Health savings and flexible spending accounts make for a nice crossover between money and medicine. This is not a personal finance podcast at all, but when I’m done with today’s theme, you’ll be able to take advantage of benefits good for your health and maybe even your pocketbook.

The main concept here is that health savings accounts, or HSAs, and flexible spending accounts, or FSAs, have pre-tax money that you can spend on various healthcare items. I’m not here to give you tax or investment advice but I do want to point out a bunch of facts about these plans that are helpful. Most of time, you sign up for either plan via your work. The HSA is easier to understand so we’ll start there—with this account, you or your employer make tax-deductible contributions which you can use for things like medical visit copays and prescriptions. A couple neat facts about HSAs are that your unspent money generally rolls over every year and that you can invest those funds like you would an IRA or 401(k). This all sounds wonderful but there are some limits, with the major constraint being that you can only qualify for an HSA if you have something called a high deductible health plan. I’ve talked about deductibles before in past episodes but the short story is that your insurance may require you to spend a certain amount out of pocket before coverage applies. The IRS defines these plans as having a deductible of $1400+ for individuals and $2800+ for families. This is why HSAs are helpful, because if you’re spending money for medical help anyway, you get a little tax relief on top. The max amount you can contribute to an HSA in 2022 is $3650 as an individual or $7300 for a family. These numbers change every year based on inflation and the IRS’s assessments. Whether you get an HSA through an employer or in some cases fund it yourself, the institution or bank who keeps that account will usually give you a debit card for your medical expenses. Even if you have or don’t have an HSA card, you should keep receipts for anything you buy with that account, so you can easily lock in whatever reimbursement you need as long as the money goes toward something eligible.

Thankfully you can find lists of eligible medical expenses from both the IRS and HSA bank websites—I’ll link both of those resources on my post at rushinagalla.substack.com. It also doesn’t hurt to check to the original HSA or FSA plan document you get at the beginning to see the specific expenses that are okay for reimbursement. Some employers have more or less restrictions on what you can use the money for beyond whatever the IRS outlines. You don’t need a high deductible health plan to get an FSA. However, only an employer can give you an FSA. The confusing part happens when you realize there is more than one type of FSA. This is just classic healthcare making life complicated, but I’ll break down the major kinds of FSAs. Although your average FSA can fund medical costs just like the HSA, some companies offer a limited-use version with money that can only be used for dental and vision care. You might also see a dependent care plan, or DCFSA, meant for child care, elder care, or some preschool services. It’s actually possible to have both an HSA and FSA. In that situation, your FSA would be limited to vision and dental or dependent care facilities. Unlike the HSA though, you can’t rollover all your unspent funds. The IRS has a 20% contribution rollover limit for FSAs every year but your employer makes the final decision on what is okay. Because of the pandemic and the recent American Rescue Plan, there are exceptions in place so you can ask your tax preparer about that if needed. For 2022, the contribution limit for a traditional medical FSA is $2850 for individuals. DCFSAs have a $5000 annual limit for individuals but are also subject to change. If you have the luxury of being able to choose between an HSA and FSA, you should think about your medical habits and tendencies so you can make the most of either plan.

Regardless of the account you have, keep your receipts—if you ever need to send them to an administrator, your reimbursements will be easy to get. For example, you shouldn’t hesitate to ask for an itemized statement from the medical office or pharmacy you go to often. Let’s pump the brakes for a bit. The reason why I’m spending time walking you though all these items is that not everyone qualifying for these accounts takes advantage of or even knows about them! The Journal of the American Medical Association held a survey in 2016 and then reviewed their findings in 2020 for adults with high deductible health plans who have or can get an HSA. The AMA’s study classified high deductible health plans with a benchmark of $1300+ for individuals and $2600+ for families (both upper limits are slightly below the IRS’s definition). The sample of people who got interviewed were ages 18-64, all of whom had a high deductible plan for at least 12 months. The results found that just one in three people actually opened an HSA account and even fewer contributed to their respective accounts in the last year. All of this is the case while the share of privately insured adults with high deductible plans went from 25% in 2010 to 40% in 2016. In essence, patients have more out of pocket responsibilities but aren’t taking advantage of HSA or FSA benefits that offset those issues. These trends are why I want to call attention to the fact that it's worth your time to check with your employer or tax guy if you qualify for those accounts. Just remember that if you actually get an HSA or FSA, save your account policy document and your receipts to make the reimbursement smooth.

No matter how you choose to spend all that hard-earned pre-tax money, expenses should be taken care of at a clinic that treats you well. In the next post, you’ll learn how to spot all the red and green flags of medical clinics. Subscribe and stay tuned to Friendly Neighborhood Patient for more healthcare commentary. I’ll catch you at the next episode.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

Telehealth and telemedicine offer so many benefits you should take advantage of. But just like how you might take whey protein, telemedicine should be a supplement and not a replacement for your health needs.

The one thing we should clear up right off the bat is that telehealth and telemedicine are not exactly the same. Telehealth options tend to be more public-facing and include things like mental health or education tools. Telemedicine is more along the lines of getting official medical care through an app or software interface. Telemedicine can however, be considered a part of telehealth, just like how a square is a rectangle but not always the other way around. However, telemedicine and telehealth aren’t replacements for in-person advice: like I alluded to earlier, you don’t want your protein powder to replace your whole nutrition plan. For the purposes of this episode, I’m going to focus on telemedicine, the pros, the cons, and how you can use these tools correctly. You shouldn’t use a power drill without knowing its limits.

The fact that you can get medical help from your home or during your travels is pretty awesome regardless. Even though telemedicine was already growing before the covid pandemic began, the geographic barriers to getting care just went poof. Having this access is also great for the elderly, patients who can’t move very well, and for busy professionals working from home. Now you might ask, oh Rushi this is nice and whatnot, but how do I actually get the virtual help? Whether you download apps like Teladoc or use a health system’s proprietary software, there are usually three kinds of telemedicine visits. The easiest one to grasp is what some may call a synchronous or live consult. This is just what happens when you talk with a doctor in real time, probably over video. Any visit of this nature works best for when you can’t make it to a clinic in-person but need an official medical opinion quickly. The next visit type is called asynchronous or store-and-forward. This involves you sending pictures or necessary medical history to someone who gets back to you with advice. In my line of work this is what happens when patients get worried about their moles and send pictures to get a handful of spots checked by the doctor. The last option is remote monitoring, which is when you have a provider check important stats like your blood pressure or glucose over time and make changes as needed.

