Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Hi as Mayan Thomas hosted the fifty five Carsey Morning
Show Monday through Friday. Hoop you tune in five am
to nine am, and I also get to facilitate this
conversation we have every Sunday at this time with John Roulman,
and of course I got to mention the team it covers.
Since see John Roman's a bit of a rock star
because of the segment. People are always really excited when
they get to meet him in person and always want
to talk with him directly. But working with any of
(00:25):
the team it covers, since he is going to get
you exactly the same place John can get you, but
he's happy to talk with you, so feel free to
call him because you're going to want to do it.
It's medical insurance and it's less can be a lot
less money than you think and a lot better coverage
than you think when you're working with John on the team.
As I always like to start out, he is your
insurance broke or working exclusively for you, not the insurance companies.
(00:49):
And he's got a couple of hundred different insurance companies
he has access to for policies, thousands of different policies,
and trust me, as I've learned over the years, there's
certainly more than one way to skin a cat, and
you can address your individual situations. We talked about choosing
the right health insurance plan last week. There's a careful
analysis of where you are in your life, how many
(01:09):
people like you have a family you're ensuring them as well.
So it's important thing to know a lot about you,
and they take all that information and then go and
find the best coverage to fit your individual situation. So
the number to call eight hundred two two five five,
that's five to one three eight hundred call. You can
also get the process of this analysis started by just
(01:30):
going to the website coversinsey dot com. Fill out as
much as you can about the information they're asking you
with the forum that's right there on the website coversinci
dot com, and they'll get right back with you. All right.
We talked about choosing the right health insurance plan last week,
and this week we're going to talk about how to
maximize your health insurance benefits. I guess once that coverage
is in place.
Speaker 2 (01:50):
Yeah, I mean, it's just kind of like we talked
about last week, really just kind of diving in making
sure that you have the right plan, but then you
know you're like kind of like, now what right? So again,
the next step really is get a get an invested
interest in understanding your coverages. You know, I mean again,
you can reach out to us. I mean, we can
always go back over with you again, but understanding your coverage,
(02:13):
understanding your plan is just so paramount because again, in
the healthcare realm, there are so many pitfalls. There's so
many situations that you can be in, just like anything
that can substantially change your livelihood in the form of
out of pocket expenses and exposure that you could be
subjucicated to. So I always tell people, you know, you know, familiarize,
(02:34):
familiar familiarize yourself with you know where, how's my copay's work?
You know, is it Do I get a copay for everything?
If I do at as a specialist, or you know,
do I get the copaid just for the visit? But
then anything as specialist is doing at that office, like
all the other tests they want to do and or
and our procedures in that office, you know, is that
going to be subjucicated to my deductible And that could
(02:57):
be And that's a huge thing we get from people
all the time where you know, go ah, Joyce want
and saw a dermatologist and he did all this stuff,
and then why do I owe all this money? Well,
that's the plan that you chose, you know, that's that
situation that you're in. That copaid did not cover everything
that that doctor was going to be doing in that facility.
So that's just kind of one thing to kind of
think about. But you know, there's there's so many different
(03:21):
scenarios that we can talk about here for the next
like eighteen weeks that can kind of come up. But
it's just kind of understanding those things. And again, you know,
for the for the most listeners, you know, let's be honest,
we have a sinus infection. We're gonna go call our doctor,
get appointment, tipul it's a cope, right, you know, that's
majority of claims or are those small claims. But then
(03:43):
when things start escalating, that's where we can really get
int those bad situations. And of course, if you're a
client of ours, reach out to us, we'll walk you
through that's a situation to make sure that you're alleviated,
because you'd be surprised how many times people go oh,
I just you know, I saw a specialist and he
advised me to an MRI, so I thought it was
just the cope, And now I'm stuck with a three
(04:04):
thousand dollars MRI at a hospital. You know, those things
don't always work out the right way. So again it's
why it's so important to really understand your plan, and
of course if you're on one of our packages, you know,
sometimes understanding how those extra levels of coverage really work out.
We do get a lot of questions about that. Sometimes
six months, two years later, I know you sold me
(04:24):
this package, I haven't had to use it yet, how
does it kind of go through? But you know, and
a lot of times, you know, I think people when
they listen to the show, they go, well, it just
seems a little bit more complicated what John's saying. I mean,
for most part is typically have two insurance cards. You
have a primary, which I tell you to like literally
put a number one on, and then you have a
(04:44):
secondary and it says number two. So when you go
into your physician's office or hospital, whatever it is, you
just tell them this is my primary coverage and this
is my secondary coverage. There's actually usually a spot on
that intake form that you can actually put that on.
And that's really, for the most part, all you ever
had have to do because nine out of ten times
that will work out perfectly fine unless we get a
(05:05):
billing issue, which you know you'll iron.
Speaker 1 (05:08):
That out too. And like when I walk in and
they say, can I see your insurance card? People have
two insurance cards. You give both of them to the
person doing the intake.
Speaker 2 (05:19):
And then you used to let them know which one's
primary because you want that one bill first. So like,
if you have a major medical plan with us, we
want you to build a major medical plan first, or
the catastrophic coverage, because that's a typically high deductible plan.
It's really just designed to pay the bigger bills. But
we want to start wing the way that deductible through
the year, right because I mean, even if you have
a thousand dollars bill and butt your my deductible's five grand,
(05:41):
you know I want you to be able to go
through the primary because yes, they're still going to apply
that thousand dollars towards you're deductible for the year. Well,
now you only have four grand left. Now the secondary
coverage comes in and hopefully that's going to pay the
entire bill that you have, if not more, and that's
where you get a check back. But in that situation,
you don't want to just use your secondary because like,
well the bill's really small, it was just my secondary. No, No,
(06:04):
whittle it away because you have no idea what's going
to happen six months from later. You might not have
to have to go to have a surgery. Well I
only wanted four grand left, right, you know, And that's
really and again that's just kind of familiarizing yourself with that.
And again, just like we talked about last week, Uh know,
your network that is so important. You know, so many
times we'll get people that go, well, I went and
(06:24):
saw this doctor. He recommended me go see the specialists.
I walked in there and they tell me they don't
take my insurance.
Speaker 1 (06:30):
You know.
Speaker 2 (06:31):
Making sure a lot of these insurance companies right now,
they have online portals. It's not something like back in
the day when I first started, like they'd have to
send you a book with every doctor in your in
your area, right, you remember those days.
Speaker 1 (06:43):
So absolutely so.
Speaker 2 (06:44):
Technology has helped streamline a lot more. Some of these
insurance companies even have apps. You can download your cellphone
and you can literally go in there, put your zip
code in, put that type of specialist you want to
go see, and it pops it out. And it's just
so important. Of course, know your network, you know, that
would say, I would say, outside of knowing your coverages,
that would be really the next most important thing to
make sure you got to go over.
Speaker 1 (07:05):
Well, how about taking advantage of free services?
Speaker 2 (07:08):
Man, This is this is huge because you when I
started in this business twenty years ago, a lot of
health insurance companies didn't really pay well on preventative care.
You know, that wasn't usually a free benefit.
Speaker 1 (07:20):
It's all the rage though these days.
Speaker 2 (07:22):
Well absolutely, I mean it's I think it's so much smarter.
