How To Save Money On Health Insurance | Open Enrollment Explained With Eileen Dougherty

we've ever done. That's right, health insurance, specifically open enrollment because for many of our listeners in the US, open enrollment starts today. Oh, we're on the edge of our seats, but make sure you're sitting down because, like Jen said, super topic, especially if you're driving, Please sit down. Yes, but seriously, so glad to be talking with Eileen, because this is an area that is so confusing and we could do well to be wise with how we're spending

in this category. I mean, for most of us, I think we mentioned it in this episode. It's it's a high ticket line item in our expenses, housing, transportation, food, and health insurance, Like those are our top expenses at any given month and certainly annually, not just the health insurance, but then the costs of healthcare, above and beyond health insurance.

So there's just so much to be considering, and Eileen really helps break it down into some really bite sized pieces of what we can be thinking about when it comes to the type of health insurance that we choose. Yeah, and we hear so much on the internet, you know, pay attention to your groceries, pay attention to your coupons and your rebate apps, and YadA YadA. When we talk about cutting expenses here on the Frugal Friends podcast, we

look at it as an eighty twenty view. So let's focus on the twenty of our expenses that get us eighty percent of our results. Instead of the small latte purchases. We're looking at our big, multi thousand dollar purchases, and health insurance is one of those. So we hope that you really are excited for this episode because it will save you tens of It could save you tens of thousands of dollars over your lifetime, way more than cutting latte's.

That's no joke. But first, our sponsors. Today's sponsor is brought to us by best case Scenarios. They're doing a hard push to remind the general public that they still exist. When Jenn and I had our intro call with them, we did sense a tinge of bitterness regarding how much attention worst case scenarios get and best case scenarios aren't promising that it will always pan out that way, but they do want us to consider them. Best case scenarios

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case things. I love that. Thank you. Best case scenarios what an underrated scenario. So if you are super interested in health care, we actually have some other episodes to queue up that are just as exciting as this one. So the first one is when we recently did, which is think is super important that everyone should listen to sometime in their life sooner rather than later. Episode two thirty. So that is how to negotiate medical bills we did

with Dr Virgie Ellington. She is a doctor and patient care advocate and so she I mean, we'd go step by step how to negotiate medical bills. And then we also touch on medical debt as well. But really really good episode because if you have to use health insurance, you're gonna have bills too, and maybe you think you can't negotiate them because you have health insurance, but that

is untrue. Uh So, and then also uh episode twelve, how to save money on healthcare, we talk a little bit about everything, so not just insurance but also health care sharing, preventative care, that counts, stuff like that. So that's way back in the archives to listen to. Yes, but we still stand by what we said in that one. So oldie but a goody. But let's get into today's episode. Very impactful, Definitely one to share with your family and friends because nobody is going to tell you I have

no clue what I'm doing with health insurance. Definitely, if you've got a company slack, drop this one in the company slack and they you know whatever HR channel in the Pizza Channel, whatever, uh, somewhere people will see it because everyone should know the things that we're talking about in today's episode, and we're talking about it with a friend of my Eileen Doherty. You know you can. You can do a podcast for four and a half years and still not be able to find the right guests.

We have guests email us every day trying to be on the show. But when you're just trying to find a female health insurance expert, those are much harder to find than I built eleven businesses and made seven million dollars and sold on my companies. Interview me. Not a lot of those, not a lot of female health insurance experts. And then you just turn around at the gym and you're like hearing I I lean, I've worked in the

US healthcare industry for twenty five years. I'm an executive vice president at a health insurance payments company, so I am unbiased to networks and you're like, what around? But then I've found the guess that a need and she loves right there waiting for me right around. Um. I did say I had a podcast, and Eileen was like, oh, I've been on podcast, and I'm like oh, oh, what do you talk about? And she's like, health insurance, and I'm like, ah, and so Eileen not just an expert

on health insurance, but also a really cool lady. So let's get into it. Turn around, I'm gonna be able to get that one out of my head. Ah, Eileen, Welcome to the Frugal Friends podcast. We are very excited to have you here to talk about this really dry subject. But hopefully we can we can amp it up a little bit. I find it exciting, the pleasure. It's exciting for me just because I know very little about this topic. Just the prospect of learning and giving tangible tips that's exciting.

