May 27, 2025 • 40 mins
Think you’ve got your health insurance figured out? Think again. Join Divya Parekh and legal experts Joanna Fawzy Doran and Monica Fawzy Bryant as they reveal hidden gaps, bust myths, and share must-know tips to help you take control of your coverage—before it’s too late.
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Speaker 1 (00:00):
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(00:20):
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Speaker 2 (00:25):
This is Beyond Confidence with your host DV park. Do
you want to live a more fulfilling life? Do you
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and financial goals? Well? Coming up on ZVA Parks Beyond Confidence,
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(00:48):
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Moving your career business forward does not have to happen
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This is beyond confidence and now here's your host.
Speaker 3 (01:09):
W Park A good morning listeners. That's Tuesday and I
get to be with you, so thank you for being
part of us. And it was Memori Levey Can. I
wanna be a tribute to all our fallen heroes and
heroes because of whom we have our freedom. So very
(01:35):
thankful for their services and for their families as well.
So we always talk about kindness Circle and the story
that I want to share is the story of Johanna,
one of our audiences. So what Johanna shared was that
(01:55):
she lives in an apartment building and what she found
was that a mom had, you know, she had her
two year old like down there, and it's like, you know,
the mom was apparently on the first floor. So what
Johanna said was like, you know what, why don't you
(02:17):
bring your baby down first, and I'll watch the baby
while your son is playing inside the house, and then
bring your son down. So just that little kindness went
such a long way and mom was so profusely grateful.
So just kind of think about it, and of course,
(02:38):
you know, you just don't want to jump into help
because people can take it another way. So just kind
of ask them and said, okay, and I'm your neighbor,
you know, identify yourself. And that's what Johanna did. So
thank you Johanna for keeping it going. For those of
you who have got our books, we thank you because
(02:58):
partial profits go to keep it our organ For those
who have not got our books, get the books, any
of the books that we have written. Entrepreneurs got in
expert to influencer, your masterpiece and actually my another book
will be coming out this year, so very excited about it.
Get it and help us spread the message. And let's
(03:20):
welcome our guests. Welcome Monica, Welcome Joanna.
Speaker 4 (03:30):
Thank you. It's nice to bear with you.
Speaker 3 (03:33):
Oh it's wonderful to have y'all, so share it with us.
If you'll recall any times from your childhood or youth
when somebody left or it was just an incident like
that left to positive.
Speaker 4 (03:46):
Mark on you, well, that is a very broad question.
I would say that.
Speaker 5 (03:56):
Maybe not from just from childhood, but I think that
in my career there have been many times in doing
the work that I've been doing where people actually took
the time to share the impact that it had on them,
and I think that that.
Speaker 4 (04:17):
Is incredibly rewarding in the work.
Speaker 3 (04:20):
That we do.
Speaker 4 (04:22):
But it also helps drive you.
Speaker 5 (04:25):
And it also helped give me perspective on the challenges
that people that other people are experiencing.
Speaker 4 (04:34):
So it gives me perspective on my own life and
how fortunate I am in many ways.
Speaker 3 (04:40):
Absolutely, how about you, Monica, I.
Speaker 4 (04:43):
Would certainly go what Joanna just shared.
Speaker 6 (04:46):
I will also say that through my professional life, I
have had the absolute honor to work with some incredibly
brilliant and hard working women, and a couple of those
women really took the time to mentor me and to
(05:06):
support me as I began my career, and that really
showed me that the power of community can mean so
many different things. And in that specific instance, you know,
the community of strong, intelligent, driven women can really lift
each other up and they can just do incredible things
in life.
Speaker 3 (05:27):
So, Joanna, what got you into becoming a lawyer?
Speaker 5 (05:32):
Well, I have to admit that when I went to
law school, I knew that I didn't want to be a.
Speaker 4 (05:41):
Litigator or be in the courtroom.
Speaker 5 (05:44):
I really found that there was power in the law
that it creates the systems that we have to navigate
and has an impact on our daily lives. And so
I really wanted to be able to engage in the
policy aspects of being a lawyer and being able to
(06:07):
shape laws in a way that have a positive impact
on our society.
Speaker 3 (06:13):
And how did you get involved in that?
Speaker 5 (06:16):
Well, I went to law school thinking that I wanted
to do that on an international level. I was an
international relations major in undergrad but then when I got.
Speaker 4 (06:28):
To law school, I found that there were a lot.
Speaker 5 (06:32):
Of places in our domestic policy that could be improved,
and so I did an internship. Well, I was in
law school that focused on providing services to people with
disabilities and cancer and that is really what led me
(06:55):
down the path to my current career.
Speaker 4 (06:58):
So it wasn't planned, but.
Speaker 3 (07:00):
It found Well, that's how life is. So many times
we have plans and life takes a detour and sometimes
we don't know. And that's the beauty of every day
and it's a beautiful gift that we all have. Someone
is go about you, how did you get into the career.
Speaker 7 (07:22):
Well, I'm sorry for the technical difficulties, but I too
had a windy path towards becoming a cancer rights attorney.
Speaker 6 (07:33):
I went to law school knowing that I wanted to have.
Speaker 4 (07:38):
An understanding of how everyday.
Speaker 6 (07:40):
People could use the law to improve society, and so
I started off working in Congress in trying to shape
do my small part in shaping public policy and laws
that would really uplift the lives of day Americans. Personal
(08:02):
reasons had me leaving Washington, d C. And then I
really struggled to find a career where I could use
my knowledge of both policy and how laws were made
and implemented, but in a really tangible way help a community.
And thankfully, through Joanna's support, that led me to the
(08:22):
cancer community and I've been here ever since.
Speaker 3 (08:26):
So how did you get together?
Speaker 5 (08:29):
So? Monica and I are actually sisters, so people know
us in the cancer community as sisters, but we effectively
grew up in a healthcare community. Our parents are both
doctors and worked in the oncology space and gave us.
Speaker 4 (08:53):
Perspective and an introduction.
Speaker 5 (08:55):
To the challenges that patients and caregivers experience when diagnosed
with sterious medical condition.
Speaker 3 (09:05):
So so many times what happens to Joanna is that
you know you're working in the corporations, the daily conundrums
and the daily humdown of life, and then all of
a sudden, I mean, of course there are pressures. You
know that you may have kids, you may not have kids,
doesn't matter whether you're single or spouse or in partnership,
(09:26):
wherever you are at, just that daily pressures are enough
as it is, and then all of a sudden, any
life threatening illness or cancer like immune and it's it
is so traumatic in itself. So now you're in that
situation or one of your loved ones is in that situation.
(09:47):
So initially, like you know, I've heard stories from my clients.
They've said that, you know, the bosses, everybody's been very supportive,
but that support kind of seems to keep on drying
up if it lingers around long. And these are like,
you know, long driven illnesses. So tell us, like, you know,
how can people get through all of that?
Speaker 5 (10:08):
There are laws that do provide protections related to employment,
both for employees who are diagnosed with serious medical conditions
like cancer, but also for caregivers. But there are also
employer policies that provide additional benefits and protections that can
be supportive. And so when we're talking about employment, we're
(10:33):
also trying to teach employers about the ways that they
can support their employees dealing with chronic or serious medical conditions,
because at the end of the day, employers want to
keep valued employees, and so we have to remember that
employers and employees they have a mutually beneficial relationship, and
(10:55):
there's value in creating an environment that.
Speaker 4 (10:59):
Supports both the needs of both.
Speaker 5 (11:03):
And so while we are generally teaching employees about their rights,
we also try to teach employers about what their legal
responsibilities are under the law, but also ways to proactively
try to support employees in those situations. But I fully
realize that that is easier said than done, and we
(11:24):
see the full spectrum of employee experience. So we see
employees who have really supportive employers throughout their.
