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 network or direct primary care (DPC). It’s important to understand which providers are covered with your plan so you can get the most out of your health care benefits. Regardless of the type of health plan you have, perhaps even more important is the relationship and access you have to a quality primary care physician (PCP).

A PCP With DPC

🚑 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

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.

Understanding Medical Bills & EOBs (Explanation of Benefits)

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.

I Went in For a Free Screening, Why Did I Get a Bill?

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 call/text 988 to connect with the Suicide and Crisis Lifeline.
-Explore tools and links at samhsa.gov or call 1-800-622-HELP (4357).
-Learn more at mhanational.org from Mental Health America.
-Contact the National Alliance on Mental Illness (NAMI) at 1-800-950-NAMI (6264) or visit nami.org/help


Is Mental Health Therapy Covered by Insurance? Understanding Mental Health Benefits

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

A PCP With DPC

Under The Coverage

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