Dear Addy: Deductibles

Dear Addy_May15Dear Addy,

I thought I hit my deductible total recently based on my receipts and explanation of benefits. My insurer says I haven’t and they have a different total of how much of my deductible is left. What is going on?
 Calculation Crazed
Dear Crazed,
You will need to check your health insurance policy for what exactly counts towards your deductible. Here are a few things that some insurance companies DO NOT count towards your deductible so watch out for them:
Services you pay for that aren’t covered by your plan.

  • Services that are exempt from the deductible, like preventive care received from an out-of-network provider.
  • Charges for services exceeding benefit maximums, like the maximum for glasses every two years might be $150 every two calendar years; if you spend more than $150 on your glasses then whatever amount is over $150 does not count towards your deductible.
  • Charges for services beyond benefit limits, like the annual benefit limit for physical therapy might be is 8 visits; costs for more than 8 visits are not covered by the plan and do not count toward your deductible.
  • Charges for out-of-network healthcare and non-network pharmacies that exceed the allowed amount.

Your insurer must include in your policy a list of what counts towards your deductible. Review this list and then update your calculations or call your insurer to reconcile their calculations and yours.

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HFA frequently receives questions from the bleeding disorders community related to advocacy issues. The questions often impact the entire community. In an effort to reach the largest audience possible with our responses to these widely applicable questions, HFA developed “Dear Addy.” Questions submitted to this column are edited in order to protect privacy and should be considered educational only, not individual guidance.