Rethink Healthcare Together - Navigating the claims process

Episode Transcript

Speaker 1 (00:08):
His Frian Thomas, host to the fifty five carecy Morning
Sure at least Monday through Friday. I always like to
call myself a facilitator for a conversation with John Rohman
from Cover since he better way to get medical insurance
for so many reasons we've learned over the years, and
we're going to be at it again. You can reach
John on the team at Coversinc dot com. I strongly
encourage you to do that. He can do a full

(00:28):
analysis of what your current insurance is and find a
better way. Since he and his team work with more
than two hundred different insurance companies that have access to
thousands of policies, you can get dollar one coverage, catastrophic coverage,
the whole litany of medical insurance benefits for less money,
and I mean a lot less money. In most cases.
He can figure out a better way for you and

(00:50):
your family, maybe your small group employer. You're looking for
insurance for your people and they can't get out of
reach for them. Trust me, he and his team have
a solution for that. Five three eight hundred call five
one three eight hundred two two five five again online Cover.
Since see John, always good to see a huge Sunday.

Speaker 2 (01:08):
Youtwoe, Brian.

Speaker 3 (01:09):
So, we've been through a.

Speaker 1 (01:11):
Lot of different categories last couple of weeks, most notably
breaking down some of the elements of acquiring insurance, and
today I understand you want to talk about navigating the
claims process.

Speaker 2 (01:24):
Absolutely, so I think this is one of those things
that can be a nightmare for a lot of individuals,
especially when you start having situations where you're having a
severe claim situation where you're having large bills, you're having
maybe you're going through a major illness or something like that,
and you start seeing all these things coming in from
everybody under the sun. I'm getting bills from here here,

(01:46):
the hospital's billing me. I haven't seen all my eobs
yet from my insurance company.

Speaker 4 (01:50):
What do I owe?

Speaker 2 (01:52):
Doio? People are telling me things are covered. I'm seeing
that it's not covered, you know, and just kind of
really navigating, you know, this process. You know. One of
the things I'll prelude here is, you know a lot
of times when I have clients that go through these situations,
it's you know, immediately they're going to call our office,
you know, they start they start that process.

Speaker 3 (02:12):
If I'm working with you and I got my medical insurance.
You know, I'm just going to call five point three
eight hundred calls and say, you guys, deal with it.

Speaker 2 (02:18):
There it is, there is. But I mean, of course,
a lot of our listeners aren't clients, and you know,
I feel like, you know, they kind of get in
these situations too. You know, I hear it all the time.
I even have friends that have coverage just through employers
and stuff like that, and they're like, John, I we
just went through all this. My wife had a surgery
and you know, she was in the hospital for you
a few days. I'm just thinking about one we just
did about six months ago for a friend, and you know,

(02:40):
he's just everything you're saying is denied denied or claim
process or you know, they're giving me bills. I haven't
seen anything back from the insurance company. So it's it
just it can get really like just lost in the weeds,
I think sometimes, and I think a lot of people
just get overly frustrated and then you know, always telling
me the last thing to do is just cut a

(03:01):
check to the hospital or whatever.

Speaker 3 (03:03):
And honestly, you and I have been over this a
million times. The hospital bills, I mean, is there is
there such thing as a low hospital bill. Were walking
in the door, They're gonna charge your grant. So this
is these are these are quite often really challenging bills
for a lot of people to pay.

Speaker 2 (03:21):
I had a client one time literally going to the
emergency room and they I guess they were so busy
they brought them back, put them in a room, you know,
did the whole like intake. The person comes around for
billing and he literally sat there for like two or
three hours. And this is a couple of years ago,
and he's like, you know what, I'm gonna go somewhere else.
So he just leaves like I'm just gonna leave and

(03:44):
walked out of the hospital. Was like I'm gone, like
I'm not doing this. And he ended up getting in
the bill for like almost three thousand dollars because I
never even saw a doctor, and you know, it just
those things happen. I mean, you just have to realize,
you know that we always says, you know, the kind
of the last step resort is to go into an
emergency room. There's so many ways to you know, do

(04:06):
things less expensive. You know, I basically say, unless it's
really life threatening, don't go to the emergency room, you know,
go to urgent care, you know, use telehealth, go to
primary care. I mean, whatever it is to stay out
of what those bills are, because you know, what most
people don't realize is those days where we used to
have copase for emergency rooms. You know, I remember, you know,

(04:28):
my my parents' insurance and you know he had, you know,
state insurance. He's a retired police officer and great coverage.
I mean, I think they probably had like one hundred
dollars copay if we went to the emergency room. And
nobody has it anymore. I mean most plans, unless you're
on a major corporate plan that can really want to
pay for all those benefits, they don't. They don't exist.

