Every week we interview people who spend their working days focused on health benefits and healthcare we ask them what they know now that they wish every healthcare consumer knew. Buckle your seatbelt. This should be over by the time you get to the grocery store.

It's a Start...

Read your medical bills like you would any other bill. Billers and coders are human too. And if you’re in a high deductible plan, you become keenly aware of the cost of billed services. And, if you’re at a bonfire, don’t discuss your medical benefits but do talk about this podcast.

Bonfires & Medical Bills

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.

Nurse Chat

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 www.quizzify.com/about

Pregnancy & ER Bills

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 Mortal: Medicine and What Matters in the End by Atul Gawande and Elisabeth Kubler-Ross' book On Death & Dying.

The Dirt on Health Care Proxy and End of Life Conversations

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 results online at 1 a.m.) and Sara, WebMD (who has a scan of her foot in her office drawer) as they chat with Dr. Adnaan Sheriff who shares what he wishes all his patients knew.

What's Up Doc?

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-expert Prisilla who helps us figure out what to ask HR or your plan administrator so we can all use our plans better.

FSA, HRA, & HSA, Oh my!

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 your plan has rollover or runout and if it includes a grace period.

Grace Periods, Rollover, Carryover and Runout

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!

These Boots Are Made for Walking...and They May Have Required Precertification

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.

Bonus Episode: Benefits for Small Business

You See Your PCP? Yeah, You Know Me!

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.

I Don't Want a New Drug

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.

To Have and to Hold: Benefit Summaries and ID Cards

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.

The Life of a Medical Claim

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 year. Most families use their insurance plan more often than that. Join us to learn what people in the industry know so they get the most out of their benefits.

Navigating Medical Benefits and Lightning Lanes

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 prescription drugs.

Medical Benefits 101

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...

Understanding the Basics of Your Health Plan

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 your wallet. 

Episode Highlights: 
- What exactly is an EOB and why should you care? 
- The must-know parts of an EOB to look out for. 
- How to use your EOB to anticipate bills and avoid surprises. 

For more hands-on learning, check out these sample EOBs: 
-- Sample EOB 1 - https://www.cms.gov/files/document/11819-sample-explanation-benefits-508.pdf   
-- Sample EOB 2 - https://www.patientadvocate.org/explore-our-resources/interacting-with-your-insurer/what-does-an-eob-look-like/  

Join us for a bite-sized dive into the world of insurance paperwork that’s both informative and surprisingly fun. By the end, you'll be an EOB-reading pro, ready to tackle your insurance mail with confidence. 

Hit play and demystify your EOB today! 💌🔍 

Subscribe now and empower yourself with knowledge in every episode!

An EOB is Not a Bill

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 COBRA, covering eligibility, enrollment, keeping your coverage, and canceling it when you've found your next opportunity. We'll share insider tips to help you navigate this process like a pro. 

Whether you're new to COBRA or you’ve been down this road before, join us for this informative discussion with our seasoned guide. Don't miss out on this essential resource for bridging the health insurance gap during job transitions.

COBRA: The Health Insurance Bridge You May Need to Cross

✨ 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, saving money, and advocating for themselves and their loved ones.

In this episode, they’ll share their top tips and insider knowledge, breaking down those daunting terms into bite-sized, easy-to-understand pieces.

🔑 Episode Highlights:
•	Discover why understanding insurance terms can be your secret weapon.
•	Learn how to ask the right questions to get the most out of your plan.
•	Real-life examples of how Jolene and Sara have used their knowledge to save money
•	Access our handy Glossary of Terms for quick reference anytime: Glossary of Benefit Plan Terms.

Join us for a fun, fast, and informative episode that proves insurance doesn’t have to be dull. In one brief episode, you’ll be empowered with knowledge that can make a real difference in your everyday life. Who knew insurance could be so empowering?
Hit play, and let Jolene and Sara guide you through the jargon jungle to become your own best advocate. Subscribe now and never miss a moment of money-saving wisdom! 💡💰

Tune in and transform the way you think about insurance—because a little knowledge goes a long way!

Jargon Jungle: Medical Insurance Benefit Terms to Know

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 want to be prepared for the unexpected, we’ve got you covered.

Get ready to become the superhero of your own healthcare journey. Tune in for a quick, informative, and downright fun dive into the ins and outs of your insurance network. By the end of this episode, you'll have the tools to confidently navigate your benefits and make the most of your healthcare plan.

🌟 **Highlights:**
- What are out-of-network benefits and why should you care?
- Step-by-step guide to finding out if you have these benefits.
- Tips and tricks for using your network when you go out-of-network.
- Real-life scenarios and expert advice to make you an insurance savvy superstar.

