Help understanding how UCR rates work (Cigna)
Employer is offering health insurance with Cigna – either an HSA plan or an open access low indemity (?) plan which pays "85% after deductible, excluding penalties and oop expenses that exceed UCR". It states that both in-network and out of network services are subject to UCR. We use a lot of health services throughout the year, including expensive prescriptions. Does this mean that for example if I went to an in-network specialist and he charges $600 for his service, but the UCR for that type of specialist where I live is $400, will I be stuck with the $200 difference even if I met my deductible or max OOP? What happens with the really expensive stuff like ERs, surgery and specialty medicines? Could we be looking at $$$$$$ of debt if a provider "over charged" for a major service? Also, is there a downside to an HSA plan (besides high deductible) for someone with high medical use? People say an HSA isn't great if you have a lot of health costs, but we've never had one so no experience. Both plans have very similar premiums as well.
submitted by /u/Blley
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