The old plan was an intricate web of reimbursement methods designed by my employer to minimize our costs. After paying $75 a week (pre-tax, deducted from my paycheck), we had a $5000 deductible. But my employer broke the $5000 into two amounts.
We could pay the first $1000 with a “flex plan,” pre-tax dollars from my paycheck put in an account we could tap for medical-related expenses by sending bills and receipts to the flex plan company. (If we didn’t spend everything we put in the flex plan, it just disappeared. It doesn’t make much sense, but it was explained to me that that was the risk we took in exchange for getting to use pre-tax dollars to pay for our health costs. It’s like gambling your family will get sick or need glasses or buy lots of Aleve — all of which are eligible for payment under the flex plan.)
After that $1000 was spent, either out-of-pocket or through the flex plan, my employer would reimburse the remaining $4000 of the deductible through another reimbursement company — again, if we sent the bills and receipts in. Only after that would the actual insurance company start paying for things itself.
But sometimes it was hard to figure out what might be covered by these reimbursement companies because the bills didn’t just come to us, they went through the insurance company, which noted the amount to be put toward the deductible and then notified us of what we were responsible for. Then a bill would follow, say, three months later. We’d get one bill from the doctor’s office (often for $5, inexplicably, because we paid a $20 co-pay upon check-in). We’d get an “explanation of benefits” from the insurance company, which looked an awful lot like a bill but wasn’t. We’d get bills from the X-ray company contracted by Maine Med. We’d get bill-looking things from Maine Med (sometimes labeled, “this is not a bill”). We had all manner of bills from Mercy Hospital regarding the birth (including more than $3000 for “hospital incidentals” and $91 to “admit” Gus the moment he was born!).
We didn’t have enough cash to pay them all (or many of them, really) out-of-pocket and wait for the reimbursements, so we typically sent the bills to the reimbursement companies and waited for the checks to come in before making the payments to whomever had billed us. Often, we were paying for things that had happened five months ago when we finally sent a check. This became quite a task, to track incoming bills, outgoing reimbursement requests, incoming checks, and outgoing payments.
So, coward that I am, I begged our office manager to take the pile of bills (it was maybe 25 pieces of paper) and help me out. She did a wonderful job, spent about five hours on the phone with various people, and in about three weeks we got a check for $2500, which covered maybe half of the Mercy bill because we couldn’t be reimbursed for things insurance doesn’t cover at all (like a circumcision: $173).
