Money started getting tighter this month. Didn't seem like it should be, since we'd been the recipients of significant largess after an ongoing online effort to defray some medical expenses. So, I dove into the bills we've paid, the ones we still have to pay, the online account pages for the insurance carrier, etc... to see what I could find.
The discoveries are confusing. The "benefit year" for my medical insurance plan runs from Oct 1 to Sept 30, so bills incurred in the final quarter of 2015 and those incurred in 2016 thru now are all in the same 'year'... The way I understand it, I have $10,000 cap on out of pocket expenses in that benefit year. Imagine my surprise when I read my annual summary for 2016 (Jan-present, so still a work in progress) and see a Patient Responsibility total of $14,534.86 for care I have received in the calendar year. Add to a PR of $531 for service in late December (the initial vision screening) and $300+ in PR for my son from an accident in late February. By my math, our family out of pocket responsibility seems to have hit nearly $15,400 so far in the benefit year. This would explain why we are short money month to month, despite having paid $7700 worth of bills from my online donation effort, about $250 / month from our own paychecks and another exactly $1500 thus far from our HSA. We will continue to get $250/month from that HSA source through Sept 20, which would basically recoup the $$ spent from our pocket funds up til now OR it can mostly cover the still $1500 outstanding from the ENT surgeon and anesthesiologist (which can't wait to be paid over these next 5 months). The hospital did cut us a break because we paid off the actual hospital (though not surgeons, labs, imaging, or anesthesia) within three days of the check in, and the imaging provider and neurosurgeon gave breaks, as well (and many many thanks to them!!!), so our ACTUAL costs over the year haven't been $15,400—they are closer to $12,200—but the insurance sees our responsibility as that much, and my question is how is that possible... a $10,000 cap should mean that when $10,000 is hit, then ALL additional charges aren't the patient responsibility... but apparently, we blew right thru $10k and are beyond halfway to the NEXT $10k.
We set the online goal for $12000 with the intent to create a cushion for added child care expenses we thought might possibly happen and thankfully, those pretty much didn't (again, generosity on the part of providers rather than us not having additional needs). I didn't think the cushion would be short by 50% on actual medical billing and be $200 of the actual medical costs for the year (to date). The fact seems to be that if the effort is 100% funded (it's at about 65% now), it will actually be SHORT of the billed 'patient responsibility' medical expenses I've seen since this event started.
So... If anyone knows WHY the numbers add up as they do, we'd love to understand better. If anyone can help in any other way, We'd appreciate that, too
The discoveries are confusing. The "benefit year" for my medical insurance plan runs from Oct 1 to Sept 30, so bills incurred in the final quarter of 2015 and those incurred in 2016 thru now are all in the same 'year'... The way I understand it, I have $10,000 cap on out of pocket expenses in that benefit year. Imagine my surprise when I read my annual summary for 2016 (Jan-present, so still a work in progress) and see a Patient Responsibility total of $14,534.86 for care I have received in the calendar year. Add to a PR of $531 for service in late December (the initial vision screening) and $300+ in PR for my son from an accident in late February. By my math, our family out of pocket responsibility seems to have hit nearly $15,400 so far in the benefit year. This would explain why we are short money month to month, despite having paid $7700 worth of bills from my online donation effort, about $250 / month from our own paychecks and another exactly $1500 thus far from our HSA. We will continue to get $250/month from that HSA source through Sept 20, which would basically recoup the $$ spent from our pocket funds up til now OR it can mostly cover the still $1500 outstanding from the ENT surgeon and anesthesiologist (which can't wait to be paid over these next 5 months). The hospital did cut us a break because we paid off the actual hospital (though not surgeons, labs, imaging, or anesthesia) within three days of the check in, and the imaging provider and neurosurgeon gave breaks, as well (and many many thanks to them!!!), so our ACTUAL costs over the year haven't been $15,400—they are closer to $12,200—but the insurance sees our responsibility as that much, and my question is how is that possible... a $10,000 cap should mean that when $10,000 is hit, then ALL additional charges aren't the patient responsibility... but apparently, we blew right thru $10k and are beyond halfway to the NEXT $10k.
We set the online goal for $12000 with the intent to create a cushion for added child care expenses we thought might possibly happen and thankfully, those pretty much didn't (again, generosity on the part of providers rather than us not having additional needs). I didn't think the cushion would be short by 50% on actual medical billing and be $200 of the actual medical costs for the year (to date). The fact seems to be that if the effort is 100% funded (it's at about 65% now), it will actually be SHORT of the billed 'patient responsibility' medical expenses I've seen since this event started.
So... If anyone knows WHY the numbers add up as they do, we'd love to understand better. If anyone can help in any other way, We'd appreciate that, too
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