But but you know, we're going to sprinkle it with fun some way, somehow. Yeah. One of the reason, I mean one of the reasons we like to interview experts and we like to critique Google articles because when I was a writer, the two topics that I was like, I do not write about these, I'm not an expert are insurance and taxes, like any type of insurance. Please don't make me write about this. They don't know it. And then they would always assign me insurance in tax articles.

And I'm like, if they're doing it to me, they're doing it to other people, So be skeptical about what you read on the internet. I'm like, let's let's talk to you. Let's talk to you. You got a background in this. Let's demystify health signing up for health insurance and using it. So let's talk about what is annual open enrollment UM and why do we have it? Why can you only do this one month a year. Okay,

that's a great question. So open enrollments strictly speaking, right, is the yearly period, usually in the fall, when people can enroll in health insurance plans for the next calendar year.

And the reason why it only happens once a year is because most most health insurance plans have annual based limits, deductibles and maximums that they've calculated in order to manage the risk for the group of people that they are ensuring, and because they're based on an entire year, they can't have people switching plans throughout the year and still manage that risk. It's a unique aspect about the way that health insurance plans are put together that leads to us

being only able to enroll once a year UM. They do allow for other time periods for enrollment UM and we'll talk about that a little bit later, but they try to keep them to a minimum. The open enrollment period will vary b based on your if you have an employer based health insurance plan UM and those are normally like around three weeks in November, and most of us of the US population is covered by their employer's

health plan. But if you have health insurance, say through the A C A, then the open enrollment runs from November one to January and during that time period you can go in and elect a new plan that matches your situation, your current situation as well as possible, and then it will become effective on January one. In most cases,

that's the best explanation I have heard from anyone. Usually these conversations about open enrollment are being had with other people who don't know why, so maybe that's part of it. But we're always just like, and why only one here? And then it ends there and we move on frustrated and ignorant. So thank you Eileen for demystifying that, like the US health insurance was is weird, right? It was not. Health insurance in the United States was not originally created

by health insurers. The very first plan that was ever created, back in the nineteen forties was put together by Baylor University Hospital for the Dallas Teachers Union. So hospital administrators created a health plan that covered a set of teachers in a local city, and the patients had absolutely no responsibility, so they said, we'll cover everything, no matter what. For it was like fifty cents a month or something, and

so no matter how much health care you needed. Not surprisingly, the very first thing to happen after that happened is that all of the physicians that were in the network immediately raised all of their rates. And that is the beginning of a long pathway that has led us to the crazy place we are today with US health insurance.

Thanks Baylor, Thanks Baylor. A munch hospital and illustrators didn't really know how to handle the risk on a health insurance plan, so not not totally thinking macro level, like what what are the consequences and the pros and cons of this? Well, but here we are. So you did talk about there could be some exceptions to open enrollment. Can you share a little bit about what what that would be, how we might find ourselves in that type

of situation sure UM. So for most health insurance plans, whether they be employer based or their government sponsored UM, you will have an option to to change your enrollment outside of an open enrollment. Those are generally referred to as special enrollment, and they're based on life events. So if you get married, if you have a baby, if you adopt, if you get divorced, if you start a new job, you have the opportunity to enroll in a

new plan. The rules around how much time you have after those events and when that additional person either becomes effective or terminates our planned dependent So you have to read your plan doctor meants to truly understand when it's actually going to become effective and when the window is

for you to make changes. The A c A actually has another exception, which is UM, if your income changes dramatically, they give me the option to modify your plan during that time period as well m HM, which it's it's

good to know that. It kind of stinks because when you have those opportunities for special enrolment, those are the times were the last thing on your mind is health insurance and you do only have a certain amount of time to to like change that if you need to, so kind of maybe checking with your health insurance plan to see when that is um is always just a good idea. Just kind of be familiar. I mean, I know it's boring, but reading your plan document is important

