HRA Coverage & Deductibles

Summary: Two weeks ago I had a CT scan with contrast because I was having pelvic/abdominal pains. My obgyn had at first scheduled me for a vaginal ultrasound, but I was unable to get the ultrasound wand in and the stomach ultrasound images weren’t clear enough to see anything. BCBS Tx isn’t covering any of the cost of the CT scan, although the billed amount was reduced because everyone was in network. My office has an HRA plan, but I’m wondering if they’re likely to reimburse me for the CT scan if BCBS didn’t “pay” for it. Would it still count towards my deductible? I plan on calling the HRA on Monday morning.

Questions:

  1. If my doctor ordered the CT scan to diagnose whether I had a medical issue pertaining to my history and would probably need surgery to remove, wouldn’t that make this CT scan preventative? It’s my understanding that preventative care, like regular pelvic checks, is covered by insurance and something I could argue with my plan provider.
  2. What is the likelihood that the HRA would consider the CT scan part of my deductible if BCBS didn’t pay anything on it, just reduced the dollar amount from $6k to $3.5k? This is what I’m going to ask them on Monday, but any pointers on language or what other questions to ask would be awesome.
  3. I do not have the money on hand to pay this and I’m currently the only member of my family who’s employed and has health insurance, so I help my parents and brother out with groceries and small things (we live in different states). If it ends up not being reimbursable, can I just call the hospital and tell them I can’t pay the $3.5k? Their offered payment plan is like $300/mo and… I can’t afford that. Would they ask for some sort of proof?

I was actually feeling like thing were on the upswing for me financially until this happened, and I feel like an idiot for not doing more research.

As background, I had two large cysts on my ovaries that we had found a couple years ago after a (very painful) vaginal ultrasound. The abdominal pains I’ve been experiencing lately were in a similar area and felt like the pains I’d get with the last cysts – they were tennis ball-sized and could have cut off blood flow to my ovaries if left in my body, so I had surgery to remove them. Because of this history, my doctor wanted to be sure of what was going on and the results we got from the ultrasound weren’t clear enough because they had to resort to just putting that goop on my stomach instead of the vaginal wand.

Because of this, he suggested I get a CT scan with contrast. I saw on my MyChart that the estimated cost of this procedure to me would be $0. At the time, I figured it’d be a couple hundred dollars and because I was in pain frequently I wanted to get it done. I would not have moved forward with it had I known that BCBS Tx wouldn’t consider it preventative and therefore isn’t covering any of the $3,500 charge.

There’s an additional $300 charge for the physician who performed the CT scan (only the name on the invoice isn’t the name of the woman I interacted with – should I bring this up? To be honest, I’m worried it could make things cost even more somehow).

I know my employer has an HRA plan, which should reduce my deductible from $5,000 to $500. I haven’t ever used it because I hadn’t needed to in the year that I’ve worked there because before this I had no medical expenses that would be reimbursable, just the regular cost of BC that reduces my body’s probability of creating more cysts and endometriosis, and regular check ups.

Thank you for reading through this, I don’t feel like I have any real-life resources I can discuss this with right now. I’ve emailed my HR person and they weren’t terribly helpful, but like I said above, I plan to call the HRA on Monday.

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Summary: Two weeks ago I had a CT scan with contrast because I was having pelvic/abdominal pains. My obgyn had at first scheduled me for a vaginal ultrasound, but I was unable to get the ultrasound wand in and the stomach ultrasound images weren’t clear enough to see anything. BCBS Tx isn’t covering any of the cost of the CT scan, although the billed amount was reduced because everyone was in network. My office has an HRA plan, but I’m wondering if they’re likely to reimburse me for the CT scan if BCBS didn’t “pay” for it. Would it still count towards my deductible? I plan on calling the HRA on Monday morning. Questions:
If my doctor ordered the CT scan to diagnose whether I had a medical issue pertaining to my history and would probably need surgery to remove, wouldn’t that make this CT scan preventative? It’s my understanding that preventative care, like regular pelvic checks, is covered by insurance and something I could argue with my plan provider. What is the likelihood that the HRA would consider the CT scan part of my deductible if BCBS didn’t pay anything on it, just reduced the dollar amount from $6k to $3.5k? This is what I’m going to ask them on Monday, but any pointers on language or what other questions to ask would be awesome. I do not have the money on hand to pay this and I’m currently the only member of my family who’s employed and has health insurance, so I help my parents and brother out with groceries and small things (we live in different states). If it ends up not being reimbursable, can I just call the hospital and tell them I can’t pay the $3.5k? Their offered payment plan is like $300/mo and… I can’t afford that. Would they ask for some sort of proof?
I was actually feeling like thing were on the upswing for me financially until this happened, and I feel like an idiot for not doing more research. As background, I had two large cysts on my ovaries that we had found a couple years ago after a (very painful) vaginal ultrasound. The abdominal pains I’ve been experiencing lately were in a similar area and felt like the pains I’d get with the last cysts – they were tennis ball-sized and could have cut off blood flow to my ovaries if left in my body, so I had surgery to remove them. Because of this history, my doctor wanted to be sure of what was going on and the results we got from the ultrasound weren’t clear enough because they had to resort to just putting that goop on my stomach instead of the vaginal wand. Because of this, he suggested I get a CT scan with contrast. I saw on my MyChart that the estimated cost of this procedure to me would be $0. At the time, I figured it’d be a couple hundred dollars and because I was in pain frequently I wanted to get it done. I would not have moved forward with it had I known that BCBS Tx wouldn’t consider it preventative and therefore isn’t covering any of the $3,500 charge. There’s an additional $300 charge for the physician who performed the CT scan (only the name on the invoice isn’t the name of the woman I interacted with – should I bring this up? To be honest, I’m worried it could make things cost even more somehow). I know my employer has an HRA plan, which should reduce my deductible from $5,000 to $500. I haven’t ever used it because I hadn’t needed to in the year that I’ve worked there because before this I had no medical expenses that would be reimbursable, just the regular cost of BC that reduces my body’s probability of creating more cysts and endometriosis, and regular check ups. Thank you for reading through this, I don’t feel like I have any real-life resources I can discuss this with right now. I’ve emailed my HR person and they weren’t terribly helpful, but like I said above, I plan to call the HRA on Monday.
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