getting organized

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End of the Year Health Insurance Tips

What? It’s December already? It snuck up on us too. Here are a few things everyone should make sure to check out, check up on, or wrap up before the New Year starts.

New coverage

2014 marks the beginning of coverage via the health insurance exchanges. If you’re thinking about enrolling in a plan through the exchanges, December is the time. Even though the deadline to enroll has been extended to March 31, if you wait, your coverage won’t become effective until the month following when you enroll. For your coverage to begin in January, you’ll need to enroll and pay your first premium by December 15th.

Leftover annual benefits

Does your plan include benefits that expire at the end of the calendar year? This is common for preventive dental care and vision benefits. Make sure you’re not leaving anything out!

FSA or HRA balances

Do you have funds left in your FSA or HRA? You may lose any money that you have set aside but not yet spent. A new rule was just passed to allow employers or benefits administrators to roll over these funds, but it is only effective if your employer chooses to implement it (the rule is optional). Check if the rule applies to you, and if not, make sure you don’t have any unspent money left! HSAs are different – the funds in an HSA always roll over, year after year.

Post-deductible procedures

Have you met your deductible for 2013? Then the end of the year is a good time to schedule any elective procedures you might want to squeeze in before your deductible rolls over in January. You could save a lot in out-of-pocket costs by getting these services done while your plan is paying at its full benefit level (rather than early in the year when your deductible has not been met).

Onward to 2014!


How to Start a New Health Plan Off on the Right Foot

Welcome to a new year, with new health benefits. You just chose a new health plan and now it’s in full effect. But most people don’t have a full understanding of how their benefits work. This means that many of them end up losing money in their spending accounts, paying more for care, or getting claims denied.

Follow these tips to make sure you start off 2013 right.

Plan for your Deductible
Guess what–deductibles have gone through the roof over the years, so that often means more cash out of your pocket. If you are one of the 65% of people who have a high deductible health plan, it’s especially important for you to plan your spending. High deductible health plans (HDHPs) come paired with Health Savings Accounts (HSAs), or accounts where you can save money just for medical expenses free from taxes. To be best prepared, you should plan to save at least the amount of your deductible in your HSA as soon as possible.

Network It
Most health plans have some restrictions on what providers you can see or they cover much more on visits to in-network providers. Find out the type of plan you have and whether you have a provider network. HMO plans are the most restrictive–don’t even think about going to a non-network provider unless you want to pay the full cost. PPOs have some more flexibility, but services in-network will be less expensive. POS plans give you more freedom, but often involve more paperwork for out-of-network visits. And finally, FFS plans allow you go to any provider you want, but few companies offer this option anymore.

Get Spent
Did you sign up for an FSA or HRA? Don’t forget about the money in your account. These funds disappear if you do not spend it by the end of the year. Do some planning now by finding what eligible expenses you expect this year so that when they come up, you’ll know to pay with your FSA or HRA, insteading of other funds. If you have an HSA, the same “Use it or lose it” rule does not apply. Your savings will roll into the next year.

Practice Prevention
All health plans must cover a list of dozens of preventive care services, all free of cost. Get your money’s worth by checking out the list and asking your physician what they recommend. Even if you have a high deductible plan and you have not met your deductible, you can still get these services completely covered, as long as you don’t have a pre-existing condition that already required one of these tests or screenings. Learn more about preventive care here.

Have a Non-Emergency Plan

What do you do on the weekend or in the middle of the night when you’re not sure if a medical condition is serious enough for the ER or can wait for a doctor’s appointment?  Most health plans have a variety of options for these uncertain situations such as nurse advice lines or extended-hours urgent care. Know your options so that if you’re caught in the situation, you can choose to avoid an expensive ER visit. Of course, always go to the ER if you are having a life-threatening emergency.


Before 2013: Squeeze Extra Dollars Out of Your Health Benefits

Before the new year rolls around, putting some attention towards your health benefits can save you a lot of money. Quick! You have limited time to make the most out of your health plan for 2012, and then to get ready for 2013.

Spend down your FSA or HRA 

If you have a Flexible Spending Account or Health Reimbursement Account, check on the date it rolls over (for most of them, it’s January). You’ll lose the funds if you don’t spend them in time. Some employers offer a grace period until March 15th, but after that date, the money disappears. See what expenses can be counted.

