Under The Coverage

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

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 confident decision this enrollment season.

If you or your spouse are the subscriber for your health insurance, you’ll be hearing from your HR team to remind you about open enrollment. There are certain life changes that allow you to modify enrollment if you are outside of the golden window of open enrollment. If you want a deeper dive, Carey joined us a while back to talk about aging off of your parent's benefit plan https://www.youtube.com/watch?v=T3xP8x5zjBw&list=PL78gefbzNivQBmnlgBkdyo_mL9KP3nz6G&index=38.

🚑 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!

🩺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. 🎧

🩺 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

💸 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! 🎧💡

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. Tune in and empower yourself with the knowledge to navigate medical necessity determinations with confidence. 🎧💡

🏥 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 the secrets with two industry experts! In this engaging and informative episode, we dive into the world of inpatient hospitalization and the critical role nurses play in keeping patients from bouncing back into the hospital. Join us for a lively conversation where Jolene and Sara talk to the experts to discuss: • Common challenges faced during the transition from hospital to home. • Why that post-discharge call from a nurse is a game-changer. • How nurses can help prevent costly readmissions. Get ready for a fun, quick, and eye-opening discussion that highlights the power of post-hospital care and how a simple phone call can make all the difference. Hit play and discover how to make the most of your recovery journey! Subscribe now and never miss out on these essential healthcare insights! 🎧💡

🏥 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!

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!

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.

✨ 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!

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!

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 by understanding what’s not covered before the bill comes in!

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 seekers. She joined the podcast to talk about the unique challenges the US health care system poses for those new to the country.

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 barriers to care, and why she what she does.