Wintersong

Do also make absolutely certain to go over your bills with a fine toothed comb and compare to your plan. Make sure the insurance company is paying what they should be paying and, if in doubt, call and clarify exactly why they haven't covered x,y or z.

Long story short, when I had my first child the insurance company only covered 80% of the obstetrician charges, as they incorrectly coded it as in-patient services when in fact our plan specifically stated that we were covered at 100%. It was close to $1000. Of course, the hospital bill needed to be paid in the interim otherwise we would have ended up in collections for that. It took me a full year and multiple phone calls (where the person I spoke to would agree that it absolutely should have been covered, promise to escalate it and then a week later I'd get another letter telling me that the charges were billed correctly) before we finally got a refund.

I gave them the benefit of the doubt and assumed it was an honest mistake until the exact same thing happened with the birth of my second child. I was also billed 20% when I had a cyst removed because they coded it incorrectly as in-patient instead of out-patient (should have been covered at 100% after a $20 co-pay).

The moral of the story is that, whether by accident or design, coding and billing mistakes do happen, so be vigilant and know what your plan covers.

yellowroom

And then after a few rounds of dealing with the bills and billing clerks and insurance companies, you fully realise where so much of the money in the US healthcare system resides - paying everyone to push all this paper around. My dentist had more billing clerks than dental nurses.

durham_lad

I find that billing errors often happen and over the 29 years we have lived in the USA I've had many incidents similar to what you describe, with many hours on the phone, letters written etc. A big problem is the Explanation Of Benefits (EOB) forms that you receive from your insurance company. The last thing an EOB does is explain very much, because there will be rows of charges for which you have to guess what they might be for, no way to know because there is no description and no code decipherable by the recipient meaning you have to call the insurance company or just suck it up (I only call if I think I am paying too much, I have no idea if the insurance company is paying for treatment I didn't have but is covered by my $30 copay).

Even simple stuff such as a flu shot my wife and I had last October. It should have been no charge to us and we didn't pay anything (we do this every year). We are currently in England and in May I received a bill for $16 from our Doctor's office. (we are on e-billing). Matching the date with our visit for flu shots it appeared that we were on the hook for $8 each for the flu shot last October, so I paid the bill rather than mess with it. Almost 2 months later (last week) I received an email that a new EOB was ready from my insurance company so I log on to the site and see that they have paid $16 to the doctor for services on the date we had the flu shot (so I will now have a $16 credit with the Doctor which I'll have to claim back because I've NEVER had a medical practice voluntarily refund any credits, and this has happened many times).

In March 2015 I had a heart issue which resulted in multiple (needed) tests and visits to a cardio centre. When the EOB's caught up with me, the facility owed me over $1,600 and when I went in for an appointment with the doctor the receptionist said that it would be a $30 co-pay, so I asked her to check my account because by my reckoning I was in credit. After checking she confirmed that I was correct and asked if I wanted today's copay taken off my credit. I told her that not only did I want that to happen I wanted to have my $1,600 refunded. No problem was the response you should get a check in the mail in a few weeks time (medical facilities in my experience always take payment by credit card but rarely have the ability to give a refund back onto the card used to pay). I told the receptionist that unless the doctor unexpectedly advised against it we were leaving next day for our annual 6 month vacation. She was then able to get onto the accounting department and after my appointment they had a refund check ready for me.

I have many more examples of similar stuff that has happened, including 2013, going to an in-network facility with in-network doctors for a medical procedure and then getting a $1,500 bill from an out-of-network lab used to test a biopsy. - That took over a year to get the charges to me down to $40

It all drives me nuts.

sir_eccles

That's what they hope most people do.

I had a $150 incorrect bill that was sent to collections once. Yes, I probably spent more of my time faxing and emailing and refuting that charge than it was worth but the f'ers weren't going to get it from me.

mrken30

The lack of billing issues with an HMO is something that made my life so much easier. I spend so many hours of my life finding if someone is in network, billing and other issues.

durham_lad

I can't do an HMO because

a) we live out of State from the company I retired from (have been on retiree Group Insurance with them since 2010)

b) we travel between 5 and 7 months per year and HMO's are far to narrow for us. This last year I investigated HMO's from my company and also through private insurance and they just don't have options outside of the State or even the city in many cases. (We live north of Houston)

With our PPO then before we set off traveling I go on the insurance website for each city we'll be staying in (from Santa Monica to Hobart) and I find the doctors and hospitals and doctors that are in network and make screen shots of the details.

carlar6

Does anyone have recommendations for health insurance?
I am moving from the UK and have no ailments. Have used the internet but would prefer personal recommendations.

Pulaski

As you are self employed, you have to go to the federal/ state portal to see who offers insurance in your state - your coverage must be ACA compliant. You likely won't have many choices.

Start at www.healthcare.gov
She's an E-2 investor.

carlar6

that's really useful to know, I will follow the link and see what options I have.
Thanks

Pulaski

You're welcome.

If you are, as you say, in good health, you will likely do best to go for a "bronze" (aka high deductible) insurance plan, with relatively low insurance premiums but you pick up the first $x,000 of medical expenses. With a high deductible plan you can open a Health Savings Account (HSA),and fund it with pre-tax income (upto $6,800 pa), just like a private pension plan, then use it for any medical expenses. If you are relatively healthy the balance in your HSA will grow and it will be available for future health expenses. I have an HSA which I have had for seven years and it is now a long way into the five figure range, my wife also has an HSA, which for tax reasons she can't put as much into, but is also in the five figure range.

The likelihood is that "insurance premiums" + HSA funding" for a high deductible account will be similar to the premiums for "traditional" health insurance. The difference is that at the end of the year you will likely have money left in your HSA, whereas insurance premiums obviously have no benefit beyond the end of the coverage period.

jxv73

HSAs have the added benefit of being pre-tax contributions; and never accruing a tax bill (unlike 401(k)s and the like)

durham_lad

What are the HSA rules if someone leaves the USA? IRA's can stay with the brokerage and be used by the non-resident similar to if they stayed resident in the USA.

mrken30

For 2016
Individual is $3350
Couple / family is $6750

MidAtlantic

What do you mean?
What are these figures?

scrubbedexpat099

How much max you can save for incidental costs each year tax free.