Should I let my work get more involved in my health care?
April 3, 2018 12:17 PM Subscribe
Our work health insurance policy is changing this June and rates are going way up. Our office accountant is seeking out other health insurance plans to save money and it turns out that my GP will not be included in this change, which is someone I really don't want to lose. According to the accountant I am considered a "valuable employee" so my boss has offered to cover the costs for me to see the doctor out of pocket. However, they want to know what those costs will be to see if it's worth it for them to switch to another provider or stick with the current policy. I have a bad feeling about this and need some advice. More details inside...
After going through several bad docs, I do not want to have to hunt down another reliable doctor especially now that miscellaneous health issues are cropping up as I get older (hitting middle age soon). With my boss's offer to compensate me for the costs to go to my doctor out of pocket they have asked me to give an estimate of how much per year it's going to cost me to continue to see them. It isn't clear yet if they would give me a lump sum based on the estimate or if they would want to see detailed bills paid by me. Side note - we are a small office (12 employees) and we have no HR department, so it a lot of direct contact with the boss and accountant.
I have a minor medical issue that I take regular meds for that require me to get regular bloodwork and check in for refills. Thankfully there is not much more to monitor at this point but I trust this doctor and want to stick with them. While I have a basic idea after talking to the help desk at my doc's office of how much it costs for annual exams and refill visits, I am not particularly savvy about the healthcare industry or what things cost. I can't be sure how much I am going to get sick in the future or if any other illness would hit how much more that could end up costing. Are there other types of fees that I'm not thinking of that insurance typically covers? Especially since I usually don't know until after I am billed by insurance - what if I'm at the doctor's office and in desperate need of their help, and I'm suddenly slapped with a huge bill I'm not ready to pay but have to because they don't take my insurance? At what point would I need to provide evidence of these visits to my work, and how could I shield my medical issues if indeed it came to that? I am a firm believer in keeping work life and private life separate, and I already dislike that work controls if/when/how much I get these benefits.
On the one hand I know I should be appreciative that my work is even bothering to try to be considerate of me and cover these costs, the other hand weighs down and I feel a huge invasion of privacy and that I might be screwed financially if I get sick. My boss tends to be a bit manipulative and I don't want them to have any further hold/info on me than necessary. Does anyone have any thoughts? Helpful questions I should ask my doctor's office or current health insurance provider? Any suggestions on how to draw a line in the sand with my boss/accountant regarding these issues? Should I just suck it up and drag my medical history with me to some new random strange doctor that takes my new insurance and hope for the best? Any feedback appreciated, thank you.
After going through several bad docs, I do not want to have to hunt down another reliable doctor especially now that miscellaneous health issues are cropping up as I get older (hitting middle age soon). With my boss's offer to compensate me for the costs to go to my doctor out of pocket they have asked me to give an estimate of how much per year it's going to cost me to continue to see them. It isn't clear yet if they would give me a lump sum based on the estimate or if they would want to see detailed bills paid by me. Side note - we are a small office (12 employees) and we have no HR department, so it a lot of direct contact with the boss and accountant.
I have a minor medical issue that I take regular meds for that require me to get regular bloodwork and check in for refills. Thankfully there is not much more to monitor at this point but I trust this doctor and want to stick with them. While I have a basic idea after talking to the help desk at my doc's office of how much it costs for annual exams and refill visits, I am not particularly savvy about the healthcare industry or what things cost. I can't be sure how much I am going to get sick in the future or if any other illness would hit how much more that could end up costing. Are there other types of fees that I'm not thinking of that insurance typically covers? Especially since I usually don't know until after I am billed by insurance - what if I'm at the doctor's office and in desperate need of their help, and I'm suddenly slapped with a huge bill I'm not ready to pay but have to because they don't take my insurance? At what point would I need to provide evidence of these visits to my work, and how could I shield my medical issues if indeed it came to that? I am a firm believer in keeping work life and private life separate, and I already dislike that work controls if/when/how much I get these benefits.
