a handy dandy trick to not overpay your bill in-office. It allows you to wait for insurance to cover its portion before putting forward any money. Sometimes they’ll have already billed insurance, but it’s always smart to check. If they still require payment, make sure to either put it on a medical card/account or save the receipt to do so later. This way, you won’t have to pay taxes on it.
“No payment is due today.”
Careful there. This phrase doesn’t actually mean no payment is due. It just means it’s going to feel free for a minute, but you’re likely going to be billed for it later. Make sure to check the appropriate portals/accounts to make sure you’re not accidentally raking up medical debt. Urgent care is a sneaky one especially!
“Can you please check to make sure that is coded correctly?”
Medical coding occurs after a visit/procedure and it translates the care you received to a standardized medical code with an associated charge. It’s not uncommon to be subjected to a medical coding error by billing, and it can result in being overcharged for your medical care. If your bill feels like it’s a little high, make sure to ask this question to the medical provider’s billing department to ensure you are being coded for the correct amount.
“Can you please make sure this is billed as a follow-up?”
If you are seeing a doctor more than once for the same issue, it can be billed as a follow-up. Follow-ups should be billed as such because they cost significantly less!
Medical Financial Account Types to familiarize yourself with:
Health Care Debit Card (and what you can spend on)
Health Savings Account (HSA)
Health Care Spending Account (HCSA)
Flexible Spending Account (FSA)
Medical Reimbursement Account (MRA)
Buzz words:
In vs. out-of-network
Co-pay
Deductible
Out-of-pocket
That’s all I’ve got for now. But stay tuned! Like I said, I will continue to add to this throughout the coming weeks and update it with all of the information I learn as I go.
Be well,
Amanda