part of being of owning a health insurance plan. And I mean, health insurance is becoming i think the fifth largest out going costs for an American household today so since and that's not always been the case, but patient responsibility has been continuously rising for decades. That is the portion that is paid by the patient on their health plan. And because of that, it's becoming more and more important for health for health insured people to become educated about

their health plan. But the reality is that the health insurance literacy in the United States is very low, and that's not surprising because it's super complicated. It is a complicated insurance plan. A lot of people don't understand how to use it and most of the time, unless you have a chronic illness, you're not using it more than

three or four times a year. So it is something that people don't have a lot of motivation to become experts at until they really need to, and unfortunately that's often past the time they've already made the choice about their health plan. So so so true. I mean, I just know it to be true. Anecdote. You know, sometimes it's in the back of my head, like I really should make sure that I've got the right type of plan and coverage, but it's like, yeah, I rarely go

to the doctor, so it's not front of mine. But I do sometimes feel like I'm playing with fire a bit with the current plan that I have. Oh, this reminds me of right before the hurricane last week. I asked my homeowners insurance broker to send me a copy of all my policies, and I was shocked that I chose because me back when I was buying my house, I chose the highest her named her gain deductible. Right, it was too late at that point. By the top point they have a named storm in your area, you

can't remind your contract. That's sort of what this is like. You know, you're you're invincible until you're not, and then you are reliant on your health plan that you chose a year ago when you thought you were never going to get sick. Yeah, So that leads us into are our first of the two questions that are gonna be the meat of this episode. So first is when I, okay, say I have insurance through my employer, it's it's what I got, it's what I chose when I got employed.

When should I like change What would prompt me to change that? Because it's much easier for me to just not to just ignore it. So why should I change it? And when that is? That's a key question for sure. So the most important thing to think about every year when open enrollment comes up is how has your life changed? Right? There is a whole group of people that when we were debating about the Affordable Care act Um in the early two thousand's, we called them the young invincibles, the

twentiesomething year old. So are you single and under thirty. The chances are that you're The amount of health care usage you have is very low, except in some stream situations. So you would want a certain type of plan. But at some point you're gonna possibly get married, want to start a family, and start working towards developing a foundation for that. And not every plan has great fertility coverage

or um coverage for having a baby. Uh, and you need to make sure that those things are well covered in a plan as your family begins to grow and mature. Also, if you have started to encounter healthcare issues UM that have increased your overall healthcare coverage, you may want to increase UM the healthcare coverage that you receive. Once you've reached the point where you're a family of six with a bunch of young kids and you have a ton of preventative care that needs to be done UM, it's

important to make that as easy as possible. And then as you continue to mature and grow, you're going to find that you'll encounter UM you know, higher risk areas based on your genetic background. As your children begin to move off to college, will be wanting to look for plans.

It may cover them until they're twenty six and UH, you'll start to look at what type of networks are available as you grow older into your sun sunshine years and are needing a set of doctors that can handle UM managing your care as you grow older, so age, family composition, UM that general demographics or things that you have to consider. M Yeah, it almost sounds like every year we would need to reevaluate if what we're using still works. Interesting that this comes up every year, Well,

not surprisingly um. Something like seventy of Americans don't choose the right healthcare coverage for their current situation UM according to recent studies. But you know, one of the things like deciding what that coverage is is then then becomes like a math equation, and who wants to go back to doing math? Like, I mean, I have a spreadsheet that I use, UM, but it's you can get really complicated.

And the reason is this right, So, the majority of Americans still make their decision for their health plan based on premium um what am I paying monthly just to get in the door on my health insurance? They look at premiums, they say that one's two hundred and this one is three hundred. Three hundred is obviously worse. I'll pick the two hundred plan. That's probably like Americans health care literacy, health insurance literacy is growing, though, so more

people are starting to make their decisions based on deductible. Right. Deductible is this other concept. It is the amount of money you have to pay out of pocket before your health insurance kicks in in the year. And those health insurance deductibles have been getting higher and higher every year, and now most Americans that are employer based insurance. Are on a high deductible healthcare plan today, so you've got

this premium and deductible. So a lot of Americans have started to choose the lower deductible right, so they'll say, oh, man, it's five thousand dollars from my family has a lot of money. I'd never be able to pay that should I have an emergency, so I'm going to choose the deductible.