On the one hand I know I should be appreciative that my work is even bothering to try to be considerate of me and cover these costs, the other hand weighs down and I feel a huge invasion of privacy and that I might be screwed financially if I get sick. My boss tends to be a bit manipulative and I don't want them to have any further hold/info on me than necessary. Does anyone have any thoughts? Helpful questions I should ask my doctor's office or current health insurance provider? Any suggestions on how to draw a line in the sand with my boss/accountant regarding these issues? Should I just suck it up and drag my medical history with me to some new random strange doctor that takes my new insurance and hope for the best? Any feedback appreciated, thank you.
If you are in the US HIPAA rules will apply and your employer has no legal right to view your medical information. You can explicitly give them rights if you wish. I would never release medical info to my employer no matter how great they are.
If you have been covered by a policy for that last year or so you should be able to get statements from the covering insurance company on the amount of money spent on your healthcare for a given period of time. Again I would not give this to my employer either.
Maybe you can speak to your doctor and ask them if there is anything they can do to get on your employers new plan?
posted by Justin Case at 12:30 PM on April 3, 2018 [2 favorites]
If you have been covered by a policy for that last year or so you should be able to get statements from the covering insurance company on the amount of money spent on your healthcare for a given period of time. Again I would not give this to my employer either.
Maybe you can speak to your doctor and ask them if there is anything they can do to get on your employers new plan?
posted by Justin Case at 12:30 PM on April 3, 2018 [2 favorites]
Since this is a GP, if you need a referral to a specialist, you might have to go to an in-network provider for that.
posted by FencingGal at 12:40 PM on April 3, 2018 [1 favorite]
posted by FencingGal at 12:40 PM on April 3, 2018 [1 favorite]
What politikitty said. I would not give my boss any more info than that, and cite HIPAA and the uncertainty of future costs.
This seems like a really inappropriate and uncomfortable thing for your boss to be asking. As a "valuable employee" maybe they could increase your salary by an equivalent amount, rather than making weird privacy-invading arrangements based on one specific doctor.
posted by beandip at 12:46 PM on April 3, 2018 [3 favorites]
This seems like a really inappropriate and uncomfortable thing for your boss to be asking. As a "valuable employee" maybe they could increase your salary by an equivalent amount, rather than making weird privacy-invading arrangements based on one specific doctor.
posted by beandip at 12:46 PM on April 3, 2018 [3 favorites]
One thing that might work - my company uses an HRA, Health Reimbursement Account, to reimburse all employees for the first half of our deductible (so we actually have a higher-deductible plan but many of us end up never paying anything out of pocket). My company does this for a fixed dollar amount per employee, but maybe your employer is thinking of using it more broadly for you?
Otherwise, this seems like a disaster waiting to happen. Would you just get a raise? Or would you have to submit receipts/EOBs for reimbursement by your employer? If you're submitting receipts or something directly to your employer, that seems like it would be a privacy nightmare. And how would that additional income be taxed?
If they use something like an HRA though, it's pretty great, so long as they actually make up the difference in cost - basically my doctor submits to insurance, insurance pays what they pay and then passes the rest of the bill on to the HRA, which pays up until my annual allowance is exhausted, then I get a bill for the rest. Administratively it's very easy.
posted by mskyle at 12:49 PM on April 3, 2018 [6 favorites]
Otherwise, this seems like a disaster waiting to happen. Would you just get a raise? Or would you have to submit receipts/EOBs for reimbursement by your employer? If you're submitting receipts or something directly to your employer, that seems like it would be a privacy nightmare. And how would that additional income be taxed?
If they use something like an HRA though, it's pretty great, so long as they actually make up the difference in cost - basically my doctor submits to insurance, insurance pays what they pay and then passes the rest of the bill on to the HRA, which pays up until my annual allowance is exhausted, then I get a bill for the rest. Administratively it's very easy.
posted by mskyle at 12:49 PM on April 3, 2018 [6 favorites]
Dr. Advicepig would have no idea how much anything like this costs, nor would anyone at the clinic. This is not really the kind of question one can accurately answer.
posted by advicepig at 12:50 PM on April 3, 2018 [1 favorite]
posted by advicepig at 12:50 PM on April 3, 2018 [1 favorite]
Best answer: You should check if what your boss is offering is even viable from a tax and employment standpoint. Your boss can't technically just give you or someone on your behalf money, untaxed. My understanding really is that all he can do is sweeten the deal overall, ie give you a raise so you'll stay despite the hardships that may be involved, but he can't dictate what you do with the money.
