Anyone else with a HDHSA insurance plan?

[Grits]

Is 10K your ded or is it also your OOP? If it's your OOP and you have that on hand it's not too bad.

Yes, $10,000 is the total family OOP maximum. If we meet that, and I surely hope we don't, then everything in network is covered at 100%. Preventive care is covered from day one. The maximum HSA contribution for us is $6,250 for 2012 which increases next year to $6450.

With the extreme difference in premiums, even if we did blow through the whole $10,000 deductible, it was the best plan financially for us, but it is hard to break away from the mindset of having a co-pay and good RX plan to paying for most everything out of pocket. I really had to break down the numbers to convince myself it was the way to go.

[malkin]

For mine the deductible is 3k. Before that, they don't pay anything, but we do get to pay the "negotiated rate." So, like some simple visit or procedure will be billed at $900.00 and the negotiated rate is $75.00, so that's what we pay.

I believe this works to the insurance company's benefit because it makes it less likely that basically healthy people will ever meet the deductible.

After the deductible they pay 80% and we still pay 20%.

The out of pocket maximum is unthinkable; I don't remember how much--it is astronomical. At that point, the insurance company will only one more horror to deal with.

[Crankin]

I understand that, Irulan. I am happy to use the $ for my eye related things. A couple of years ago, I used it for acupuncture, after I negotiated the price down with the practitioner, and then I got the $ back from the HSA. My Blue Cross only pays for acupuncture if it's done by an MD and I was too lazy to research the approved people, so I went with a regular acupuncturist. I know I'm lucky in that DH's company has these great benefits, but I also feel safe that there's a safety net in my state. It's not perfect, but all of the clients I see have our state mandated insurance for low income people and they get good benefits. In fact, I wouldn't have a job if it wasn't for the behavioral health initiative that's specifically part of this plan, for this population.

[Irulan]

[B]F" So, like some simple visit or procedure will be billed at $900.00 and the negotiated rate is $75.00, so that's what we pay.

That's pretty standard, you pay the rate contracted with the plan. Every plan I've ever had has worked that way. Yet another thing wrong with the ins. in the country. Every one gets a different contracted rate, and heaven forbid you are paying cash w/o a plan...

[malkin]

Just like air travel, except that air travel used to be fun.

[Grits]

Trying to get my first Canadian RX filled. We'll see how it goes.

They are going to contact the MD (via faxed form, I assume) for the RX. I'm not sure how obvious it is going to be to the physician's office that it is a Canadian company. If there is any trouble, I guess I'll just get a paper prescription that I can mail in. So far the pharmacy itself has been very good to work with. They confirm and re-confirm that everything is correct and you do want them to proceed with the order. They also tell you exactly what is being shipped, who manufactures it and where. This particular prescription (Restasis for dry eyes) is less than half what I would pay here. My husband has a prescription for Diovan HCT that, generic, will be about a fourth of what we are paying for brand name here.

[Irulan]

It's not illegal to do it. There should not be issues. I routinely had my MD fax renewals etc to the Canadian pharmacy.