(04:48):
So you're gonna you're gonna be looking at your deductible.
You're gonna be looking at your co insurance, and the
way deductibles are nowadays, especially like people you know, god forbid,
if they're only on the marketplace and don't have anything else.
We're talking about like a healthcare dot gov. I mean,
you look at the out of pockets of those plans.
I mean, this year's ninety two hundred for an individual,
it's eighteen thousand, four hundred for a family. Yes, if
you go to the emergency room, prepare to pay almost

(05:11):
nine grand potentially for being in there, and good luck,
God forbid, they have to do a CT scan. I
mean I've seen CT scans in hospitals for fifteen eighteen grand,
you know, and you can do that outpatient for you know,
a couple, you know grand maybe.

Speaker 3 (05:28):
Yeah.

Speaker 2 (05:29):
I actually have a colleague of mine. One time he
went into the hospital and he goes, uh, he had
just had massive pain. He's like, I can't deal with it.
I'm going to go into the hospital and you know,
he's sitting in the room. The doctor comes in and
he basically goes, you know, you know, well, we think
it might be a kidney stone. He goes, but we
want to do a CT scan, do all this test,
and just to kind of make sure he goes. He goes, well,

(05:50):
let me ask you a question. He goes, how long
you've been a doctor for I guess the one goes
like eighteen years or something like that, and he goes, so,
in your professional medical opinion, what do you actually think
this is. She's, oh, I'm very sure it's it's a
kidney sent like house, sure like percentage wise, She goes,
probably ninety five percent. She goes, great, he goes, I'll
take your recommendation. That's at ninety five percent chance it's

(06:13):
it's a kidney stone. He goes, So write me a
prescription for a CT scan. And he goes. If this
doesn't go away or have problems, I'll go get a
CT scan or whatever you need me to do in
a day or two where I can get it for
six hundred bucks a hundred dollars. I don't want to pay,
you know, meet my deductible here, you know, pay another
seven thousand dollars for a TCT scan today. She goes, oh,

(06:35):
I guess that makes sense.

Speaker 3 (06:39):
Really another comfortable any good? Not sure if it completely applies,
but similar kind of thing. I have a standing dermatology
appointment because I have family history. My dad had all
kinds of different skin cancers because he spent so much
time outdoors with a little kid on. And I've had
to have a couple of you know, questionable cells removed before,

(06:59):
and you know, there are always just very little spots,
and I am. She says, well, here, let me get
a little piece. We'll do a biopsy and then if
it is something we need to take care of, we'll
come back and get rid of it. I'm like, it's
like three millimeters white, just go ahead and cut the
whole thing off. Mauths. I mean, why would that Why
would you want me to come back here when the

(07:20):
procedure you're doing is really the same thing, except on
just a slightly larger scales. He's like, Okay, I can
do that problem solve.

Speaker 2 (07:28):
I mean, you're absolutely right. I mean, even in that situation,
depending upon the plan. And this is you know, kind
of going into our segue of really just understanding how
your coverage works. You know, if you're on a wrong
type of plan. I'm not saying a wrong plan, but
a majority of the plans that are out there, you're like,
you don't get a copey for that procedure. Like you
might have the cope as a specialist. Maybe you have

(07:50):
a let's say forty fifty dollars hundred dollars cope for
that specialist visit, But as soon as they do that
little in office surgical procedure, a lot of the times
that's not covered under that cope. That's subjicated to your
deductible and co insurance for majority of people. So you're
gonna go home and have that done. You're like, okay,
well I have a fifty dollars cope for this, and
then then you get walloped with a five, six, seven
hundred dollars bill because they cut something off of you