I mean, you know, I mean getting ahead of problems.
I mean, you have no idea how many clients over
the years that I've helped and I call them, we
call them the good old boys, you know, the ones
that you know, they're they're in their fifties and they go,
I don't go to a doctor. I'm you know, I'm
not going to go in unless I'm dying. Well, the
(07:44):
problem is, you know, we always think that this is
this is something that's probably a heart attack waiting to
happen because he hasn't seen a physician in thirty years. Right,
that's your husband. Get him in, you know, because you
know somebody walking around with one hundred and sixty blood pressure,
I mean, is you know or more? It's gonna be
somebody that's going to have a massive problem in the future.
(08:05):
And we see the insurance companies more and more now
paying for these services. Of course, it's a mandate, you know,
with the healthcare reform bill. You know that these plans
it's called minimum essential coverage, has to have has to
have it in there. And that's why it's just so
important to utilize those benefits. It's it's funny when I
when I do reviews with clients, I was like, oh,
(08:27):
how you know, what what'd you guys do last year?
I didn't use that at all. I was like, you
didn't even get your physical, you didn't get your mammogram.
Like now, I was like, you do realize they're free?
I say, not only free, I have a secondary plan
that'll actually give you a check for like two hundred
and fifty bucks if you go do it, So please
go get it done. I'd like to get you that
check for two hundred fifty dollars, Like, Oh, I didn't
realize this is gonna get paid to do it. I
(08:48):
was like, that's literally the packages I'm building for your
listeners is like they get paid to do these benefits.
So like, go get it done. And you know, we
have seen a huge uptick on that, and you know,
we've had clients call back like oh hey on something.
You know it's like ah, and I'm like, oh, I
feel so good that you went in like and that
you had it done. So you know, that's a huge
benefit that most people don't take advantage of. You know,
(09:11):
of course, scheduling those regular checkups. You know, it's just
it's just it's just so important to make sure you're
using that. And you know, things like you know, vaccines
and stuff like that are going to be covered, the screenings,
your PSA test, uh, your COLO rectal exams, you know,
I mean you don't typically always have to do that,
but there's other things like COLO guard and stuff like
(09:32):
that that these insurance companies are utilizing so you don't
have to. There's less invasive things. So again, it's just
so important to make sure you're utilizing your benefits. I mean,
get the benefit out of your health insurance you're paying
for it. Have them pay something. I'm I'm in that
boat with you. I don't want to sell you something
you just don't use at all.
Speaker 1 (09:49):
Well, and again it's for your own benefit. And you know,
I also have to add it. And it's really important
to have a primary care physician that you see at
least annually. They have a good baseline established, so they
have a benchmark from which to you know, gauge you
the following year to see if anything's deteriorated or falling apart,
or maybe you know you've had an experience, you know,
(10:11):
a sudden weight loss and you get on the scale
and the doctor says, hmmm, last year you were twenty
pounds heavier. Did you go on a diet And you're like, no,
I just sorted losing weight. Well, there's a red flag
you might have cancer. So you know, baseline, having it
established and having a good relationship.
Speaker 2 (10:25):
And then and then, but there's also people that just like,
I don't want to do that, you know, I don't
you know, I don't want to have to go see
a primary care guys. Can you can do these a
urgent cares. Most of them don't realize you can get physical.
With those urgent cares, they can do a lot of
stuff for you, at least get you the information back
and you know with the online medical information now that's
(10:46):
uff's there, they can they can pull it up if
they're in that system, and they can see the ongoing trend.
So you know, I know how hard sometimes it is.
The fine a primary care nowadays, you know so many
places those don't even take new patients. So again, you
will have access to that. Your plans will still cover.
You can even go through an urgent care because they're
still doctors.
Speaker 1 (11:04):
Try to getting into a dermatologist.
Speaker 2 (11:06):
Oh I know, we'll talk about that here in a minute.
Oh really absolutely, so up come a teaser, little teaser. Yeah.
The other thing too, you know we've talked about this
last week, like hsas and fessays. A lot of these
will kind of be geared to, especially fessays. If you're
an employees employer sponsored plan, you probably already had to
get that structured here at the end of last year.
(11:28):
But again this is kind of like four planning. You know,
hsas are really good plans. You know, if you have
an opportunity to take advantage of it, especially if you're
relatively healthy. Don't be scared of these plans. But most
people don't really understand when you buy a health savings account,
it's a highductible health plan. They're not going to have
co pays for doctor visits. You're not gonna have co
payce for prescriptions. Basically, whatever you're deductible is that you
(11:49):
chose three, five, seven, ten grand, whatever it is, you're
going to have to meet that deductible before the insurance
company pays anything, which is not bad. I mean typically
your highductible plans are gonna be significant any less expensive
than those plans. They are going to have all those
extra benefits in it, like the copays for doctor visits
and prescription coverage. But again this is geared more for
someone that doesn't really utilize a lot of medical expenses.
(12:11):
So if you're younger, then you're like, I don't I'm
not going through a long term I'm not seeing a
doctor once a month, Like probably a really good option
for you. But the kicker here is fun the savings account, Like,
don't just take a highductible health plan and don't put
the extra money away. So many people take these plans down.
They're like, oh, I thought by buying this plan, there
(12:32):
were some of that money went into a health savings
I was like, no, that's the premium for the plan.
You have to then open up a savings account and
start putting the money away there. And it's it's advantagents
for you because it works just like an IRA. So
the money that you're putting into that account is you're
writing it off in your taxes, right, So if you
can put three four five grand into that account, you're
you're you're you're reducing your income on that as far as.
Speaker 1 (12:54):
Your paycheck too, So you don't have to have the
discipline to actually you can.
Speaker 2 (12:57):
Do You can absolutely do that too. Allow your listeners.
Of course, you know that we deal with are self employed,
so again they have to take advantage of that. You
can set up a health savings accounts pretty much any bank,
So again, do to that because it builds up over
time and some of the things that people don't realize.
It's an IRA. So at fifty nine and a half,
if you have money in there, you can use it
(13:18):
like a regular IRA. You can start taking money out
and pay taxes on it. The other thing that's really
nice too, is you can actually utiltilize it when you
go on Medicare. You can actually use your HSA money
to pay your part B premiums. Oh really, which right
now this year is one hundred and eighty five bucks
a month. So again, might as well use it with
tax free money, you know, and still cover medical expenses
(13:40):
later on in life, even though you can no longer
fund it once you go on Medicare. So we've had
a lot of Medicare people. I'm hinting to you. If
you are on Medicare and you are still on a
group health plan and you're on an HSA, you cannot
fund it anymore. So stop doing it as a IRS
big red plan.
Speaker 1 (13:58):
Oh no. The last thing you want to do is
invite an audit.
Speaker 2 (14:02):
No no, And we hear so many people doing that.
And the other thing question we get a lot of
time is f f f s a's flexible spending accounts.
Again typically gonna be done through your employer. But again
you have to really understand how an FSA works. It
is something that you have to, you know, put money into,
but of course you have to use that money by
(14:23):
the end of the year.
Speaker 1 (14:24):
Yeah, that's the reason I find a little uncomfortable with
those as a concept.