Don’t confuse your HSA. These funds stay with you year after year!

Take advantage of your deductible

Most plan deductibles also roll over at the end of the year. If you have already met your deductible, think about whether there are any other services or procedures you need to do soon. Scheduling them before the year ends might save you from having to pay completely out of pocket in the new year.

Fund your HSA

If you have an HSA, you already know that the money that goes into it is free from taxes. Did you also know that you can keep depositing up until April 15th and your contributions will count towards your 2012 income? That means you can add more funds if you didn’t deposit enough this year or aim for the maximum contribution to get the most tax savings.

Review next year’s plan

It’s time to look at what’s new for your health plan (or all the important details if you switched plans!). The top benefits to focus on? The deductibles (individual and family, as well as in-network and out-of-network), any changes to the drug formulary, and any changes to the provider networks. These last two rule changes often surprise consumers who think their plan will be the same as it was last year.


Why Understanding Your Health Plan Just Got a Bit Easier

Wouldn’t it be great if overnight, understanding health insurance magically became easier?

That was the aim September 23, 2012, but whether it actually happened is still in question.

On the 23rd, a new benefit from Health Reform kicked in, aimed at making it easier for consumers to understand insurance and compare plans.

It’s called the Uniform Summary of Benefits and Coverage (SBC). Right now, health plans already send you long, complicated SBCs. But the problem is, every one is different (ever tried to compare two of these?).

But now, every plan will be required to present their information in a standardized way, using the same definitions, so you can compare apples to apples.

Think of nutrition labeling—we can see instantly exactly how much more sodium is in one bag of chips versus another. That’s the goal behind the Uniform SBCs. And the “labels” actually don’t look that different from what’s on your food…

Even better, the new document also include “coverage examples,” or a theoretical breakdown of costs for some common medical conditions. See example SBCs here.

It’s a step forward, but here at Simplee, we know it’s not enough to make shopping for health insurance as easy as shopping for sweet potato chips. For example, it’s still difficult to compare 70% and 80% co-insurance when you don’t know the full cost of a service.

Basically, the new SBC will make is easier for consumers to choose between health plans, but after that, it’s still a challenge to understand claims and bills once you start using the plan.

Everyone with a private health plan will see this benefit. Look for it when you receive your plan documents each year or on your health plan’s website.



Simplee member offers tips for better dental care

Whenever we are tell people about Simplee, we are struck by how everyone seems to have some story about getting overcharged by a provider, rejected by an insurance company, and generally bumped around in a system that is decidedly customer unfriendly. 

Today’s story comes from Simplee user David of Sunnyvale, CA:

We all know that planning can be very effective. It is especially important when it comes to dental insurance. Since most dental insurance (including mine) has an annual cap, making sure this cap is used in the most effective way could save you big bucks.  I always heard stories from friends about the thousands of dollars they paid out of pocket for their dental treatment, and now I know why.

About 2 years ago my dentist told me I needed a root canal and a crown.  These two treatments are very expensive, with costs ranging from $1,000 to $1,500 each.  Put these two together and they can easily surpass the cap on the annual dental insurance allocation—mine, for example, was $2,000.  Once your cap is met you need to start paying for treatments out of pocket.  So since it has been the end of the year, I scheduled the root canal right away and the crown for the beginning of the year.  The expenses fell into two different years so I stayed below my cap.  I still had to pay the deductible of the treatment but I probably saved hundreds or even thousands of dollars.

A few lessons I learned from this:

1) Track your dental spending for each family member

2) Plan ahead and be aware of your annual cap

3) Make sure that for major treatments, you submit a pre-authorization to your insurance so you know exactly how much you will pay for the service before you start with the treatment

Thanks for sharing again, David


Why Should I Track My Medical Bills?

Let’s say you decide to rent an apartment. You don’t know all the details in the lease and the landlord calls you on a regular basis to say there’s another expense…Would you please send a check (for some amount that sounds random)? Something just doesn’t feel right here…

Yet many of us are like that with our health care. It’s understandable—who can really decipher all the documents and sort through all the mail?

But it’s important to understand the basics of your health plan and to track your bills for several reasons. A little time could save you money later on. Here’s why.