No matter what type of visit you prefer, the take-home message is that you should let telemedicine be your swiss army knife to get started on your medical needs in a timely manner. Some apps like Teladoc or MD Live can get you access to a professional in under 24 hours. Getting an opinion that fast is wonderful, but you should draw the line for what needs to be done in-person. However, this doesn’t have to be black and white. Let’s say you have a rash or some kind of break out. You open whatever telemedicine app is on your phone and you speak to a general doctor that same day. You might then get referred to a specialist like a dermatologist for in-person or virtual help to better fix your issue.

Specialties like dermatology, radiology, family medicine, and cardiology mesh with telemedicine nicely compared to other sectors. We’re not yet at the point where your surgeon could do many clean robot-assisted procedures from halfway across the world, but we’re getting there. I’m going to link a longer article by the company eVisit that summarizes a lot of the telemedicine basics and screenshot a separate graphic that shows the best and worst uses of virtual care. I’d argue that telemedicine is at its peak when patients get continuity of care over a long period to ease lifestyle and chronic issues.

Not everything goes to plan. I want to be fair in talking about the less effective side of virtual care. For one thing, not everyone is tech savvy, even in 2022. Both providers and patients might have problems with internet connectivity or may not know how to switch the camera on a phone. You don’t need to a tech power user to fix this issue, but for virtual care you should use the device you find most intuitive whether it be your phone, computer, or tablet. Another issue is that we can lean hard on telemedicine or telehealth for replacing all in-person care, which can be dangerous because some issues might only be found during actual physical exams. Also, heaven forbid that someone would use a telemedicine app as a replacement for an emergency that should be taken care of with 911. As I’ve talked about in previous episodes, there are steps worth taking for exploring your options with in-person doctors. You can definitely try a combo where you see the primary doctor once a year and then seek assistance via telemedicine as needed throughout the year. Another thing to consider is that HIPAA and other privacy rules that govern how patients and doctors communicate online about health needs could also change on a dime. To address this concern, you can ask your provider or insurance company if the primary telemedicine platform being used encrypts your data and is HIPAA-secure. Due to the pandemic, there are exceptions in place but it never hurts to ask if the software of choice makes sense with a security standard. And last but not least, pricing can also be an issue. Since the onset of covid, generally speaking, insurance plans are willing to foot the bill for a remote visit, but platforms can still charge you a convenience fee per consult or providers might end up having you get services or advice that would be considered out-of-network. For those of us who ordered a lot of food from DoorDash or UberEats, the hidden and subtle fees on top of the main course add up fast. This why you should review pricing or fee schedules published on telemedicine platform websites or call the number on the back of your insurance card to get an idea of your virtual care benefits.

Even with all of telemedicine’s pros and cons, the long story short is to use the tools correctly without letting the tools use us. Although telemedicine costs and coverage might be murky at best, there are great tools you can use to handle your medical expenses, whether they be virtual or in person—the HSA and FSA! In the upcoming podcast, we’ll talk about the heath and financial benefits of those accounts. Subscribe and stay tuned to Friendly Neighborhood Patient to get informed about healthcare. I’ll catch you at the next episode.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

Saying a doctor is busy is like calling the sky blue. You still might be asking though, why are clinic schedules so damn packed? After we take a trip behind the scenes for why the doctor’s waiting room earns its title, you’ll be prepared to handle any reasonable wait time.

There are really two boxes to unpack for talking about how doctors get heavily booked: 1) the day-to-day operations (when the doctor is quick or slow to get you at any given time) and 2) the big picture trends and seasons explaining the congestion in the first place. This is why I’m going to split this episode into sections for those areas. We’ll start with a situation that hits very close to home: you’re in the waiting room, and you seem to be waiting much longer than you should. It doesn’t matter whether you’re going to a private clinic or the largest health system in your state. In either place, you’re probably going to hunker down and scroll through your phone, twiddle your thumbs, or both while the doctor gets ready to pick you up.

There could be many reasons why your provider runs behind or has a long wait-list, but one major factor that always stays the same is that doctors’ earnings rely on volume and procedures—not by time spent per patient. Procedures involve both materials and motor skills as well as time it should be no surprise for that being expensive. But a doctor generally can’t bill a consult to patients or insurance plans by the minute like a lawyer can, at least not without serious proof of medical necessity. This reality of the medical profession is a major part of why clinic schedules get overbooked and things run slow. Not to mention that demand for medical care runs high to begin with. A doctor’s lateness on any given day usually varies by specialty. A mostly consultative practice like internal medicine or family medicine may not keep you waiting more than 20 minutes, but it could be normal for a popular surgeon to have an hour-long wait.

Regardless of specialty, the fact of the matter is that day-to-day responsibilities unrelated to actual patient care pile up fast. Let’s step in the primary doctor’s shoes for a moment. You see your first patient at 8:00am for a 30-minute visit. You go through the usual routine of getting medical history, doing the physical exam, and hopefully putting together a treatment plan if needed. It feels like it’s been five minutes but the clock has already moved 20 minutes. Then your patient has a last-minute concern or question right at the 29th minute. You’re obligated to address those issues. You and a scribe are frantically trying to enter all this info on a chart note. Suddenly it’s been 35 or 40 minutes and you realize there are 20 to 30 patients to go. Oh, and you also need to deal with any prescriptions, lab orders, follow-up plans and whatnot. In a nutshell, that is how a doctor’s calendar snowballs. I’m not trying to put blame on either the doctor or the patient—that scenario I mentioned is just reality. Besides administrative needs there also could, of course, be an emergency, or there may be a doctor-to-doctor phone call that needs to be answered. Everything I mentioned tends to be the main obstacles to keeping an efficient schedule which these days seems impossible. This is why, even if you as a patient have an appointment that’s supposed to start at 10AM, you should ask the front desk staff at the clinic what the current wait time is and if the doctor is running behind. A couple years ago when I saw my primary doctor, I needed to wait an hour in the exam room. When my doc finally got to me, he looked so rushed and harried that I didn’t even bother to ask about the delay. This is why you shouldn’t have any major plans booked right after a medical appointment.

