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This Web site contains a compilation of more than a thousand consumer finance  columns written by Tony Novak from the 1980s through 2006, updated and reformatted for maximum usefulness today.  New material was added after 2010.

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Managing a health savings account

originally posted: 11/22/2006  reposted: 2/18/2011 This post has not been recently reviewed or revised by the author and may be out of date. If you notice an error or are in doubt, please send a new question by email or ask for an update. Email

Q: My husband & I are self-employed in a small town and we obtained an HSA compatible insurance policy and account last fall for our family (3 children). We are struggling with doctors who do not seem to know how to handle these type of policies. If we give them the insurance information so that we can get the network pricing, they want to charge us full price for everything and send it into the insurance company, even though we tell them we have a very large deductible and will be paying for the visit. The insurance company, of course, eventually sends a statement saying that the charges are not covered and the doctor sends us a bill for the full amount - no discounts from anywhere. If we walk in and say that we are paying cash, almost all of the doctors will say that they have a "cash discount" price, but we basically have to lie and say that we have no insurance in order to get that. My husband read somewhere that the insurance companies ask doctors to submit everything to them so they'll have all of our medical history on file, even though chances are that we will not make our deductible for the year. What's the point of having an HSA and making our own health care choices when they are telling us how to do it? It seems like it shouldn't be this hard. Do you have any suggestions?

A: The simple answer is to use a PPO discount plan like Careington listed below (available for about $270 per year for the whole family that includes dental, Rx, doctors and hospitals) that is separate from your insurance. The medical providers treat discount plan billings the same as insurance claims - there is no difference from the provider's point of view. Use the insurance only for the largest claims. Also, make sure that your HSA is managed by a company separate from your insurance carrier. I adapted this strategy for myself a few years ago and am much happier with the overall results. While it may be illegal to deliberately hide your medical history from your insurer, many people feel that the benefits of privacy that you mentioned are more important in the ongoing management of health care finances. Keep in mind that insurers may use diagnosis that they receive, rather than medical claims, to set insurance rates higher for some policyholders. If you are not required to provide information to the insurer, don't do it. As a side note, it may not pay in the long run to discount fees charges by your personal physician for personal care. Many people report that they feel they are treated better and given more time when they pay the full cash price for an office visit or annual physical exam. Your question indicates that you are "ahead of the curve" in the thinking and management of your health savings account health plan. Most Americans are just becoming familiar with the concept and have yet to form any opinions as to the best way to actually manage their new consumer-driven health plans.


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