Today I learned that my health insurance is through a self-insured employer plan, and the funds to pay claims come from the employer’s funds.
There are therapeutic treatments I’d like for myself and other family members that are not medically necessary, strictly speaking, but would be helpful. OT, psychotherapy, etc. These are likely to be OON, and in a year could easily exceed the OON out-of-pocket max, which means claims would come from the employer’s funds.
Does anyone know if it’s possible to trigger some kind of backlash from the employer by making large claims over several years? Like, 20K or more each year? Supposedly, there’s no annual or lifetime max, but I wonder if there’s a secret asterisk of exceptions that we don’t know about. Kind of like how “out of pocket max” is always calculated from the “eligible amount”, which is different than the provider’s bill and can change daily. Could I lose the ability to enroll in my current plan (HDHP wiht HSA), and have to choose a different option next enrollment period?
I can afford the OON out-of-pocket max as a family, but I can’t afford to lose insurance or employment as a result of choosing helpful, but not strictly necessary, therapies. Any info would be helpful!
submitted by /u/TweezleSnoofThe2nd
[link] [comments]Today I learned that my health insurance is through a self-insured employer plan, and the funds to pay claims come from the employer’s funds. There are therapeutic treatments I’d like for myself and other family members that are not medically necessary, strictly speaking, but would be helpful. OT, psychotherapy, etc. These are likely to be OON, and in a year could easily exceed the OON out-of-pocket max, which means claims would come from the employer’s funds. Does anyone know if it’s possible to trigger some kind of backlash from the employer by making large claims over several years? Like, 20K or more each year? Supposedly, there’s no annual or lifetime max, but I wonder if there’s a secret asterisk of exceptions that we don’t know about. Kind of like how “out of pocket max” is always calculated from the “eligible amount”, which is different than the provider’s bill and can change daily. Could I lose the ability to enroll in my current plan (HDHP wiht HSA), and have to choose a different option next enrollment period? I can afford the OON out-of-pocket max as a family, but I can’t afford to lose insurance or employment as a result of choosing helpful, but not strictly necessary, therapies. Any info would be helpful! submitted by /u/TweezleSnoofThe2nd [link] [comments]Read Morer/HealthInsurance