Speaker 4 (11:35):
Health condition experience.
Speaker 5 (11:37):
But then we also, unfortunately see the downsides of when employers.
Speaker 4 (11:42):
Don't understand their legal obligations or are less concerned with
supporting their employees.
Speaker 3 (11:50):
So let's say, let's begin with an employer, what can
they already put in place so if something like this
happens to prepared for it well.
Speaker 5 (12:01):
From an employee perspective, I think the most important thing
is to understand your rights and where the laws do
and don't apply to.
Speaker 4 (12:10):
Excuse me, they're specific employer.
Speaker 5 (12:14):
So every law that we talk about actually applies to
different types of employers. So if you're looking for protection
under the Family and Medical Leave Act, for example, which
is a federal law, it only applies to private employers
with fifty or more employees, or to state, local, or
federal government employees. So if you know that that's a
(12:36):
benefit that you want to have access to, if you're
looking to work for a smaller employer that might not
be the right fit for you, or understanding what additional
benefits that smaller employer might be willing to provide even
though they're not legally required to do it. So you
can be strategic in looking for employment opportunities.
Speaker 4 (12:59):
But in order to do that, you have to kind
of understand the laws that would be helpful to.
Speaker 5 (13:03):
You in dealing with a chronic or serious medical condition
and then look for employers that are actually bound by
those laws. The same thing is true though when you're
looking at benefits, so looking at employer health insurance benefits,
for example, if you know that you have a chronic
(13:24):
or serious medical condition, making sure that you have access
to quality health insurance coverage is key. We sometimes assume
that all employers have the same health insurance coverage or
it's going to be good health insurance coverage because it's
being provided by an employer, and that might not be true.
So understanding how to look at those options and figure
(13:48):
out if it's going to meet your needs is also
something that employees can proactively do when looking at employment opportunities.
Speaker 3 (13:57):
Yeah, no, that's definitely because that is the time they
can negotiate and they can make the decisions. You know,
which company to even look for. So as you mentioned that,
if you have that, you also talked about insurance. So
there's so many different types of insurances. So let's kind
of explore, like, you know, a couple of options. One
(14:19):
is insurance given by the companies. One is there are
a lot of contractors a lot of entrepreneurs, So in
both situations, what options they can consider and what they
can go with.
Speaker 5 (14:33):
For individuals who aren't working for an employer that is
going to offer them benefit, there are specific options available
and so then it might come down to where you
live and your income level. But generally speaking, if you're
not taking those two things into consideration. There are private
(14:56):
health insurance plans that are offered through state health insurance marketplaces.
So those marketplaces are often called exchanges or sometimes people
call them ACA plans or Obamacare plans, but effectively, the
government created a shopping mall for health insurance coverage called marketplace,
and in going to the marketplace, you can find all
(15:20):
of the private health insurance plans that are offered to
you in your state that also have to provide some
consumer protections, and depending on your income level, you might
qualify for financial help to actually buy your health insurance
plan or to lower some of your out of pocket costs.
So depending on your employment, if you're in contract employment,
(15:43):
or you're an entrepreneur, or even in some gig jobs,
those are all times where you might not have access
to employer sponsored insurance and you could look at the
marketplace to see what health insurance options are available to you.
And then depending on your state and your income level,
you might also qualify for medicaid in your state.
Speaker 3 (16:06):
Yeah, these are some very important points in your experience.
Are there any criterias that people need to keep in
mind as they're making their selections.
Speaker 5 (16:16):
I think there are definitely some key things that we
want people to understand when looking at their insurance options.
I would say there are three key things. The first
is make sure you know all of your options, because
you can't effectively compare your options and pick the best
plan for you if you actually don't know.
Speaker 4 (16:34):
What all of your options are.
Speaker 5 (16:36):
And I think that's true of somebody who's shopping in
the marketplace, but it's also true if somebody's getting different
choices from an employer. So if your employer gives you
three options for insurance, that's also an opportunity to actually
compare your options. The second piece is, once you know
your options, how do you compare them?
Speaker 4 (16:56):
And you do that by making.
Speaker 5 (16:58):
Sure that you're looking at the cost that you're looking
at whether or not it actually covers your providers and
your prescription drugs. So if you pick a plan that
doesn't cover the doctors and the hospitals and the pharmacies
that you go to or the prescription drugs that you take,
it's a pretty ineffective plan for you. And so comparing
(17:20):
those three things are going to help make sure that
you're picking the best plan for you. The third thing
that you have to do is to actually do the
math because most people are only picking a health insurance
plan by looking at the monthly premium, but that is
only one small piece of the cost of health insurance coverage.
(17:42):
If you're dealing with a chronic or a serious medical condition,
the chances.
Speaker 4 (17:48):
Are you're going to have a lot of.
Speaker 5 (17:51):
Out of pocket expenses because when you're using healthcare, you
have to pay those out of pocket costs like copays
and co insurance amounts. So what most people don't realize
is that there's something called an out of pocket maximum,
and that is a cap on how much you have
to pay out of pocket each year, and when you
reach that cap, your.
Speaker 4 (18:12):
Insurance will kick in at one hundred percent for the
rest of the year.
Speaker 5 (18:16):
So you could have a one thousand dollars out of
pocket maximum, or you could have a ten thousand dollars out.
Speaker 4 (18:22):
Of pocket maximum, depending on the plant.
Speaker 5 (18:25):
And so when you have a chronic or serious medical condition,
you want to take into consideration not just the monthly premium, but.
Speaker 4 (18:32):
The out of pocket maximum.
Speaker 5 (18:34):
So we have a pretty easy math formula to help
people figure it out. You just take the monthly premium
and you multiply it by twelve, because that's how much
it's going to cost you to have the plan for
the year, and then you add that to the out
of pocket maximum, which is the most that you'll pay
out of pocket for the year for your medical expenses,
and that's going to give you the real cost of
(18:55):
not just having insurance for the year, but also what
you would pay out of pocket for your care, and
that's the most that you would pay. So in doing
that math, you can easily figure out which plan is
going to actually cost you the most or the least
by the end of the year.
Speaker 4 (19:12):
And that is really key in the work that.
Speaker 5 (19:14):
We do because most people are going to hit their
out of pocket maximum if they have a chronic or
serious medical commission right now.
Speaker 3 (19:23):
That's definitely a great point to consider. And also some
of the plans having being through the Ringers myself and
with some of my clients is that there is another
catch if you can elaborate on that, like sometimes that
out of pocket can be just for individual or for family.
Speaker 5 (19:43):
That's true, so you also have to understand how the
out of pocket maximum works for your specific plan. So
if we're talking about marketplace plans, those marketplace plans are
actually the most protective from a consumer standpoint, because it
requires those plans to include to the out of pocket
in the out of pocket maximum, your copays, your deductibles,
(20:05):
co insurance amounts that you pay both for your medical
care and for your prescription drugs.
Speaker 4 (20:11):
So everything gets to help you meet your out of
pocket maximum.
Speaker 5 (20:15):
Employer plans are allowed to carve things out, so they
might say, we are going to not include the deductible
in your out of pocket maximum, so you have to
pay both your deductible and then you have to also
meet your out of pocket maximum. Or some will say
we're not going to include your deductible or your co payments,
We're only going to include co insurance amounts in your deductible.
Speaker 4 (20:39):
And then some.
Speaker 5 (20:39):
Employer plans will say, well, we're going to give you
a separate out of pocket maximum for your prescription drugs,
So you not only have to meet an out of
pocket maximum for your general medical care like office visits
or hospitalizations, but you also have an out of.
Speaker 4 (20:54):
Pocket maximum for prescription drugs.
