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May 20, 2011 | | Comments 0

You Asked About: What Can I Purchase With My Hsa

Thomas asks…

What does “not in compliance” mean for a health insurance company?

We both lost our jobs due to the economy and are now self-employed trying to raise our family of five on low-income wages. I was a teacher, he was in construction, this is not what we planned but life happens. We took at least a 50% paycut and lost our health insurance.

We privately purchase high deductible HSA health insurance through BCBS. It seemed like the responsible thing to do. Our deductible is $5k and our max out of pocket is $11k. We will be out around $7k this year. I was told to negotiate with the hospital and doctors. However, they told me they could not negotiate because it was not “in compliance”. They said they used to be able to cut rates but now they can‘t -they have to notify the insurance company in writing if they do. I‘ve called the hospital billing people, I‘ve called BCBS, I‘ve tried to figure out what this compliance issue is and where it comes from –what document, what language? The hospital billing people didn’t know and BCBS gave me the run-around.

What I can gather is that BCBS will not let the hospital give us a discount because then THEY would also want the same discount. This seems crazy to me! Why would they care if we are paying our premiums The hospital takes the hit, not them. Maybe I‘m wrong.

Does anyone know what they mean or where this comes from. Nobody can answer my question. We just don’t have the money. We might be able to pay on it month by month but anything can happen at anytime. I can‘t be assured that I‘ll still have my job or my husband won’t break his arm and not be able to work…I just can‘t.

Frustrated! -But if anyone could help me with what this “compliance” thing is, I‘d greatly appreciate it.

Chas answers:

Anything being “Out of Compliance” or “Not in Compliance”, means it is not following the rules, laws, requirements, stipulations, program, agreement, etc. You need to discuss this with them, and ask them to answer you in detail, what exactly is not in compliance. It could be one thing or several things that are not in compliance. I’ve also seen that fancy wording on things that were of minimum nature (i.e. Someone omitted their middle initial on a document and was therefore, out of compliance). If you cannot find the exact information in their Compliance area (a document, a manual, a leaflet, a brochure), then you need to call them, ask for a manager or supervisor, and ask where exactly the rule is, that you are not in compliance with. They know their paperwork and manuals and where everything is, because it’s their company. But you can’t possibly know, because you don’t work there. If you make it clear that you’ve done your homework and are still “lost” over this, then hopefully someone there will have the time to help you with this. Good luck.

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