There’s no doubt that medicine is a complicated profession and the issues we talked about throw the schedule out of whack. However, you need to have clear standards for what acceptable timing should be. My rule is that if a primary doctor or specialist makes me wait over half an hour for at least three appointments in a row, I’m getting my medical care elsewhere. You might be okay for waiting longer or less than I do, so consider what you can tolerate. I’ll link some more background info for what slows down a doctor’s schedule on my Substack page, which you can find at rushinagalla.substack.com. Sometimes though, you might be lucky enough to be part of a clinic that runs on time and keeps you waiting 10 minutes at the most. But the doctor’s waitlist could be four months to book a visit. This is more of a big-picture, macro issue compared to the day-to-day factors we just went over.

Of course, if a given doctor is skilled and popular, it would make sense for that person to have many eager patients lined up. That being said, medical offices do have a little seasonality. The clinic directory and promotion company ZocDoc crunched some of their visit data back in 2016 and put out some helpful insights with a graphic showing the busiest months of the year for each medical specialty. I’ll link the data at rushinagalla.substack.com but generally speaking, the findings suggest that March, January, and August (in that order) tend to be the crowded months with November and December being less busy. This would vary by specialty. The main bias of this study is that most of the clients ZocDoc tracks are private or semi-corporate clinics that aren’t necessarily part of a greater hospital system. Regardless of that issue, the general take-home point is that you should aim to book your visit in a calmer month and either early in the morning or right after a clinic’s lunch hour. Another helpful recurring survey done by the healthcare staffing company AMN found that even back in 2017, the average wait for a new patient appointment booking was about 24 days! This is before the COVID-19 pandemic made schedules crazier. That number grew about 30% from 2014. The stats were drawn through five major specialties the study reviewed: cardiology, dermatology, orthopedic surgery, gynecology, and family medicine. That AMN study argues that increased health coverage, more chronic issues (e.g. diabetes, hypertension), and a continued under-supply of doctors are the main drivers for raising wait times. If you’re having an emergency, you need to just roll with the given time that a facility offers, but the data imply that you should book medical visits more than a month ahead of time when possible. A simple calendar or app reminder goes a long way.

With a little patience and the background info you know now, there are a couple takeaways from this topic. Getting medical care in a timely manner gets easier when you have 1) defined standards for delays you’re willing to tolerate and 2) that you book your standard visits months ahead of time, especially when you can work to see your doctor for preventative rather than reactive care. One awesome tool that can also help you with navigating our medical system is actually telemedicine. Telehealth and telemedicine were growing before the pandemic but they’re popular services now. We’ll spend time in the next post on when it makes sense to use those virtual health tools. Stay tuned and subscribe to Friendly Neighborhood Patient for more healthcare guidance. I’ll catch you at the next episode.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

You could say that medical advice and prescriptions are the salt and pepper of healthcare. Unfortunately, there will be times when you run out of prescriptions that you need to continue and you are worried about what needs to be done next. After this episode, you’ll be able to handle prescription refills, no sweat.

Let’s say you’re leaving the clinic with a treatment plan in mind and your doctor either gave you a physical prescription or sent an electronic one to your pharmacy. Now you fill the prescription either at the pharmacy or in the mail and you happily follow instructions for a while. Then you notice that you’re out of pills or whatever cream you’re using and you still have more treatment to follow through with. The first thing you should do here is to check if you have any refills. Usually on the paper or electronic prescription there should be a number that shows how many refills your doctor approved. Think of refills like this: your doctor whips up the play, meaning the treatment plan and drug, and then throws you the ball. As the receiver you’ll get the ball but you still have to catch it. The major concept here is that refills don’t just pop into existence, it’s your responsibility to get them—not enough providers are clear about that. In this situation, you can just reach out to the pharmacy and get your medication refilled without needing to call the clinic (unless of course you have treatment questions).

There are a few ways to get a refill, but in most cases you will need to give your prescription number. For example, on the pill bottle of a common medication like Metformin, there should be a label that will have your prescription number and approved refills along with other critical info like pharmacy contact details and your name. Since we live in the 21st century and have mini supercomputers in our pockets, using a pharmacy’s mobile app or website is helpful to get automatic refills as long as you know your prescription number. Even with modern technology like this you can still have issues with a pharmacy’s website and you may not be able to reach their team over the phone easily. Even when calling patients’ pharmacies from my clinic I’ve been on hold for over half an hour sometimes. In the worst case scenario, where you’re having problems getting a hold of the pharmacy, it’s best to go in person if possible—just bring your ID and other basic info so the pharmacist or pharmacy tech staff can find your record. Having a mail-order for your prescriptions is a great set up also, especially if there are meds you need to take consistently over time.

Even with all these great methods, you should know when to ask for a refill. Ideally you should contact your pharmacy if you think you’ll run out of medication in a week or two and you know a refill is needed because you got a treatment plan to finish. I say this because even though pharmacies can be pretty fast with refilling common meds, you might still have trouble waiting for re-ordered stock especially with today’s supply chain issues—it’s better to have a little bit of lead time and be proactive.

Numbers are an important theme here because most drugs are dispensed with a time limit or maximum quantity. For example, a tube of a common skin cream like Triamcinolone can be prescribed for 30 grams with two refills or the doctor can write up a 30-day supply with any refills allowed for that period. Although your provider is the one who decides the safe and effective amount of medication you need, it’s actually the health insurance plans who lay down the hard quantity and refill limits to keep a lid on the US’s already very high prescription drug costs. Health plans usually read over the latest clinical research and FDA guidance on each medication in the market to set those restrictions. The operations and content director at the GoodRx prescription indexing company goes into more detail about this in a separate article that I’ll link on my Substack post found at rushinagalla.substack.com. When it comes to these limits though, not everything fits together well like that jigsaw puzzle you spent a few long days trying to finish. The best medicine varies so much by the individual that your run-of-the-mill prescription length or amount may not make sense. That is why both patients and doctors are welcome to ask insurance plans to approve unusual amounts of medicine with a quantity limit exception. Your doctor’s office can file this and send any other pertinent clinical info the insurance needs to get this request done. One quick note before we get to the big picture. If a situation comes up where you lose a prescription or if you need a backup supply of meds for travel, you can reach out to your pharmacy to get an emergency refill (usually up to a 30-day supply depending on the medication). That being said, in some cases it might be easier to contact your doctor’s office directly and get a new prescription.

