As I continue to rest up from COVID — getting well has taken a little longerthan I’d planned — this is a moment when we’d really like to hear from you.
What do you want us to share in the future?
What tips do you have about navigating the health care system that you want other folks to know?
If you just want to introduce yourself, say why you subscribed, and let us know a little about you, we’d love that too. We want to get to know everyone as we build this community.
How to choose the right Medicare plan, are Medicare advantage plans worth it? How do you select the rights parts for Medicare there seem to be so many parts to pick from
The most frustrating thing to me is the challenge of actually speaking with an actual human regarding coverages/exemptions/inclusions/copays, etc. Any advice on how to get through to actual representatives who can actually answer actual questions would be greatly appreciated and worth the price of admission...
Hi, I just wanted to say that I really appreciate the work that’s being done here! I’m a recent college grad and I always figured that having health insurance through your employer meant that you were set / in good hands. Then I got a bill for over $100 for a ‘phone visit’ with a doctor where all she did was say that I needed to come in for an in person visit (where I was charged another hundred dollars!). I know these fees are relatively small, but it was a big deal for me at the time. Thanks to this newsletter and podcast, I feel empowered to challenge the system and advocate for myself instead of blindly trusting healthcare providers. THANK YOU!
Here are a few tips regarding finding insurance. Look into using an independent insurance broker. They can enroll many different health plans. Like travel agents, they are paid by the health plans - not the client. Once you get a short-list of possible plans, go to the health plan website. Click on "for Providers". Often there is more detailed info (such as devices on formularies etc) than is shared with the general public.
I learned about the show when my son interned for you in year 2 and have learned sooooo much, so thank you. I'd love some more tips on helping young adults (1) find insurance when they are no longer eligible for their parent's plans or if their parents lose coverage before they turn 26 and they don't have coverage through their workplace and (2) for those with chronic conditions (and who need really expensive biologic infusions or other specialty medications) find or manage coverage so they are not bankrupted. For example, most workplace coverages (and university coverages for PhD students) don't cover biologics and there are all sorts of hoops that need to be jumped through (all of which seem to require reaching your out of pocket max) and there is no standardization so every time you switch insurance (due to job change or university change) or location of where you live, you need to go through an agonizing reauthorization process (even though it is the same treatment and often the same provider organizations) which takes soooo much time. And no one tells you about the whole pharma sponsored co-pay programs that many of the companies have available to make their products more affordable when insurance does not cover them. I'd also love a primer for these young adults. While mine have been managing most of their stuff, the whole pre-authorization/paperwork/must be on phone for hours thing has been beyond their grasp as they are (gasp) in classes or working in an environment that does not allow them to be on the phone waiting for hours at a time.
Thanks again for the work you do. I am spreading the word about the first aid kit because if it helps just one person be more sane....
Insight into nonprofit hospitals. If they don't have equity holders, what is the incentive structure to not tell patients about charity policies? Where does all this money flow to, administrators, buildings, endowments? Interview a former hospital CFO or administrator.
LOVE your work Dan. I'd love some 'call to action' opportunities. And given everyone is short on time, provide template emails or letters etc. so that we can let our legislators, insurance companies, local hospitals etc, know that we are SICK of the run-around, ridiculous (and intentionally complicated) paperwork, sky-high costs associated with ANYTHING healthcare. Perhaps a 'call to action' to end each publication? and THANK YOU!
Here are my tips: 1. Having read Laurie Todd, the Insurance Warrior's book, I'm armed and encouraged! 2. In the face of denial of coverage, appeal. If you lose the appeal, take heart. Consider the war, not the battle. In my case, I am considering letting go of one unpaid office visit to gear up for the bigger battle. 3. Don't wait to appeal a denial. In my case, the front-line "patient services" person *incorrectly* told me my visit would be covered. Turns out she was wrong. Always call at least twice! Speak to more than one person, and by all means, ask for a supervisor! By the time I learned that the uninformed "patient services" rep was wrong (I received the contradicting letter later, in the mail), I had 3 days to appeal the decision. The insurer said that appeals take two weeks. So I asked for an "urgent" appeal. They denied me again, saying my request did not warrant urgency. So they were wrong, and I suffered for it. When I persisted, saying I received wrong information from them at first, they simply stalled, knowing they had the upper hand. It's harder to get something covered after the visit. So always give as much lead time as you can when making an appeal. 4. Let your PCP help you fight for coverage if you have to see an out-of-network specialist, as in my case. Your PCP and staff know a lot more about fighting with insurance companies than the average patient. With disputes like mine, the PCP is often called to do a "peer to peer" consultation with the insurer. Be sure to let your doc know, early, that you're being denied an out-of-network coverage, and they should help fight for you. To that end, always be nice to your doc and to their staff. Their jobs are not easy.
