In today’s episode, we dive deep into prior authorization, a process often seen as a bureaucratic hurdle but one that can significantly impact patient care. Backed by alarming statistics from the American Medical Association—where 24% of surveyed physicians reported prior authorization led to adverse patient events—we uncover the hidden challenges of this system.

Join us as we define prior authorization, explore why it exists, and discuss its consequences, from treatment delays to financial strain. We’ll also explain what happens when authorizations are denied, what waivers mean, and how patients can advocate for themselves through appeals and exceptions.

With real-world examples, we highlight the frustrations of healthcare providers and patients alike, from systemic miscommunications to the controversial role of insurance reviewers. Finally, we share practical tips to help you reduce prior authorization roadblocks and better navigate this complex process.

If you’ve ever wondered why an MBA can override an MD, or how insurance gatekeeping affects healthcare access, this is the episode for you.

DISCLAIMER: The information contained in this podcast is intended as general information only and is not intended to serve as medical, legal, or financial advice, nor is it intended to be a substitute for professional advice of a medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact an appropriate professional directly to receive advice tailored for you. The views and opinions expressed by our hosts and any guests are their own and do not necessarily reflect those of their employers or any affiliated organizations. You assume full responsibility for the use of any information obtained through this podcast.

In this episode of Avoid Staying Sick and Going Broke, we take a deep dive into what healthcare changes might be on the horizon following the 2024 election and the return of a Trump administration alongside a GOP Congress. From potential adjustments to Medicare and Medicaid to shifts in the Affordable Care Act (ACA), Bobbi and Cass provide a thoughtful, non-political breakdown of what’s likely to happen—and what might stay the same.

We explore topics like:

• Medicare Changes: Will the age for Medicare rise? Could prescription drug pricing evolve under a “most favored nation” approach?
• Medicare Advantage: Is privatized healthcare set to expand further?
• Medicaid: How could work requirements and state-by-state policies affect coverage?
• Temporary Health Plans: Will these “cheaper” plans make a controversial comeback?
• Women’s Health: How will abortion access, birth control funding, and IVF policies be impacted at both federal and state levels?

Bobbi shares insights on site neutrality, telehealth expansion, and the potential for more provider audits in an effort to cut “waste.” We also touch on the future of health savings accounts (HSAs) and the possible implications for patients and providers alike.

If you’re concerned about the future of healthcare—whether you’re a patient, provider, or policymaker—this episode offers an informative and balanced perspective on what to expect in the coming years.

DISCLAIMER: The information contained in this podcast is intended as general information only and is not intended to serve as medical, legal, or financial advice, nor is it intended to be a substitute for professional advice of a medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact an appropriate professional directly to receive advice tailored for you. The views and opinions expressed by our hosts and any guests are their own and do not necessarily reflect those of their employers or any affiliated organizations. You assume full responsibility for the use of any information obtained through this podcast.

*Trigger Warning: Mention of DNC and miscarriage.* 

Navigating health insurance can be tricky, as our co-hosts, Bobbi Buell and Cass Lewis will share today. Focusing on the pitfalls of temporary plans and how to navigate open enrollment, they discuss why temporary plans might not cover pre-existing conditions, how coverage caps can leave you unprotected for costly treatments, and why these plans don’t follow ACA guidelines. 

The episode offers practical advice on setting a health insurance budget, verifying provider networks, and ensuring prescriptions are covered. Even the basics are covered! The hosts also highlight options like Medicaid and VA care for those seeking alternative coverage. 

This episode provides essential insights to help patients make informed decisions during open enrollment.

DISCLAIMER: The information contained in this podcast is intended as general information only and is not intended to serve as medical, legal, or financial advice, nor is it intended to be a substitute for professional advice of a medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact an appropriate professional directly to receive advice tailored for you. The views and opinions expressed by our hosts and any guests are their own and do not necessarily reflect those of their employers or any affiliated organizations. You assume full responsibility for the use of any information obtained through this podcast.

Resources Mentioned:

Healthcare.gov

In this episode of the Avoid Staying Sick and Going Broke podcast, hosts Bobbi Buell and Cass Lewis take a deep dive into the complexities of Medicare Advantage, or as they sometimes call it, “Medicare Disadvantage.” With humor, personal anecdotes, and decades of experience in healthcare billing and patient advocacy, Cass and Bobbi explore how Medicare Advantage differs from traditional Medicare and what this means for patients—especially our elderly loved ones.

Bobbi highlights the advantages for healthy patients and the disadvantages for those managing chronic illness. Together, they tackle critical questions, such as why private insurers might prioritize profits over care and what patients should look for when choosing a Medicare plan.

They also provide practical tips for listeners to consider when choosing between traditional Medicare and Medicare Advantage, stressing the importance of understanding co-pays, deductibles, prescription drug needs, and the prior authorization process.

With Medicare open enrollment approaching, Cass and Bobbi offer timely advice for those considering switching plans or helping loved ones make informed decisions. 

Stay tuned for future episodes where Bobbi and Cass will dig deeper into related topics like prior authorization and prescription drug coverage under Medicare Part D.

DISCLAIMER: The information contained in this podcast is intended as general information only and is not intended to serve as medical, legal, or financial advice, nor is it intended to be a substitute for professional advice of a medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact an appropriate professional directly to receive advice tailored for you. The views and opinions expressed by our hosts and any guests are their own and do not necessarily reflect those of their employers or any affiliated organizations. You assume full responsibility for the use of any information obtained through this podcast.

Welcome to Avoid Staying Sick and Going Broke, the show that takes the headache out of healthcare and brings you a humorous guide to navigating the confusing world of medical jargon, insurance bills, and everything in between. Whether you’re mystified by your latest hospital bill, unsure what a deductible even is, or just curious about how the healthcare system works, you’ve come to the right place.

On this show we break down the complex healthcare landscape into bite-sized, easy-to-understand pieces. No need to feel overwhelmed—we’ll help you decode the terminology and share tips on becoming your own best healthcare advocate. You’ll also learn how to avoid the financial pitfalls of medical care (aka “financial toxicity”) and leave feeling empowered, informed, and maybe even entertained.

Plus, healthcare professionals can tune in for insights on how to better explain medical details to their patients with clarity and compassion. So, grab your coffee (it’s good for you!) and get ready to dive in—it’s time to make healthcare a little less stressful and a lot more understandable!

**DISCLAIMER: The information contained in this podcast is intended as general information only and is not intended to serve as medical, legal, or financial advice, nor is it intended to be a substitute for professional advice of a medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact an appropriate professional directly to receive advice tailored for you. The views and opinions expressed by our hosts and any guests are their own and do not necessarily reflect those of their employers or any affiliated organizations. You assume full responsibility for the use of any information obtained through this podcast.