Speaker 2 (14:28):
It's good if you have something planned, like if I'm
planning to get something done. If I know, like, hey,
I have to get a surgery done this year, I
know what my deductible is. That's a great situation. My
brother actually set up one. He's a he's a he's
a cop up in Walkee and he's like, you, guys,
my wife, she's my sister in law. She's putting money
(14:49):
into an f s A. I'm like, oh, that's great,
Like what are you using the money for?
Speaker 1 (14:52):
Oh?
Speaker 2 (14:53):
She just contributes the maximum. How I'm like, but you
guys don't really use it. I was like, so where
does that money go at the end of the year.
Speaker 1 (15:00):
Goes?
Speaker 2 (15:00):
I don't know, it goes, it disappears.
Speaker 1 (15:03):
See, So like not using all your vacation days. You
find out the end of the year that you had
fifteen extra days carrying over. You're like, I don't get
any carryover. It's gone, it evaporated, Like it's crazy.
Speaker 2 (15:15):
So yes, in her situation is like, well, I why
don't you stop doing that?
Speaker 1 (15:19):
Right over and stopping at a health savings account.
Speaker 2 (15:23):
Yeah, So again just just really important things to not allize.
The other thing is again kind of going back to
knowing you're out of pocket expenses, track your expenses. I
tell everyone, you know, the best thing you can do.
I do this exactly the same way. So every year
I have a mellow polder. I put the plan here
on it, I get all the claims and eobs and everything.
I put them all in there, and I track what's
(15:44):
going on because you know, things happen. You know, I'm
dealing with insurance companies and trusting that everything that they're
doing and guys going towards deductibles and all types of stuff.
So I do track that stuff for myself. And again
it's if you average person going to one doctor visits year,
you don't really need to go that route, but especially
someone that has conditions where they're meeting deductibles. And the
(16:06):
other thing too is just because you get a bill
from a doctor or a hospital doesn't mean you owe
that money. I really want to kind of point that
out because so many times we'll see where there's billing
issues where the hospital didn't bill your insurance properly, or
in my case, this has happened multiple times because I
changed my plans, even though I gave them my new stuff.
(16:28):
They still build an insurance company had seven years ago. Well,
they don't always notify me, and then I just get
a bill. So you want to match what the bills
are from the hospital or whatever you're doing with the
actual explanation of benefits that you actually get back from
the insurance company. You will always get an explanation of
benefits from an insurance company if they receive a claim.
(16:50):
If they don't receive a claim because of a billing
issue and you get a bill, that's because your insurance
company never got notified. So it's an easy step process,
and we advise this is probably one of the number
one phone calls that we get is you know, I
got a bill? Do I owe this money? I'm like,
well did you get did you get an EOB from
your insurance company? And I was like, well, wait a
couple of weeks if you get one. If you don't,
(17:12):
let us know and we'll try to navigate that with
the insurance company to find out what happened. And then
if ninety five percent of the time it's it's a
billing issue from the provider, yeah, yeah, but again just
knowing that and don't pay that bill because I mean,
it's it's it's it's harder to get them to then
rebill if you paid your bill. So take a deep breath.
(17:33):
You know, it's not something they're going to go hit
your credit with and it's and trust me, they want
to get paid too. They don't want to just come
out to you and just put you in collection.
Speaker 1 (17:41):
So noah, I know, because the collection you just get
what a third or something of the reason. I don't
even know.
Speaker 2 (17:45):
If it's that much. I mean I've I've known people
that do that business and you're talking five to ten
cents on a dollar, oh lord, and they go after
for maximum amounts. So that's what I've heard, so I
mean it's it's crazy. So again, just do your due
diligence that know you're out of pocket expenses and you know,
absolutely utilize that. Next thing, of course, telehealth. I love telehealth.
(18:08):
I've been a big proponent of that for years. I
mean we've been at some levels using telehealth probably for
like the last fifteen years of my business. And I
know it's a bigger thing that kind of came up
through COVID and you know, a lot of health plans
now have telehealth and I brought up stories in the show.
You know, my wife got poison ivy. We didn't know
(18:29):
what it was, and you know they they you mentioned
dermatologists earlier, right, I mean they literally brought dermatologists on
the call and they were she was facetiming, was showing
this rash that she got, and they go, yeah, that
definitely looks like poison ivy. Well, the primary care didn't
know right away. I mean how long would that have
take us to figure that out? You know if we
went to the saw in person primary care and then go, okay,
(18:50):
well now I got to get a specialist visit for
you to go see a dermatologist. Well, now I can
get in eight weeks later by the time you know,
who knows what happened with gone at that point.
Speaker 1 (19:00):
Or you try to figure it out yourself and you
go online, where do you start? All I have is
you have a rash. You have no way of knowing
what it is. It's not like you're saying poison you know,
images of poison ivy and trying to match what you've got.
You got to start with nothing images of skin rash.
I mean you mentioned when you come up with like
it kind of looks like that a little bit. No, no, no, no,
they get they're smarter people in the world that are
(19:21):
out there to figure out.
Speaker 2 (19:23):
You have no idea. And you know what's nice too,
is there are a lot of plans out there that
still don't have this within their plans. A lot of
the plans that we sell Brian actually have this already
incorporated with the packages, so you're getting free telehealth. We
actually have a plan right now that we rolled a
lot of our clients in. It's uh, it's like fifty
bucks a month for the whole family. It's absolutely free usage.
(19:48):
You can use as much as you want. But it
comes with mental health. And another big proponent right now
is access to mental health. And we know, I mean
I know first and how hard it is to get
in to see anybody nowadays in that it's worse in
dermatology it is. But these programs right now, this program
(20:09):
we actually picked up literally you can Utiliza for any
adult member of your family. They get access to mental
health for free and it's unlimited use. And there's a
lot of programs out there right now. I've seen them
all the time online. I mean they're charging three, four
or five hundred bucks a month to get into their
mental health program. I'm like, this is fifty bucks a
(20:31):
month through a major telehealth company and they're giving it
to you for free, like take full advantage of that.
Speaker 1 (20:38):
So I'd say it's it's it's.
Speaker 2 (20:40):
Remarkable, and I know the stigma that a lot of
listeners probably have behind that and it's just sometimes maybe
going to a facility that has that. But I mean,
you can do this from the comfort of your home.
Speaker 1 (20:49):
Yeah, no walking into the office, going to the you know,
the psychologist or you know, psychiatrist's office and you know,
sitting in the waiting room or anything like that. And
that's that's an amazing benefit that right now.
Speaker 2 (21:00):
And we roll that out a lot to our employer
groups so that your employees have access to those benefits too,
because I mean, it could be just stress, it could
be something going on at work or going on home. Like,
let's let's nip that in the butt. So when that
employee comes back in the next day to go to work,
they already talked to somebody and they're and they're they're
they're working their way through it, not sitting at their
desk and going my life's terrible and I'm not going
(21:23):
to work today.
Speaker 1 (21:24):
It's doing in their own juices. That's right, Yeah, that's
right ugly.
Speaker 2 (21:27):
And then just the next thing really kind of going
into is review and understand your claim process. You know
how to submit claims properly and sure your provider submits
the claim. That's that's the big one. Like we just
kind of hinted on a lot of claim denials, a
lot of issues typically come from billing. The first thing
I always tell people when you call in and they go, hey,
(21:50):
my claim's not getting paid. I got a bill, is like,
all right, first step just reach out to your provider
make sure they actually build the right insurance company. If
that steps are already done, then I can really pick
up the ball and move forward. Because of hippo lows,
I can't just call your provider, where's what's going on?