Billing mistakes happen 

Anywhere from 30 to 40% of all medical bills contain errors of some type, according to health finance expert Stephen Parente at the University of Minnesota. Some claim the figure is even higher. These errors can include things like upcoding (attaching a more expensive billing code to the service you received so that you are charged for a more), charging more than once for the same service, or breaking a service down into separate parts and charging for each of those (like the gloves and tools used during a surgery). There are many tips for spotting these errors, but the place to start is tracking and reviewing each bill as it comes.  Check your claims detail in Simplee to see your provider charges explained in simple language.

Multiple bills

Medical bills are hardly straight-forward, so you can end up paying more than need to. It’s common to receive multiple pieces of mail related to a single medical service. The first is often an Explanation of Benefits (EoB). You know, the letter that looks like a bill but says on the top “This is not a bill.” An EoB is just a notification from your health plan that they received a bill from your doctor and explains what they plan to pay. Following an EoB, you can expect a bill from your doctor or provider. Sometimes, multiple bills are sent for the same item, so it can be confusing to determine whether you’ve paid one or not. A good way to track these is by the date of service. You may even want to keep track of the date of your medical appointments so that you can easily match these up.  And of course, you can also track things in the Simplee dashboard, which combines information from your provider and your insurance company in one place.

Tax breaks

 If your annual medical expenses exceed 7.5% of your adjusted gross income, you can deduct them from your taxes. This includes pretty much anything that is medically necessary, such as: insurance premiums (though only a portion), co-pays and coinsurance, prescription drugs, home care, acupuncture, mental health, dental treatment, glasses, and medical supplies.

Late fees

This is an obvious one. Late payments come with a late fee, so don’t put yourself there if you don’t need to. If you are unable to pay a bill right away, contact the hospital or provider. Many offer payment plans or will negotiate a discount.

Understand your spending

Finally, it’s good to know when you meet your plan’s deductible or out-of-pocket maximum. This information can help you see when you can expect your plan to pay, when you’re free from your coinsurance (whew!), how much you are spending, and how well your health plan is working for you.  Here is another area where Simplee is a big help– your deductible is tracked automatically, and you’ll get an email when it is met.

Tracking medical bills isn’t fun, but Simplee makes it a lot easier.  If you’ve been avoiding tracking your expenses, now is the time to jump in!


Getting The Most Out Of Your Health Insurance Plan

Health plans certainly come with no shortage of rules. And you’ll want to be sure to follow them in order to get the most out of your coverage.

1) Find the freebies.

If you joined your health plan on or after September 23, 2010, you can get many preventive care services free of cost. Yes, that means no co-pay or coinsurance, even if you have not met your deductible.  This includes services such as cholesterol and diabetes screenings, women’s exams, osteoporosis tests, STI (sexually transmitted infection) counseling, immunizations, smoking cessation evaluations, depression screening, many screenings for children, and more. For a complete list, visit

Even if you were enrolled in your health plan prior to September 23, 2010, the plan may still offer the same preventive care benefits, so it is worth investigating.  Check out the “Your Plan” tab in your Simplee dashboard to see details of what your plan offers.

In addition, many plans also offer benefits such as discounts on gym memberships, weight-loss programs, or vitamins. After all, most everything that keeps you healthy and away from the doctor will save both you and your plan money in the long run.

2) Use your network.

If you have an HMO or PPO, your plan contracts with a network of providers. You are probably already aware that seeing physicians within the network will save you money. But plans may also contract with network hospitals, labs for blood tests, medical supply companies, home health providers, or imaging centers. Checking to see if these providers are a part of your plan before going to them for services can also save you money.

And after you have received the service, make sure to check your claim over on Simplee to make sure that you were properly charged.

3) Plan around the deductible.

Many plans have an annual deductible. For example, if your deductible is $500, you must pay $500 out of pocket for your medical care before the plan starts paying for any covered services. If you reach your deductible during the year, it may save you money to take care of any other health needs you have that year, before your deductible renews. Or if you know you will be incurring a number of health expenses that will put you over your deductible, you may want to plan them to fall within the same deductible year so you do not end up needing to meet the deductible twice. If for example you have a calendar-year deductible and you are planning a series of procedures, you may want to avoid scheduling the first in December, in case they lapse into January.