How to access mental health services is a sorely needed topic. How to access services if you have coverage through work? Do you have to start with an EAP? With higher deductible plans, how much can people be expected to pay for each session of talk therapy? How well do online services work? How do people on Medicare or Medicaid access services? How does talk therapy work with a general practioner who may prescribe meds? What community resources are available?
We hear so much about the mental health crisis, but precious little on current resources and needs at a more localized level. My own experience navigating an employer EAP and ongoing treatment was very eye opening. As a recent retiree, I am not seeing a clear path.
I’m joining the Medicare wagon! I’ve learned so much from your podcast and newsletters. Now that it’s Medicare time, much of what I’ve learned about private insurance doesn’t apply and I’m so confused. I’d love to have guidance from you and your guests. On another note, I hope you feel better soon!!
I'm being yanked around by my insurance over the course of >50 calls over 8 months due to them giving a Letter of Agreement, and then just deciding to not pay it. Thanks to the podcast, I gained the stubbornness that I need to get as far as I have. I have two tips for people:
1. Obviously keep a log. I use Excel. But more so, record the specific time of day down to the minute. (E.G. 4:21PM PST) Then whenever you reference a previous contact, include the time of day with it. It can sometimes spook that especially obstinate kind of associate that thinks you are just another dumb member of the populace that isn't taking notes and will just "quietly go away."
2. Hanging up and calling again is absolutely a viable strategy with the big providers. I have had helpful people, kind people, clueless people, antagonistic people that seem to hate my guts, and everything in-between. Every time, EVERY TIME you call your insurance, you get a roulette wheel. If you get a crap spin, (Somebody trying to get you to start at 0 again) try spinning again. Hang up immediately (if they're rude) and call again. Reset your anger and don't bring up or acknowledge the previous call. You can got so much further with a kind associate. So don't waste your time with the bad ones.
1. My wife and I had to change our Primary care doctor because they decided to convert into a "Concierge Medicine Model." This means they still take our insurance but we would have to pay a membership fee of $2,300 per year. We are mid-30's and fairly health so we really only go in for annual check-ups and paying this membership fee just didn't make financial sense. It sucks because we loved our Doctor but we're basically being forced out. I've heard about this happening to others, but only anecdotally. Is this a new nationwide trend?
We found a doctor in our neighborhood and everything looked great on their website, but then we go to the "Membership Model" part with an $83 per month charge. The practice said they could provide receipts for out-of-network insurance submissions, but that doesn't work for us. Again, it sucks because the level of care this practice was offering looked great.
Is this the future of medicine because insurance companies have made it so impossible?
2. We got a new primary care doctor and according to CareFirst, our insurance, they were in-network. My wife goes in and two weeks later gets a $600+ bill for blood work because the place they send their blood work to was out of network. My wife calls and they casually mention if we let them know, they can send our blood work to Lab Corp(our in-network lab). It's kind of infuriating they didn't mention this at the beginning of the appointment and now it seems like we are on the hook for this bill that isn't really in our budget. Is it possible to get out of this?
I have an appointment there in two weeks, and I will be sure to mention they need to send my blood work to our in-network lab, but my fear is that maybe they wont. It would be pretty easy for anyone I tell to forget to make that note on my file. How can I insulate myself against having to try to dodge a $600 blood work bill? Do i have to go so far as to record the conversation our type something up and have them sign it?
Again, how common is this? Are there protections against it?
Thanks for doing your amazing show and building this community.