Speaking of new medications, you might be wondering what happens when you completely run out of refills. Thankfully, you’re not the end of the road. You’re now at the stage where you can ask for a prescription renewal. Just like how from very far away an emu looks like but isn’t actually an ostrich, a renewal is not the same thing as a refill even if it’s similar in principle. A renewal is a brand new round of medications and refills that get approved solely at your prescriber’s discretion. You can ask for a renewal when you visit or call your doctor but you can also have the pharmacy send that request on your behalf. Sometimes your provider can have strict rules on how he or she manages renewals; either you might need to see your doctor for a visit every time you need a renewal or if you were seen in the last 12 months your provider may just approve re-upped meds immediately. Doctors usually want to interact directly with patients for prescription review just to make sure medical history, lab work, and your other health details are current.

Now you’re up to speed on how to get refills and renewals done on time and on target. What might not happen in a timely manner though is your return to the doctor’s office and if the clinic even runs on schedule during any given day. In the next podcast, I’ll break down everything behind the scenes that clogs up the doctor’s calendar. Stay tuned and subscribe to Friendly Neighborhood Patient to get wise on healthcare. I’ll catch you at the next episode.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

I can tell you for sure more people feel concerned rather than excited to visit the doctor. Some patients get anxious if not terrified of medical offices. All that being said, there are simple tips which can help you approach your doctor with confidence; no liquid courage required.

Just like how we can be vulnerable during intimacy, discussing sensitive items with the doctor, to no one’s surprise, makes for a lot of apprehension and worry. In the exam room, there are a zillion things you don’t want to hear from the doctor that can stress you out. To name a few big ones, you might be worried about what you’ll be diagnosed with, if you need to be pricked with a needle, or if you need to go through a challenging treatment plan. For many patients, hearing bad medical news or having an awful experience at the clinic tilts their opinion of healthcare professionals drastically. From my own experience seeing physicians and also helping patients at my clinic, I believe the worst thing patients can feel is the doctor criticizing them for having a bad medical situation in the first place. Although I’m glad this doesn’t happen at my own workplace, other providers who victimize patients create unreal anxiety. Unfortunately, some doctors like that do exist. However, let me say one thing before you curl into a ball or stick your head in the sand: just like in entrepreneurship and other parts of life, it’s a bigger risk to do nothing about discussing your health for the sake of dignity rather than be a little open about your well-being. As a little kid growing up with asthma, I used to keep my mouth shut when my doctor would ask me if I had that issue because I felt that if I didn’t reveal my weakness or worries about my weakness, I could make myself feel better. As a result I didn’t comply with the care I needed back then and things were much harder than necessary. I’ve learned it’s actually better to manage your fears rather than manhandle them. That’s why, right now, we’ll cover straightforward tips on mitigating worries from seeing the doctor. I’ll also link helpful resources from Mt. Sinai’s and the Nemours’ children’s health systems that give a little more detail on ways for patients to deal with medical anxiety. You’ll find these links, among others, on my post at rushinagalla.substack.com.

If nothing else, you should know that you’re not the only person on planet earth who fears the doctor. Just because you see other people on Instagram or Snapchat living their seemingly perfect lives doesn’t mean they’re unafraid of needles or tough medical news. Everyone deals with their own struggle behind the scenes. A clear sign of medical anxiety no matter what your background is happens when you’re constantly rescheduling appointments better than procrastinating your regular work. Before even going to the clinic, acknowledging out loud that you are worried about the medical visit is the first step to self-compassion in having a better experience with a doctor. Voice to another family member or yourself that you’re having this nervousness. Just like how you should have your visit goals in mind before reaching the clinic as we talked about in previous episodes, you can briefly rehearse the sensitive topics you’re planning to cover. You could also hand your doctor some pre-written notes to go over so you don’t need to bring up sensitive issues from scratch.

Taking either of these steps keeps you from holding all the emotions and history so tight that you forget how to talk with another human being let alone your doctor. Here’s another thing to consider from the professional’s side of the exam table: good physicians are trained to discuss hard and uncomfortable matters besides solving health issues, while having more incentives to help you rather than judge you. If you close yourself up like a clam, the doctor would find it hard to get the additional bits of medical and social detail he or she needs to make the best treatment plan. Imagine your doctor totally missing something important like a smoking habit, rapid change in weight, or a new medication you take because you were too worried to say anything.

Vocalizing your worries ahead of time lets you summon a little bravery in the exam room to open up the conversation more. The next couple tools we have to deal with medical anxiety, funny enough, come from how we navigate our children’s healthcare experiences. Adolescents have their fair share of emotional and physical changes making them nervous at the clinic, but medical anxiety tips for teens and young ones can also make sense for adults. Along those lines, a nice way handle medical office fear is to bring a trusted friend or family member with you to the visit for moral support. It also doesn’t hurt to ask the medical office ahead of time if you should expect any tests or procedures at the visit. If you know what’s coming and have someone by your side, your medical care, among other parts of your life, changes for the better. All of that should be no surprise, but nervousness has a way of making us forget what we need to remember. Building trust with your doctors is critical for anyone but when you’re young, that is a golden opportunity to be open with medical professionals, which then sets you up for better care in the future. The bottom line here is expressing that you want to take charge of your care while admitting your nervousness. That is music to the doctor’s ears because the conversation then gets personalized for addressing your needs and worries. Even though it’s better to do these things when you have your first medical visit experiences as a little human, it’s never too late for owning up to your healthcare as a bigger human.

Now you should be well-armed to handle anxieties at the clinic that are within your control. On another note, you might be walking out of the office feeling good about your treatment plan so far, but then you notice that your medications have a limited supply and the instructions are written in that classic doctor and pharmacy gibberish, pushing your stress levels back up again. For the next topic, we’ll unpack how to deal with the confusing world of prescription refills. Stay tuned and subscribe to Friendly Neighborhood Patient for more American healthcare know-how. I’ll catch you at the next episode.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

Superman may be great at pretty much everything but the other heroes use their own particular skills for a reason. When it comes to medicine there are issues that even general practitioners can’t handle, so when the time comes they will refer you to a specialist. Once we break down how referrals work you will improve your follow-up care with simple insights.

