I have insurance through my employer. I have a policy with a $2000 deductible, but there is a $1000 HRA. So essentially, the HRA covers the first $1000 of my medical expenses, I would pay the second thousand, then have 20% coinsurance after the deductible. Since I also qualify for Medical Assistance for being low income, the MA actually pays for my deductible and coinsurance. But this is where the problem comes in.
The HRA is set up for direct deposit. So anytime I go to the doctor at the beginning of the year, my insurance puts the claim toward the deductible and pays $0, but then the HRA deposits whatever amount to my checking account. I should then use that deposit to pay the provider, but I never get a bill from the provider. The past 3 years I’ve gotten my HRA money deposited into my bank account, and never get bills from the providers.
I’ve actually called my providers and asked why they haven’t billed me and they say it’s because the Medical Assistance paid for it. I’ve called the Medical Assistance and told them about this, several times over the years. I’ve straight up told them that I have an HRA account that should be covering the first $1000 of my claims, so the MA shouldn’t be paying for these claims. Every time I’ve called about it, they don’t really seem to care. They’re of the mindset that the claim showed that my insurance didn’t pay because I haven’t met the deductible yet, so the MA should pay. But they’re failing to understand that even though the insurance didn’t pay, the HRA did, so I’m essentially getting to pocket my whole HRA every year.
I guess I’m just concerned that some day the MA is going to take back their money that they’ve paid out on claims, which would be thousands that I don’t have at this point. Or worse, they could try to nail me for fraud, even though I’ve reported this to them several times.
submitted by /u/fartmitten
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I have insurance through my employer. I have a policy with a $2000 deductible, but there is a $1000 HRA. So essentially, the HRA covers the first $1000 of my medical expenses, I would pay the second thousand, then have 20% coinsurance after the deductible. Since I also qualify for Medical Assistance for being low income, the MA actually pays for my deductible and coinsurance. But this is where the problem comes in. The HRA is set up for direct deposit. So anytime I go to the doctor at the beginning of the year, my insurance puts the claim toward the deductible and pays $0, but then the HRA deposits whatever amount to my checking account. I should then use that deposit to pay the provider, but I never get a bill from the provider. The past 3 years I’ve gotten my HRA money deposited into my bank account, and never get bills from the providers. I’ve actually called my providers and asked why they haven’t billed me and they say it’s because the Medical Assistance paid for it. I’ve called the Medical Assistance and told them about this, several times over the years. I’ve straight up told them that I have an HRA account that should be covering the first $1000 of my claims, so the MA shouldn’t be paying for these claims. Every time I’ve called about it, they don’t really seem to care. They’re of the mindset that the claim showed that my insurance didn’t pay because I haven’t met the deductible yet, so the MA should pay. But they’re failing to understand that even though the insurance didn’t pay, the HRA did, so I’m essentially getting to pocket my whole HRA every year. I guess I’m just concerned that some day the MA is going to take back their money that they’ve paid out on claims, which would be thousands that I don’t have at this point. Or worse, they could try to nail me for fraud, even though I’ve reported this to them several times.
submitted by /u/fartmitten [link] [comments]Read Morer/HealthInsurance