Speaker 5 (20:57):
So understanding how yours specific plan it deals with out
of pocket maximums is key.
Speaker 4 (21:04):
To understanding it.
Speaker 5 (21:05):
It's also key to understanding how to do the math,
because if you have two separate out of pocket maximums
for prescription drugs and for medical care. You have to
add those things together plus the premiums. And then if
you do have a family plan, you not only have
your individual out of pocket maximum, you also have a family.
Speaker 4 (21:23):
Out of pocket maximum.
Speaker 5 (21:25):
That is only really helpful if you have more than
two people on your family plan because generally the way
that it works is once two people on the plan
meet their out of pocket maximum, the family out of
pocket maximum is also met, So that means anybody else
on the family plan for the rest of the year
(21:46):
could basically get.
Speaker 4 (21:47):
Free access to medical care.
Speaker 5 (21:49):
So that's not helpful if you only have two people
on the plan because you still have to meet your
own out of pocket maximums.
Speaker 3 (21:58):
Yeah, and that's really good for nation. So now, okay,
you've gone through looked at your options, and you've decided
on your medical coverage, and like you know, the years
are going through and sometimes you know the transitions. It
could be people are changing jobs, people could be moving.
(22:21):
There are some family changes, like you know, you'll get
married or retired or getting eligible for many cares, so
there's so different things. How can people navigate those changes?
Speaker 5 (22:33):
Unfortunately, picking a health insurance plan is not a one
time chore for us to engage in, so.
Speaker 4 (22:42):
We think we've picked the best plan.
Speaker 5 (22:44):
Unfortunately, every single year those plan options change, the costs
change with the cover change, the networks of providers change,
So every single year, even if we're getting coverage through
an employer, we should still be looking at our insurance
options and making sure it still covers the things we
need it to cover, and looking at that math to
(23:05):
see which is most cost effective.
Speaker 4 (23:08):
But when you're.
Speaker 5 (23:08):
Trying to deal with changes in your other circumstances, if
you're moving, then that adds an additional layer of complication
because if you're moving even zip codes, so not even
if you're moving out of state, but if you're moving
zip codes, that might change your insurance options. So if
you're changing if you have a marketplace plan and you
(23:32):
change zip codes, the plan you have right now might
not be available in that new zip code.
Speaker 4 (23:37):
Same thing if you're moving states. If you're moving states,
you definitely want to take.
Speaker 5 (23:42):
A look at the new state's marketplace plans.
Speaker 4 (23:46):
But that's almost a true of employer plans. So if
you are.
Speaker 5 (23:50):
Living in one state and maybe you're a remote worker,
if you move to a new state, you want to
make sure that whatever health insurance plan your employer provid
you is going to cover you if you go to
providers in that new state, So you have to actually
pay attention to make sure.
Speaker 4 (24:09):
Some employer plans have national.
Speaker 5 (24:11):
Networks of providers, so that isn't a problem. But if
your employer offers you an HMO, that's generally going to
come with a limited network of providers that is geographically specific,
So making sure that you can still use that plan
is part of that analysis. If you're thinking about retiring
(24:33):
and you haven't yet turned sixty five, then you're going
to be looking at the marketplace and then, depending on
your income level, medicaid.
Speaker 4 (24:41):
So the marketplace is.
Speaker 5 (24:42):
Really a place where we're seeing a lot more movement
because we do see a lot of people in entrepreneur
roles and contract work and in a gig economy, many
more people are using the marketplace, but also because many
employers are offering health insurance coverage, so it provides that
(25:04):
additional way to get access to insurance if somebody has
turned sixty five and is eligible for Medicare. Medicare is
incredibly complicated, so trying to understand how you actually make
good Medicare decisions is very difficult for the average person.
(25:24):
I mean, I have a law degree and I do
this work on a daily basis.
Speaker 4 (25:27):
And Medicare stumps us all the time.
Speaker 5 (25:30):
Because there's so much nuance to the way that it
gets implemented. But on a very kind of basic introduction
to Medicare, there's generally two lanes that people can drive
down to get access to Medicare coverage.
Speaker 4 (25:45):
You can either.
Speaker 5 (25:46):
Get what's called traditional Medicare, which is basically fee for service.
You can go to any provider across the country who
accepts Medicare.
Speaker 4 (25:55):
But then you can also.
Speaker 5 (25:57):
Get access to your Medicare benefits through a managed care plan,
which is sold by a private insurance company and has
a specific network of providers that you go to and
is usually geographically specific to where you live.
Speaker 4 (26:10):
So when you make.
Speaker 5 (26:13):
Those initial choices about Medicare, there are pros and cons
to each lane, and you have to figure out which
is really going to be.
Speaker 4 (26:20):
The best for you.
Speaker 3 (26:22):
So, talking about Medicare, there you know so many people
and who are retiring, and especially the baby boomers and
all that you know. As they were saying, I think
so I don't know where I read that. How many
millions of people are going to be toning sixty five
and retiring or whatever looking for the Medicare. So do
(26:44):
you have any resources or options that can help people
or do you help people across the whole you know,
United States or is it different for different states?
Speaker 5 (26:57):
We do so Medicare options, depending on kind of which
lane you're choosing to drive down.
Speaker 4 (27:02):
Are going to be specific to where you live.
Speaker 5 (27:04):
So at Stratage Cancer we have a lot of resources
to help people navigate Medicare. We also have a program
called Triage Health, which is for anyone trying to navigate
healthcare related issues like trying to figure out what your
health insurance options are. So at triageealth dot org if
somebody wants to learn about Medicare.
Speaker 4 (27:26):
We actually have a Medicare Topics.
Speaker 5 (27:28):
Page where there are guides to help people understand the
different types of Medicare options. We have a worksheet to
help people do the math to make their Medicare choices.
We even have some animated videos to explain that some
of the key aspects of Medicare. But we do also
(27:48):
have recorded and live events to help educate people on
their Medicare choices. So really they're getting access to the
care that they need and not experiencing the financial burden
that can come along with.
Speaker 4 (28:02):
A serious medical condition.
Speaker 3 (28:05):
That's fantastic. You know, you're doing some great work out there.
So now, coming back to the original scenario that we
had talked about, somebody's in the corporation, all of a
sudden they find out that, you know, they are experiencing
life threatening disease, and it could be anything as you
had mentioned earlier, cancer or otherwise, what's their best choice?
(28:30):
I mean, you know, they are so bogged down during
that time, So how can they keep their cool and
what are some of the steps that they can take
to ensure that they are aware of their rights and also,
like you know, ensuring that they're forming that partnership with
the employer to kind of work through this hard time.
Speaker 5 (28:53):
I think dealing with work and a serious medical condition
and making decisions about what to do next involves a
lot of factors. It might be about somebody's work environment
and whether or not they feel comfortable disclosing if they
have a supportive work environment.
Speaker 4 (29:16):
It could be about the size of their employer.
Speaker 5 (29:19):
And what laws and legal protections they have access to.
Speaker 4 (29:23):
It could be about benefits they have access to.
Speaker 5 (29:27):
It could also just be a very personal decision about
whether or not somebody wants to focus on their health
or try to balance work and their health.
Speaker 4 (29:37):
So there's a.
Speaker 5 (29:38):
Lot of pieces that go into those types of decisions, but.
Speaker 4 (29:43):
I think really at the core of.
Speaker 5 (29:44):
It is understanding how your medical condition is going to
impact you and your ability to do your job. There
are certainly types of medical conditions and types of jobs,
and those medical conditions are going to prevent so from
doing their job. But at Triash Cancer, our goal is
to help people understand what their goals are and then
(30:07):
how do we help someone meet their goals. So, if
their goals are to stay at work, Understanding how the
Americans the Disabilities Act provide someone access to accommodations so
that they can get help in doing their job or
even returning to work, if it's about taking time off,
if that's their goal, Understanding how the ADA and the
(30:29):
FMLA provides those legal.
