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What to consider when you have a high-deductible insurance plan


Anyone having surgery will probably have a few out-of-pocket costs that aren’t covered by health insurance. But if you have a high-deductible health plan (HDHP), your costs may be quite a bit higher.

Because of that, it’s a good idea to do some planning before surgery so you can get a clearer picture of what your costs will be and make a plan for paying them.

The deductible, in health insurance terms, is the amount that you have to pay before the insurance company starts helping with the costs.

A high-deductible plan, according to the federal IRS definition, is a plan with deductibles of at least $1,350 for individuals and $2,700 for a family. Typically people with HDHPs can put some money aside tax-free in a health savings account (HSA) to be used for medical expenses not covered by their insurance.

(It’s also possible to have a plan with high deductibles that is not considered an HDHP by IRS standards, so you are not allowed to save tax-deductible money in an HSA.)

Even after paying your deductible, you may have coinsurance payments, or portions of the remaining amount that you have to pay. For instance, you may have to pay 20% or 30% of the bill after paying your deductible, depending on your insurance plan.

It can get complicated, but we’re happy to work with you before surgery to figure out what your costs are likely to be.

Here are some things you’ll want to find out:

  • Is Specialty Surgical Center an in-network provider under your insurance plan? Your insurance company will pick up more of the costs for providers that are in their network.
  • Are the surgeons, anesthesiologists, radiologists, physical therapists in-network providers?
  • If any providers are not in-network, how much will this increase your costs?
  • What does your insurance pay for the procedure or procedures you’ll be having? Ask for the CPT code for the procedure so you can check with your insurance company on whether the procedure is covered and how much they’ll pay for it.
  • Are there coinsurance payments you will be responsible after you meet your deductible?

By answering all those questions, you should be able to get a good estimate of what your out-of-pocket costs are going to be. Now it’s time to think about how you’re going to pay for them.

If you have a health savings account, check your balance. It may be a financial lifesaver for you. If you don’t have a health savings account, do you have other savings you can tap? Or perhaps you can put the remaining bills on a low-interest credit card.

If you have no other options, providers will often let you set up a payment plan to pay off your bill in installments. You’ll need to make arrangements with each separate provider, but generally, they will work with you to find a solution. They’d much rather set up a payment plan up front than wait until your bill is months late.

Going through surgery and recovering from surgery are stressful enough, physically and emotionally. It’s best to avoid dealing with financial stress on top of that. Planning ahead can help you feel like you’ve got that part of the problem under control, so you can just focus on healing.

Specialty Surgical Center is located in Sparta, New Jersey, and our staff consists of board certified surgeons and anesthesiologists performing procedures in orthopedics, sports medicine, spinal care, podiatry, urology, pain management, ENT, hand surgery, lithotripsy, brachytherapy, GYN, and laser surgery.

For more information about Specialty Surgical Center, call 973-940-3166 or visit our Contact Page.

The information contained in this article is for educational purposes only and is not intended to replace or counter a physician’s advice or judgment. Please always consult your physician before taking any advice learned here or in any other educational medical material.