When any given doctor sends you to another provider, the primary intent to get medical opinions, surgical work done, or diagnostic help to support the best possible treatment for you. Picture a scenario where you’re in the exam room and your primary doc advises you to get a chest X-ray and visit a nearby plastic surgeon for something like a complex excision. This is where the hand-off in your care begins. A chord and line diagram made by the health tech company Amino shows the most common types of referrals. This retrospective study based on about 211 million referrals in 2016 shows that not every referral is a visit per se; a significant part of referrals from primary doctors like internists are directed to X-rays, EKGs, and mammograms. In essence, anything ordered for a diagnostic purpose is also considered a referral. When you open this graphic on my Substack post, which you’ll find at rushinagalla.substack.com, you’ll notice that internists, ER docs, and pediatricians are the common referring physicians, while radiologists, cardiologists, and dermatologists are part of the most popular rendering physicians. One thing patients get confused with is the slight difference between a consultation and a referral. The former concerns a doc-to-doc conversation for an opinion and the latter is a formal transition of care. For example, your internist might talk with a dermatologist about a rash you have to get insight on what treatment makes sense but you do not actually book with the dermatologist—that is a consultation. When you need to physically or virtually see the dermatologist yourself for the issue, that is a referral.

There’s one major concept I want to clear up for patients first: doctor referrals go beyond word-of-mouth because there are medical and legal elements that apply when getting in to see a specialist. A referral does not work like the sorting hat in Harry Potter that magically puts you where you need to be. As I’ve talked about in previous episodes, when you have an HMO or POS health plan you need to get a referral from your PCP to get coverage for a specialist. You don’t need to worry about this if you have a PPO or EPO plan, but you and the referring doctor would need to check if a specialist would be in-network to begin with. Regardless of the health plan, the actual transfer of care is a standard or coded document originating from the PCP and insurance, or a letter from doctor to doctor with all your necessary medical history attached. With all the info and extra steps, both parties assisting in your care will be able to 1) prove that your referral exists so you don’t get lost between offices and 2) legally bill your health plan. To be frank, referrals get so complicated that the average clinic has a separate manager or coordinator to handle them. Another factor to consider is that the wait time for a specialist like a cardiologist or dermatologist can take months. That’s why if you’re in a situation where you know that you need a particular specialist’s expertise, it’s a good idea to book earlier with your general physician to secure a referral in a timely manner. When the primary care office sends a referral, there’s probably a limit on time or number of appointments you can have with a specialist. Insurance companies usually mandate such a duration so medical fees don’t go overboard given that a specialist would charge way more than a general physician for a visit.

Thankfully we can leave the insurance and legal side of things alone for the rest of this episode and dig more into how you and your primary doc can make a great referral just like a clean baton pass on a running track. If you’ve never had a referral before, it’s best to trust your PCP’s medical judgement when it comes to picking the specialist. However, you should get the contact info for a specialist’s facility so you can research how their office works. Basically, trust the medical opinion from your doc, but verify that the office you’re being sent to is accessible. The two big red flags to watch for are if the PCP does not follow up with you to see if your referral went through and if the specialist’s office does not contact you within two or three days of getting the referral. To nip any problems in the bud, I suggest asking your PCP exactly what to expect for the referral in terms of urgency, visit expectations, and the content of what he or she is sending to the specialist. The American Academy of Family Physicians has an old but surprisingly applicable template of how the elements I mentioned fit together. The article will be in the post on my Substack page again found at rushinagalla.substack.com. Some physicians are going to be very hands-on. The proactive general doctor will call the specialist’s or lab’s office to speak with the rendering physician and provide other information about you that may be hard to define in an electronic medical record. Think of this like how a pro football scouting report gives you nitty gritty details on the opposing quarterback but a human coach walking through game film of the quarterback in action gives you even more insight. If your doctor cares and advocates for you this much, hold them a little tighter than a winning lottery ticket. The opposite end of the spectrum is the doctor delegating the majority of referral responsibility to you. Here your PCP sends a referral letter to another office but may give you prescriptions, labs, or any necessary written chart notes to hand off to the specialist when you go in.

The content of a specialist visit will be more focused than a traditional checkup. There are specialists who do take a holistic approach to their care but in most cases, they will address only your immediate medical priorities and PCP’s main concerns. Regardless of format, make the most of the time you have, continue to ask important questions like with a routine checkup, and get the written visit summary, assessment, or treatment plan after everything is done. You can also check if the specialist will send notes and correspondence back to your PCP. Your general doctor should also make clear with the specialist whether you are going to be immediately released back under the primary care office’s wing or if you need to continue following up with the specialist. Naturally this is going to vary with your current medical situation. In any case, we’ve finally closed the loop for how a typical referral works! The bottom line is that a ensuring a successful hand-off of medical care happens when you get transparency and clear expectations. When the time comes for you to get referred to specialists or labs, ask your PCP what their office’s exact referral process is, and get the contact info for where you are being sent to.

Before we finish up, there’s one question that might have popped up in your mind: what if I’m a little nervous or too scared to ask my specialist any questions or advocate for myself? This “whitecoat syndrome” is actually a real thing and there are plenty of patients out there who fear going to a clinic, but coming up next, we’ll talk about ways to deal with that anxiety and have an easier time face-to-face your doctors no matter where you go. Stay tuned and subscribe to Friendly Neighborhood Patient for even more medical system tips and tricks. I’ll catch you at the next episode.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

Whether individuals or employers pick your health coverage, you can still make sense of insurance choices to match up with your lifestyle and current medical situation. Knowing the relationships between various insurance components makes each plan type digestible.

Before we even talk about insurance plan types, we need proper self-awareness. If we know ourselves and our health tendencies, we’ll find a better insurance plan fit. This logic applies both to individual patients picking health plans from online marketplaces and businesses purchasing health plans for their employees’ best possible coverage.

The major tradeoffs for any health plan involve the relationships between deductibles, out-of-pocket limits, provider access, and premiums. In general, the monthly premium you pay for the privilege of coverage falls if you have a high deductible and/or a small provider network. On the flipside, paying a ginormous premium should give you both comprehensive and vast coverage. Rather than trying to get lost in the sauce with all those complex numbers, it’s better to ask yourself some targeted questions first to find proper balance of payments with your need for care.

I’m going to link on my Substack a great article from NerdWallet with a full list of insurance considerations and plan comparisons, but for now we’ll cover the two best questions with the most impact on your choice. Ask yourself: do you see your primary doctor or a specialist a lot? If you do, you should keep in mind whether or not your preferred doctors take your insurance and also if you need to drop significant copays and coinsurance when going to the clinic. The next thing to ask is this: are your current medications covered under insurance and are they brand-name drugs? Insurance companies talk about what drugs they do and don’t cover on a huge list called a formulary. You can request the current year’s formulary from the insurance directly or check it out at the company’s matching website so you can know for sure if your current meds are approved or have alternatives.