Speaker 4 (30:31):
Protections to be able to do that.
Speaker 5 (30:33):
Maybe somebody has access to state disability insurance options and
that makes it easier for someone to decide to take
time off work or not so the decisions around what
to do next, I think are really rooted in figuring
out what your goals are with work, and then how
(30:53):
you can meet those goals using the laws and protections
and benefits and programs that are available to help you
do that. And that's really the core of what we
do at Triage Cancer is helping people understand what those
laws are and what their options are so that people
can make the best.
Speaker 4 (31:11):
Decision for them.
Speaker 3 (31:13):
And just like you had shed, like you know, there
were like two to three points people could keep in
mind as they were going and looking for different options
for the insurance. Are there any key points that people
need to keep in mind as they're making these decisions?
Speaker 4 (31:31):
I would say the first is talk to your healthcare team.
Speaker 5 (31:34):
So if you haven't yet maybe started treatment, and you're
not sure how your medical condition is going to impact you,
or even if you've just started, what the long term
implications of that could look like.
Speaker 4 (31:46):
But talking to.
Speaker 5 (31:47):
Your healthcare team and understanding how your medical condition is
going to impact you and the treatment.
Speaker 4 (31:52):
That you're going through.
Speaker 5 (31:53):
The second piece is understanding what your rights are, and
then three figuring out what.
Speaker 4 (32:00):
Is important to you, What are your goals.
Speaker 5 (32:02):
So if your goals are to stay at work and
to stay in your career, and you know, some people
actually like their jobs and that's where they find their
support system, and so it is sometimes very important for
people to stay at work. Other people that is less important,
and they're more focused about how can they take the
time off.
Speaker 4 (32:20):
To focus on their health.
Speaker 5 (32:22):
So figuring out you know, how your health is being impacted,
your rights, and then your goals I think would be
the first three things to do. And then sorting through
that information is actually why we came to our organizational name.
The action of triaging through that information and then figuring
(32:42):
out what needs to be dealt with first and what
can be waiting until later.
Speaker 3 (32:47):
And what can people do if insurance denies coverage to them.
Speaker 4 (32:51):
I think this is something that we see a lot.
We're seeing it in the news, discussions around how health
insurance companies are denying coverage for care and or denying
coverage for prior authorizations to get access to care. And unfortunately,
we know that most people take no for an answer,
and that is really unfortunate because we know, based on
(33:16):
data that when somebody is denied a coverage for care
ninety nine point nine percent of the time, they're not
appealing even to the first level of appeal. So even
though we hear about appeals in the work that we do,
very few people are actually taking advantage of that consumer
(33:37):
protection where you not only have a right to appeal
that insurance company's decision if they say no, and you
have a private insurance plan, like through an employer or
an individual plan, you can go outside the insurance company
to an independent entity, to what's called an external medical
review or an independent medical review, and they decide whether
(34:02):
or not the care that you've been prescribed by your
healthcare team is medically necessary. And if they decide that
it is, that decision is binding on the insurance company
they have to cover it. And we know based on
data that about on average fifty percent of the time
patients are successful when they go through that external appeal.
So if ninety nine point nine percent of people are
(34:24):
taking no for an answer, but if they got to
the external appeal stage, they would actually win their appeal
fifty percent of the time, that's a lot of people
who That is a lot to how long here.
Speaker 3 (34:37):
That people can receive Yeah, and really that.
Speaker 5 (34:43):
God, what that translates to is that people either aren't
getting care that their healthcare team prescribed or they're paying
for it out of pocket. So that just contributes to
the financial burden if they're paying for something out of
pocket that their insurance company should have covered.
Speaker 3 (35:01):
Right, Yeah, and I'm assuming that you help out with
that as well.
Speaker 4 (35:07):
We do.
Speaker 5 (35:08):
So your ability to appeal depends on the type of
insurance that you have, but across all types of insurance
you have the right to appeal. It's just that the
details of how you actually go about doing that are
different based on the different types of insurance that are available,
whether it's an employer plan or Medicaid or Medicare or
maybe even VA Healthcare.
Speaker 4 (35:30):
So the process is different based on the plan.
Speaker 3 (35:35):
Absolutely, So quick question for you, given all of this,
this is very very important topic that you brought it up.
Thank you for that. How can people connect with you
and Monica? How can access the Initially it's strategicancer dot org.
(35:58):
Outside of that, like you know, just reach out to
you through your website or any other venues.
Speaker 5 (36:05):
Yes, absolutely, you can visit triage cancer dot org or
Triage health dot org and you will find a plethora
of information about a variety of different topics that come
up when navigating healthcare, whether it be health internt GO,
our employment issues, or disability insurance, but also finances and
consumer rights and managing medical bills or maybe estate planning
(36:30):
documents and medical decision making documents like advanced healthcare directives.
Speaker 4 (36:35):
We provide information about all of.
Speaker 5 (36:37):
Those legal issues that are also state specific, and then
if somebody would like to learn more, they can attend
our free educational events, which they can sign up for
on our website. And then we also have a free
legal and financial navigation program where we will answer people's one.
Speaker 4 (36:56):
On one questions.
Speaker 5 (36:57):
So if somebody was going through of those healthcare transitions
or is newly eligible for Medicare and isn't sure how
to make the right decision, we can help someone understand
their options so that they can make the best decisions
for them.
Speaker 3 (37:15):
Absolutely. And if also y'all have written a book, correct.
Speaker 4 (37:20):
We have.
Speaker 5 (37:20):
So Monica and I have both taught law school classes
on cancer rights law and there wasn't a book. So
teaching a law school class without a book is a
lot of work because we have to compile the readings
for each class.
Speaker 4 (37:37):
So seeing that gap in the literature. We actually co.
Speaker 5 (37:42):
Wrote cancer rights Law that was published by the American
Bar Association, so that not only we can use the
book in class, but that.
Speaker 4 (37:51):
Others can as well.
Speaker 5 (37:53):
But we also wrote it in a way that it's interdisciplinary,
so healthcare professionals can also use this information to support
patients and caregivers, but also advocates and others who just
want to understand their rights in many of those areas
I mentioned are covered in that book.
Speaker 8 (38:16):
Any last thoughts you would like to share, I would
just encourage people to understand what their options are even
if you're not dealing with the serious medical condition.
Speaker 5 (38:27):
One of the reasons we created Triage Health was to
try to help people understand these issues before they need it,
so that they have a good health insurance plan so
that if they are diagnosed with a serious medical condition,
they're already prepared and certainly to understand what your employment
rights are because in looking at job opportunities, you can
(38:49):
take that information into consideration when making employment choices as well.
Speaker 3 (38:56):
Very powerful, Well, thank you for joining us and share
hearing all these details, and like you know, Joanna and
Monica Yola doing such great work, so thank you for
doing it. And keep helping people and so listeners, I
(39:17):
pray to God that none of you have to face
any of these, but if you do, you know where
to go. You know, definitely check out their website and
our prayers and thoughts would be with you through the
tough times. So thank you for being part of our show,
and be careful you. We want you to have happy,
(39:40):
healthy life and that also means good healthy financial life
as well, So take care of yourself and also want
thank you for making the show technically possible. Until next time,
be well and take care.
Speaker 2 (39:58):
Thank you for being part of Beyond With your host
v Park, we hope you have learned more about how
to start living the life you want. Each week on
Beyond Confidence, you hear stories of real people who've experienced
growth by overcoming their fears and building meaningful relationships. During
Beyond Confidence, Dvpark shares what happened to her when she
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(40:19):
people across the globe. She not only coaches people how
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If you are ready to live the life you want
and leverage your strengths. Learn more at www dot dwpark
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(40:40):
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(00:20):
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Speaker 2 (00:25):
This is Beyond Confidence with your host DV park. Do
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This is beyond confidence and now here's your host.
