How do I get reimbursed for out of network health expenses
November 22, 2013 9:18 AM   Subscribe

I have had quite a lot of medical expenses this year - much of it not covered by insurance. I will speak to my accountant about tax write offs. Is there anyway to get reimbursed for any of the following out of network: blood tests (expensive tests) phone consultations dr visits vitamins travel time Thank you in advance
posted by kbbbo to Health & Fitness (10 answers total) 2 users marked this as a favorite
Who are you expecting to reimburse you? Your insurance company? You'd have to ask them. They probably have an appeals process for denied claims.
posted by Leontine at 9:20 AM on November 22, 2013 [2 favorites]

What country and state are you filing taxes in?
posted by muddgirl at 9:21 AM on November 22, 2013

Your health insurance terms and conditions should clearly state what is covered and what isn't. If you chose a less expensive option that does not allow out of network procedures, then why are you expecting to be reimbursed? By the way, I don't know any standard health insurance that covers the cost of phone consultations, vitamins or travel time.

If it is indeed covered (again, call your insurance company), do appeal. I've had $1200 in medical bills covered on an appeal.
posted by HeyAllie at 9:27 AM on November 22, 2013

You can only deduct medical expenses that are greater than 7.5% of your AGI, and since it's a deduction and not a credit, you only get back the amount that you'd pay in taxes (varies depending on your tax bracket, but probably 25% or so).
posted by hwyengr at 9:29 AM on November 22, 2013 [1 favorite]

If you have a high deductible plan, the way it's usually supposed to work is that you put money in a HSA. The HSA comes with a debit card you can use to pay for all the health-related expenses that aren't covered by your insurance, including co-pays, lab work, and medications (including over the counter). You may not be able to use this option for this year but I suggest you look into it for 2014.

Either way, though, you won't get reimbursement for travel time.
posted by treehorn+bunny at 9:31 AM on November 22, 2013

The place I work for offers pretty goddamn Cadillac health insurance - the last time I had to use it (minor surgical procedure, drugs, follow-up), my co-pays came to a grand total of $5. They (the insurance company) would absolutely not reimburse me for travel time or for unapproved out-of-network care. I would use the flex account to pay for stuff like vitamins if those are covered (and I don't know if they are).

Your policy should cover all of this, very likely in boring and difficult to understand language. What does your policy say?
posted by rtha at 9:35 AM on November 22, 2013

My insurance company has very specific policies about what % of my out-of-network expenses are reimbursed. I submit a claim form with a receipt for my expenses. The insurance company processes then and sends me a reimbursement. In some cases my doctor will submit the claim for me if I give him the claim form.
posted by deanc at 9:55 AM on November 22, 2013

This question can only be answered by reviewing your specific insurance policy. I'm assuming you're in the US, and on some kind of group health insurance through an employer.

Is there 0 reimbursement for out-of-network? Do you have an HMO? Have you tried filing a claim against your health insurance for these expenses? Has that claim been denied? Would there be secondary insurance to seek a claim against? (an example would be if this expense occured because of an accident in a home, workplace, or automobile.)

If your claim is denied, there is no secondary insurance, no health savings account to reimburse yourself from, your last avenue of recourse would be tax deductions. Your accountant should be able to advise you with this.

I would also question a health provider who orders expensive tests from an out of network lab, and wonder why you were not given advanced notice or the choice of another lab. Was this some kind of quasi-medical thing like a vitamin levels test from an alternative medicine practitioner, or genetic sequencing like 23andme?

For travel time and over-the-counter items like vitamins, you should look into starting an FSA for next year. Your accountant should be able to advise you on this.
posted by fontophilic at 10:09 AM on November 22, 2013

You can only deduct medical expenses that are greater than 7.5% of your AGI ...

The threshold was raised to 10% starting in 2013, unless you are over the age of 65. Starting in 2017, those over 65 will also have a 10% threshold. This change was part of the Affordable Care Act, under the assumption that out-of-pocket expenses will be limited by new insurance.
posted by JackFlash at 10:43 AM on November 22, 2013

You can also only deduct medical expenses at all if you itemize, so that's another thing.
posted by Sequence at 11:52 AM on November 22, 2013

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