Once you finish that Q&A with yourself, the next step is knowing the actual plan options. The four most common plans are the PPO, HMO, EPO, and POS. The differences between the plans vary by how wide your provider network is and how your care is coordinated to begin with. Let’s dive right in: the PPO, or preferred provider organization, is where the insurance gives you approved coverage for a specific list of providers and facilities. The people on that list would be considered “in-network” where you can get healthcare at the lowest negotiated cost possible. Think of the PPO like how Apple designs its product in-house with all the features but the action of making that product real happens elsewhere. This insurance dictates your coverage but is otherwise hands-off during the moments when you actually get your healthcare. You’re still welcome see a provider who’s not on the PPO’s list but you would definitely have a higher cost of doing so, usually with increased deductibles and coinsurance.

The HMO, or health maintenance organization, on the other hand is pretty much what happens if an insurer runs the whole supply chain of both medical care and the financial components of coverage. Kaiser Permanente is the example of an HMO and is the largest one in the US. If you happen to be a Kaiser member, you get access to their doctors, their facilities, and insurance administrators for supposedly a better price. The only major disadvantage is that you cannot see anyone outside of Kaiser or another HMO unless you enjoy footing the entire medical bill. You would also need an official referral to see any specialist, like a surgeon or dermatologist, which can slow down your care in some circumstances. In this system you need to have a primary doctor who coordinates all your orders and referrals.

Another insurance type called the EPO, or exclusive provider organization works just like a PPO but you can’t see anyone out-of-network without paying full price. With this plan your provider network is restricted like HMO, but you can see a specialist without a referral or extensive oversight from a primary doctor. If we stick with our previous example using Apple as the PPO, we know that the company designs the iPhone in California, makes the phone in China, and you can use it anywhere once you buy it. If Apple were an EPO plan, imagine being able to use the iPhone only in your state or town and nowhere else. The final major plan, called Point-of-Service or POS, is (to keep things brief) a hybrid of an HMO and PPO. My Substack page for this episode found at rushinagalla.substack.com will have a table showing the major pros and cons between all the plan types I mentioned.

For now though, let’s just pump the brakes: how can you make apples-to-apples comparisons, even if there are more insurance plan variations than there are shades of gray? Believe it or not, it’s possible to line up insurance plan options just like your Amazon shopping cart. The holy grail document you need to pull this off is the summary of benefits and coverage (SBC). The point of the SBC is to show out-of-pocket costs, common medical event scenarios, and covered or excluded services in one place for any given plan. I’ll link an example of this on my Substack home page as well.

SBC documents can be found on any insurance marketplace website or healthcare.gov. If your employer is giving or sponsoring the insurance, then reaching out to your HR department is the best move to get the summary. When you get a chance to lay out each plan’s SBC side by side, you can see at a bird’s-eye view what you need to pay for various items like getting traditional visits, lab draws, complex but routine surgeries, certain therapies, and more. It also doesn’t hurt to ask the insurance company directly for policy documents if you need to check the fine-print coverage for a specific procedure, drug, or lab draw which the SBC may not have room to comment on.

Since we’ve gone over the most critical items for plan considerations, plan types, and comparing those choices with an SBC, we can keep taking steps for learning how other parts of medical care fit your lifestyle and situation. As we’ve discussed before, your insurance plays a huge role in how much power the primary doctor has over your care. However, there will come times when you need to see a specialist with expertise that an internal medicine or family medicine doctor can’t offer. In the next post, I’ll unpack the black box that is getting a specialist referral so that aspect of care will be less daunting, more productive, and empowering for you.

Subscribe and stay tuned to Friendly Neighborhood Patient for more practical healthcare guidance. I’ll catch you at the next episode.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

It’s hard to pick the flavor of ice cream you want at the shop unless you know yourself well. I know I’m that guy who takes forever to pick something when I’m in line. Choosing to get your healthcare in a private or public setting can make you feel the same way. Once we go over the major types of medical practices, you can rest easy with finding an office that’s a great fit for your needs.

You should have a say on what kind of medical practice works best for your situation, but there are tradeoffs as the practice size increases and decreases. Before we dive into the various types of medical practices, it’s critical to know the incentives on the other side of the exam table, meaning, what do doctors have to consider when it comes to owning their practice or being employed by a hospital/corporation? In a totally private setting where the doctors own everything, they can practice exactly how they want. These physician-owners shoulder more administrative burden. Employed physicians, especially in a hospital or corporate environment, get security from a paycheck and in theory can just focus on patient care but with some more red tape involved.

According to the American Medical Association’s most recent biennial survey of physicians in Fall 2020, 49% of active physicians work in a fully private setting with complete physician ownership—that is a five-percentage-point drop from 2018. The next 40% of doctors worked directly for a hospital or health system, including smaller practices that are owned in part by a corporation. Consolidation is the best word to sum up medical practice trends over this past decade. Now let’s step away from the doctor’s side of things to understand what the medical practice pros and cons are for you, the patient.

Think of practice settings like the differences between traditional ice cream, gelato, or a sorbet. All those foods have the same purpose of appeasing your sweet tooth but in distinct ways. Along the same lines, all medical practices are supposed to heal and enhance you but the setup changes how that process works. The simplest office to grasp is the solo practice. This the clinic that your grandparents would describe like, “back in my day the doctor was also the bookkeeper and the receptionist.” In this situation, the doctor has no other partners or employed professionals other than basic staff. You as a patient mainly benefit from the doctor having skin in the game. The solo doctor takes a huge financial and personal risk to keep the clinic this way, especially with rising medical school loan payments overhead. Therefore, if the solo provider messes up badly, the patient population disappears in no time flat. As a result, you get more attention and niche expertise. Seeking this kind of practice makes sense if the doctor you’re looking for is a specialist for a particular condition you have. Like if you have a propensity for skin cancer, seeing a dermatologist who mainly takes patients for those cancers in a solo or small office could make sense. The solo practice is a dying breed though—currently 14% of physicians (and decreasing) still run things like that.

