How Going To HR Made A Health Insurance Co-Pay Hike Less Huge

The beginning of a new year often brings an unhappy change: rate and co-pay hikes for your health insurance. E’s insurer made a change to ER visit copays that, given that his daughter is being treated for cancer and makes more frequent emergency visits than most children, would have cost the family a lot more money. So he turned to his company’s HR department for help…and actually received it.

My insurance, effective Jan 1, 2012, increased the ER Copay – what used to be $50 a visit is now $100 a visit for the first 3, then $200 per visit thereafter. I understand their need for this – they are wanting to discourage people from using ERs as a substitute for a doctors office or an after-hours clinic.

My daughter however is going through Chemotherapy and whenever she runs a fever she must to go the ER if it is outside of normal clinic hours at the hospital. Kids in general can get sick a lot, but with Chemo, you can’t just ‘wait it out’ – it is imperative they get to an ER because of the chemo side effects. I was deeply concerned about this increase – since it is not my ‘choice’ to take her to the ER but a mandate by her Oncologist. They are afraid of infections in her port and other issues that could cause serious problems.

I contacted my HR department which was already aware of my daughters condition (FML paperwork is on file for her condition) and they put me in touch with someone at the insurance company. I had said that since these ER visits would not be by choice, but as a result of the Chemo, that I was afraid we would quickly be paying $200 per ER visit. Their conclusion was that due to her ongoing serious condition, that I would still have to pay the co-pay of $100, but I would not be subjected to the increase after the 3rd visit.

The moral of the story is if your insurer has a similar plan in place for your ER copays this year, contact your HR department or your insurer. All it took for me was a few phone calls and a detailed email to my HR person to potentially save me quite a bit of money in
co-pays.

E. didn’t want us to neame the insurer, but it’s a national provider that you’ve most likely heard of.