(08:13):
at a dermatology office. I mean, and that's you know,
just something that most people of course don't plan for.
They think it's covered, and you know it's not because
that's how their their insurance policy operates. And that's like
I said, you know, the biggest thing on them is
really just you need to understand your coverages. And most people,
you know, when they buy health insurance policy or any

(08:35):
type of policy, they they just put it in a
filing cabinet somewhere. They never really look at it, and
it you know, we're in a situation when it comes
to health insurance where we get a card and we
think it's like you know that black American Express card.
I can use it anywhere I can. It's good wherever
I'm using it. And then what happens is is just
it doesn't always pan out the way you want it to.

(08:56):
And that's that's that's a tough pill. Of swallow when
you know people are ill informed.

Speaker 3 (09:00):
Oh without question, then comes them paying out the checking account.
You get the building here and I have to pay
because the insurance didn't covered or put within the stop right.

Speaker 2 (09:09):
There uncovered, because I mean, you know that that whole
term is it can get very scary.

Speaker 3 (09:15):
You know.

Speaker 2 (09:15):
We just had a I mean, you know it was
even a personal situation. You know, I know my insurance
very well, and you know, a doctor recommended me to
have a test done, and the facility called us and
they were like, hey, you know, we reach out to
your insurance and they said they would cover this bill.
And I'm like, what do you mean by covered? She goes, well,

(09:35):
your insurance will pay for it. I'm like, no, I won't.
I mean this is the process that I mean, my
deductibles high. It's like it's not going to be under that.
It's like, well what do you charge for this? And
they're like, I don't know how to get back to you.
I need to know what this is actually going to
cost before I make the decision to do it here
or get it somewhere else. And you know, basically they
called us back and like, oh you know it's it's

(09:56):
seven hundred dollars of this. I'm like, so, how is
it covered or my plan? Well, I think it goes
against your deductible. It was like, yeah, exactly, not covered.

Speaker 3 (10:04):
Man Like, sorry, this goes toward your annual deductible. So
it whittled it down by whatever the service was charged,
and you're back to, you know, whatever's rest on your
deduct one at Food's as that before things will be
truly cut.

Speaker 2 (10:19):
Oh exactly. And then for the someone that just takes
that word for it, you know, they're just it's just
it's just that big tough bill to swallow. So yeah,
just really understanding your coverages, your limitations, your exclusions, and
you know, if you're a client of our is the
best question at that point is just you don't have
to go through that fifty page manual. Just reach out
to us if it's a call, you know, and then
we'll actually tell you like, yes, that's a that's something

(10:42):
that's in your contract. This is how it's going to
work out, you know, so that you're very prepared and
you have all the information that you need to make
that best informed decision for your family.

Speaker 3 (10:52):
Well, how important is it to I guess gather all
the information why you're at the provider's office. I mean
I I honestly I don't remember, with the exception of
pieces of paper they might hand me, like on discharge,
you know, here's Karen feeding instruction for the little lesion.
You know that we just took off your arm. But
what other information should we asking for or thinking about

(11:14):
when we're when we're when we're when we're there.

Speaker 2 (11:16):
Well, I mean, one of the things that can really
help you is always trying to get an itemized bill
with codes right. That's the easiest thing for us, especially
if if it comes back as like some sort of
a claim denial or they're saying that something's not being processed.
Get member two. Insurance companies are very black and white.
I mean they deal in codes, right, And you'd be
surprised how many times a code or procedures build improperly

(11:41):
and the codes are off for whatever reason you might
have gone on and they oh, we you know, transpose
the number, you know, and that wasn't something that was
covered under your insurance policy or something that wasn't covered
the right way. Itemized bills are very important because again
it's not like I can go to your doctor with
hippo laws and go, hey, mister, my client was in here,

(12:01):
can I ecanalyze my bill for them? I mean, so
that that helps us in the process, but also helps you,
you know, when you're calling in back into it, like
as let's say an insurance company and trying to understand
maybe why your explanation of benefits came back and said,
you know, not a cover charge, and that can be
you know, don't just take that word for it. You
have to do a little bit of due diligence there

(12:21):
to make sure it was actually built properly.