If we move up to the heaviest weight class, we find ourselves with hospitals and corporate medicine, both of which are growing. Think of the VA, Stanford’s health system, or The Cleveland Clinic as examples. Pretty much every professional at those places is employed and not, at the end of the day, beholden to patients even if that is what they are paid for. It really is the opposite of the solo practice we started with. Devorah Goldman’s December 20th editorial in the Wall Street Journal illustrates the major con of big medical settings turning into assembly lines of care. But with all that being said, people still go to hospitals and corporate health systems to get not just emergency care but also supreme access to resources, technology, and expertise that a small clinic may never offer. Red tape and zero physician autonomy are just the main drawbacks here.

With the final common medical practice styles, we can meet in the middle. Simple examples could be like a primary care clinic that has 10 internists or a cosmetic outfit that has two dermatologists and three plastic surgeons. The former example would be considered a single-specialty and the latter a multi-specialty practice. In this scenario physicians can be employees or partners in the clinic—in fact, ~69% physicians run clinics with these setups. From the doctor’s side of things, these group practices spread the financial risk among partners and usually have more administrative firepower to handle a lot of patients in little time. People can argue that group practices are the Goldilocks’s of all the clinics, because as a patient you get the best possible balance of access to better medical equipment and facilities along with the facility itself not being so large that the care gets bureaucratic and the doctors forget to respect your story.

Now that we’ve covered the basic kinds of healthcare settings, what should all that mean to you? Coming back to ice cream is the easiest way to explain things. You may love gelato more than regular ice cream or sorbet, but nothing is stopping you from getting the benefits of all three depending on your current taste, or in the case of healthcare, your specific medical needs. Obviously, your health insurance plays a huge role in places you can or can’t access but you should be taking advantage of all the practice types that apply to you. If you happen to consider yourself a reasonably healthy individual with a small handful of routine medical issues to address, you probably benefit the most from visiting small offices or single-specialty groups matching with your needs. If on the other hand you have a variety of severe and chronic issues to work through, most of your care may happen at a hospital or massive health system with the most resources for treatment options. Overall, you’re now in a better position to judge the appropriate practice setting—just remember that you get both more resources and more bureaucracy as the medical setup gets larger.

Since we’ve gone over the major types of medical practices, we can thread the needle back to health insurance. One major decision you make (or more likely your employer makes) is to pick an HMO or PPO insurance model for coverage. Even if you don’t know what those acronyms mean yet, knowing the important differences will help you choose the coverage making the most sense alongside the type of medical practice you want to visit.

Stay tuned and subscribe to Friendly Neighborhood Patient for more savvy healthcare guidance. I’ll catch you at the next episode.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

You might think your insurance will be a gentleman and pay for dinner, but the company will probably split the bill or make you pay the whole thing instead. After this episode though, you’ll be able to tackle the basics of health insurance like deductibles and copays without a problem.

Understanding your medical insurance might feel like scaling a sheer cliff. Once we cover the basic concepts you’ll have enough hand- and foot-holds to do that climb. Before we start that let’s check out the big picture. The concept of insurance should matter to you because in 2020, just over 91% of all Americans had medical coverage during all or part of that year. Employers are still the biggest customers for insurance, covering around 55% of the population. Medicare, which is handled by the government, covers the next 18% of Americans. These stats all come from the most recent US census. This all means that medical coverage will touch you or be offered to you in some way. That or you’ll have a sleek-looking insurance card that doesn’t actually cover anything. Regardless of whether it’s publicly or privately funded, health insurance still has a few core mechanics, all of which are based on the idea of “medical necessity,” which is a broad phrase by design so the insurance can justify paying or, in most cases, not paying for your care. Once we know the lingo, it’s easier to grasp different styles of plans.

I linked a couple glossaries of health plan terms from the Bureau of Labor Statistics and UPenn’s student health service on my Substack home page, which you can find at rushinagalla.substack.com.

Now we can go ahead and master three major pillars of coverage: copays, coinsurance, and deductibles. Copays are easier on the uptake—they’re just a fixed payment you make on the same day you are seen by the provider or medical facility you go to. For example, your insurance says that you have to spend $50 for a copay when seeing your primary doc. However, the first curveball here is that your copay can vary across different services. That $50 copay for your primary doctor can turn into a $100 copay at a specialist. In any case, you can just think of copays in terms of dollars.

The next concept to attack, coinsurance, turns up the heat a little bit, but I’m confident you can handle it. Think of coinsurance as a percentage that you want to keep as low as possible. For a regular visit your insurance might say that you need to pay 30% of the bill before the rest is covered. That percentage would definitely vary between seeing a preferred provider or someone who’s out of network (i.e. a provider who does not accept or have a deal with your insurance company). Your insurance can still make you responsible for more costs even after you pay coinsurance if the provider bills for something that the health plan won’t cover no matter what (like a cosmetic enhancement or removal).

Let’s move on to the infamous phenomenon that is the deductible. Think of it like a comically expensive toll gate. A deductible is a minimum figure you need to spend on your healthcare before insurance covers anything. My insurance for example demands that I spend $1000 out of pocket during the year on regular visits and services. Depending on the health plan you can have multiple deductibles for individuals, families, different services, and out-of-network care. Even though I haven’t met a single person who enjoys them, deductibles are common in health plans with low premiums. The premium is just the monthly fee you or your employer pays to have medical coverage in the first place. There is some good news in all this: a decent number of health plans can still fully cover preventative care visits, like seeing your primary doctor, without forcing you to pay a deductible. It’s like having the privilege of free drinks and a table at the clubhouse where you pay thousands a year for membership. I’m going to link a useful article from Verywell health on my Substack, again found at rushinagalla.substack.com, that covers those nuances further.

Believe it or not, there is a light at the end of the tunnel where your insurance covers just about everything. That light is the out-of-pocket maximum. This is best served with an example. If your health plan has a coinsurance of 20% and you get an eye-watering $100,000 hospital bill, you would think that you need to pay $20K (=0.2 * 100,000) before any coverage happens. But if you happen to have an out-of-pocket max of $10K for the particular hospital work you got, then your insurance picks up the other $90K if you have met all other copay/coinsurance/deductible obligations. This sounds all well and good but you probably have an out-of-pocket maximum just for in-network providers and emergency services. If you know you’re getting something complicated in the near future like a knee replacement or extended drug therapy, it’s smart to call the number on the back of your insurance card to ask for what your out-of-pocket max would be for a given medical situation. Most insurers will also slap on a lifetime limit. This reflects the fact that your insurance will only pay a certain amount for you, usually in the single-digit millions, over the existence of your membership. So if you wake up one day and want to replace your body parts with some flashy cybernetics for a few million bucks, just keep in mind what your lifetime coverage is and whether or not particular services are included with coverage.

