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What Should I Do About Billing Problems When Using HSA Money?

If you run into a billing problem or misunderstanding with a hospital or doctor's office for which you're planning to use money from your Health Savings Account (HSA), you could be in trouble.

This article will help you understand how hospital and doctor visits are different when paying with a Health Savings Account. Not better or worse, just different.

If you have an HSA, you must have health insurance. It's a requirement. However, if you are using money from your HSA, it means that you haven't hit the deductible of your policy yet.

In this particular situation, life is a bit different when it comes to resolving billing disputes with hospitals.

Insurance companies have a comprehensive system for dealing with billing disputes when they have covered a hospital stay or doctor visit. But when they haven't covered it because you are still within your deductible, that comprehensive dispute resolution system doesn't necessarily apply.

Here are some points to keep in mind when you are dealing with a hospital in a billing dispute, and you have paid with HSA money. I learned these important points when I was talking to an expert in this field named Dr. Vincent Riccardi, who is the owner of American Medical Consumer (, a company dedicated to helping people resolve billing disputes with hospitals and doctors.

Here's what Dr. Riccardi has to say:

  • First, discuss the issue with your physician. Sometimes the problem stems from an incorrectly applied billing code and the doctor can easily change it to please the hospital and resolve the problem on the spot.
  • Negotiate in person. Especially if you just don't have the money to pay a bill, it makes the best sense to negotiate face-to-face with the person at the hospital who has the authority to reverse or reduce the charges. Hospitals would often rather be paid part of a bill than risk losing the entire bill. Be honest and forthright and you may have a good chance in negotiating a reduced fee from the hospital. This includes the situations where it was a misunderstanding on your part. It's at least worth a try.
  • Don't bother going to the State Medical Board. In most cases, they are not able to help you. This is the case with most government agencies. Even the Departments of Insurance cannot help, because this isn't an insurance problem, it is technically a fee-for-service situation.
  • Recourse to a lawyer is usually not fruitful unless there is a big amount involved. For amounts less than $5,000 (which is what most HSA-style deductibles are), a lawyer probably won't be able to help you.
  • Remember that the only things that count in negotiations like this are the things that have been written down. If a doctor mentioned something to you but didn't write it down, it probably won't help you. Get things in writing all the way through the process.
  • I think of HSAs as a way to "be your own insurance company" for the small stuff (under your deductible). That is its power. But it also means that when it comes to disputes, you also have to "be your own insurance company" and take charge of the negotiations with the hospital, just like an insurance company would. Your willingness and ability to negotiate will influence your ability to get unfair charges reversed or, at least, lessened. But it's a "do it yourself" situation, so be aware of that when you sign up for an HSA.

    Daryl Kulak is the author of the book "Health Insurance Off the Grid - A Wonderful Way to Use Alternative Medicine and Save Money on Insurance Using the New Health Savings Account (HSA)."

    The book provides a nine-step plan to get your self-employed or small business health insurance costs under control using a unique approach you won't find anywhere else. The book is available for sale as an e-Book or paperback at the Website

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