So as long as you have that kind of done
and like, yes, we build your insurance company, they declined it.
(22:13):
Of course, if you're a client, reach out to us.
We can start working through it. See if the provider
got a wrong code on there, or if there was
a pre existing condition or just something kind of going on.
We can start alleviating that symptom, that situation. But again,
just kind of understanding that and how to submit claims
properly because it's really really important. You know a lot
of people, like we have listeners that have multiple products.
(22:35):
It's sometimes these claims have a shelf life, right. I
mean it's not like, oh, I had a claim thirteen
years ago, I can still go back and get my
money back from the insurance company. Some of these plans
out there and not a lot of the stuff that
we sell. You know, you have to submit within a
certain timeframe thirty sixty ninety days, So don't delay on
those situations, especially things like since we do so many
(22:57):
cancer policies and critical illness policies, you know there's there's
a timeframe before you can get your money because they're
gonna have to do their due diligence. Make sure that's
a proper claim you actually had cancer. So again, making
sure you submit those claims on time. At least get
us involved in those situations so that way we can
start the process and the paperwork for you because I
(23:17):
want to make sure you get your money up front.
I want to make because they're you know, the process there,
Brian is I got diagnosed with cancer. I have a
cancer policy. I want them to start paying. Well, the
insurance company doesn't know if that's a legitimate claim. So
we have to provide that paperwork saying, yes, here's the cancer,
this is where the doctor wrote it down that you
were diagnosed with cancer. This is what the type of
cancer was. Submit that documentation to the insurance company so
(23:40):
they can cut you that fifty thousand dollars check.
Speaker 1 (23:43):
Right.
Speaker 2 (23:43):
You know, that's why I want to get that in
your hand, because again, you know what you're going to
be going through for the next six months or more.
We want to make sure that money's in your checking
account so you can go through that. So again, just
kind of understanding those situations is really really important. And again,
do not think that of an insurance company turns around
declines your claim, that that's set in stone. I mean,
(24:05):
we've battled for clients considerably over the years, and a
lot of situations we're able to get those claims paid out.
There's loopholes. It's just like you mentioned. Being a lawyer,
I mean I've seen the loopholes. You know, certain insurance
companies and certain states have different regulations and sometimes insurance
companies blanket decline and I go, well, you're in a
(24:26):
state that you can't decline for that. I've literally had
those conversations and I go, yeah, we have to pay
that bill. So it's yeah, I mean, it's those things happen,
and I mean I think we're kind of in that
state of awareness right now with things that have happened
here a few months ago with like United Healthcare and
stuff like that. You know, a big proponent with them
was the fact that they declined so many claims that
(24:48):
all kind of came to light, and that's something that
we deal with all the time. So again it's you know,
as a broker working with so many different insurance companies,
it's I can tell you that they've all done it.
It's not a situation where like this company up here
never does it like they all do it at that
realm because everything to them is black and white, right,
and there's no gray area. So we have to make
(25:09):
sure that we're doing the right things in our processes
and how we submit claims and do things, so to
make sure that that is alleviated from you and to
the average person. That can be a nightmare I can't
imagine if I mean, I literally I've had claim denials.
I turn around to my care team and I hand
them my bill because at this stage, they do it
all day every day. They know better than I do
(25:30):
now on how to get these things taken care of.
So it's around yourself with good people. You have to
I don't deal with the client claims every day. They do.
They know exactly who to go to, what happened, and
you know, even and a lot of times it's just
again CPT codes are wrong from the physician, and it
happens so often. Medical billing errors are prominent in today's stage.
(25:53):
I mean most people don't understand that, but it happens
all the time. That is something you have to be
aware of. And like I said, if if you're not
wanting to do that on your own, I mean, just
come to us and get that as your burger. I mean,
even if you're on an ACA plan. I put this
out to you people right now, if you're on an
Obamacare plan, affordable care at Healthcare dot got, whatever you
(26:13):
want to call it, and if you bought it yourself
and you would rather have our team, and even though
you took care of yourself. You can call us. We
can actually become agent record for you on that policy,
and then you're a client of ours and we can
start helping you. There's no additional costs, costs you nothing
to do that. You can just say, hey, I did
this my first on my own January first. I did
(26:34):
not have an agent help me, or I had an
agent help me. I don't even know who it was.
I would prefer to work with you, guys all we
have to do it. Takes like five minutes to become
your agent, and now you're working with us and there's
no additional cost, nothing else happening to you.
Speaker 1 (26:49):
You just bought yourself a lot of phone calls.
Speaker 2 (26:51):
Friend, I'd rather help them.
Speaker 1 (26:53):
I can pass up on an opportunity to have John
on the team to help you out in this. Ye.
Speaker 2 (26:57):
No additional cost, no additional cost at all.
Speaker 1 (27:00):
Oh that's five one three eight hundred two two five five.
By the way, I just had to get that in there, John.
If somebody's like I can do that, I can do that. Yes,
five one three eight hundred call you.
Speaker 2 (27:09):
Can absolutely do that. And you also get a free
evaluation at that point, just to make sure the right plan.
Speaker 1 (27:14):
Yeah, I mean I figured you would do that.
Speaker 2 (27:16):
We're to do that. It's not just calls up. I'm
going to be your agent. I mean, we're still going
to do our due diligence, make sure you're the right plan.
But again, at the end of the day, I'm not
here to upsell you or anything like that. I'd rather
just start working with you. You can see what we do,
and if you feel comfortable with us, you might want
to pick up something later on.
Speaker 1 (27:32):
That's just absolutely, absolutely amazing. Well, we only have another
minute or so left in the segment here. Anything you
want to pass along before we part company this morning.
Speaker 2 (27:40):
Yeah. The other big thing here, and this goes out
to everybody. I don't care if you're on Medicare, I
don't care if from the marketplace. Keep informed with changes
of your insurance plans. You'll get letters throughout the year
if anything changes with your plan, or your rates are changing,
or doctor provider networks are coming out. Don't just throw
those paperwork away.
Speaker 1 (27:58):
Read it.
Speaker 2 (27:58):
If you have a question, call us. We can go
over that to make sure that doesn't really affect you.
But again, like in September, you start getting those annual
notices of change for Medicare. I mean they're really big,
you know. I mean you I've literally watched insurance the
hospital groups like just get dropped in the middle of
that time frame and you lose and you lose your doctor.
(28:19):
So like, don't be sitting there like well they yeah,
I got this letter from them back in like March,
and then I still went to the doctor and now
I'm paying the bill because they're no longer a network.
Like if you see something like that, if you're a
listener client, if you ever get a letter like that,
you call us. Let's make sure that we don't we
can adjust your plan, change that we need to or
kind of advise you when we can do that, because
(28:40):
you have to do that. Don't don't. They'll just throw
those letters away so hard because they're notifying you and
they can stand by that train.