Speaker 3 (01:09):
W Park A good morning listeners. That's Tuesday and I
get to be with you, so thank you for being
part of us. And it was Memori Levey Can. I
wanna be a tribute to all our fallen heroes and
heroes because of whom we have our freedom. So very
(01:35):
thankful for their services and for their families as well.
So we always talk about kindness Circle and the story
that I want to share is the story of Johanna,
one of our audiences. So what Johanna shared was that
(01:55):
she lives in an apartment building and what she found
was that a mom had, you know, she had her
two year old like down there, and it's like, you know,
the mom was apparently on the first floor. So what
Johanna said was like, you know what, why don't you
(02:17):
bring your baby down first, and I'll watch the baby
while your son is playing inside the house, and then
bring your son down. So just that little kindness went
such a long way and mom was so profusely grateful.
So just kind of think about it, and of course,
(02:38):
you know, you just don't want to jump into help
because people can take it another way. So just kind
of ask them and said, okay, and I'm your neighbor,
you know, identify yourself. And that's what Johanna did. So
thank you Johanna for keeping it going. For those of
you who have got our books, we thank you because
(02:58):
partial profits go to keep it our organ For those
who have not got our books, get the books, any
of the books that we have written. Entrepreneurs got in
expert to influencer, your masterpiece and actually my another book
will be coming out this year, so very excited about it.
Get it and help us spread the message. And let's
(03:20):
welcome our guests. Welcome Monica, Welcome Joanna.
Speaker 4 (03:30):
Thank you. It's nice to bear with you.
Speaker 3 (03:33):
Oh it's wonderful to have y'all, so share it with us.
If you'll recall any times from your childhood or youth
when somebody left or it was just an incident like
that left to positive.
Speaker 4 (03:46):
Mark on you, well, that is a very broad question.
I would say that.
Speaker 5 (03:56):
Maybe not from just from childhood, but I think that
in my career there have been many times in doing
the work that I've been doing where people actually took
the time to share the impact that it had on them,
and I think that that.
Speaker 4 (04:17):
Is incredibly rewarding in the work.
Speaker 3 (04:20):
That we do.
Speaker 4 (04:22):
But it also helps drive you.
Speaker 5 (04:25):
And it also helped give me perspective on the challenges
that people that other people are experiencing.
Speaker 4 (04:34):
So it gives me perspective on my own life and
how fortunate I am in many ways.
Speaker 3 (04:40):
Absolutely, how about you, Monica, I.
Speaker 4 (04:43):
Would certainly go what Joanna just shared.
Speaker 6 (04:46):
I will also say that through my professional life, I
have had the absolute honor to work with some incredibly
brilliant and hard working women, and a couple of those
women really took the time to mentor me and to
(05:06):
support me as I began my career, and that really
showed me that the power of community can mean so
many different things. And in that specific instance, you know,
the community of strong, intelligent, driven women can really lift
each other up and they can just do incredible things
in life.
Speaker 3 (05:27):
So, Joanna, what got you into becoming a lawyer?
Speaker 5 (05:32):
Well, I have to admit that when I went to
law school, I knew that I didn't want to be a.
Speaker 4 (05:41):
Litigator or be in the courtroom.
Speaker 5 (05:44):
I really found that there was power in the law
that it creates the systems that we have to navigate
and has an impact on our daily lives. And so
I really wanted to be able to engage in the
policy aspects of being a lawyer and being able to
(06:07):
shape laws in a way that have a positive impact
on our society.
Speaker 3 (06:13):
And how did you get involved in that?
Speaker 5 (06:16):
Well, I went to law school thinking that I wanted
to do that on an international level. I was an
international relations major in undergrad but then when I got.
Speaker 4 (06:28):
To law school, I found that there were a lot.
Speaker 5 (06:32):
Of places in our domestic policy that could be improved,
and so I did an internship. Well, I was in
law school that focused on providing services to people with
disabilities and cancer and that is really what led me
(06:55):
down the path to my current career.
Speaker 4 (06:58):
So it wasn't planned, but.
Speaker 3 (07:00):
It found Well, that's how life is. So many times
we have plans and life takes a detour and sometimes
we don't know. And that's the beauty of every day
and it's a beautiful gift that we all have. Someone
is go about you, how did you get into the career.
Speaker 7 (07:22):
Well, I'm sorry for the technical difficulties, but I too
had a windy path towards becoming a cancer rights attorney.
Speaker 6 (07:33):
I went to law school knowing that I wanted to have.
Speaker 4 (07:38):
An understanding of how everyday.
Speaker 6 (07:40):
People could use the law to improve society, and so
I started off working in Congress in trying to shape
do my small part in shaping public policy and laws
that would really uplift the lives of day Americans. Personal
(08:02):
reasons had me leaving Washington, d C. And then I
really struggled to find a career where I could use
my knowledge of both policy and how laws were made
and implemented, but in a really tangible way help a community.
And thankfully, through Joanna's support, that led me to the
(08:22):
cancer community and I've been here ever since.
Speaker 3 (08:26):
So how did you get together?
Speaker 5 (08:29):
So? Monica and I are actually sisters, so people know
us in the cancer community as sisters, but we effectively
grew up in a healthcare community. Our parents are both
doctors and worked in the oncology space and gave us.
Speaker 4 (08:53):
Perspective and an introduction.
Speaker 5 (08:55):
To the challenges that patients and caregivers experience when diagnosed
with sterious medical condition.
Speaker 3 (09:05):
So so many times what happens to Joanna is that
you know you're working in the corporations, the daily conundrums
and the daily humdown of life, and then all of
a sudden, I mean, of course there are pressures. You
know that you may have kids, you may not have kids,
doesn't matter whether you're single or spouse or in partnership,
(09:26):
wherever you are at, just that daily pressures are enough
as it is, and then all of a sudden, any
life threatening illness or cancer like immune and it's it
is so traumatic in itself. So now you're in that
situation or one of your loved ones is in that situation.
(09:47):
So initially, like you know, I've heard stories from my clients.
They've said that, you know, the bosses, everybody's been very supportive,
but that support kind of seems to keep on drying
up if it lingers around long. And these are like,
you know, long driven illnesses. So tell us, like, you know,
how can people get through all of that?
Speaker 5 (10:08):
There are laws that do provide protections related to employment,
both for employees who are diagnosed with serious medical conditions
like cancer, but also for caregivers. But there are also
employer policies that provide additional benefits and protections that can
be supportive. And so when we're talking about employment, we're
(10:33):
also trying to teach employers about the ways that they
can support their employees dealing with chronic or serious medical conditions,
because at the end of the day, employers want to
keep valued employees, and so we have to remember that
employers and employees they have a mutually beneficial relationship, and
(10:55):
there's value in creating an environment that.
Speaker 4 (10:59):
Supports both the needs of both.
Speaker 5 (11:03):
And so while we are generally teaching employees about their rights,
we also try to teach employers about what their legal
responsibilities are under the law, but also ways to proactively
try to support employees in those situations. But I fully
realize that that is easier said than done, and we
(11:24):
see the full spectrum of employee experience. So we see
employees who have really supportive employers throughout their.
Speaker 4 (11:35):
Health condition experience.
Speaker 5 (11:37):
But then we also, unfortunately see the downsides of when employers.
Speaker 4 (11:42):
Don't understand their legal obligations or are less concerned with
supporting their employees.
Speaker 3 (11:50):
So let's say, let's begin with an employer, what can
they already put in place so if something like this
happens to prepared for it well.
