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Q re: HSA/high deductibles/Rx benefits

Discussion in 'Parents of Children with Type 1' started by virgo39, Mar 14, 2012.

  1. virgo39

    virgo39 Approved members

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    Oy!

    This year, DH enrolled in a high-deductible health plan with a health savings account.

    No prescriptions are covered until we meet our deductible. We have not yet met our deductible.

    Test strips cost $100/vial through the company's prescription benefit provider and $50/vial through American Diabetes Wholesale.

    He was told today by one of his company's benefit people that:

    even though we are paying out-of-pocket until we meet the deductible, we must use the company's prescription benefit provider (Medco) for all prescription items

    AND

    if we do not do so, the purchase will not be applied to the deductible

    This just seems ... wrong to me. I've asked DH to escalate within his company, but don't have a good sense of how these HSAs work.

    Can anyone point me in the direction of a good source of information?

    TIA
     
  2. Flutterby

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    I don't know how that works either, but it seems wrong to me as well. They are charging DOUBLE what other places would charge? Ridiculous!
     
  3. lynn

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    We have had a couple of different HSAs. I think the company's benefit person is wrong. I would contact the company directly.
     
  4. mmgirls

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    I have no knowledge about those sort of plans, but have a few bits of advice.

    No matter what way you look at it the cost of an RX item should be per Rx not per box. SO make sure your Rx's are written for the total amount you need per month.

    Secondly, you should be able to use your savings account in advance of its balance. SO we say that we will put in $1500 in the year, January 1st we can start to use those funds up to that limit even if we have not put in that much yet.

    You should be getting the insurance price not an out of pocket price, you are using insurance but you need to pay the deductible first not the same as out of pocket cost pricing. so make sure that is what they are qouting you.
     
  5. KatieSue

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    For our insurance any prescription refilled more than twice, MUST go through Caremark mail order or they don't cover it at all. We originally used a local wholesaler and it was cheaper but they won't cover anything if we use them.
     
  6. Flutterby

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    That works for some things. But for strips, if you are paying out of pocket, you are paying per box. If her script is for 400 strips and they are $100 per box and she has to be 100% before she meets her insurance deductable then she's paying $400 for that script. Even pills are billed that way.
     
  7. virgo39

    virgo39 Approved members

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    That is how our other plan worked as well. But not exactly what we are being told now -- the suggestion seems to be that unless we run the prescriptions through Medco from the start (we have new prescriptions for strips, insulin, and lancets) nothing will count towards the deductible. If Medco was offering competitive pricing (or at least in the ballpark), I would be less concerned.
     
  8. Jordansmom

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    Actually with an HSA you can only spend what you have contributed, unlike an FSA which you can spend up to your yearly contribution when ever you want.
     
  9. virgo39

    virgo39 Approved members

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    That is our understanding also. But I believe that once contributions "catch up" with expenditures, we can then use funds in the account to reimburse ourselves.

    I am going to review the benefit booklet when we get it (it's March and we've had to request it multiple times) and see if there is a plan description or other paperwork we need to look at.
     
  10. Gracie'sMom

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    We have the same type of insurance. It took me two years of diabetes to figure the insurance thing out. Yes, you have to go thru someone contracted with the insurance for it to count toward your deductible. It has to be covered for it to count. It stinks, however, for us we quickly realized that we will be meeting the deductible anyway, so just spend it and get it over with. Does that make sense? Doesn't matter if we spend it in $50 increments or $100 increments, we are spending the $4000 either way and then things will be covered. In fact, we meet our $7000 maximum out of pocket by fall each year, and then we don't have any co-pay, so we just assume our costs for the year will be $7000. We put the deductible in a FSA at the beginning of the year and pay it from there, to make it feel less painful. Luckily for us, Michigan has a special supplemental health insurance for children with diabetes (would have been nice to know about it for the first two years of diabetes, though), so now they pick up her deductible and co-pay on diabetes related items.
     
  11. Jordansmom

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    Yes, it's a bit more of a hassle, but once you have extra money in your HSA you can go back and file claims for any money you spent out of pocket and pay yourself back. Also it's nice that any extra funds in the HSA roll over to the next year. You don't have to spend or lose it every year like an FSA.
     

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