If you itemize, you could do the math on whether your itemized medical deductions for out of pocket medical expenses will offset whatever costs you might incur. You could probably also talk to the insurance provider about the likelihood that your out-network doctor can use in-network labs and that sort of thing, to minimize your out-network costs.
Unfortunately this is a real situation for a lot of people and what your boss is offering would be more common if it was completely above-board, so I would not count on this as a solution to your problem.
Your physician can't predict your medical future but they could tell you what their cash rate is for standard services and the expected costs for your care at a maintenance level.
posted by Lyn Never at 12:57 PM on April 3, 2018 [5 favorites]
If you itemize, you could do the math on whether your itemized medical deductions for out of pocket medical expenses will offset whatever costs you might incur. You could probably also talk to the insurance provider about the likelihood that your out-network doctor can use in-network labs and that sort of thing, to minimize your out-network costs.
Unfortunately this is a real situation for a lot of people and what your boss is offering would be more common if it was completely above-board, so I would not count on this as a solution to your problem.
Your physician can't predict your medical future but they could tell you what their cash rate is for standard services and the expected costs for your care at a maintenance level.
posted by Lyn Never at 12:57 PM on April 3, 2018 [5 favorites]
According to the accountant I am considered a "valuable employee" so my boss has offered to cover the costs for me to see the doctor out of pocket.
I would personally be VERY uncomfortable being expected to negotiate this privately with the CEO and accountant. That's just not appropriate. And how does this work anyway, they value you in particular so they'll cover your costs, but Boris in accounting is SOL because sometimes he's a little late getting back from lunch?
Their new health insurance policy apparently does not provide adequate coverage, they recognize this in your case, they therefore should switch to a provider that can provide an appropriate level of service for their company. For all the employees in their company.
(I am not a lawyer or an insurance agent or an HR person)
posted by desuetude at 1:06 PM on April 3, 2018 [2 favorites]
I would personally be VERY uncomfortable being expected to negotiate this privately with the CEO and accountant. That's just not appropriate. And how does this work anyway, they value you in particular so they'll cover your costs, but Boris in accounting is SOL because sometimes he's a little late getting back from lunch?
Their new health insurance policy apparently does not provide adequate coverage, they recognize this in your case, they therefore should switch to a provider that can provide an appropriate level of service for their company. For all the employees in their company.
(I am not a lawyer or an insurance agent or an HR person)
posted by desuetude at 1:06 PM on April 3, 2018 [2 favorites]
Best answer: One thing that might work - my company uses an HRA, Health Reimbursement Account, to reimburse...
You should check if what your boss is offering is even viable from a tax and employment standpoint.
I don't have time at the moment for chapter and verse on the ERISA fiduciary and IRS rules for HRAs, but Lyn Never is right - what your boss is proposing is problematic under tax and employee benefits law (essentially it would be a rogue HRA).
posted by Pax at 1:12 PM on April 3, 2018 [1 favorite]
You should check if what your boss is offering is even viable from a tax and employment standpoint.
I don't have time at the moment for chapter and verse on the ERISA fiduciary and IRS rules for HRAs, but Lyn Never is right - what your boss is proposing is problematic under tax and employee benefits law (essentially it would be a rogue HRA).
posted by Pax at 1:12 PM on April 3, 2018 [1 favorite]
Your company can almost probably offer more than one plan to employees -- if there's a plan that's more expensive that covers your doctor, they could offer that as a buy-up option (people contribute the extra above the cost of the 'standard' plan if they also wanted access to the better network) but pay your buy-up for you as a bonus. That way your doctor is covered without their seeing your medical bills or you having to figure out your medical costs in advance.