Speaker 1 (28:47):
It's time. Just good another day. Don't there to go
to a job role cover since you can get the
process started cover. Since dot com there's a lot as
much information on the forum right there as you can
or again called five one three ball by would be
given
Hi as Mayan Thomas hosted the fifty five Carsey Morning
Show Monday through Friday. Hoop you tune in five am
to nine am, and I also get to facilitate this
conversation we have every Sunday at this time with John Roulman,
and of course I got to mention the team it covers.
Since see John Roman's a bit of a rock star
because of the segment. People are always really excited when
they get to meet him in person and always want
to talk with him directly. But working with any of
(00:25):
the team it covers, since he is going to get
you exactly the same place John can get you, but
he's happy to talk with you, so feel free to
call him because you're going to want to do it.
It's medical insurance and it's less can be a lot
less money than you think and a lot better coverage
than you think when you're working with John on the team.
As I always like to start out, he is your
insurance broke or working exclusively for you, not the insurance companies.
(00:49):
And he's got a couple of hundred different insurance companies
he has access to for policies, thousands of different policies,
and trust me, as I've learned over the years, there's
certainly more than one way to skin a cat, and
you can address your individual situations. We talked about choosing
the right health insurance plan last week. There's a careful
analysis of where you are in your life, how many
(01:09):
people like you have a family you're ensuring them as well.
So it's important thing to know a lot about you,
and they take all that information and then go and
find the best coverage to fit your individual situation. So
the number to call eight hundred two two five five,
that's five to one three eight hundred call. You can
also get the process of this analysis started by just
(01:30):
going to the website coversinsey dot com. Fill out as
much as you can about the information they're asking you
with the forum that's right there on the website coversinci
dot com, and they'll get right back with you. All right.
We talked about choosing the right health insurance plan last week,
and this week we're going to talk about how to
maximize your health insurance benefits. I guess once that coverage
is in place.
Speaker 2 (01:50):
Yeah, I mean, it's just kind of like we talked
about last week, really just kind of diving in making
sure that you have the right plan, but then you
know you're like kind of like, now what right? So again,
the next step really is get a get an invested
interest in understanding your coverages. You know, I mean again,
you can reach out to us. I mean, we can
always go back over with you again, but understanding your coverage,
(02:13):
understanding your plan is just so paramount because again, in
the healthcare realm, there are so many pitfalls. There's so
many situations that you can be in, just like anything
that can substantially change your livelihood in the form of
out of pocket expenses and exposure that you could be
subjucicated to. So I always tell people, you know, you know, familiarize,
(02:34):
familiar familiarize yourself with you know where, how's my copay's work?
You know, is it Do I get a copay for everything?
If I do at as a specialist, or you know,
do I get the copaid just for the visit? But
then anything as specialist is doing at that office, like
all the other tests they want to do and or
and our procedures in that office, you know, is that
going to be subjucicated to my deductible And that could
(02:57):
be And that's a huge thing we get from people
all the time where you know, go ah, Joyce want
and saw a dermatologist and he did all this stuff,
and then why do I owe all this money? Well,
that's the plan that you chose, you know, that's that
situation that you're in. That copaid did not cover everything
that that doctor was going to be doing in that facility.
So that's just kind of one thing to kind of
think about. But you know, there's there's so many different
(03:21):
scenarios that we can talk about here for the next
like eighteen weeks that can kind of come up. But
it's just kind of understanding those things. And again, you know,
for the for the most listeners, you know, let's be honest,
we have a sinus infection. We're gonna go call our doctor,
get appointment, tipul it's a cope, right, you know, that's
majority of claims or are those small claims. But then
(03:43):
when things start escalating, that's where we can really get
int those bad situations. And of course, if you're a
client of ours, reach out to us, we'll walk you
through that's a situation to make sure that you're alleviated,
because you'd be surprised how many times people go oh,
I just you know, I saw a specialist and he
advised me to an MRI, so I thought it was
just the cope, And now I'm stuck with a three
(04:04):
thousand dollars MRI at a hospital. You know, those things
don't always work out the right way. So again it's
why it's so important to really understand your plan, and
of course if you're on one of our packages, you know,
sometimes understanding how those extra levels of coverage really work out.
We do get a lot of questions about that. Sometimes
six months, two years later, I know you sold me
(04:24):
this package, I haven't had to use it yet, how
does it kind of go through? But you know, and
a lot of times, you know, I think people when
they listen to the show, they go, well, it just
seems a little bit more complicated what John's saying. I mean,
for most part is typically have two insurance cards. You
have a primary, which I tell you to like literally
put a number one on, and then you have a
(04:44):
secondary and it says number two. So when you go
into your physician's office or hospital, whatever it is, you
just tell them this is my primary coverage and this
is my secondary coverage. There's actually usually a spot on
that intake form that you can actually put that on.
And that's really, for the most part, all you ever
had have to do because nine out of ten times
that will work out perfectly fine unless we get a
(05:05):
billing issue, which you know you'll iron.
Speaker 1 (05:08):
That out too. And like when I walk in and
they say, can I see your insurance card? People have
two insurance cards. You give both of them to the
person doing the intake.
Speaker 2 (05:19):
And then you used to let them know which one's
primary because you want that one bill first. So like,
if you have a major medical plan with us, we
want you to build a major medical plan first, or
the catastrophic coverage, because that's a typically high deductible plan.
It's really just designed to pay the bigger bills. But
we want to start wing the way that deductible through
the year, right because I mean, even if you have
a thousand dollars bill and butt your my deductible's five grand,
(05:41):
you know I want you to be able to go
through the primary because yes, they're still going to apply
that thousand dollars towards you're deductible for the year. Well,
now you only have four grand left. Now the secondary
coverage comes in and hopefully that's going to pay the
entire bill that you have, if not more, and that's
where you get a check back. But in that situation,
you don't want to just use your secondary because like,
well the bill's really small, it was just my secondary. No, No,
(06:04):
whittle it away because you have no idea what's going
to happen six months from later. You might not have
to have to go to have a surgery. Well I
only wanted four grand left, right, you know, And that's
really and again that's just kind of familiarizing yourself with that.
And again, just like we talked about last week, Uh know,
your network that is so important. You know, so many
times we'll get people that go, well, I went and
(06:24):
saw this doctor. He recommended me go see the specialists.
I walked in there and they tell me they don't
take my insurance.
Speaker 1 (06:30):
You know.
Speaker 2 (06:31):
Making sure a lot of these insurance companies right now,
they have online portals. It's not something like back in
the day when I first started, like they'd have to
send you a book with every doctor in your in
your area, right, you remember those days.
Speaker 1 (06:43):
So absolutely so.
Speaker 2 (06:44):
Technology has helped streamline a lot more. Some of these
insurance companies even have apps. You can download your cellphone
and you can literally go in there, put your zip
code in, put that type of specialist you want to
go see, and it pops it out. And it's just
so important. Of course, know your network, you know, that
would say, I would say, outside of knowing your coverages,
that would be really the next most important thing to
make sure you got to go over.
Speaker 1 (07:05):
Well, how about taking advantage of free services?
Speaker 2 (07:08):
Man, This is this is huge because you when I
started in this business twenty years ago, a lot of
health insurance companies didn't really pay well on preventative care.
You know, that wasn't usually a free benefit.
Speaker 1 (07:20):
It's all the rage though these days.
Speaker 2 (07:22):
Well absolutely, I mean it's I think it's so much smarter.
