You’ve Met Your Deductible: Which Medical Services Should You Have Before Year’s End?

It’s almost Thanksgiving, which means Black Friday is around the corner. With sales and discounts unlike any other time of the year, Black Friday is paradise when you’re on a budget. (Yes, this has to do with health — stick with us!)

The arrival of Thanksgiving also means it’s almost the end of the year. By this point, many people have met their health insurance deductibles and out-of-pocket maximums. This makes many health care and medical services significantly less expensive.

Translation: Meeting your deductible is basically the health care equivalent of scoring a great deal on Black Friday.

The 101 on Deductibles

Before going any further, let’s do a quick recap of how insurance and deductibles work.

    Common Insurance Terms, Explained

  1. Premium: The amount you pay each month for your insurance
  2. Deductible: The amount you must pay for health and medical services first before your insurer covers anything
  3. Co-pay: The amount you pay for routine services, such as annual physicals, to which your deductible doesn’t apply
  4. Out-of-Pocket Maximum: The absolute maximum amount you will pay for health and medical services each year
  5. Claim: The bill your health care provider sends to your insurance company for payment

For example, if you have a $1,000 deductible, that means that you have to pay $1,000 on health and medical services out of your own pocket before insurance kicks in. Once you have met your deductible, insurance will start to cover a large portion of your health care costs and you will pay a copay (the remaining cost that the insurance doesn’t cover). Every plan is different, but with many plans, your insurance will cover 80% of the cost, while you will be responsible for 20%.

Things get even better if you’ve met your out-of-pocket maximum. This is the absolute most you will pay each year. So, let’s say you have a $1,000 deductible and a $1,500 out-of-pocket maximum, and you’ve met your $1,000 deductible. You will now be responsible for copays on services — but only up to $500 worth. Once you’ve hit that, insurance will cover 100% of your health care and medical costs.

This doesn’t mean that services that were never covered will suddenly be covered. If your insurance plan does not cover cosmetic plastic surgery, such as a nose reconstruction, it won’t start covering it just because you’ve met your deductible. Before scheduling any services, check with your insurance company to make sure you know what will be covered and what you will need to pay.

And without further ado, here are the top 8 medical services to get once you’ve hit your deductible.

1. Bone Densitometry (DEXA, DXA)

A bone densitometry tests your bone density — the bone’s mass and mineral make-up. This test allows us to screen for osteoporosis, which is a condition where your bones become weak and fragile, and are more prone to breaks. Anyone can develop osteoporosis, but it’s particularly common in older women.

Testing involves a simple scan, so it is very easy and painless. While it does use a little bit of radiation, it only uses very low, safe doses. If you’re not sure if a screening is right for you, check with your primary care provider.

At Stormont Vail:

2. Physical Therapy

You don’t need to have a major injury or be an athlete to receive physical therapy. Physical therapy can be helpful if you have problems with pain, stiffness, motor skills, coordination, balance, or strength.

These are problems that you may have been putting off managing, especially if they aren’t severe. However, getting them fixed could greatly improve your quality of life, and possibly prevent these issues from getting worse in the future.

At Stormont Vail:

  • Where to get physical therapy: Outpatient Physical Therapy
  • How to make an appointment: Call (785) 354-6116

3. Joint Replacement Surgery

If you have an achy joint pain, joint replacement surgery is one of the best things you can do to relieve the pain and get back to living the life you had before the pain set in. Again, this is one of those procedures people tend to put off until the pain get so bad that they have no choice.

With your expenses decreased, it’s time to address that pain and not take it into the new year.

Since joint replacement surgery requires pre- and post-surgical care, the expenses can easily add up. Receiving the surgery when you’ve met your deductible is a great way to cut back on these costly procedures.

At Stormont Vail:

You can also receive pre- and post-surgical education to help you through the surgery and recovery processes at our Total Joint Center. Call (785) 354-6325 for more information.

4. Skin Care

Skin conditions such as acne, warts, and eczema are also conditions that you may have avoided treating. They may be frustrating, but you consider them “livable” and think of treatment as a waste of your money. However, once you’ve met your deductible, treatment and management are much more affordable.

