Under The Coverage
Nova Healthcare Administrators
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Every week 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
Available episodes
Newest first
Oldest first
4 days ago
Tiers for Fears (around pharmacy benefits)
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 to share insight around this facet of the insurance industry.
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4 days ago
Navigating Medical Benefits and Lightning Lanes
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.
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Sep 29, 2022
Understanding Your FSA: It Covers More than Co-Pays and Compression Stockings
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.
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Sep 8, 2022
A PCP With DPC
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).
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Jul 28, 2022
I Don't Want a New Drug
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.
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Jul 21, 2022
50 Shades of Insurance Grey - Deductible, Copay, Coinsurance and Out-of-Pocket Maximums
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 for (e.g.: 20% for a service) after the deductible has been met. A copay is a flat fee for service (e.g. $25 for specialist visits). Short story is that coinsurance is a percentage paid for services and a copy is a flat dollar amount paid for services. Your out-of-pocket maximum is always more than your deductible and is inclusive of all plan spend including copays, deductibles, and coinsurance.
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Jun 9, 2022
You See Your PCP? Yeah, You Know Me!
You See Your PCP? Yeah, You Know Me! by Nova Healthcare Administrators
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May 26, 2022
These Boots Are Made for Walking...and They May Have Required Precertification
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!
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May 12, 2022
Grace Periods, Rollover, Carryover and Runout
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.
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May 5, 2022
FSA, HRA, & HSA, Oh my!
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.
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May 4, 2022
Bonus Episode: Benefits for Small Business
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.
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Apr 28, 2022
Babies & Benefit Plans
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 to year. As a dad in the industry, he’s trodden this well-worn path.
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Apr 21, 2022
Navigating the Perfect Storm
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.
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Apr 14, 2022
What's Up Doc?
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.
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Apr 7, 2022
Feeling 23
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.
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Mar 31, 2022
The Dirt on Health Care Proxy and End of Life Conversations
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.
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Mar 24, 2022
Pregnancy & ER Bills
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
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Mar 17, 2022
There's more than one way to fill a tooth
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.
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Mar 10, 2022
Nurse Chat
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.
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Mar 3, 2022
Prior Authorization and COBeasts
Abigail shares what prior authorizations are and how to protect yourself. She also lets us know why you’re being asked if you have “other insurance” which is referred to COB or Coordination of Benefits in the industry.
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Feb 24, 2022
No News is Not Always Good News
Hello, Nurse! In this episode Jolene and Sara talk to a nurse who also has health benefits. Anita shares how she advises patients she talks to during her workday and the importance of advocating for the patient.
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Feb 17, 2022
Bonfires & Medical Bills
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.
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Feb 10, 2022
Choosing a Health Plan
Does your employer offer more than one health plan? Overwhelmed and need some direction? We get it. Listen in as Carey helps guide you through what you need to think about to make the right decision and pick the plan that’s best for you and your wallet.
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Feb 1, 2022
New Years Resolution 2022: Impress Sister-in-Law with EOB-Reading Skillz
Marisa has worked in the healthcare industry for more than 22 years and she feels really strongly about her Explanation Of Benefits (EOBs) and getting in good with her sister-in-law. Marisa shares why an EOB should be read, even if it’s electronic. #gogreen
You can follow our podcast on Twitter @UndrTheCoverage
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Jan 19, 2022
Jerame Spoke on HSAs (and high deductible plans)
Tune in for some high-level guidance to determine if a high deductible health plan (HDHP) with a Health Savings Account (HSA) is a smart choice. And, if you are a Pearl Jam fan you can sing the episode title to the tune of Jeremy if you’d like!
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Jan 18, 2022
It's a Start...
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.
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