posted by snaw at 1:45 PM on April 3, 2018 [4 favorites]
posted by snaw at 1:45 PM on April 3, 2018 [4 favorites]
Best answer: this is an awful idea for so many, many reasons. please don't do this, as it will come back to bite you in the ass somehow, at some point.
posted by misanthropicsarah at 2:11 PM on April 3, 2018
posted by misanthropicsarah at 2:11 PM on April 3, 2018
Sorry, typo in my previous comment. Read that as some 'almost certainly' or 'most probably' - I've seen a menu of plans offered at lots of companies, so assume it's possible/legal for yours. Plus, they can always just give you a raise to cover your "buy-up" payment if it's dicey for them to pay it for you directly.
posted by snaw at 2:53 PM on April 3, 2018
posted by snaw at 2:53 PM on April 3, 2018
I like snaw's suggestion. Find out if your GP is on any other plans in that network. Perhaps your company will kick in some of the balance of the premium.
posted by radioamy at 3:22 PM on April 3, 2018
posted by radioamy at 3:22 PM on April 3, 2018
Can you find out what a policy through the ACA would cost — one that your doctor accepts? A friend of mine works full time, but doesn't like their work health insurance plan. So they signed up through the ACA for a different plan and told work no thanks to theirs. Could your boss give you a raise that would cover the cost for external insurance? I mean, it would probably be higher than the rate they would be paying for you as part of the larger company pool, but maybe not insanely higher. Then they'd just take you off the company plan entirely.
posted by clone boulevard at 5:23 PM on April 3, 2018 [1 favorite]
posted by clone boulevard at 5:23 PM on April 3, 2018 [1 favorite]
I work for a health insurance company. It's not unusual for a business to structure their plan in a way that provides perks for executives; like they're on the same plan as all the the other employees but the employer pays their premium. Offering to cover this out of pocket is little strange.
Are the boss and accountant working with a health insurance broker? Employees usually don't get involved in these decisions. The uncertainty of the future costs makes this incredibly risky.
posted by girlmightlive at 7:12 PM on April 3, 2018 [2 favorites]
Are the boss and accountant working with a health insurance broker? Employees usually don't get involved in these decisions. The uncertainty of the future costs makes this incredibly risky.
posted by girlmightlive at 7:12 PM on April 3, 2018 [2 favorites]
Have you talked with your doctor about joining the network for your new insurance? It's not unusual for a practice to sign up with a plan if they know they have a particular patient who needs it.
posted by platinum at 10:30 PM on April 3, 2018 [1 favorite]
posted by platinum at 10:30 PM on April 3, 2018 [1 favorite]
Best answer: My boss tends to be a bit manipulative and I don't want them to have any further hold/info on me than necessary.
I had a feeling this bit was coming. This is a way for them to get their tendrils further into you. Ask for a raise equal to the max out of pocket for in network and out of network, and if they balk at that, find a new doctor.
posted by Rock Steady at 6:47 AM on April 4, 2018 [1 favorite]
I had a feeling this bit was coming. This is a way for them to get their tendrils further into you. Ask for a raise equal to the max out of pocket for in network and out of network, and if they balk at that, find a new doctor.
posted by Rock Steady at 6:47 AM on April 4, 2018 [1 favorite]
Response by poster: Thanks everyone. After looking at HRAs, trying to understand out of network and in network coverage/costs, talking to the doctor's office about their out of pocket costs, and feeling incredibly uncomfortable about the whole thing I decided to slowly back away from this bomb in disguise. I replied to the accountant's request for a decision with "I cannot predict how much my medical expenses will be. Do what is best for the company and I will sort things out for my health in my own way."
My boss still privately offered me a small sum of money over email, to which I haven't responded.
posted by cristinacristinacristina at 7:18 PM on April 18, 2018
My boss still privately offered me a small sum of money over email, to which I haven't responded.
posted by cristinacristinacristina at 7:18 PM on April 18, 2018
This thread is closed to new comments.
posted by politikitty at 12:23 PM on April 3, 2018 [7 favorites]