Anonymous
Anonymous asked in Business & FinanceInsurance · 2 months ago

Income based medical clinics and high deductible insurance?

I have long had a high deductible plan that only covers me if I spend over $6400 which I have never done.

I need a new Dr and its difficult to get quick appointments anywhere expect the income based place.

I told them I have no insurance because I effectively do not.

Plus I want to get a low rate.

Should I tell them I actually do have the high deductible plan?

My last visit was $150 to a regular no appointment place so I am trying to pay less.

They apparently deal with a lot of very, very low income people. I don't have any of the stuff they ask for like food stamps or free phone service or any of that.

Should I just fess up and tell them I have a high deductible plan or tell them I have no insurance?

I want to avoid paying $150 every time I go to the Dr.

She said it would be $35-55. until I meet with a financial counselor.

I told her I could provide a tax return but they wanted something more recent.

Update:

Nobody is going to sue or arrest me over it.

Update 2:

I just called my insurance company. They said it is 100% up to me if I chose to use my insurance or not.

Just that if I don't tell them, that visit will not count toward my $6400 deductible.

My concern is if I tell them, I will end up paying $150 for a brand new Dr versus the $35-55 I will pay by not having or using insurance on the visit.

Update 3:

Eva, I do not have a paystub.

I have AFA insurance but I can chose not to use it which is what I am contemplating.  I understand it will not count toward my deductible.

Update 4:

ACA, not AFA.  I have marketplace insurance.

Update 5:

1. Your HDHP insurance covers you from day #1.

2. Your HDHP insurance begins saving you money in doctor appointment costs from day #1, if you go to in-network providers

3. If you told the income based clinic that you did not have insurance, you committed fraud. Because you DO have insurance AND The insurance is worthwhile.

- no one is going to sue you or arrest you over it. You are just taking benefits away from people who likely need it more than you.

Above answer from A HUNCH 

Update 6:

I still dont think its fraud. And how does it take benefits from someone else.

Bottom line is if I have to go to the dr every 6 months for routine crap. I would rather pay $50-75 than $150. At the same time, I like having my downside protected at $6400 or whatever in the event I need open heart surgery.

6 Answers

Relevance
  • 2 months ago

    You dont have to think its fraud for it to be fraud.  This is meant to be offered to the indigent, not to people who have insurance.  

    You like the cheap cost of the cheap treatment...who wouldnt?  That doesnt make it right.  Legal might be another story.  

    Free clinics are for people who cannot afford any treatment...not for you.  Defend yourself however you would like, but you are morally wrong on this one.  

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  • 2 months ago

    Look for another metal plan with lower deductible.

    • Never
      Lv 7
      2 months agoReport

      Yes, spend thousands to save $100 twice a year. SMH

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  • Judy
    Lv 7
    2 months ago

    Yes you do have insurance, so tell them what you have.

    • Never
      Lv 7
      2 months agoReport

      I'm afraid they will say, "he has insurance" and charge me $150 instead of their much lower income based rates.

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  • 2 months ago

    1. Your HDHP insurance covers you from day #1.

    2. Your HDHP insurance begins saving you money in doctor appointment costs from day #1, if you go to in-network providers

    3.  If you told the income based clinic that you did not have insurance, you committed fraud.  Because you DO have insurance AND The insurance is worthwhile.

    - no one is going to sue you or arrest you over it.  You are just taking benefits away from people who likely need it more than you.

    In response to the comment:

    - there is no such thing as ACA insurance.

    - all insurance (marketplace, private, employer based), medicaid, and medicare in in the USA is governed by a law called the Affordable Care Act (nick-named Obamacare).

    - your insurance through the marketplace works EXACTLY the same as my private health insurance and my siblings employer based insurance.  The only difference is that you are eligible for a subsidy AND you likely have a reduced provider network.

    In response to the comments:

    How does it take money away from others?

    The clinic doesn't get an unlimited amount of case.  They get the majority of their money from grants (government or private), likely donations, and from the small amount of money they charge patients.

    If they have $1000 and charge you $55 because you lied to them about having insurance, that means that you received $X that you didn't deserve.  Do you think they had just an extra $75-$100 sitting around?  They don't and by you taking their money fraudulently, someone's got to pay.  Who is that?  Future patients or maybe they will have to make their eligibility requirements stricter.  

    - no different than how shop lifting increases the prices for everyone else.

    So if you want to pay "rather pay $50-75 than $150" figure out a way to do that without committing fraud.

    - find a doctor in a lower income area

    - talk to your doctor to see if you pre-pay in cash, will they reduce the cost or they have another way that you can pay less. 

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  • Eva
    Lv 7
    2 months ago

    You are committing fraud if you deny that you have insurance when you do have it. They will see that you do when you provide a pay stub to them to confirm your income.

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  • NA
    Lv 7
    2 months ago

    Tell them.  If it makes a difference and you don't tell them, you could be sued or arrested.

    • ...Show all comments
    • A Hunch
      Lv 7
      2 months agoReport

      "Can" in theory sure... remotely a chance in real life = he has more of a chance of winning the lottery (even if he doesn't buy tickets). 

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