Speaker 3 (12:23):
Should they have any itemized bill ready for you when
you leave?

Speaker 2 (12:27):
Sometimes they can, I mean sometimes you can get it afterward.
I would just always ask. I mean again, if it's
a regular doctor visit, something small, that's fine, you know,
I wouldn't you know, I'm not saying like every time
you go in for a flu you know, visit or
something like that, I need to get a minimized bill,
just you know. I mean, we're really talking about procedures, surgeries,
you know, basically, anything that you think is in the

(12:47):
call you more than a thousand bucks. You should do
that just to kind of make sure because what people
don't really kind of understand how insurance works because you know,
I get this all the time, like my insurance does
it cover my doctors? Like, you know, you're insurance covers you.
You're the insurance, right, You're the one paying the premiums.
The goal with insurance is to make you whole, right,
So what a lot of people don't realize, you know,

(13:10):
a lot in a lot of situations, we just kind
of go back. Even sometimes in situations where you can
negotiate cash payments, you know, the insurance companies can reimburse you.
You know, one of the things that we actually help
a lot of our clients with because we have so
many levels of coverage and layers of coverage that we
help clients with is number one. If you think of bills, again,

(13:30):
I always say more than a thousand dollars, sometimes it
is better to have a conversation like, hey, what's your
cash price? Because sometimes a cash price that you can get,
especially when it's lower than you're deductible, you know, let's
think about like like an MRI or something like that.
Sometimes these cash prices could be drastically less expensive then
even running it through insurance and praying they get a
good discount you know, attached to it.

Speaker 3 (13:52):
Credit for that cash payment if it doesn't get processed.
This distinction between process that.

Speaker 2 (13:57):
You can because you can submit that claim back to
the insurance company. You can file claim and you can
get that cheaper price and still get it paid adjusted towards.
You're deductible for the year.

Speaker 3 (14:05):
Okay, So in case I have upcoming glaucoma surgery, they
blast little laser holes in your eyes to albit drained.
So I'm at that point in my life whatever, it's
a family history thing. So I know what the charges
for the two eyeballs, And I asked her on the phone,
I said, is that the provider rate or is at
the cash rate? And she sounded very confused. I know

(14:26):
you have a negotiated discount rate for those in your
provider network. Is that what the charge is or is
this just the sort of build rate, which you and
I both know is usually quite substantially larger than what
they would normally pay out. And so Alton, I got
the answer to my question, but that was the follow up.
It was going to be how do I end up
getting that credit through my insurance company? So it's a form,

(14:49):
it's a form. Yeah, you, it's a form that you
fill out. Again, like we've talked numerous times on the show,
you know, we have layers of coverage that we provide
for clients, and some of those layers are those first
dollar coverage indentity plans. That's one of the foundations how
we build a lot of the packages for a lot
of our groups, a lot of our individuals, is so
they have those first dollar benefits and what you'll see

(15:11):
in a lot of situations though, Brian, is you know,
by orchestrating cash price. So basically how an indemnity plan works.
If this is the first time you're listening.

Speaker 2 (15:19):
To it, it's a fixed benefit amount depending upon whatever
you do. So if it's an MRI, you may have
a let's say, an indemnity benefit says you know, we're
going to pay seven hundred bucks, right, so you have
a secondary policy anytime you get an MRI it's seven
hundred dollars. Well, if you're going to go through the
hospital and get the an MRI for three grand, you know,
again we're partnering is up with a catastrophic major medical plan.

Speaker 3 (15:40):
Right.

Speaker 2 (15:41):
So let's say your catastrophic major medical plan as a
let's say five thousand dollars Dudwell, which is low in
today's market. So let's say that three thousand dollars MRI. Well,
guess what's going to happen? The insurance companies and get
negotiate it. You pray they get a good discount. Maybe
it knocks it down to two grand. Well, that two
grands going to go against your deductible. The secondary coverage

(16:02):
is going to give you seven hundred dollars, So it's
still gonna cost you thirteen hundred dollars for that MRI.
Right where negotiating up front saying hey, I know my
secondary coverage is going to pay seven hundred. What's a
cash price on this three thousand? Maybe it's less, or
maybe it's Then it's a situation where you're not nearly
getting much of a discount because you're not going to
see a gigantic discount, typically at a hospital network facility.