I mean, you know, I mean getting ahead of problems.
I mean, you have no idea how many clients over
the years that I've helped and I call them, we
call them the good old boys, you know, the ones
that you know, they're they're in their fifties and they go,
I don't go to a doctor. I'm you know, I'm
not going to go in unless I'm dying. Well, the
(07:44):
problem is, you know, we always think that this is
this is something that's probably a heart attack waiting to
happen because he hasn't seen a physician in thirty years. Right,
that's your husband. Get him in, you know, because you
know somebody walking around with one hundred and sixty blood pressure,
I mean, is you know or more? It's gonna be
somebody that's going to have a massive problem in the future.
(08:05):
And we see the insurance companies more and more now
paying for these services. Of course, it's a mandate, you know,
with the healthcare reform bill. You know that these plans
it's called minimum essential coverage, has to have has to
have it in there. And that's why it's just so
important to utilize those benefits. It's it's funny when I
when I do reviews with clients, I was like, oh,
(08:27):
how you know, what what'd you guys do last year?
I didn't use that at all. I was like, you
didn't even get your physical, you didn't get your mammogram.
Like now, I was like, you do realize they're free?
I say, not only free, I have a secondary plan
that'll actually give you a check for like two hundred
and fifty bucks if you go do it, So please
go get it done. I'd like to get you that
check for two hundred fifty dollars, Like, Oh, I didn't
realize this is gonna get paid to do it. I
(08:48):
was like, that's literally the packages I'm building for your
listeners is like they get paid to do these benefits.
So like, go get it done. And you know, we
have seen a huge uptick on that, and you know,
we've had clients call back like oh hey on something.
You know it's like ah, and I'm like, oh, I
feel so good that you went in like and that
you had it done. So you know, that's a huge
benefit that most people don't take advantage of. You know,
(09:11):
of course, scheduling those regular checkups. You know, it's just
it's just it's just so important to make sure you're
using that. And you know, things like you know, vaccines
and stuff like that are going to be covered, the screenings,
your PSA test, uh, your COLO rectal exams, you know,
I mean you don't typically always have to do that,
but there's other things like COLO guard and stuff like
(09:32):
that that these insurance companies are utilizing so you don't
have to. There's less invasive things. So again, it's just
so important to make sure you're utilizing your benefits. I mean,
get the benefit out of your health insurance you're paying
for it. Have them pay something. I'm I'm in that
boat with you. I don't want to sell you something
you just don't use at all.
Speaker 1 (09:49):
Well, and again it's for your own benefit. And you know,
I also have to add it. And it's really important
to have a primary care physician that you see at
least annually. They have a good baseline established, so they
have a benchmark from which to you know, gauge you
the following year to see if anything's deteriorated or falling apart,
or maybe you know you've had an experience, you know,
(10:11):
a sudden weight loss and you get on the scale
and the doctor says, hmmm, last year you were twenty
pounds heavier. Did you go on a diet And you're like, no,
I just sorted losing weight. Well, there's a red flag
you might have cancer. So you know, baseline, having it
established and having a good relationship.
Speaker 2 (10:25):
And then and then, but there's also people that just like,
I don't want to do that, you know, I don't
you know, I don't want to have to go see
a primary care guys. Can you can do these a
urgent cares. Most of them don't realize you can get physical.
With those urgent cares, they can do a lot of
stuff for you, at least get you the information back
and you know with the online medical information now that's
(10:46):
uff's there, they can they can pull it up if
they're in that system, and they can see the ongoing trend.
So you know, I know how hard sometimes it is.
The fine a primary care nowadays, you know so many
places those don't even take new patients. So again, you
will have access to that. Your plans will still cover.
You can even go through an urgent care because they're
still doctors.
Speaker 1 (11:04):
Try to getting into a dermatologist.
Speaker 2 (11:06):
Oh I know, we'll talk about that here in a minute.
Oh really absolutely, so up come a teaser, little teaser. Yeah.
The other thing too, you know we've talked about this
last week, like hsas and fessays. A lot of these
will kind of be geared to, especially fessays. If you're
an employees employer sponsored plan, you probably already had to
get that structured here at the end of last year.
(11:28):
But again this is kind of like four planning. You know,
hsas are really good plans. You know, if you have
an opportunity to take advantage of it, especially if you're
relatively healthy. Don't be scared of these plans. But most
people don't really understand when you buy a health savings account,
it's a highductible health plan. They're not going to have
co pays for doctor visits. You're not gonna have co
payce for prescriptions. Basically, whatever you're deductible is that you
(11:49):
chose three, five, seven, ten grand, whatever it is, you're
going to have to meet that deductible before the insurance
company pays anything, which is not bad. I mean typically
your highductible plans are gonna be significant any less expensive
than those plans. They are going to have all those
extra benefits in it, like the copays for doctor visits
and prescription coverage. But again this is geared more for
someone that doesn't really utilize a lot of medical expenses.
(12:11):
So if you're younger, then you're like, I don't I'm
not going through a long term I'm not seeing a
doctor once a month, Like probably a really good option
for you. But the kicker here is fun the savings account, Like,
don't just take a highductible health plan and don't put
the extra money away. So many people take these plans down.
They're like, oh, I thought by buying this plan, there
(12:32):
were some of that money went into a health savings
I was like, no, that's the premium for the plan.
You have to then open up a savings account and
start putting the money away there. And it's it's advantagents
for you because it works just like an IRA. So
the money that you're putting into that account is you're
writing it off in your taxes, right, So if you
can put three four five grand into that account, you're
you're you're you're reducing your income on that as far as.
Speaker 1 (12:54):
Your paycheck too, So you don't have to have the
discipline to actually you can.
Speaker 2 (12:57):
Do You can absolutely do that too. Allow your listeners.
Of course, you know that we deal with are self employed,
so again they have to take advantage of that. You
can set up a health savings accounts pretty much any bank,
So again, do to that because it builds up over
time and some of the things that people don't realize.
It's an IRA. So at fifty nine and a half,
if you have money in there, you can use it
(13:18):
like a regular IRA. You can start taking money out
and pay taxes on it. The other thing that's really
nice too, is you can actually utiltilize it when you
go on Medicare. You can actually use your HSA money
to pay your part B premiums. Oh really, which right
now this year is one hundred and eighty five bucks
a month. So again, might as well use it with
tax free money, you know, and still cover medical expenses
(13:40):
later on in life, even though you can no longer
fund it once you go on Medicare. So we've had
a lot of Medicare people. I'm hinting to you. If
you are on Medicare and you are still on a
group health plan and you're on an HSA, you cannot
fund it anymore. So stop doing it as a IRS
big red plan.
Speaker 1 (13:58):
Oh no. The last thing you want to do is
invite an audit.
Speaker 2 (14:02):
No no, And we hear so many people doing that.
And the other thing question we get a lot of
time is f f f s a's flexible spending accounts.
Again typically gonna be done through your employer. But again
you have to really understand how an FSA works. It
is something that you have to, you know, put money into,
but of course you have to use that money by
(14:23):
the end of the year.
Speaker 1 (14:24):
Yeah, that's the reason I find a little uncomfortable with
those as a concept.
