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Navigating The HSA Process: What I Thought I Knew

On the TV show Modern Family, characters Gloria and Jay annoy the first-time parents and the instructor in their baby-care class with their jokes and know-it-all attitude about parenting. “Done…I win!” yells Gloria as she holds up her swaddled plastic baby like a trophy and then slams it down on the table in triumph.

In my experience, I was probably more like one of the nervous first-time parents in the class, but with regards to handling the finances of having a baby I thought I had it in the bag. I had been on my own insurance plan for ten years managing my own health care expenses. I was on a high deductible health plan for several years and had amassed a decent amount of funds in my health savings account (HSA). In addition, I work in the health insurance industry. Although, I’m not involved in educating clients about HSAs (as some of my colleagues do), I have a good understanding of how they work, or at least I thought I did. Being a financial analyst, I thought that dealing with the costs associated with having a baby would be a breeze. Ironically, navigating the healthcare system was more challenging than I anticipated. Throughout the process of going through a pregnancy and delivery with complications, I learned the following four things about navigating the HSA process:

1: Insurance carriers often tout their online capabilities, including the ability to price out certain medical procedures and find which facilities are the most cost-effective. Use this tool to help guide you when researching a doctor, facility, or medical procedure pricing.        

One of the first decisions I made after discovering I was pregnant was selecting both an obstetrician and a hospital. I selected an OB practice and affiliated hospital based on the recommendation of a friend who was a Labor and Delivery Nurse. Occupied with fighting nausea and comparing my growing baby to a fruit or vegetable each week, I did not think about the cost of delivery until halfway through my pregnancy. Luckily, most of the major hospitals in my area charged about the same amount for a delivery, including the hospital I had chosen. However, as I would later find out, if you have any sort of medical complication, all bets are off on how much everything will cost.

2: Know your deductible period.

I have been fortunate that I have never had any serious medical issues. Prior to my pregnancy, my experience utilizing the healthcare system consisted of annual checkups and the occasional doctor’s visit for a minor illness. Even though I had a general idea of what the prenatal checkups and delivery were going to cost, I was still cost-conscious because my pregnancy and delivery were going to cross two deductible time periods. Since my insurance policy was on a January policy period, and my baby was not due until April, I could potentially have to satisfy my deductible twice on the high deductible health plan.

3: Anticipate additional expenses.

Throughout the pregnancy, I was asked if I wanted to take optional prenatal tests. It was difficult to determine how much these tests would cost as the doctors did not know, and delaying the procedure to call the insurance company to find out would have required another doctor’s visit. Frankly, I did not have the time for this; however, I also did not want to be a bad mother by refusing the test.

During my pregnancy, I had minor complications which involved an outpatient procedure in the hospital operating room. This one procedure caused me to blow through my single deductible the first-time and make a small dent in my health savings account. My biggest surprise was when I delivered my baby girl five weeks early. Nothing from my prenatal visits indicated a preterm delivery. However, due to respiratory issues my baby stayed in the neonatal intensive care unit (NICU) for ten days.

Whatever treatments the doctors suggested, my husband and I contemplated what was best for my baby, without thinking of the potential cost. We breathed a sigh of relief when my baby was released, and we switched our focus to learning how to be first-time parents. In the midst of sleepless nights, learning how to breastfeed, and changing endless amounts of dirty diapers, the bills started coming in from multiple areas: the hospital, labs, the NICU.

Even though my check-ups and delivery occurred in the same facility, the bills came from different billing offices and were numerous. We received different iterations of bills for the same services with many adjustments, but no details on what they were for. The term explanation of benefits (EOBs) was meaningless to me because the statements did not explain anything at all (especially on the larger claim amounts). They included clarifying descriptions such as “medical services” and “inpatient physician services.” Two of the largest stressors were worrying that services would be deemed out-of-network (subject to an even higher deductible) and getting final notices before being sent to the collections agency. As a new mother, I did not have the energy or time to dig deeper into the EOBs. I was just thankful I had enough money saved in my HSA to make the problem go away.

4: Billing offices and Insurance Carriers make mistakes.

One particular genetic screening that I needed cost $25, but it was not billed correctly and I received a bill for thousands of dollars as the lab was out-of-network. It took a few phone calls to the insurance carrier and laboratory performing the test to straighten out. In another instance, I received a bill for $4,000 which did not correspond with any of my EOBs. It turns out; there were some adjustments that the insurance carrier made which did not carry through to the doctor’s office until later. Eventually, I got a revised bill for $2,400 which did tie to my EOBs.

Having a baby is arguably the happiest thing you can be in the hospital for and I cannot imagine the stress involved dealing with a life-threatening condition on top of facing huge medical bills. Although there is not much we can do to change the cost associated with hospital visits and medical care, we can work to educate ourselves and become wiser healthcare consumers. It is one thing to be able to articulate how a medical plan should function, but it is another to actually navigate the healthcare system. My pregnancy and delivery not only produced a beautiful daughter, but also provided me with practical experience to share with others.

by Jessica Lee, OneDigital Senior Market Analyst