Health Insurance: Test Your IQ

What you don’t know might cost you!

The air has already gotten a bit crisper on some of my morning walks. While that may mean apples and candy corn for some, it also signals open enrollment for health insurance for many of us.

We have the most complicated healthcare system in the world, largely because of the role insurance plays. Insurance is a legal contract and for non-attorneys, the language is crazy-making if you even read the fine print (and most of us don’t).

Knowing even a few key things about health insurance can make the difference between feeling in control and finding yourself facing unexpected bills. read more

Health Insurance Open Enrollment: Trick or Treat

Some people think of October as Trick or Treat time; Patient Advocates see it as the kickoff of health insurance open enrollment for the coming year, whether employer-sponsored, individual, and/or Medicare.

It may not be as playful as donning a costume or carving a jack o’lantern, but approaching your open enrollment period with the right spirit can certainly help you from getting tricked the next year.

So you’re not in the dark:

  • Assess how much financial risk you feel comfortable with. This might be influenced by how much savings you have, how often you need healthcare, and especially your personality. Some of us are more inclined to take chances; some of us protect ourselves against every possible negative outcome we can.
  • Understand what health insurance is and isn’t. It doesn’t eliminate your risk of getting sick or hurt, and it doesn’t protect you from all financial risk if those things happen. Health insurance is a way to lessen your risk from the cost of illness and injury (which can be substantial), and how much it protects you depends on several things in your control.
  • Keep this rule of thumb in mind: When you look at your insurance options, the lower your monthly payment for insurance (the premium), the more out of pocket expenses you’ll incur if you get sick or hurt. In other words, it’s important to balance the monthly expense against what you can afford to lose overall. A lower monthly expense may not be the best overall financial choice for you.
  • Staying in the network for your insurance can be a bit like figuring out who’s really in that ghost costume at the party. It can be really confusing. But it may be the most important aspect of making your insurance work for you. If you’re changing plans from the previous year, and if staying with your doctors and hospitals are important to you, it’s critical that you check to see if they’re in network for a new plan.
  • Full disclosure: Virtually none of us (OK, I know a select few) actually read their full insurance contract until they have to. But if you don’t read anything else, it’s important to look carefully at the provisions for emergency care. If you never leave home, it may be less important for you, but many plans have coverage limits outside their geographic service area or special requirements for emergency care to be covered. This has important implications to consider if/when you’re traveling.

And if this all feels a bit too tricky, call us for a 15 minute consultation and we’ll help you put the light back in your open enrollment jack o’lantern. read more


Emergency. defines it this way: “a sudden, urgent, usually unexpected occurrence or occasion requiring immediate action. “

In my healthcare experience lifetime, perhaps nothing has changed more than the role of the hospital emergency room. In my youth the hospital had two roles: caring for very ill or post-surgery patients needing nursing care until they could be released home, and attending to accidents (think someone getting their hand injured by machinery or being in an auto accident).

As a variety of things have changed in our healthcare system over the years, there are some common beliefs about emergency rooms that we should take a closer look at. read more

In or Out, Round About – Navigating Out of Network Providers

Stethoscope and hundreds of American dollars

Health insurance is complicated and healthcare costs a lot. If you’re not up for a complicated read, here’s the short version: Don’t use out of network providers if you can avoid it. If you think healthcare is expensive, out of network healthcare is very expensive! But if you want to dig a bit deeper, read on.


Maybe your doctor has recommended you see a certain specialist who’s not in your insurance network. Maybe you’re in an accident and the closest hospital isn’t in your insurance network. What then? read more

It costs how much??

Health care costs scrabble

Anymore, it seems for most of us every medical bill has a surprise when we first open the envelope!

How does a provider (doctor, hospital, laboratory, imaging center) decide how much healthcare costs? It’s a pretty closely guarded secret, and it’s not uniform across providers. But suffice it to say, it definitely requires some serious accounting that is largely invisible to consumers. Coined the “chargemaster” by Time author Stephen Brill, providers establish a base price for each and every service they provide. This is the price that they bill insurers and patients without insurance for services. It includes their overhead costs (staff, facilities, billing), and is essentially the base price for services. Understandably it’s higher for hospitals who have more significant overhead costs and lower for office based providers. Consider this “retail” pricing. read more

Does Insurance Cover That?


Inevitably when I’m asked what I do and respond that I’m a private patient advocate, one eyebrow raises, followed by “What’s that?”

My “Private Patient Advocate” elevator speech goes something like this:

“Private patient advocates are independent professionals that help patients and their families clarify options for managing their healthcare as well as the cost of their care. This might mean things like sourcing a doctor for a second opinion, facilitating better coordinated care, researching nursing homes, or negotiating insurance claims and medical bills.” read more