Vent About How Scammy HDHPs Feel

I've had my HDHP plan for the last three years and I still can't get over how scammy it feels. Each year, after I meet my high deductible, I still have to pay the full amount for in-network services for a couple months after because my doctor's offices take forever to process the claim and my insurance company also takes a long time to process the claim. I know my insurance should start covering some amounts of this but until the claims are processed, I'm required to pay upfront the full amount. So then I have multiple claims where I overpaid and need to claw back the money I spent.

What insurance companies tell you is that once you hit your deductible, your insurance starts paying for some of your covered services. And that once you hit your OOP, your cost share is $0 for covered services. What they don't tell you is that after you hit your deductible/OOP, they can take a couple months to process that and in the meantime, you have to pay much more than you had bargained for.

This money most of the times comes back to you but I find that healthcare providers never proactively refund money they owe you until you give them hell about it. You call multiple times, fill up their voicemail, get put on hold for hours. You show them your EOB from your insurance only for them to say that they need to process it through their system first. I ask them how long it takes and they say 30-45 business days. I ask my insurance for help and they say to talk to the provider. And then sometimes you decide that $20, $40, $100 isn't worth it to be on hold during your lunch break so you let your doctor's office keep the money they owe you.

And this problem is made worse when your OOP or deductible is integrated with a separate pharmacy benefit manager that's disconnected from your health insurance company. According to my PBM, I've hit my OOP a couple months ago and have received my latest medicines at no cost. My health insurance company, however, has no record of this information (yet) and so I still have to pay a significant co-insurance at covered doctor's appointment until my health insurance company is up to date.

submitted by /u/open_reading_frame
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