Saturday, January 22, 2005

Health Savings Accounts

Medviews comments about health savings accounts. I have an account with my employer where I can be reimbursed for certain eligible expenses, with pre-tax money. However, this is limited in amount and you have to predict at the beginning of the year how much to have withheld from your pay. At the end of the year, whatever you haven't claimed is forfeited.

THAT'S RIGHT>>your money is GONE. But not with a HSA.

The advantages to the HSA are several:
  • rolls over to next year if not spent
  • based on a high deductible medical insurance plan, so your premiums are smaller
  • rewards fiscally conservative medical decisions
  • because your doctor is paid by you and not the insurance company, she is encouraged to cater to you, at least to some degree.

My wife uses a dentist that is not on our dental insurance panel and we have to pay a little more. However, when she walks into the office, they greet her by name, smile and cater to her. The waiting room is nice and the dentist sees her on time. He sits down and talks to her as she needs. She fired her previous dentist because he was dismissive.

I am a firm believer in the consumer being aware of the costs of services and making informed choices based on this awareness.

As an ER doc, I frequently see patients who would not be there if they had to absorb, in any way or any amount, the cost of the visit. Six months of back pain that just can't wait until tomorrow morning. I can't count how many times I've seen someone on Sunday afternoon for a problem they've had for months and who has an appointment the next day. Or the patient who has been evaluated by multiple physicians, including specialists, with multiple tests far beyond my capability in the ER, over many months who presents because she expects me to be able to tell her what's wrong with her. These patients would not be in the ER if they had to deduct the cost of that visit from their HSA's.