Speaker 5 (12:01):
From an employee perspective, I think the most important thing
is to understand your rights and where the laws do
and don't apply to.
Speaker 4 (12:10):
Excuse me, they're specific employer.
Speaker 5 (12:14):
So every law that we talk about actually applies to
different types of employers. So if you're looking for protection
under the Family and Medical Leave Act, for example, which
is a federal law, it only applies to private employers
with fifty or more employees, or to state, local, or
federal government employees. So if you know that that's a
(12:36):
benefit that you want to have access to, if you're
looking to work for a smaller employer that might not
be the right fit for you, or understanding what additional
benefits that smaller employer might be willing to provide even
though they're not legally required to do it. So you
can be strategic in looking for employment opportunities.
Speaker 4 (12:59):
But in order to do that, you have to kind
of understand the laws that would be helpful to.
Speaker 5 (13:03):
You in dealing with a chronic or serious medical condition
and then look for employers that are actually bound by
those laws. The same thing is true though when you're
looking at benefits, so looking at employer health insurance benefits,
for example, if you know that you have a chronic
(13:24):
or serious medical condition, making sure that you have access
to quality health insurance coverage is key. We sometimes assume
that all employers have the same health insurance coverage or
it's going to be good health insurance coverage because it's
being provided by an employer, and that might not be true.
So understanding how to look at those options and figure
(13:48):
out if it's going to meet your needs is also
something that employees can proactively do when looking at employment opportunities.
Speaker 3 (13:57):
Yeah, no, that's definitely because that is the time they
can negotiate and they can make the decisions. You know,
which company to even look for. So as you mentioned that,
if you have that, you also talked about insurance. So
there's so many different types of insurances. So let's kind
of explore, like, you know, a couple of options. One
(14:19):
is insurance given by the companies. One is there are
a lot of contractors a lot of entrepreneurs, So in
both situations, what options they can consider and what they
can go with.
Speaker 5 (14:33):
For individuals who aren't working for an employer that is
going to offer them benefit, there are specific options available
and so then it might come down to where you
live and your income level. But generally speaking, if you're
not taking those two things into consideration. There are private
(14:56):
health insurance plans that are offered through state health insurance marketplaces.
So those marketplaces are often called exchanges or sometimes people
call them ACA plans or Obamacare plans, but effectively, the
government created a shopping mall for health insurance coverage called marketplace,
and in going to the marketplace, you can find all
(15:20):
of the private health insurance plans that are offered to
you in your state that also have to provide some
consumer protections, and depending on your income level, you might
qualify for financial help to actually buy your health insurance
plan or to lower some of your out of pocket costs.
So depending on your employment, if you're in contract employment,
(15:43):
or you're an entrepreneur, or even in some gig jobs,
those are all times where you might not have access
to employer sponsored insurance and you could look at the
marketplace to see what health insurance options are available to you.
And then depending on your state and your income level,
you might also qualify for medicaid in your state.
Speaker 3 (16:06):
Yeah, these are some very important points in your experience.
Are there any criterias that people need to keep in
mind as they're making their selections.
Speaker 5 (16:16):
I think there are definitely some key things that we
want people to understand when looking at their insurance options.
I would say there are three key things. The first
is make sure you know all of your options, because
you can't effectively compare your options and pick the best
plan for you if you actually don't know.
Speaker 4 (16:34):
What all of your options are.
Speaker 5 (16:36):
And I think that's true of somebody who's shopping in
the marketplace, but it's also true if somebody's getting different
choices from an employer. So if your employer gives you
three options for insurance, that's also an opportunity to actually
compare your options. The second piece is, once you know
your options, how do you compare them?
Speaker 4 (16:56):
And you do that by making.
Speaker 5 (16:58):
Sure that you're looking at the cost that you're looking
at whether or not it actually covers your providers and
your prescription drugs. So if you pick a plan that
doesn't cover the doctors and the hospitals and the pharmacies
that you go to or the prescription drugs that you take,
it's a pretty ineffective plan for you. And so comparing
(17:20):
those three things are going to help make sure that
you're picking the best plan for you. The third thing
that you have to do is to actually do the
math because most people are only picking a health insurance
plan by looking at the monthly premium, but that is
only one small piece of the cost of health insurance coverage.
(17:42):
If you're dealing with a chronic or a serious medical condition,
the chances.
Speaker 4 (17:48):
Are you're going to have a lot of.
Speaker 5 (17:51):
Out of pocket expenses because when you're using healthcare, you
have to pay those out of pocket costs like copays
and co insurance amounts. So what most people don't realize
is that there's something called an out of pocket maximum,
and that is a cap on how much you have
to pay out of pocket each year, and when you
reach that cap, your.
Speaker 4 (18:12):
Insurance will kick in at one hundred percent for the
rest of the year.
Speaker 5 (18:16):
So you could have a one thousand dollars out of
pocket maximum, or you could have a ten thousand dollars out.
Speaker 4 (18:22):
Of pocket maximum, depending on the plant.
Speaker 5 (18:25):
And so when you have a chronic or serious medical condition,
you want to take into consideration not just the monthly premium, but.
Speaker 4 (18:32):
The out of pocket maximum.
Speaker 5 (18:34):
So we have a pretty easy math formula to help
people figure it out. You just take the monthly premium
and you multiply it by twelve, because that's how much
it's going to cost you to have the plan for
the year, and then you add that to the out
of pocket maximum, which is the most that you'll pay
out of pocket for the year for your medical expenses,
and that's going to give you the real cost of
(18:55):
not just having insurance for the year, but also what
you would pay out of pocket for your care, and
that's the most that you would pay. So in doing
that math, you can easily figure out which plan is
going to actually cost you the most or the least
by the end of the year.
Speaker 4 (19:12):
And that is really key in the work that.
Speaker 5 (19:14):
We do because most people are going to hit their
out of pocket maximum if they have a chronic or
serious medical commission right now.
Speaker 3 (19:23):
That's definitely a great point to consider. And also some
of the plans having being through the Ringers myself and
with some of my clients is that there is another
catch if you can elaborate on that, like sometimes that
out of pocket can be just for individual or for family.
Speaker 5 (19:43):
That's true, so you also have to understand how the
out of pocket maximum works for your specific plan. So
if we're talking about marketplace plans, those marketplace plans are
actually the most protective from a consumer standpoint, because it
requires those plans to include to the out of pocket
in the out of pocket maximum, your copays, your deductibles,
(20:05):
co insurance amounts that you pay both for your medical
care and for your prescription drugs.
Speaker 4 (20:11):
So everything gets to help you meet your out of
pocket maximum.
Speaker 5 (20:15):
Employer plans are allowed to carve things out, so they
might say, we are going to not include the deductible
in your out of pocket maximum, so you have to
pay both your deductible and then you have to also
meet your out of pocket maximum. Or some will say
we're not going to include your deductible or your co payments,
We're only going to include co insurance amounts in your deductible.
Speaker 4 (20:39):
And then some.
Speaker 5 (20:39):
Employer plans will say, well, we're going to give you
a separate out of pocket maximum for your prescription drugs,
So you not only have to meet an out of
pocket maximum for your general medical care like office visits
or hospitalizations, but you also have an out of.
Speaker 4 (20:54):
Pocket maximum for prescription drugs.
Speaker 5 (20:57):
So understanding how yours specific plan it deals with out
of pocket maximums is key.
Speaker 4 (21:04):
To understanding it.
Speaker 5 (21:05):
It's also key to understanding how to do the math,
because if you have two separate out of pocket maximums
for prescription drugs and for medical care. You have to
add those things together plus the premiums. And then if
you do have a family plan, you not only have
your individual out of pocket maximum, you also have a family.