Speaker 2 (14:28):
It's good if you have something planned, like if I'm
planning to get something done. If I know, like, hey,
I have to get a surgery done this year, I
know what my deductible is. That's a great situation. My
brother actually set up one. He's a he's a he's
a cop up in Walkee and he's like, you, guys,
my wife, she's my sister in law. She's putting money
(14:49):
into an f s A. I'm like, oh, that's great,
Like what are you using the money for?
Speaker 1 (14:52):
Oh?
Speaker 2 (14:53):
She just contributes the maximum. How I'm like, but you
guys don't really use it. I was like, so where
does that money go at the end of the year.
Speaker 1 (15:00):
Goes?
Speaker 2 (15:00):
I don't know, it goes, it disappears.
Speaker 1 (15:03):
See, So like not using all your vacation days. You
find out the end of the year that you had
fifteen extra days carrying over. You're like, I don't get
any carryover. It's gone, it evaporated, Like it's crazy.
Speaker 2 (15:15):
So yes, in her situation is like, well, I why
don't you stop doing that?
Speaker 1 (15:19):
Right over and stopping at a health savings account.
Speaker 2 (15:23):
Yeah, So again just just really important things to not allize.
The other thing is again kind of going back to
knowing you're out of pocket expenses, track your expenses. I
tell everyone, you know, the best thing you can do.
I do this exactly the same way. So every year
I have a mellow polder. I put the plan here
on it, I get all the claims and eobs and everything.
I put them all in there, and I track what's
(15:44):
going on because you know, things happen. You know, I'm
dealing with insurance companies and trusting that everything that they're
doing and guys going towards deductibles and all types of stuff.
So I do track that stuff for myself. And again
it's if you average person going to one doctor visits year,
you don't really need to go that route, but especially
someone that has conditions where they're meeting deductibles. And the
(16:06):
other thing too is just because you get a bill
from a doctor or a hospital doesn't mean you owe
that money. I really want to kind of point that
out because so many times we'll see where there's billing
issues where the hospital didn't bill your insurance properly, or
in my case, this has happened multiple times because I
changed my plans, even though I gave them my new stuff.
(16:28):
They still build an insurance company had seven years ago. Well,
they don't always notify me, and then I just get
a bill. So you want to match what the bills
are from the hospital or whatever you're doing with the
actual explanation of benefits that you actually get back from
the insurance company. You will always get an explanation of
benefits from an insurance company if they receive a claim.
(16:50):
If they don't receive a claim because of a billing
issue and you get a bill, that's because your insurance
company never got notified. So it's an easy step process,
and we advise this is probably one of the number
one phone calls that we get is you know, I
got a bill? Do I owe this money? I'm like,
well did you get did you get an EOB from
your insurance company? And I was like, well, wait a
couple of weeks if you get one. If you don't,
(17:12):
let us know and we'll try to navigate that with
the insurance company to find out what happened. And then
if ninety five percent of the time it's it's a
billing issue from the provider, yeah, yeah, but again just
knowing that and don't pay that bill because I mean,
it's it's it's it's harder to get them to then
rebill if you paid your bill. So take a deep breath.
(17:33):
You know, it's not something they're going to go hit
your credit with and it's and trust me, they want
to get paid too. They don't want to just come
out to you and just put you in collection.
Speaker 1 (17:41):
So noah, I know, because the collection you just get
what a third or something of the reason. I don't
even know.
Speaker 2 (17:45):
If it's that much. I mean I've I've known people
that do that business and you're talking five to ten
cents on a dollar, oh lord, and they go after
for maximum amounts. So that's what I've heard, so I
mean it's it's crazy. So again, just do your due
diligence that know you're out of pocket expenses and you know,
absolutely utilize that. Next thing, of course, telehealth. I love telehealth.
(18:08):
I've been a big proponent of that for years. I
mean we've been at some levels using telehealth probably for
like the last fifteen years of my business. And I
know it's a bigger thing that kind of came up
through COVID and you know, a lot of health plans
now have telehealth and I brought up stories in the show.
You know, my wife got poison ivy. We didn't know
(18:29):
what it was, and you know they they you mentioned
dermatologists earlier, right, I mean they literally brought dermatologists on
the call and they were she was facetiming, was showing
this rash that she got, and they go, yeah, that
definitely looks like poison ivy. Well, the primary care didn't
know right away. I mean how long would that have
take us to figure that out? You know if we
went to the saw in person primary care and then go, okay,
(18:50):
well now I got to get a specialist visit for
you to go see a dermatologist. Well, now I can
get in eight weeks later by the time you know,
who knows what happened with gone at that point.
Speaker 1 (19:00):
Or you try to figure it out yourself and you
go online, where do you start? All I have is
you have a rash. You have no way of knowing
what it is. It's not like you're saying poison you know,
images of poison ivy and trying to match what you've got.
You got to start with nothing images of skin rash.
I mean you mentioned when you come up with like
it kind of looks like that a little bit. No, no, no, no,
they get they're smarter people in the world that are
(19:21):
out there to figure out.
Speaker 2 (19:23):
You have no idea. And you know what's nice too,
is there are a lot of plans out there that
still don't have this within their plans. A lot of
the plans that we sell Brian actually have this already
incorporated with the packages, so you're getting free telehealth. We
actually have a plan right now that we rolled a
lot of our clients in. It's uh, it's like fifty
bucks a month for the whole family. It's absolutely free usage.
(19:48):
You can use as much as you want. But it
comes with mental health. And another big proponent right now
is access to mental health. And we know, I mean
I know first and how hard it is to get
in to see anybody nowadays in that it's worse in
dermatology it is. But these programs right now, this program
(20:09):
we actually picked up literally you can Utiliza for any
adult member of your family. They get access to mental
health for free and it's unlimited use. And there's a
lot of programs out there right now. I've seen them
all the time online. I mean they're charging three, four
or five hundred bucks a month to get into their
mental health program. I'm like, this is fifty bucks a
(20:31):
month through a major telehealth company and they're giving it
to you for free, like take full advantage of that.
Speaker 1 (20:38):
So I'd say it's it's it's.
Speaker 2 (20:40):
Remarkable, and I know the stigma that a lot of
listeners probably have behind that and it's just sometimes maybe
going to a facility that has that. But I mean,
you can do this from the comfort of your home.
Speaker 1 (20:49):
Yeah, no walking into the office, going to the you know,
the psychologist or you know, psychiatrist's office and you know,
sitting in the waiting room or anything like that. And
that's that's an amazing benefit that right now.
Speaker 2 (21:00):
And we roll that out a lot to our employer
groups so that your employees have access to those benefits too,
because I mean, it could be just stress, it could
be something going on at work or going on home. Like,
let's let's nip that in the butt. So when that
employee comes back in the next day to go to work,
they already talked to somebody and they're and they're they're
they're working their way through it, not sitting at their
desk and going my life's terrible and I'm not going
(21:23):
to work today.
Speaker 1 (21:24):
It's doing in their own juices. That's right, Yeah, that's
right ugly.
Speaker 2 (21:27):
And then just the next thing really kind of going
into is review and understand your claim process. You know
how to submit claims properly and sure your provider submits
the claim. That's that's the big one. Like we just
kind of hinted on a lot of claim denials, a
lot of issues typically come from billing. The first thing
I always tell people when you call in and they go, hey,
(21:50):
my claim's not getting paid. I got a bill, is like,
all right, first step just reach out to your provider
make sure they actually build the right insurance company. If
that steps are already done, then I can really pick
up the ball and move forward. Because of hippo lows,
I can't just call your provider, where's what's going on?
