03 Nov Met Your Deductible? Why December Is a Smart Time to Schedule Pain Treatment
If you have already met your health insurance deductible this year, December may be a cost effective time to schedule pain care you and your physician have been considering. Many plans reset deductibles and out of pocket maximums on January 1, so care received before the end of your plan year may cost less than the same care after your benefits reset.
If you have been managing back pain, neck pain, or joint pain this year, here is what to know about your benefits as the year comes to a close.
How Do Deductibles and Out of Pocket Maximums Work?
Your deductible is the amount you pay for covered care before your insurance starts sharing the cost. After you meet it, you typically pay a copay or coinsurance. Your out of pocket maximum is the most you will pay for covered services in a plan year. Once you reach it, your plan generally pays for covered, in network services for the rest of that plan year. Coverage details vary, so check your plan for specifics.
On many plans, both amounts reset on January 1, which means progress toward your deductible starts over in the new plan year.
Why Might December Be a Good Time to Schedule Pain Treatment?
If you have had imaging, specialist visits, physical therapy, or other medical care this year, you may be close to meeting your deductible or may have met it already. In that case, care received before your plan resets may cost you less out of pocket than the same care in January or February.
Cost is only one consideration. The decision to pursue any treatment should be based on your symptoms, your diagnosis, and a discussion with your physician.
Should You Use Your FSA Before the Year Ends?
If you have a Flexible Spending Account (FSA), unused funds are generally forfeited after the plan deadline. Some employers offer a short grace period or allow a limited carryover, so check your plan details. Many medical expenses, such as office visits and copays, may qualify for FSA use. If you have a Health Savings Account (HSA), your funds generally roll over from year to year.
What Types of Pain Care Do Patients Often Consider?
Depending on your diagnosis and your physician’s recommendation, options that patients sometimes discuss with their provider include:
- A new patient consultation or follow up evaluation to better understand the source of your pain
- Epidural steroid injections, which may help relieve certain types of nerve pain in the neck, back, or legs
- Facet joint injections and medial branch blocks, which may help with certain types of spine pain
- Radiofrequency ablation, which may provide longer lasting relief for some patients with certain joint or spine conditions
- Joint injections for knee, hip, or shoulder pain
Not every treatment is appropriate for every patient. Your physician can help determine which options, if any, may be right for you. To learn more about what to expect from injections, read How Long Do Epidural Steroid Injections Last?
How Can You Plan Ahead?
Year end schedules can fill up, and some procedures may require prior authorization from your insurance company, which can take time. These steps may help:
- Call your insurance company to confirm how much of your deductible and out of pocket maximum you have met
- Confirm your plan year end date, since some employer plans do not follow the calendar year
- Check your FSA balance and any deadlines for using funds or submitting claims
- Contact our office with questions about scheduling
Is Year End Treatment Right for You?
Every patient’s situation is different. The right time to seek care is when you and your physician agree it is appropriate, whether that is in December or later. A consultation can help you understand your options, their potential benefits and risks, and what your insurance may cover.
Frequently Asked Questions
Does my deductible always reset on January 1?
Many individual and employer plans run on a calendar year, but some employer plans use a different plan year. Check your plan documents or call your insurer to confirm your reset date.
What if I have not met my deductible yet?
Care you receive this year generally counts toward this year’s deductible, and you may be able to use FSA funds before they expire. Your insurer can tell you exactly where you stand.
Will I need prior authorization?
Some procedures require it and some do not, depending on your plan and the treatment. Because approval can take time, asking early may help.
Plan Ahead Before Your Benefits Reset
If you have been considering pain treatment, the end of the year can be a practical time to review your benefits and talk with a specialist about your options. Our team can answer your questions and help you understand what may be appropriate for your situation.
Schedule a consultation with Principal Spine to discuss your pain and your treatment options before the new year.
Disclaimer: This article is for general educational purposes only and is not medical advice. It does not replace an evaluation by a qualified healthcare provider. Treatment options, risks, and results vary from person to person. Please consult your physician about your specific situation.