How to choose the right Medicare plan, are Medicare advantage plans worth it? How do you select the rights parts for Medicare there seem to be so many parts to pick from
I am 61 and waiting on to decide when to enroll in Medicare; I plan on working to age 67 and have employer sponsored BlueCross/Blue Shield of IL HMO
The most frustrating thing to me is the challenge of actually speaking with an actual human regarding coverages/exemptions/inclusions/copays, etc. Any advice on how to get through to actual representatives who can actually answer actual questions would be greatly appreciated and worth the price of admission...
Hi, I just wanted to say that I really appreciate the work that’s being done here! I’m a recent college grad and I always figured that having health insurance through your employer meant that you were set / in good hands. Then I got a bill for over $100 for a ‘phone visit’ with a doctor where all she did was say that I needed to come in for an in person visit (where I was charged another hundred dollars!). I know these fees are relatively small, but it was a big deal for me at the time. Thanks to this newsletter and podcast, I feel empowered to challenge the system and advocate for myself instead of blindly trusting healthcare providers. THANK YOU!
Here are a few tips regarding finding insurance. Look into using an independent insurance broker. They can enroll many different health plans. Like travel agents, they are paid by the health plans - not the client. Once you get a short-list of possible plans, go to the health plan website. Click on "for Providers". Often there is more detailed info (such as devices on formularies etc) than is shared with the general public.
I learned about the show when my son interned for you in year 2 and have learned sooooo much, so thank you. I'd love some more tips on helping young adults (1) find insurance when they are no longer eligible for their parent's plans or if their parents lose coverage before they turn 26 and they don't have coverage through their workplace and (2) for those with chronic conditions (and who need really expensive biologic infusions or other specialty medications) find or manage coverage so they are not bankrupted. For example, most workplace coverages (and university coverages for PhD students) don't cover biologics and there are all sorts of hoops that need to be jumped through (all of which seem to require reaching your out of pocket max) and there is no standardization so every time you switch insurance (due to job change or university change) or location of where you live, you need to go through an agonizing reauthorization process (even though it is the same treatment and often the same provider organizations) which takes soooo much time. And no one tells you about the whole pharma sponsored co-pay programs that many of the companies have available to make their products more affordable when insurance does not cover them. I'd also love a primer for these young adults. While mine have been managing most of their stuff, the whole pre-authorization/paperwork/must be on phone for hours thing has been beyond their grasp as they are (gasp) in classes or working in an environment that does not allow them to be on the phone waiting for hours at a time.
Thanks again for the work you do. I am spreading the word about the first aid kit because if it helps just one person be more sane....
Options beyond aca- private ppo, hmo.
Insight into nonprofit hospitals. If they don't have equity holders, what is the incentive structure to not tell patients about charity policies? Where does all this money flow to, administrators, buildings, endowments? Interview a former hospital CFO or administrator.
How to navigate qualifications for insurance-covered hospice care for loved ones with later-stage neurodegenerative disease?
How to navigate qualifications for insurance-covered hospice care for loved ones with later-stage neurodegenerative disease?
LOVE your work Dan. I'd love some 'call to action' opportunities. And given everyone is short on time, provide template emails or letters etc. so that we can let our legislators, insurance companies, local hospitals etc, know that we are SICK of the run-around, ridiculous (and intentionally complicated) paperwork, sky-high costs associated with ANYTHING healthcare. Perhaps a 'call to action' to end each publication? and THANK YOU!
Here are my tips: 1. Having read Laurie Todd, the Insurance Warrior's book, I'm armed and encouraged! 2. In the face of denial of coverage, appeal. If you lose the appeal, take heart. Consider the war, not the battle. In my case, I am considering letting go of one unpaid office visit to gear up for the bigger battle. 3. Don't wait to appeal a denial. In my case, the front-line "patient services" person *incorrectly* told me my visit would be covered. Turns out she was wrong. Always call at least twice! Speak to more than one person, and by all means, ask for a supervisor! By the time I learned that the uninformed "patient services" rep was wrong (I received the contradicting letter later, in the mail), I had 3 days to appeal the decision. The insurer said that appeals take two weeks. So I asked for an "urgent" appeal. They denied me again, saying my request did not warrant urgency. So they were wrong, and I suffered for it. When I persisted, saying I received wrong information from them at first, they simply stalled, knowing they had the upper hand. It's harder to get something covered after the visit. So always give as much lead time as you can when making an appeal. 4. Let your PCP help you fight for coverage if you have to see an out-of-network specialist, as in my case. Your PCP and staff know a lot more about fighting with insurance companies than the average patient. With disputes like mine, the PCP is often called to do a "peer to peer" consultation with the insurer. Be sure to let your doc know, early, that you're being denied an out-of-network coverage, and they should help fight for you. To that end, always be nice to your doc and to their staff. Their jobs are not easy.