(16:27):
Then it's going, well, where else can I get this done?
And you start looking at all I mean especially here
in the Cincinnati area. I mean we have so many
different imaging places. I mean, I know you sponsor one,
you know these facilities. I mean I seemris all the
time in these places for four or five six hundred
bucks and then so basically, you know, thinking about on
that realm, it's well, they also work on cash prices,

(16:48):
so they probably would bill higher, you know, if you
have to. If the course they have to run through
insurance and then wait, you know, six eight weeks to
get their check, or they're going to say, hey, no,
here's our cash benefit. And I've literally done this. We
did this for my son. It was four hundred and
fifty dollars as a cash benefit. Well I'm like, well, great,
that's what I'm going to do. I'll pay four to
fifty Today. I went, I need that itemized bill because

(17:09):
has to have the coating on it, and then I
basically fell out a claim form. They're usually one page
with both the most of these companies, they have a
lot of them have online uploads. You just upload it
with a copy of your itemized bill, and then they
sent me a check for seven hundred bucks. I talked
with the additional So it's just about navigating those situations
and kind of knowing what you're going through and just
having the right documentation and you know, knowing that listen,

(17:32):
I can fill out a claim form, and most people like,
why don't I fall out a form like, they literally
paid you to fill it out and it didn't cost
you thirteen hundred dollars out of pocket in that situation,
so it will save you more money in the long run.

Speaker 3 (17:43):
Well, anywa if someone doesn't have the type of policy
you're referring to, this this process that you just walked
through about haggling what I'm going to call it with
the provider, negotiating the discount and then going to your
insurance provider and downloading that form at least gives you
the credit for what you negotiated with them. Absolutely, So

(18:06):
it's good to do and write to do in all
cases even if you don't have that you know.

Speaker 2 (18:10):
Yeah, I mean that four and fifty dollars woul still
go against your deductible for the rest of the year,
you know, and then you save a lot more money.

Speaker 3 (18:17):
Forms are online at the insurance company the policy you have,
you go to their website.

Speaker 2 (18:22):
You can go to their website. Most insurance companies Brian
nowadays have some sort of like online user portal. But
I'll tell you right now, those claim forms are actually
in your policies. So the big policies that you get
if you're buying your own health insurance, of course they'll
you get a big fifty page manual. There's there's a
claim form in there. At at some point there's one
in there. Make a copy of it and send it

(18:43):
in because they want you to have access to that
because again, you could be at a network, you could
be whatever a situation is. But again, their their job
is of course to make you whole, not pay the provider.
I mean, I think the provider just kind of got
involved at some point because it's easier for the thing
to make sure they get paid. That's why they're going
to build your insurance for you, because like I said,

(19:04):
and then of course doing that immediately, you know, it
is going to avoid any type of delays you know,
in that process. And then, like I said, a lot
of times, submitting those claims are very easy, and track
them too.

Speaker 1 (19:15):
You know.

Speaker 2 (19:15):
The biggest thing that a lot of people will do
is they'll get a bill from a hospital and then
and then they call our office. You know, they go, John,
I got a bill? Do I owe this money? I'm like, well,
first thing is did you get a letter from the
insurance company. It's called an explanation of benefits. Well, I
haven't seen that yet. I was like, wait, just just
just wait. We want to make sure they actually even

(19:35):
build your insurance first. I mean we always say, like
ninety percent of the problems that we run into when
clients call in, it's usually a provider issue. Maybe they build.
I mean, now I've told you numerous times. I change
my insurance all the time. So the biggest issue I
always run into is somebody builds some insurance I had
five years ago, and now I'm getting you know, of
course they ain't paid a bill, so now I'm getting