But to get back on track, let’s just do a quick recap before we close things out. Long story short: think of copays with dollars, coinsurance with percentages, and deductibles with toll gates. The plot twist here is that your insurance may combine two or three of those payment types. So just be aware that, for example, you could have a $2000 deductible then 10% coinsurance for everything after that.

For now though, we’ll take a break from insurance side of things and shift back to medical care. Knowing when to seek private healthcare or hospital and corporate healthcare is the next thing we’ll talk about so you can take advantage of the coverage you do have! Subscribe to Friendly Neighborhood Patient for more healthcare tips and tricks. I’ll catch you at the next episode.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com

Here you are opening mail to find that your insurance sent a letter which is apparently not a bill, yet it says you owe money for your recent doctor’s visit. Once we translate this letter into English, you’ll have nothing to worry about.

This letter I’m talking about usually arrives in the coming weeks after any given medical visit or service. This document states, in bold lettering, that it’s not a bill, yet the number of dollar figures on there raises your blood pressure anyway. This letter is an explanation of benefits (EOB). It’s supposed to show how your insurance is covering or not covering medical care. If there are times in life where you need to keep your expectations low, reading your EOB is one of those times. Before we dive in, there are two main reasons why you should take a glance at your EOB: 1) to check if you will owe any medical bills later and 2) to make sure your provider billed you correctly. Soon you’ll be able to take care of these two goals no problem. This is how we’ll dip our toes in the muddy water that is American health insurance so we can get more comfortable with time.

Even though there are probably more EOB formats than flavors of vanilla ice cream, the core pieces stay the same. Usually, there is a table with various numbers. The top left or top right of that same page would have the patient and insured person’s name, claim and policy numbers, and the medical provider’s info. The real star of the show is the table, so for now we will focus on how to read that in particular. I will have an example diagram in this post and on my newsletter’s home page at rushinagalla.substack.com if you want to follow along. Even if there are more than ten columns on an EOB table, three major categories should stand out to you. 1) The medical care, 2) the charges/what you are billed, and 3) the money you actually owe after insurance coverage (or lack thereof).

In terms of the medical care, you should be seeing a brief one-line description for the actual service you got done in one of the left-most columns whether that be something like an office visit, lab draw, or a surgical procedure. That written description gets paired with a five-digit number called a CPT code, which I will talk about later, but you should make sure a date is there along with that code. That “date of service” should match with your own record of when you were at the clinic.

Now for the charges. The largest dollar number on that table is likely the full amount billed or claimed by your provider. This is where your insurance company begins to cut that number down with things like allowables and discounts. Most providers negotiate with your insurance to get pre-approved rates for every visit and procedure. Let’s say your doctor bills you $100 for a typical office visit. Your insurance might say the doctor can only bill $90 for the appointment and on top of that, the insurance applies another $30 discount because you saw that doctor within the health plan’s preferred list of physicians. Suddenly the balance so far is $60 (= $100-($100-$90)-$30 insurance discount), which is the final amount the provider should be paid. Now we’re at the moment of truth to see if your insurance feels like paying that leftover $60. If you’re lucky enough to have bulletproof coverage, then your insurance pays that $60 to the clinic and you can now enjoy the rest of the day with whatever you do after five o’clock. However, that $60 is also the point where your deductible, copay, and coinsurance may apply. I will spend much more time on those concepts in the next episode, but for the purposes of this example, let’s just keep things simple.

Say your copay is $40 and you spent that amount already when you went to the clinic. A copay is just a fixed payment you give to the office on the same day you get seen. Now your EOB’s final column might state that you now owe $0 from that $60 balance which means, after your copay, the insurance covered the other $20 (= $60 balance -$40 copay).

Whenever you owe any more money to the doctor’s office, your EOB will highlight that amount as “patient responsibility” which is a fancy way of saying that you should be happy when paying up. I have yet to meet someone who enjoys paying their doctor more than necessary. Overall, I would suggest that you keep all your EOBs saved in one place so you can easily check how effective (or not) your coverage is over time.

A couple quick side notes before we move on: the EOB will have a little footnote or other number in the table called a remark code, which you should make sure to check, because those comments might explain why parts of your visit charges were adjusted or denied. Also: every time you get official, on-the-record healthcare visit or service, you should get an EOB even if you do not have a bill to pay. If you don’t receive an EOB statement that you’re expecting, go ahead and contact your insurance company or medical office ASAP (some health plans may just give you a copay receipt instead of an EOB). If one of your parents or your spouse is the primary insurance holder, that person should receive the EOB first.

I realize that I’ve thrown a lot of stuff at you so far but now we can talk about the big picture on how to check if your medical charges and coverage are kosher. The first two things you should check for accuracy on your EOB besides your basic info are the date of service and the procedure code for that service. That five-digit procedure or visit code is shorthand for any kind of medical care you receive. Most providers use the CPT code system when sending a claim. You don’t need to be a coding expert to know if your EOB is proper. Just take the CPT number on your EOB (e.g. 99213, 11102) and Google “that number + AAPC.” That acronym (AAPC) is for the American Academy of Professional Coders which is by far the best resource for defining any of the services you get. That page is another link I’ll have on my Substack. If that code you looked up from your EOB does not match with the actual experience of what you had at the clinic, like if you went for a visit but the letter shows you had a surgical procedure instead, something is definitely wrong. At this point you should call the doctor’s office to check why they coded the visit incorrectly and if they possibly overcharged you.

With all that done we’ve accomplished the two basic goals for how to read your EOB and get your beak wet for understanding the link between your medical care and insurance. Now you can see how much you owe for medical care and get an idea of the clinic billing you appropriately for corresponding services. Even though I’ve seen and written my own fair share of medical claims, my head still explodes when I talk about insurance too much, so we’ll save our discussion about major concepts like deductibles, coinsurance, and copays for the next podcast.

Stay tuned and subscribe to Friendly Neighborhood Patient for more healthcare tips and tricks. I’ll catch you at the next episode.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit rushinagalla.substack.com