Under The Coverage

Lower levels of literacy, English as a second language, transitioning to the United States from a foreign country – all of these factors make it increasingly more difficult to understand and use medical benefits. Abby Grainge works as a family nurse practitioner at Jericho Road Community Health Center in Buffalo, NY and is also the medical director of Vive, Jericho Road’s shelter for asylum seekers. She joined the podcast to talk about the unique challenges the US health care system poses for those new to the country.

When you picture a nurse, you might envision a hospital or physician’s office. But nurses also work in a clinical capacity for health plan administrators. Lorene wants the world to know she and her team and other nurses in the industry work hard to walk with members on their journey to better health. In this episode she discusses how nurses work to help members, how they help patients who may face barriers to care, and why she what she does.

Congratulations, you’re hired! When you get a job offering health benefits it’s important to understand the basics. Where do you go if you’re sick? How much will it cost? Which physicians and facilities are in-network and what does that even mean? Jerame volunteers for a workplace readiness program where he often addresses health insurance questions. And he has some advice for you...

If there was a course in high school or college to help us understand how medical benefits work and what the terms mean, maybe we’d be better equipped to navigate health care systems. In this episode, Kyla talks to us about the questions she asks providers to avoid unnecessary cost, seeking the most cost-effective treatments for herself, and how she manages conversations around the cost of prescription drugs.

When you think of behavioral health and substance use services, you most likely don’t think to call your health insurance company. Here’s a secret: You can. And you should! Did you know there is a team of people working at your health insurance company who can help link you to in-network resources if you’re in need of mental health guidance and support? Registered Nurses, Corrine and Molly share insights on the processes put in place that help members navigate behavioral health and substance use treatment options through the lens of their medical benefit plan.

Helping people become healthy and well is one of Steph’s passions. We second that, which is why we invited him to join us to discuss his background story and shed light on how important it is to utilize your benefits properly. At the end of the day, you’re paying for these services. Leveraging experience and advocacy can positively impact your health outcomes. Listen up!

High deductible health plans with health savings accounts can feel overwhelming. On one hand, the plan cost is usually less than that of a traditional copay plan but then you remember you may have to lay out a lot of money up front before your plan’s copays kick in. Jenelle shares how she started building funds in her HSA a little at a time over time and how she thinks about health care expenses.

You head to the doctor for a routine appointment. A claim is born! In this episode Barb chats with us about a medical claim’s journey in the health care delivery system. It isn’t always a simple process but having a baseline understanding of how a claim gets processed might help you gain insight into industry timelines and requirements.

Do you want to learn more about the hottest couple in health insurance? Getting familiar with your benefit summary and ID card can help you out in the long run. During this episode we chat with Alicia about benefit summaries, ID cards, and walk through three network-related situations you may find yourself in.

Have you heard any chatter around price transparency tools? The average person spends more time reading Amazon reviews before buying a new blender than they do researching how much it costs to get a mammogram or MRI. Access to price transparency tools finally gives the patient access to the information allowing us to make more informed decisions about care that include the actual cost of it! Imagine having the ability to evaluate medical providers and services based on quality, cost, and location. Join us to learn how these tools function and how it will benefit us as consumers...we also share some caveats you’ll want to know.