Speaker 4 (21:23):
Out of pocket maximum.
Speaker 5 (21:25):
That is only really helpful if you have more than
two people on your family plan because generally the way
that it works is once two people on the plan
meet their out of pocket maximum, the family out of
pocket maximum is also met, So that means anybody else
on the family plan for the rest of the year
(21:46):
could basically get.
Speaker 4 (21:47):
Free access to medical care.
Speaker 5 (21:49):
So that's not helpful if you only have two people
on the plan because you still have to meet your
own out of pocket maximums.
Speaker 3 (21:58):
Yeah, and that's really good for nation. So now, okay,
you've gone through looked at your options, and you've decided
on your medical coverage, and like you know, the years
are going through and sometimes you know the transitions. It
could be people are changing jobs, people could be moving.
(22:21):
There are some family changes, like you know, you'll get
married or retired or getting eligible for many cares, so
there's so different things. How can people navigate those changes?
Speaker 5 (22:33):
Unfortunately, picking a health insurance plan is not a one
time chore for us to engage in, so.
Speaker 4 (22:42):
We think we've picked the best plan.
Speaker 5 (22:44):
Unfortunately, every single year those plan options change, the costs
change with the cover change, the networks of providers change,
So every single year, even if we're getting coverage through
an employer, we should still be looking at our insurance
options and making sure it still covers the things we
need it to cover, and looking at that math to
(23:05):
see which is most cost effective.
Speaker 4 (23:08):
But when you're.
Speaker 5 (23:08):
Trying to deal with changes in your other circumstances, if
you're moving, then that adds an additional layer of complication
because if you're moving even zip codes, so not even
if you're moving out of state, but if you're moving
zip codes, that might change your insurance options. So if
you're changing if you have a marketplace plan and you
(23:32):
change zip codes, the plan you have right now might
not be available in that new zip code.
Speaker 4 (23:37):
Same thing if you're moving states. If you're moving states,
you definitely want to take.
Speaker 5 (23:42):
A look at the new state's marketplace plans.
Speaker 4 (23:46):
But that's almost a true of employer plans. So if
you are.
Speaker 5 (23:50):
Living in one state and maybe you're a remote worker,
if you move to a new state, you want to
make sure that whatever health insurance plan your employer provid
you is going to cover you if you go to
providers in that new state, So you have to actually
pay attention to make sure.
Speaker 4 (24:09):
Some employer plans have national.
Speaker 5 (24:11):
Networks of providers, so that isn't a problem. But if
your employer offers you an HMO, that's generally going to
come with a limited network of providers that is geographically specific,
So making sure that you can still use that plan
is part of that analysis. If you're thinking about retiring
(24:33):
and you haven't yet turned sixty five, then you're going
to be looking at the marketplace and then, depending on
your income level, medicaid.
Speaker 4 (24:41):
So the marketplace is.
Speaker 5 (24:42):
Really a place where we're seeing a lot more movement
because we do see a lot of people in entrepreneur
roles and contract work and in a gig economy, many
more people are using the marketplace, but also because many
employers are offering health insurance coverage, so it provides that
(25:04):
additional way to get access to insurance if somebody has
turned sixty five and is eligible for Medicare. Medicare is
incredibly complicated, so trying to understand how you actually make
good Medicare decisions is very difficult for the average person.
(25:24):
I mean, I have a law degree and I do
this work on a daily basis.
Speaker 4 (25:27):
And Medicare stumps us all the time.
Speaker 5 (25:30):
Because there's so much nuance to the way that it
gets implemented. But on a very kind of basic introduction
to Medicare, there's generally two lanes that people can drive
down to get access to Medicare coverage.
Speaker 4 (25:45):
You can either.
Speaker 5 (25:46):
Get what's called traditional Medicare, which is basically fee for service.
You can go to any provider across the country who
accepts Medicare.
Speaker 4 (25:55):
But then you can also.
Speaker 5 (25:57):
Get access to your Medicare benefits through a managed care plan,
which is sold by a private insurance company and has
a specific network of providers that you go to and
is usually geographically specific to where you live.
Speaker 4 (26:10):
So when you make.
Speaker 5 (26:13):
Those initial choices about Medicare, there are pros and cons
to each lane, and you have to figure out which
is really going to be.
Speaker 4 (26:20):
The best for you.
Speaker 3 (26:22):
So, talking about Medicare, there you know so many people
and who are retiring, and especially the baby boomers and
all that you know. As they were saying, I think
so I don't know where I read that. How many
millions of people are going to be toning sixty five
and retiring or whatever looking for the Medicare. So do
(26:44):
you have any resources or options that can help people
or do you help people across the whole you know,
United States or is it different for different states?
Speaker 5 (26:57):
We do so Medicare options, depending on kind of which
lane you're choosing to drive down.
Speaker 4 (27:02):
Are going to be specific to where you live.
Speaker 5 (27:04):
So at Stratage Cancer we have a lot of resources
to help people navigate Medicare. We also have a program
called Triage Health, which is for anyone trying to navigate
healthcare related issues like trying to figure out what your
health insurance options are. So at triageealth dot org if
somebody wants to learn about Medicare.
Speaker 4 (27:26):
We actually have a Medicare Topics.
Speaker 5 (27:28):
Page where there are guides to help people understand the
different types of Medicare options. We have a worksheet to
help people do the math to make their Medicare choices.
We even have some animated videos to explain that some
of the key aspects of Medicare. But we do also
(27:48):
have recorded and live events to help educate people on
their Medicare choices. So really they're getting access to the
care that they need and not experiencing the financial burden
that can come along with.
Speaker 4 (28:02):
A serious medical condition.
Speaker 3 (28:05):
That's fantastic. You know, you're doing some great work out there.
So now, coming back to the original scenario that we
had talked about, somebody's in the corporation, all of a
sudden they find out that, you know, they are experiencing
life threatening disease, and it could be anything as you
had mentioned earlier, cancer or otherwise, what's their best choice?
(28:30):
I mean, you know, they are so bogged down during
that time, So how can they keep their cool and
what are some of the steps that they can take
to ensure that they are aware of their rights and also,
like you know, ensuring that they're forming that partnership with
the employer to kind of work through this hard time.
Speaker 5 (28:53):
I think dealing with work and a serious medical condition
and making decisions about what to do next involves a
lot of factors. It might be about somebody's work environment
and whether or not they feel comfortable disclosing if they
have a supportive work environment.
Speaker 4 (29:16):
It could be about the size of their employer.
Speaker 5 (29:19):
And what laws and legal protections they have access to.
Speaker 4 (29:23):
It could be about benefits they have access to.
Speaker 5 (29:27):
It could also just be a very personal decision about
whether or not somebody wants to focus on their health
or try to balance work and their health.
Speaker 4 (29:37):
So there's a.
Speaker 5 (29:38):
Lot of pieces that go into those types of decisions, but.
Speaker 4 (29:43):
I think really at the core of.
Speaker 5 (29:44):
It is understanding how your medical condition is going to
impact you and your ability to do your job. There
are certainly types of medical conditions and types of jobs,
and those medical conditions are going to prevent so from
doing their job. But at Triash Cancer, our goal is
to help people understand what their goals are and then
(30:07):
how do we help someone meet their goals. So, if
their goals are to stay at work, Understanding how the
Americans the Disabilities Act provide someone access to accommodations so
that they can get help in doing their job or
even returning to work, if it's about taking time off,
if that's their goal, Understanding how the ADA and the
(30:29):
FMLA provides those legal.
Speaker 4 (30:31):
Protections to be able to do that.