Also keep in mind that some plans may have a separate deductible for in-network providers than for out-of-network providers—you might be starting from zero if you go out of network, even if you’ve already met the in-network deductible.

4) Ask about your drugs.

Every health plan has a formulary, or list of drugs that are covered. Formularies often divide drugs into tiers, or different levels of coverage: For example, a tier 1 drug may have a $35 co-pay while a tier 2 drug has a $10 co-pay. Doctors often have no way of knowing the level of coverage for a drug on your plan when they are prescribing it. Before filling a prescription, you can check the level of coverage with your plan. If it falls on a more expensive tier (or is not covered at all), ask your doctor if there is a similar or equivalent drug you can take which might have better coverage.

5) Understand utilization management.

Many plans now use a process called “utilization management,” where certain procedures must have prior-approval from the plan before they are covered. You should find out if your plan has such requirements. If so, always make sure you have gone through all the steps to get a service authorized before you receive it. Usually, it is up to your doctor’s office to contact your insurance company to start the utilization review, but it is ultimately your responsibility to make sure it gets done.

Above all, the best way to get the most out of your plan is to understand the rules. Every health plan is different. Sometimes, the rules can even be different for two people with the same plan, depending on when each of them joined. You can view all the details about your specific plan when you log in to your Simplee account. If you have any additional questions, call the plan—it’s best to know so you don’t get that surprise bill later on.


From the Simplee Community: “Simplee Has Made It Very Clear To Me.”

Many thanks to Simplee user David for writing us this story about how Simplee gave him peace of mind after the birth of his new baby:

As my wife was going through her pregnancy for the past 9 months, many things went through my mind.  Of course there was joy, excitement and great anticipation of the big day, but there was also anxiety.  We didn’t know if everything would go well, if the baby would be healthy, if we would need a C-section, or if we would have problems dealing with insurance.  The cost of everything would be so high without insurance paying for it.

I was very excited when I first read about Simplee on TechCrunch.  I thought that health insurance simplified would be great.  I already have similar service for banking (Mint) and I was very happy with them, so I jumped on the chance to get into the private beta.  It worked just like I thought it would.  Bills charged to my health insurance would show up on Simplee, and it was very clear to me whether or not a claim was successful, or if it was denied for whatever reason.  It would also tell me the amount that I am responsible for paying in every claim.  If a claim was listed as denied, it would state the reason and show clearly that I was not responsible for paying the rejected amount.  It definitely gave me peace of mind that I understood the claims, because reading the health insurance statements directly, they make things so complicated!

During the week after the baby’s delivery, you can imagine that everything was very hectic.  Relatives visiting, bringing the baby home, taking care of my wife, visiting the pediatrician for the first time—the last thing we wanted to worry about is whether or not we would be charged tens of thousands in bills.  Thankfully, Simplee has made it very clear to me what is going on.  I would definitely recommend everyone join Simplee to get an understanding of your health insurance.

Thanks for the kind words, David, and congratulations on your new baby!  To experience how easy your medical bills can be with Simplee, get started today with a free account.


My Year-Round Tax Assistant (at least for Health Care Expenses)

It’s tax time and so many people I know are sifting through receipts paper-clipped together and envelopes of medical bills to try to tally up their tax-deductible medical expenses over the last year. I remember these days well.

This year, I was amazed at how easy it was to see how much I’d spent on health care over the last year. Almost too easy. On my Simplee home page, “Your Spending” jumps out in big bold numbers that are hard to miss. And then, I can drill down into the date of each appointment, the exact service that was billed, how much my insurance paid, and more.

It’s as if someone was collecting all my medical bills throughout the year and organizing, filing, and summarizing them all for me. And they probably won’t mix up or triple count those multiple bills I got for the same doctor’s visit back in… July?

Simplee doesn’t contain everything for your taxes, only the expenses for medical care. Expenditures such as transportation costs, premiums, and long-term care services are all tax-deductible, but Simplee only tracks insurance related expenses. But this is a huge start to just giving me a sense of how much I’ve spent and whether it’s worth claiming the deduction (Your expenses must be more than 7.5% of your adjusted gross income or you must file schedule A to deduct medical expenses).

So next April, I look forward to having Simplee as a resource to understand my health care spending and at least ease some of that pain before April 15th