So as long as you have that kind of done
and like, yes, we build your insurance company, they declined it.
(22:13):
Of course, if you're a client, reach out to us.
We can start working through it. See if the provider
got a wrong code on there, or if there was
a pre existing condition or just something kind of going on.
We can start alleviating that symptom, that situation. But again,
just kind of understanding that and how to submit claims
properly because it's really really important. You know a lot
of people, like we have listeners that have multiple products.
(22:35):
It's sometimes these claims have a shelf life, right. I
mean it's not like, oh, I had a claim thirteen
years ago, I can still go back and get my
money back from the insurance company. Some of these plans
out there and not a lot of the stuff that
we sell. You know, you have to submit within a
certain timeframe thirty sixty ninety days, So don't delay on
those situations, especially things like since we do so many
(22:57):
cancer policies and critical illness policies, you know there's there's
a timeframe before you can get your money because they're
gonna have to do their due diligence. Make sure that's
a proper claim you actually had cancer. So again, making
sure you submit those claims on time. At least get
us involved in those situations so that way we can
start the process and the paperwork for you because I
(23:17):
want to make sure you get your money up front.
I want to make because they're you know, the process there,
Brian is I got diagnosed with cancer. I have a
cancer policy. I want them to start paying. Well, the
insurance company doesn't know if that's a legitimate claim. So
we have to provide that paperwork saying, yes, here's the cancer,
this is where the doctor wrote it down that you
were diagnosed with cancer. This is what the type of
cancer was. Submit that documentation to the insurance company so
(23:40):
they can cut you that fifty thousand dollars check.
Speaker 1 (23:43):
Right.
Speaker 2 (23:43):
You know, that's why I want to get that in
your hand, because again, you know what you're going to
be going through for the next six months or more.
We want to make sure that money's in your checking
account so you can go through that. So again, just
kind of understanding those situations is really really important. And again,
do not think that of an insurance company turns around
declines your claim, that that's set in stone. I mean,
(24:05):
we've battled for clients considerably over the years, and a
lot of situations we're able to get those claims paid out.
There's loopholes. It's just like you mentioned. Being a lawyer,
I mean I've seen the loopholes. You know, certain insurance
companies and certain states have different regulations and sometimes insurance
companies blanket decline and I go, well, you're in a
(24:26):
state that you can't decline for that. I've literally had
those conversations and I go, yeah, we have to pay
that bill. So it's yeah, I mean, it's those things happen,
and I mean I think we're kind of in that
state of awareness right now with things that have happened
here a few months ago with like United Healthcare and
stuff like that. You know, a big proponent with them
was the fact that they declined so many claims that
(24:48):
all kind of came to light, and that's something that
we deal with all the time. So again it's you know,
as a broker working with so many different insurance companies,
it's I can tell you that they've all done it.
It's not a situation where like this company up here
never does it like they all do it at that
realm because everything to them is black and white, right,
and there's no gray area. So we have to make
(25:09):
sure that we're doing the right things in our processes
and how we submit claims and do things, so to
make sure that that is alleviated from you and to
the average person. That can be a nightmare I can't
imagine if I mean, I literally I've had claim denials.
I turn around to my care team and I hand
them my bill because at this stage, they do it
all day every day. They know better than I do
(25:30):
now on how to get these things taken care of.
So it's around yourself with good people. You have to
I don't deal with the client claims every day. They do.
They know exactly who to go to, what happened, and
you know, even and a lot of times it's just
again CPT codes are wrong from the physician, and it
happens so often. Medical billing errors are prominent in today's stage.
(25:53):
I mean most people don't understand that, but it happens
all the time. That is something you have to be
aware of. And like I said, if if you're not
wanting to do that on your own, I mean, just
come to us and get that as your burger. I mean,
even if you're on an ACA plan. I put this
out to you people right now, if you're on an
Obamacare plan, affordable care at Healthcare dot got, whatever you
(26:13):
want to call it, and if you bought it yourself
and you would rather have our team, and even though
you took care of yourself. You can call us. We
can actually become agent record for you on that policy,
and then you're a client of ours and we can
start helping you. There's no additional costs, costs you nothing
to do that. You can just say, hey, I did
this my first on my own January first. I did
(26:34):
not have an agent help me, or I had an
agent help me. I don't even know who it was.
I would prefer to work with you, guys all we
have to do it. Takes like five minutes to become
your agent, and now you're working with us and there's
no additional cost, nothing else happening to you.
Speaker 1 (26:49):
You just bought yourself a lot of phone calls.
Speaker 2 (26:51):
Friend, I'd rather help them.
Speaker 1 (26:53):
I can pass up on an opportunity to have John
on the team to help you out in this. Ye.
Speaker 2 (26:57):
No additional cost, no additional cost at all.
Speaker 1 (27:00):
Oh that's five one three eight hundred two two five five.
By the way, I just had to get that in there, John.
If somebody's like I can do that, I can do that. Yes,
five one three eight hundred call you.
Speaker 2 (27:09):
Can absolutely do that. And you also get a free
evaluation at that point, just to make sure the right plan.
Speaker 1 (27:14):
Yeah, I mean I figured you would do that.
Speaker 2 (27:16):
We're to do that. It's not just calls up. I'm
going to be your agent. I mean, we're still going
to do our due diligence, make sure you're the right plan.
But again, at the end of the day, I'm not
here to upsell you or anything like that. I'd rather
just start working with you. You can see what we do,
and if you feel comfortable with us, you might want
to pick up something later on.
Speaker 1 (27:32):
That's just absolutely, absolutely amazing. Well, we only have another
minute or so left in the segment here. Anything you
want to pass along before we part company this morning.
Speaker 2 (27:40):
Yeah. The other big thing here, and this goes out
to everybody. I don't care if you're on Medicare, I
don't care if from the marketplace. Keep informed with changes
of your insurance plans. You'll get letters throughout the year
if anything changes with your plan, or your rates are changing,
or doctor provider networks are coming out. Don't just throw
those paperwork away.
Speaker 1 (27:58):
Read it.
Speaker 2 (27:58):
If you have a question, call us. We can go
over that to make sure that doesn't really affect you.
But again, like in September, you start getting those annual
notices of change for Medicare. I mean they're really big,
you know. I mean you I've literally watched insurance the
hospital groups like just get dropped in the middle of
that time frame and you lose and you lose your doctor.
(28:19):
So like, don't be sitting there like well they yeah,
I got this letter from them back in like March,
and then I still went to the doctor and now
I'm paying the bill because they're no longer a network.
Like if you see something like that, if you're a
listener client, if you ever get a letter like that,
you call us. Let's make sure that we don't we
can adjust your plan, change that we need to or
kind of advise you when we can do that, because
(28:40):
you have to do that. Don't don't. They'll just throw
those letters away so hard because they're notifying you and
they can stand by that train.
Speaker 1 (28:47):
It's time. Just good another day. Don't there to go
to a job role cover since you can get the
process started cover. Since dot com there's a lot as
much information on the forum right there as you can
or again called five one three ball by would be
given
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