(19:58):
a bill. So I have to basically call back to
the billing department make sure they build the right insurance.
I did that actually a lot last year. But you know,
once that kind of gets processed through, then I get
the explanation from the insurance company, and then I want
to make sure that matches up with what I'm seeing
in the bill. You'd be surprised how often it doesn't
match for whatever reason. You know, I had to claim

(20:21):
here recently personally, where I got the EOB back from
the insurance company, goes, hey, you're your exposures one hundred
and thirty bucks. I'm like, okay, that's not too bad. Well,
the doctors the facility build us like seven hundred and
I'm like, this doesn't match. Here, this doesn't match. And
what I realize is the insurance come of course I
got their big discount, and then they didn't apply that

(20:44):
to the bill, so they just went off the regular
bill and then build me the full amount and they're like, oh, yeah, yeah, yeah,
we'll fix that. I'm like, I'm sure I could go
back to them and wait for them to refund my money,
you know, if I ended up paying that bill. But
that again, that's a process, and again just doing your
due diligence. You know, if you're gonna have claims like that,

(21:05):
I tell my clients, get a file, you know, match
them up, make sure things are kind of orchestrating out
the right way. But of course it gets exponentially worse
when someone's going through major claims, you know, like a
cancer where you're seeing claims left and right from every
single person under the sun that's seen you.

Speaker 3 (21:23):
A complicated confusing about hospital visits. If you're in for
even a day, you're gonna end upatting bills from physicians
that you don't even remember seeing like that random guy
that just sticks his head in the room, you know,
the physician on call and does everything going. You're like, fine, okay,
and there's a watch four hundred doll it's ching.

Speaker 2 (21:42):
You just hear the walking ahead. They're just pushing a button.
It's it sounds like a cash register.

Speaker 3 (21:47):
This isn't like type pication. This isn't the surgeon who've
worked on me.

Speaker 2 (21:51):
Now, and you know we've been running into you know,
and this hasn't happen all the time, but you know,
a lot of times, Brian, especially when we have clients
that have large claims and ongoing issues, the secondary policies,
those indemnity plans will continue to pay. Right, So if
I have a plan that basically says, you know, every
day that I'm in the hospital at pays three grand,

(22:11):
well eventually on my catastrophic coverage, if I'm in the
hospital for a while, I've met my deductible. So now
my primary insurance is actually paying all my bills. Right.
We run into an issue with some of these hospitals
not wanting to build a secondary insurance. They basically turned
to the client, go, Brian, well, we already got our
money from the primary coverage. We don't need to bill
your secondary coverage. I'm like, it helps the client because

(22:32):
that three thousand dollars a day while they're in the hospital,
that's coming back to them. You just have to build them.
So then of course we have to get involved. We
try to you know, work with the provider, and then
of course they tell us no. We're like, okay, now
we need itemized bills while you're in the hospital. I
need to see that, and then we help them through
that process of submitting the claim. We had a client
a couple of years ago. I mean she was in
the hospital like well over a month, you know, dealing

(22:56):
with leukemia, and they basically, you know, she was on
a planet literally paid like five grand a day when
she was in the hospital. So she was going to
use this money as basically an income replacement for her,
and you know, they called in. They were sore, right,
She's we haven't seen any of our checks. We haven't
gotten any money from the secondary insurance. I'm like, well,
we just looked at the you know, there's no explanation

(23:18):
of benefits. They've never received anything. And it was exactly
that situation where the hospital stopped billing her secondary coverage.
They're like, we already got paid and she's like, well,
this would help me. It's easier if you bill them
then they'll just pay me. They're like, well, we're not
going to do that. So of course, you know, we
helped her through that situation, taught them how to do it,
but they had a lot of different bills, like you mentioned,

(23:40):
every where under the sun, and filling out different claim forms.
I mean he was like, this took me like two
days to do, like NonStop filling out claim forms and
itemizing and making sure. I mean it was a process,
but I mean at the end of the day, I
mean they were extremely happy. They ended up going up
over a couple hundred thousand from the secondary coverage. And
that's what it's and that's what it's there for. That's

(24:02):
when we write these plans for clients. I always go, listen,
if I can just cover your out of pocket expenses,
that's a win. But in the worst day in your life,
if you're really laid up and you're going to like, well,
how am I paying for the fact that I'm not working,
and that extra money comes back to you and helps
you through that process. That's what we really want to
see from these things, and that's what we try to
do for our clients.