If you don’t have any immediate concerns, it’s still a good idea to see a dermatologist for a general screening. Your dermatologist may be able to find signs of serious skin conditions, such as cancer, before they become too difficult to treat.

At Stormont Vail:

5. Plastic Surgery

Both cosmetic and reconstructive surgery fall under the plastic surgery umbrella. While many insurance companies won’t cover cosmetic procedures, such as brow lifts or tummy tucks, they will often cover reconstructive ones, such as inverted nipple correction, fixing burn scars, or breast reduction. You will need to check with your insurance company to see which surgeries are considered cosmetic, and which are considered reconstructive.

If there’s a cosmetic procedure you’ve been longing to try, but insurance won’t cover it, this might still be a good time to get it. You won’t be spending as much on other medical costs, and some of the associated costs, such as post-surgical pain prescriptions, may be covered.

At Stormont Vail:

6. Upper Endoscopy

This might be the time to finally figure out why your stomach is always giving you problems.

An upper endoscopy examines your upper gastrointestinal tract. It can diagnose problems that often cause upset stomachs, such as celiac disease, gastroesophageal reflux disease (GERD), or ulcers.

If you get it taken care of quickly enough, you may be able to enjoy holiday dinners without running to the bathroom.  

At Stormont Vail:

  • Where to get an upper endoscopy: Cotton O’Neil Digestive Health Center
  • How to make an appointment: Call (785) 270-4800
  • Referral: Unless required by your insurance, you do not need a referral for an upper endoscopy

7. Jumpstart Your “Lose Weight” New Year’s Resolution

Losing weight and getting in shape are some of the most common New Year’s resolutions. However, you don’t need to wait until January 1 to get started. Losing just 5 to 10% of your current weight lowers your risk of obesity-related conditions, such as heart disease and type 2 diabetes — and the earlier you begin, the quicker you can get on the road to good health.

Many insurance companies provide coverage for services related to weight loss. If you meet with a provider about diet and exercise plans, medication therapy, or bariatric surgery, your insurance company might have your back.

Just be sure to triple check before assuming that you’re covered. Some insurance plans only cover weight loss services if you are obese or have other related, chronic conditions, such as high blood pressure or diabetes.

At Stormont Vail:

  • Where to get help with weight loss: The Weight Management Center
  • How to make an appointment: Call (785) 354-9591 Ext. 21611
  • Referral: Unless required by your insurance, you do not need a referral. However, you must meet certain criteria:
    • Have a Body Mass Index (BMI) over 30, OR
    • Have a BMI over 27 and also have weight-related conditions, such as high blood pressure or high cholesterol
  • Not sure that you qualify? Call (785) 270-4440 to schedule an appointment with a primary care provider

8. Get a Sleep Study

Tiredness is easy to brush off as “just a part of life.” But if you’re always feeling fatigued, you could have a sleep disorder, such as sleep apnea or narcolepsy. Some disorders are more of a nuisance, but others can increase your risk of serious conditions, such as heart attack or stroke.

An overnight sleep study monitors what’s happening in your brain and body as you sleep, in order to see if you have a sleep disorder. Most studied are attended sleep studies, where you will spend the night at a sleep center. If you’re only being tested for obstructive sleep apnea and not another type of sleep disorder, you may be able to complete the study at home.

At Stormont Vail:

  • Where to get a sleep study: The Sleep Center
  • How to make an appointment: Call (785) 354-9591
  • Referral: You will need a referral to see a sleep physician, who can then order a sleep study. Call (785) 354-4440 to schedule an appointment with a primary care provider so you can obtain a referral

9. Stock Up on Your Prescriptions

Time to refill a prescription? Ask your pharmacist about ordering a 90-day supply. This will hold you over into the new year, lowering your future expenses.

If your insurance covers certain medical supplies, such as blood sugar test strips or infusion pumps and supplies, you may want to look into purchasing a small stock of those, too.

At Stormont Vail:

Not quite sure if any of these services are right for you? Talk to your primary care provider for their recommendations. Call (785) 270-4440 to set up an appointment with a Stormont Vail primary care provider.

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