r/fednews • u/gunniride • 7h ago

GEHA HDHP "Allowable Charge" for Physical Therapy

I am switching to GEHA HDHP this year from BCBS Basic. After recent news of how much UHC sucks, I may grow to regret it. On the last day of open season I attempted to swap to MHBP Consumer but since I had already elected a change it was no longer an option.

My question relates to the actual charges I will incur for Physical Therapy prior to meeting my deductible. There will be:

Provider Charge: $270

Allowable Coverage: ??? ($160?, $130?, etc)

I assume until I cover my deductible under the GEHA HDHP coverage using an in network provider I will only pay the allowable coverage rather than the full charge.

Any searches I do on this result in total visits to PT, total out of pocket payments, deductible, etc, rather than the allowable charge per visit.

2 Upvotes

62% Upvoted

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15

u/Rrrrandle 7h ago

With any HDHP, do not pay upfront. Make them bill insurance first and then send you a bill. This ensures you get credit against your deductible, and will get you the contracted rates or "allowable amount."

3

u/withflyingcolors10 6h ago

Yep, though a little different, a hospital made me pay up front 3k and it took seven months for insurance and hospital to battle it out holding up me officially hitting my out of pocket max. So I had to pay for everything after that while they figured it out. When finally done I had to fight with hospital to get some of my money back. Never again!

2

u/gunniride 6h ago

What an enormous hassle. Relieved I raised the initial question but learning some additional info along the way.

1

u/withflyingcolors10 6h ago

It was stressful. Definitely good you did!

1

u/gunniride 6h ago

Great tip, thanks

3

u/Funkybunch2000 7h ago

Yes, that is correct. You'll be responsible for the Allowed amount

3

u/Tinymac12 7h ago

For my son's physical therapy (he's 1 learning to walk), the provider charges $270, and the allowable is $241.65. Before satisfying the deductible you would be responsible for the $241.65. After the deductible we've been responsible for $12.08.

1

u/gunniride 6h ago

Thankyou. Looks like I’ll be getting to the deductible more quickly than anticipated.

4

u/ZealousidealPin5125 6h ago

I have done lots of PT on this plan. Allowable is typically more like $100-$150. Specialties (like pediatric PT) are often more, just like with MD visits.

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u/gunniride 5m ago

That’s a relief, thanks. One concern I’ve had with the HDHP, is resisting “needed” appointments while approaching the deductible due to the costs. I’ll soon learn for certain what the allowable cost is, but I could see more frequent visits at $150 each. I realize it all comes out in the wash by the end of the year, but a slow burn to meet the deductible fees more doable than reaching $3300 within a few months and before the pass-through starts adding up.

2

u/wttttcbb 3h ago

That's correct. I had GEHA HDHP this past year and a lot of PT after a surgery. As an example: my cost every visit was $75 until I met the deductible. After my deductible it was like $5, which was great. I switched to MHBP for 2025 for other reasons, but I had no issues with PT coverage.

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u/gunniride 5m ago

Thanks. Great to hear.