Don't miss out—hit play and empower yourself with knowledge that could save you time, money, and stress. Because understanding your health insurance shouldn’t be a headache, it should be your superpower! 💪✨

Subscribe now and stay tuned for more quick and easy tips to master your health and wellness!

Unlock Your Insurance Superpowers: Navigating Out-of-Network Benefits!

🏥 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 options like a pro.

🔑 Episode Highlights:
•	DME: Durable, reusable medical equipment for home use.
•	Prosthetics: Custom-made devices to replace missing body parts.
•	Appliances: Supportive devices that improve body function or stability.

Get the lowdown on what makes each category unique and how to ensure you're covered. From wheelchairs to hearing aids, we’ve got the info you need to make informed decisions about your health care.

Tune in for a quick, fun, and informative session that turns complex medical jargon into clear, actionable insights.
Hit play and become the master of your medical benefits today! 🎧💡

Subscribe now and never miss an episode of healthcare know-how!

Medical Gear Decoded: DME, Prosthetics, and Appliances Explained!

💸 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 and an aging population in driving up costs.

Get ready for a quick, engaging, and informative discussion that makes sense of the dollars and cents behind your medical benefits. Hit play to become a smarter healthcare consumer!

Subscribe now and never miss an episode of healthcare know-how! 🎧💡

Breaking Down Insurance Premiums for Medical Benefits

🩺 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 
- Key screenings, counseling, vaccines and medications you should know about. 
- How the Affordable Care Act (ACA) helps cover these preventive services. 

Tune in to get the scoop on keeping healthy, making informed choices, and ensuring you’re getting the preventive services you need—all with a smile and a bit of fun! Don’t miss out—hit play now and start your journey to better health! 🎧✨ 

Links to learn more:  
Looking for quick access to the USPSTF A&B Recommendations? https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations 

Find ACIP recommendations and guidelines for vaccines https://www.cdc.gov/vaccines/?CDC_AAref_Val=https://www.cdc.gov/vaccines/hcp/acip-recs/index.html#print 

Understanding the ACIP & How Vaccine Recommendations are Made in the US https://www.youtube.com/watch?v=WWf4xVw1-PE

Preventive Services 101

🩺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 complicated pregnancy, serious health condition of one of her babies, and insurance challenges while out of state for specialized care. 🚼
🔑Episode highlights include:  
- The role of nurses in health insurance
- How to stay organized and proactive to help better manage care
- The importance of mental health and well-being when dealing with serious health diagnoses
Allison shares her deep gratitude for the support she received, including nominating her case manager for a regional excellence award, which she won. The episode beautifully highlights how a compassionate case manager can make all the difference during medical crises.  Tune in to hear about how the unique benefits of having knowledgeable nurses from the insurance side involved in the process, and how their understanding of both medical and insurance landscapes can play an instrumental role in guiding you through your most stressful health situations. 🎧

The Power of a Caring Nurse in Your Corner

🚑 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 protects you from, and where it falls short—especially when it comes to those pricey ambulance rides. Whether you're trying to avoid financial surprises in an emergency or just want to be better prepared, this episode is a must-listen. Tune in and take control of your health care costs before the unexpected happens! 

🔑 Episode Highlights: 
- When to Use Emergency Services: Clear guidance on when to head to the ER vs. seeking care elsewhere. 
- Breaking Down Costs: A look at the fees you can incur
- The No Surprises Act: What it covers, what it doesn’t, and how it impacts your emergency bills. 
- Avoiding Financial Shocks: Tips on how to protect yourself from unexpected charges in an emergency. 
- Advocating for Yourself: Practical advice on negotiating bills and ensuring you’re only paying for what you need. 
- Join us for a crash course in understanding emergency care costs—before you're faced with the bill! 🚑💡 

Subscribe now and never miss an episode of health benefits know-how!

The Price of Panic: What you need to know about ER Expenses

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 window?

In this episode, we break down the basics of choosing and updating your benefits, so you feel confident about your options when it matters most.

Want more? Check out our earlier conversation with Carey about what happens when you age off your parent’s health plan: https://www.youtube.com/watch?v=T3xP8x5zjBw&list=PL78gefbzNivQBmnlgBkdyo_mL9KP3nz6G&index=38.

How and When to Make Changes to Your 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 confident decision this enrollment season.

It’s Open Enrollment: Which Health Plan Should I Pick?

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.

What’s the Difference Between an HSA and an FSA?

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. 

In-Network vs Out-of-Network Explained

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://youtu.be/47bJ6iU97jI?feature=shared 

Deductibles, Copays & Coinsurance - Health Insurance Terms You Should Know

We talk to people who work behind the scenes but are also consumers of healthcare. We ask them what they know now that they wish every healthcare consumer knew. Find us on Twitter @UndrTheCoverage or send us a question to podcast@novahealthcare.com

Under The Coverage

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