Under The Coverage

Your mental health matters - and knowing your benefits is the first step toward getting the right care and support. In this episode of Under the Coverage, we break down common mental health benefits, including therapy coverage, Employee Assistance Programs (EAPs), and what to expect when accessing care through your workplace. We also share resources for immediate support: -Visit 988lifeline.org or...

Isn’t preventive care supposed to be free? Then why did you get a bill after your screening? In this episode, we explain the difference between preventive and diagnostic care, and why asking one extra question at your checkup might change what ends up on your bill. Learn what to ask your provider so you’re not caught off guard.

Ever get a bill in the mail and wonder if it’s actually a bill? Enter the Explanation of Benefits (EOB). In this episode, we'll review what an EOB is and what it tells you about your care and costs. You’ll also learn what steps to take if something doesn’t look right.

Still confused by the difference between a deductible, copay, and coinsurance? You’re not alone. In this episode, we break down the health insurance terms that show up on nearly every benefit plan. We’re here to help you figure out what you’re spending where so you can make the best decision for you and your wallet. If you’re looking for even more information, check out our previous episode: https...

You always hear that you need to look for an in-network provider but do you really know why? In this episode, we explain how provider networks work, why staying in-network can save you money and how to identify what your costs might be if you choose to see an out-of-network provider.

Wondering how to use an HSA or FSA—or decide which one is better? In this episode, we break down the rules, tax savings, and pros and cons of each so you can take advantage of these powerful benefits.

Trying to figure out which health plan is best for you? In this episode, we break down the key differences between copay-based plans and high-deductible health plans (HDHPs), and explain how provider networks can impact your choices. Whether you’re comparing premiums, thinking about out-of-pocket costs, or wondering which plan fits your lifestyle, we’ll give you the tools to make a smarter, more c...

It’s that time of year again, open enrollment season! If you (or your spouse) are the subscriber for your health insurance, chances are you’ll be hearing from your HR team soon with reminders to review your benefits. But did you know there are also certain life events, like getting married, having a baby, or changing jobs, that let you make changes to your coverage outside of the open enrollment w...

🚑 Ever wondered why a quick trip to the ER or a ride in an ambulance can lead to a shocking bill in your mailbox? In this episode, we break down everything you need to know about emergency services and the costs that come with them. From understanding when to dial 911, to the hidden fees that could catch you off guard, we’ve got you covered. We’ll also dive into the No Surprises Act—what it prote...

🩺Ever been faced with a scary, serious health situation and felt overwhelmed and unsure of where to turn for help? In this moving episode, we hear from Allison, a former patient whose life was profoundly impacted by the care and support provided by one of Nova's case management nurses. Allison recounts her journey, starting from the surprise of learning she was pregnant with twins to navigating a...

🩺 Ready to take control of your health? Join Jolene and Sara for a quick, fun, acronym-filled dive into the world of preventive services, zero dollar copays and the ACIF and USPSTF! In this short episode, you'll learn why preventive care is essential and how the Affordable Care Act (ACA) guides your zero copay benefits. We'll cover: - Who is the USPSTF and the ACIP? - What’s considered preventive...

💸 Ever wonder why your medical benefits cost an arm and a leg? Join Jolene and Sara in this short and lively episode as they dive into the reasons behind the high price tags on insurance premiums in the United States. This episode unpacks: • The average annual cost of coverage in the United States. • The pros and cons of cutting-edge treatments and pricey new drugs. • The role of chronic diseases...

Have you ever had a service reviewed or denied by your insurance with the explanation that it wasn’t “medically necessary”? Join us as our medical management team helps us understand what medical necessity really means. We’ll explore: • When something is reviewed for medical necessity • Real-life examples • Appeals process • Practical advice for navigating this complex part of health insurance. Tu...

🏥 Whether it’s you or a loved one in the hospital you know that going home is a great relief, but it can also be worrisome. It can be a challenge to absorb and remember all the notes you get before discharge. You can call the doctor’s office, but you might also get a phone call from a nurse at your insurance company. Have you ever wondered why they’re calling? Jolene and Sara are here to uncover...

🏥 Ever wonder what exactly counts as Durable Medical Equipment (DME), a prosthetic, or an appliance? Join Jolene and Sara in this quick and lively episode as they team up with registered nurses Lorene and Stefanie to demystify these categories of medical devices. Our expert panel will break down the key differences, helping you understand what your plan covers and how to navigate your healthcare...

Ever felt like navigating your health insurance is like solving a riddle wrapped in a mystery? Fear not, dear listener! In this action-packed 10-minute episode, we're here to demystify the world of out-of-network benefits. Join us as we unveil the secrets to discovering if you have out-of-network benefits and how to use them like a pro. Whether you’re planning a trip, switching doctors, or just wa...

Leaving a job often means losing your employer-sponsored health insurance. But, COBRA, the Consolidated Omnibus Budget Reconciliation Act, can be your lifeline during this transition. COBRA allows you to temporarily continue your health coverage. It's like a bridge that helps you cross the gap between jobs without losing the benefit plan you have. In this episode, we'll dive into the world of COBR...

✨ No one grows up dreaming of working in insurance, but let's face it—knowing the ins and outs can be a game-changer! Join industry veterans Jolene and Sara for a whirlwind tour through the surprisingly fascinating world of insurance lingo. With over a decade of experience each, Jolene and Sara have learned terms that might sound boring but are actually the keys to asking the right questions, sav...

Ever received an EOB (Explanation of Benefits) from your insurance company and thought, "What even is this?" Spoiler alert: it's not a bill! But it is your crystal ball, giving you a heads-up about any upcoming bills. Join us in this quick, fun, and enlightening episode as we break down the mystery of the EOB. We’ll walk you through the key info it contains, how to read it, and what it means for y...

Understanding health insurance benefits Ugh. Obviously, it’s stressful and we often find out we’re learning at the most vulnerable time – when we or one of our dependents are sick or are not feeling well. There’s nothing worse than trying to make sense of something when you are feeling your worst. Tracey joins the podcast to help us walk through how she has learned to get in front of the problem b...

Lower levels of literacy, English as a second language, transitioning to the United States from a foreign country – all of these factors make it increasingly more difficult to understand and use medical benefits. Abby Grainge works as a family nurse practitioner at Jericho Road Community Health Center in Buffalo, NY and is also the medical director of Vive, Jericho Road’s shelter for asylum seeker...

When you picture a nurse, you might envision a hospital or physician’s office. But nurses also work in a clinical capacity for health plan administrators. Lorene wants the world to know she and her team and other nurses in the industry work hard to walk with members on their journey to better health. In this episode she discusses how nurses work to help members, how they help patients who may face...

Congratulations, you’re hired! When you get a job offering health benefits it’s important to understand the basics. Where do you go if you’re sick? How much will it cost? Which physicians and facilities are in-network and what does that even mean? Jerame volunteers for a workplace readiness program where he often addresses health insurance questions. And he has some advice for you...

If there was a course in high school or college to help us understand how medical benefits work and what the terms mean, maybe we’d be better equipped to navigate health care systems. In this episode, Kyla talks to us about the questions she asks providers to avoid unnecessary cost, seeking the most cost-effective treatments for herself, and how she manages conversations around the cost of prescri...

When you think of behavioral health and substance use services, you most likely don’t think to call your health insurance company. Here’s a secret: You can. And you should! Did you know there is a team of people working at your health insurance company who can help link you to in-network resources if you’re in need of mental health guidance and support? Registered Nurses, Corrine and Molly share i...