Speaker 3 (24:21):
Well, what about those situation and not every policy covers everything.
There are certain exceptions and exclusions, and sometimes you claim
actually may get denied. And what's one to do in
those circumstances. I guess, first off, you have to really
make sure whether it's been a proper denial, which is
kind of a long line to what we've been talking
about that year, but appeals process can make additional arguments.

Speaker 2 (24:45):
Oh yeah, I mean we actually had a claim one time.
Because again, what a lot of people don't realize sometimes
is that, you know, everybody thinks that if I go
out today and buy health insurance policy from wherever, right,
that they all operate under the same you know, ACA guidelines.
So we're talking about the Affordable Care Act wall, right.
So the only places that actually have to cover pre

(25:07):
existing conditions are group plans are getting through employers or
the healthcare marketplace. So a lot of the private plans
that we help clients with are vastly less expensive, but
again they typically have somewhere in a neighborhood of like
a you know, some companies are you know, twelve month
waiting period on pre existing conditions. Some have two years.
I mean I've seen some of the sharing ministries out

(25:27):
there have three years, you know, So we see what
that means. If they can correlate that claim that you're
having to something that you were being treated for previously,
they're not going to pay for the claim. So basically
what we do is we we help them navigate that.
So we had a client one time going she was
actually suffering from UTIs, shot out UTIs and then what

(25:49):
had transpired is she ended up having a cisburse on
her kidney, which actually put her into sepsis. So the
correlation the insurance company was trying to make was the UTIs,
which can be corroborated back to the cysts that she had.
That's what they were looking at that then caused the sepsis.

(26:09):
So they were trying to call that a pre existing condition.
I was like, no, not not in this state, and
that's there's a causality. So it's basically you can't go
that far. Yes, the cysts could have cost the UTI,
but the UTI wasn't a direct thing for the sepsis,
so they ended up having to pay sepsis. That was
a big bill because she was in the hospital for
a while. So then again, having someone that can navigate
that and help with the appeals process, I mean, she

(26:31):
would never be able to do that on her own.

Speaker 3 (26:33):
Well, of course there are customer service reps. Again going
back to you, you and the team that covers, since
you would navigate these challenges for someone who's working with you,
but for someone to listen to audience who isn't. You
can contact the customer service office and try to work
with them.

Speaker 2 (26:51):
Yeah, you can try.

Speaker 3 (26:52):
You're back to marketing for Cover States because get all
these things that we just walked through to the largest
that our cover by John Rollman a team at covers.
Since it's the one stop shopping. You don't have to
talk to your insurance company, you don't have to talk
to the customer service department at the hospital. You don't
have to spend time hours on the phone navigating the challenges.

(27:13):
You don't really have to fully understand your explanation of benefits.
It's just like, hey, help me here.

Speaker 4 (27:19):
I'm mean, abide, I got bills that I don't think
I should be paying, trying to convince them to pay
well and this would be a great opportunity to remind
folks how to get in touch with you. And again,
you don't have an obligation to reach out to John
and the team. Just start the process and figure out
what they can do for you.

Speaker 3 (27:36):
And you know, like us and my wife and I
talk with John and turns out we're in a really
good place. He wasn't really anything that John could do,
but the way of benefit hurt by way of benefiting
my wife and me with our coverage, I call that
peace of mind. But since there's so many ways to
skin a catch on and the team are aware of,
you may end up in a far far better situation.

(27:57):
It's five one three eight hundred call five one three
eight hundred two two five five, spend a few minutes
with them on the phone, or I think more easy
coversincy dot com is a form there, and as John says,
please fill out as much information in that form as
possible when you're there. It'll remain confidential. They're not going
to sell your information to anybody. You're working exclusively with

(28:18):
John and the cover since eighteen and they'll get back
with you very quickly. John's always pleasure interesting, as always
meaning medical insurance. They're fascinating another edition of Rethink Healthcare,
together with John Roman of Cover sincey