Under The Coverage

Helping people become healthy and well is one of Steph’s passions. We second that, which is why we invited him to join us to discuss his background story and shed light on how important it is to utilize your benefits properly. At the end of the day, you’re paying for these services. Leveraging experience and advocacy can positively impact your health outcomes. Listen up!

High deductible health plans with health savings accounts can feel overwhelming. On one hand, the plan cost is usually less than that of a traditional copay plan but then you remember you may have to lay out a lot of money up front before your plan’s copays kick in. Jenelle shares how she started building funds in her HSA a little at a time over time and how she thinks about health care expenses.

You head to the doctor for a routine appointment. A claim is born! In this episode Barb chats with us about a medical claim’s journey in the health care delivery system. It isn’t always a simple process but having a baseline understanding of how a claim gets processed might help you gain insight into industry timelines and requirements.

Do you want to learn more about the hottest couple in health insurance? Getting familiar with your benefit summary and ID card can help you out in the long run. During this episode we chat with Alicia about benefit summaries, ID cards, and walk through three network-related situations you may find yourself in.

Have you heard any chatter around price transparency tools? The average person spends more time reading Amazon reviews before buying a new blender than they do researching how much it costs to get a mammogram or MRI. Access to price transparency tools finally gives the patient access to the information allowing us to make more informed decisions about care that include the actual cost of it! Imagi...

Is your medical network the same as your plan administrator? Do you know what medical network you use and how to find an in-network provider? Do you have more than one network you can use? In this episode we talk to Todd about how you can answer some of these questions just by looking at your ID card. And once you know what these logos mean, you can have better conversations to guide staff at the...

We’ve got a fever...and the only prescription is more understanding around pharmacy benefits. Are pharmacy benefits different from medical benefits? What’s a formulary? How can someone save money by requesting a generic version of a brand name drug (if possible)? Carly loves these topics. She enjoys helping others understand the complex world of pharmacy benefits. And we’re so happy she joined us...

New season, new music, new guests and more to learn about medical insurance benefits, ID cards, price transparency tools, and networks. If this sounds like an awful semester of learning, think about it as an investment that will pay you back in spades. Most Americans spend more time researching their vacation than understanding medical plan benefits – and a vacation might happen once or twice a ye...

FSAs are a “sleeper benefit” - in a world where the price of everything seems to be increasing before our eyes – a medical FSA can save you money on items you’re buying anyway. The key is, understanding what’s eligible so you can take advantage of the savings with as little frustration as possible.

Most members are accustomed to understanding which providers are in-network and out-of-network based on a logo on their insurance ID card. But the marketplace is changing and it’s not the same for every plan member anymore. Some benefit plans offer a national network but others may feature a regional network and a wrap network for out-of-area coverage, reference-based pricing (RBP) without any net...

Have you ever had a medication, benefit or medical visit denied by your plan? Can you appeal a decision? How do you know ? Join us and learn more about what you can do.

This week Jolene and Sara (who is somehow broadcasting from a submarine) are joined by Todd who helps them understand the difference between deductible, copay, coinsurance and out-of-pocket maximum. A deductible is the amount a member must spend out of pocket prior to the insurance plan covering a portion of the expenses. Coinsurance is the portion of the benefit expense the member is responsible...

You See Your PCP? Yeah, You Know Me! by Nova Healthcare Administrators

Precertification and prior authorization. What is it? When is it needed? Who is responsible for obtaining it? In this episode, Charlene helps Sara and Jolene answers some of these confusing questions and Sara is still talking about the problem with her foot!

Welcome to the Land of Confusion. Pro: Your employer provides a benefit plan that offers a reimbursement account and you want to participate. Con: Sometimes the frustration you experience with the plan makes the benefit feel less beneficial and more problematic. Who needs that? We asked Jerame to come back and talk to us about what happens at the end of a plan year. It’s helpful to understand if y...

Little help, please! There is so much to unpack when it comes to deciding if reimbursement benefits are right for you – and which option to choose. Reimbursement benefits offset expenses by setting aside pre-tax funds to pay for account-eligible expenses. FSAs, HSAs, and HRAs have a lot of rules around them that can make a reimbursement account tricky to use. Jolene and Sara are joined by resident...

Looking for guidance on how to build a benefit plan that works for you and your employees? Listen up! In this bonus episode, Jolene and Sara speak to Niko Caparisos of Prosperity Benefits about building a benefit plan for small businesses. You don’t need 1,000 employees to get a plan that works for you.

Life gets real when you welcome a bundle of joy to your world. Part of this new reality also includes assessing health plan coverage and benefits. Pete joined Jolene and Sara to discuss what happens to your benefits when you’re planning for a new addition to the family. It’s smart to evaluate how you think you’ll use your benefits before you pick your plan. And, it’s ok to change plans from year t...

Managing a new diagnosis involves a steep learning curve. Being diagnosed with a chronic condition while pregnant adds a new layer of complexity. And when it all happens at the start of a new plan year...well...we’ll let Jamie guide you through that.

Your body, YOUR information! Requesting your medical records, copies of scans, and test results should be a common occurrence. Armed with this information you can save yourself from unnecessary duplication of services. Your records are also a great way to help a provider fill in the gaps between your last visit or when you transition from a different provider. Join Jolene (who reads her blood test...

If you’re between the ages of 18 and 25 or if you’re the parent of an 18-25 year old, listen up! Carey helps our listeners figure out if and when younger adults should change benefit plans.

Sara and Jolene promised short episodes and this one runs a little longer but it’s worth it. Having conversations around end-of-life planning are not easy and the paperwork that accompanies them doesn’t make it any easier. Teresa talks about the documents you’ll want to have on hand and she shares why end of life conversations are vital to living. In this episode Teresa references two books: Being...

When we're at the doctor's office, a lot of information is sometimes thrown at us in a short time. We may have questions but hesitate to ask for various reasons. But asking questions can save you some money. Al Lewis shared so many great tips we just kept recording and the listeners win. Al talks about a product through preTRM.com and about managing ER bills. You can learn more about Quizzify at w...

Have you ever considered Silver Diamine Fluoride (SDF) as an alternative to crowns or fillings? There may be a silver lining to Silver Diamine. Listen in to learn about a treatment option to ask your dentist about. Al Lewis of Quizzify joins Sara and Jolene to talk teeth. Visit www.quizzify.com to learn more about Quizzify.

Nurses are a force. They bring skill, compassion, and commitment to their role – whether they’re in a medical office, a hospital, or an insurance company. Meet Nick to learn why you might benefit from talking to one.