How to access mental health services is a sorely needed topic. How to access services if you have coverage through work? Do you have to start with an EAP? With higher deductible plans, how much can people be expected to pay for each session of talk therapy? How well do online services work? How do people on Medicare or Medicaid access services? How does talk therapy work with a general practioner who may prescribe meds? What community resources are available?
We hear so much about the mental health crisis, but precious little on current resources and needs at a more localized level. My own experience navigating an employer EAP and ongoing treatment was very eye opening. As a recent retiree, I am not seeing a clear path.
I’m joining the Medicare wagon! I’ve learned so much from your podcast and newsletters. Now that it’s Medicare time, much of what I’ve learned about private insurance doesn’t apply and I’m so confused. I’d love to have guidance from you and your guests. On another note, I hope you feel better soon!!
I'm being yanked around by my insurance over the course of >50 calls over 8 months due to them giving a Letter of Agreement, and then just deciding to not pay it. Thanks to the podcast, I gained the stubbornness that I need to get as far as I have. I have two tips for people:
1. Obviously keep a log. I use Excel. But more so, record the specific time of day down to the minute. (E.G. 4:21PM PST) Then whenever you reference a previous contact, include the time of day with it. It can sometimes spook that especially obstinate kind of associate that thinks you are just another dumb member of the populace that isn't taking notes and will just "quietly go away."
2. Hanging up and calling again is absolutely a viable strategy with the big providers. I have had helpful people, kind people, clueless people, antagonistic people that seem to hate my guts, and everything in-between. Every time, EVERY TIME you call your insurance, you get a roulette wheel. If you get a crap spin, (Somebody trying to get you to start at 0 again) try spinning again. Hang up immediately (if they're rude) and call again. Reset your anger and don't bring up or acknowledge the previous call. You can got so much further with a kind associate. So don't waste your time with the bad ones.
2 suggestions for shows.
1. My wife and I had to change our Primary care doctor because they decided to convert into a "Concierge Medicine Model." This means they still take our insurance but we would have to pay a membership fee of $2,300 per year. We are mid-30's and fairly health so we really only go in for annual check-ups and paying this membership fee just didn't make financial sense. It sucks because we loved our Doctor but we're basically being forced out. I've heard about this happening to others, but only anecdotally. Is this a new nationwide trend?
We found a doctor in our neighborhood and everything looked great on their website, but then we go to the "Membership Model" part with an $83 per month charge. The practice said they could provide receipts for out-of-network insurance submissions, but that doesn't work for us. Again, it sucks because the level of care this practice was offering looked great.
Is this the future of medicine because insurance companies have made it so impossible?
2. We got a new primary care doctor and according to CareFirst, our insurance, they were in-network. My wife goes in and two weeks later gets a $600+ bill for blood work because the place they send their blood work to was out of network. My wife calls and they casually mention if we let them know, they can send our blood work to Lab Corp(our in-network lab). It's kind of infuriating they didn't mention this at the beginning of the appointment and now it seems like we are on the hook for this bill that isn't really in our budget. Is it possible to get out of this?
I have an appointment there in two weeks, and I will be sure to mention they need to send my blood work to our in-network lab, but my fear is that maybe they wont. It would be pretty easy for anyone I tell to forget to make that note on my file. How can I insulate myself against having to try to dodge a $600 blood work bill? Do i have to go so far as to record the conversation our type something up and have them sign it?
Again, how common is this? Are there protections against it?
Thanks for doing your amazing show and building this community.