Speaker 5 (30:33):
Maybe somebody has access to state disability insurance options and
that makes it easier for someone to decide to take
time off work or not so the decisions around what
to do next, I think are really rooted in figuring
out what your goals are with work, and then how
(30:53):
you can meet those goals using the laws and protections
and benefits and programs that are available to help you
do that. And that's really the core of what we
do at Triage Cancer is helping people understand what those
laws are and what their options are so that people
can make the best.
Speaker 4 (31:11):
Decision for them.
Speaker 3 (31:13):
And just like you had shed, like you know, there
were like two to three points people could keep in
mind as they were going and looking for different options
for the insurance. Are there any key points that people
need to keep in mind as they're making these decisions?
Speaker 4 (31:31):
I would say the first is talk to your healthcare team.
Speaker 5 (31:34):
So if you haven't yet maybe started treatment, and you're
not sure how your medical condition is going to impact you,
or even if you've just started, what the long term
implications of that could look like.
Speaker 4 (31:46):
But talking to.
Speaker 5 (31:47):
Your healthcare team and understanding how your medical condition is
going to impact you and the treatment.
Speaker 4 (31:52):
That you're going through.
Speaker 5 (31:53):
The second piece is understanding what your rights are, and
then three figuring out what.
Speaker 4 (32:00):
Is important to you, What are your goals.
Speaker 5 (32:02):
So if your goals are to stay at work and
to stay in your career, and you know, some people
actually like their jobs and that's where they find their
support system, and so it is sometimes very important for
people to stay at work. Other people that is less important,
and they're more focused about how can they take the
time off.
Speaker 4 (32:20):
To focus on their health.
Speaker 5 (32:22):
So figuring out you know, how your health is being impacted,
your rights, and then your goals I think would be
the first three things to do. And then sorting through
that information is actually why we came to our organizational name.
The action of triaging through that information and then figuring
(32:42):
out what needs to be dealt with first and what
can be waiting until later.
Speaker 3 (32:47):
And what can people do if insurance denies coverage to them.
Speaker 4 (32:51):
I think this is something that we see a lot.
We're seeing it in the news, discussions around how health
insurance companies are denying coverage for care and or denying
coverage for prior authorizations to get access to care. And unfortunately,
we know that most people take no for an answer,
and that is really unfortunate because we know, based on
(33:16):
data that when somebody is denied a coverage for care
ninety nine point nine percent of the time, they're not
appealing even to the first level of appeal. So even
though we hear about appeals in the work that we do,
very few people are actually taking advantage of that consumer
(33:37):
protection where you not only have a right to appeal
that insurance company's decision if they say no, and you
have a private insurance plan, like through an employer or
an individual plan, you can go outside the insurance company
to an independent entity, to what's called an external medical
review or an independent medical review, and they decide whether
(34:02):
or not the care that you've been prescribed by your
healthcare team is medically necessary. And if they decide that
it is, that decision is binding on the insurance company
they have to cover it. And we know based on
data that about on average fifty percent of the time
patients are successful when they go through that external appeal.
So if ninety nine point nine percent of people are
(34:24):
taking no for an answer, but if they got to
the external appeal stage, they would actually win their appeal
fifty percent of the time, that's a lot of people
who That is a lot to how long here.
Speaker 3 (34:37):
That people can receive Yeah, and really that.
Speaker 5 (34:43):
God, what that translates to is that people either aren't
getting care that their healthcare team prescribed or they're paying
for it out of pocket. So that just contributes to
the financial burden if they're paying for something out of
pocket that their insurance company should have covered.
Speaker 3 (35:01):
Right, Yeah, and I'm assuming that you help out with
that as well.
Speaker 4 (35:07):
We do.
Speaker 5 (35:08):
So your ability to appeal depends on the type of
insurance that you have, but across all types of insurance
you have the right to appeal. It's just that the
details of how you actually go about doing that are
different based on the different types of insurance that are available,
whether it's an employer plan or Medicaid or Medicare or
maybe even VA Healthcare.
Speaker 4 (35:30):
So the process is different based on the plan.
Speaker 3 (35:35):
Absolutely, So quick question for you, given all of this,
this is very very important topic that you brought it up.
Thank you for that. How can people connect with you
and Monica? How can access the Initially it's strategicancer dot org.
(35:58):
Outside of that, like you know, just reach out to
you through your website or any other venues.
Speaker 5 (36:05):
Yes, absolutely, you can visit triage cancer dot org or
Triage health dot org and you will find a plethora
of information about a variety of different topics that come
up when navigating healthcare, whether it be health internt GO,
our employment issues, or disability insurance, but also finances and
consumer rights and managing medical bills or maybe estate planning
(36:30):
documents and medical decision making documents like advanced healthcare directives.
Speaker 4 (36:35):
We provide information about all of.
Speaker 5 (36:37):
Those legal issues that are also state specific, and then
if somebody would like to learn more, they can attend
our free educational events, which they can sign up for
on our website. And then we also have a free
legal and financial navigation program where we will answer people's one.
Speaker 4 (36:56):
On one questions.
Speaker 5 (36:57):
So if somebody was going through of those healthcare transitions
or is newly eligible for Medicare and isn't sure how
to make the right decision, we can help someone understand
their options so that they can make the best decisions
for them.
Speaker 3 (37:15):
Absolutely. And if also y'all have written a book, correct.
Speaker 4 (37:20):
We have.
Speaker 5 (37:20):
So Monica and I have both taught law school classes
on cancer rights law and there wasn't a book. So
teaching a law school class without a book is a
lot of work because we have to compile the readings
for each class.
Speaker 4 (37:37):
So seeing that gap in the literature. We actually co.
Speaker 5 (37:42):
Wrote cancer rights Law that was published by the American
Bar Association, so that not only we can use the
book in class, but that.
Speaker 4 (37:51):
Others can as well.
Speaker 5 (37:53):
But we also wrote it in a way that it's interdisciplinary,
so healthcare professionals can also use this information to support
patients and caregivers, but also advocates and others who just
want to understand their rights in many of those areas
I mentioned are covered in that book.
Speaker 8 (38:16):
Any last thoughts you would like to share, I would
just encourage people to understand what their options are even
if you're not dealing with the serious medical condition.
Speaker 5 (38:27):
One of the reasons we created Triage Health was to
try to help people understand these issues before they need it,
so that they have a good health insurance plan so
that if they are diagnosed with a serious medical condition,
they're already prepared and certainly to understand what your employment
rights are because in looking at job opportunities, you can
(38:49):
take that information into consideration when making employment choices as well.
Speaker 3 (38:56):
Very powerful, Well, thank you for joining us and share
hearing all these details, and like you know, Joanna and
Monica Yola doing such great work, so thank you for
doing it. And keep helping people and so listeners, I
(39:17):
pray to God that none of you have to face
any of these, but if you do, you know where
to go. You know, definitely check out their website and
our prayers and thoughts would be with you through the
tough times. So thank you for being part of our show,
and be careful you. We want you to have happy,
(39:40):
healthy life and that also means good healthy financial life
as well, So take care of yourself and also want
thank you for making the show technically possible. Until next time,
be well and take care.
Speaker 2 (39:58):
Thank you for being part of Beyond With your host
v Park, we hope you have learned more about how
to start living the life you want. Each week on
Beyond Confidence, you hear stories of real people who've experienced
growth by overcoming their fears and building meaningful relationships. During
Beyond Confidence, Dvpark shares what happened to her when she
stepped out of her comfort zone to work directly with
(40:19):
people across the globe. She not only coaches people how
to form hard connections, but also transform relationships to mutually
beneficial partnerships as they strive to live the life they want.
If you are ready to live the life you want
and leverage your strengths. Learn more at www dot dwpark
dot com, and you can connect with vat contact at
(40:40):
dvpark dot com. We look forward to you joining us
next week
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