The problem with making that choice is that sometimes you're choosing a lower deductible but ending up with a higher premium, and the total amount you're paying in premiums throughout the year is more than what you bought down in deductible, and many people don't make that. They don't add that up in their heads, so they feel like they're covering themselves better, but actually they're paying more out of pocket monthly in order to de risk the plan. So that's

something to consider. Another thing to consider is that most most plans today don't end in deductible um. Once you hit your deductible, either for your family or for individuals, you have to pay something called coinsurance UM. Many plans that coinsurance is eight twenty or nine ten up to a certain maximum. What that means is that you still pay twenty percent or ten percent until you reach a

maximum dollar amount. Many people don't realize that there's that additional money on the entail in there, so they'll pick a lower deductible and end up with a plan which actually, over the entire cost of the year, if you max it out, is more expensive than if they had chosen a ninety ten plan. So, as you can see, this kind of stuff gets really complicated. There's also additional things out there um that you need to consider when looking for a plan. My personal favorite is the one that

everyone overlooks, which is the quality of the network. So one thing that most people don't realize is that there's these big health insurance plans out there that we call them the Bucah's Blue Cross, United, Signa, Etna, and they have the best networks and they sell their networks to other health insurance plans to use. Since they have the biggest networks, they have the biggest ability to negotiate down

rates as well on the allowed amounts. So if you have a United plan, you're starting at a lower dollar amount for that service than somebody else's who might be on what they thought was a cheaper plan with the worst network, something a lot of people don't consider. How can you tell the difference between a good network and a not so good network, or maybe even like where is my doctor? Where do I want my doctor to be? Like, So always start with exactly what you just said, right,

start with my doctor. Right, who are all the doctors that my family uses? And if you're looking at a new plan, check to make sure all those doctors are in network. A lot of times people don't even take that step, and once they've moved into the new plan, they now have to get all new doctors, which is a big hassle and can affect your continuity of care. And then you wouldn't get the same amount of the

same quality of care in that year that you would expect. Yeah, then the next step is there are provider network directories all over the internet. They're required to publish them. You can go and type in your city and see how big the network is and how comprehensive do I recognize all the doctors? Is there only one psychiatrist in my entire hundred mile area? Um? And you can get an

idea for the depth of the network. Of course, if you hear the names Blue Cross, United, signat not like it's going to be a big, comprehensive, well negotiated network. Mm hmmm. This might be adjacent to what you've already said, and maybe you've covered it already. But if if I'm in a position where I've decided I do want to relook at this and maybe I do need to make a change, are there any things that you would say, kind of in general, these are the most important things

to be looking at when choosing health coverage. Yes, so, I think a lot of times people focus on the dollars, and that is important, Like I think it is a key feature, UM, But here are a couple of other things you might want to consider. So again, the network for me is a really big one because United negotiated discounts are significantly bigger than a lot than than say a smaller UM self funded plans negotiated discounts would be.

But you should also be taking a look at the planned documents, which are always available as part of the open enrollment walkthroughs, to look at plan exclusions and any plan maximums that are on the plan. Right, So it's very common for UM certain things that you may be wanting in the period in life that you're in to be excluded like fertility treatments. UM, that's a big exclusion, UM, and sometimes that is a really important part of what unique.

Also certain types of diabetes treatments, certain types of drugs that you may be wanting. For mental health, there was a big legislation that just passed in the last couple of years UM for mental health parity, requiring that mental health coverage be equivalent to medical coverage on all plans that are covered by the a c A, but not necessarily on employer based plans. So it's important to pay attention to mental health coverage. Another thing I think it's

really interesting UM to consider is the maximums. Most state laws and federal law prevent UM full healthcare coverage plans from putting like an nual or a lifetime maximum on their benefit. But if you happen to be UM trying to purchase a plan yourself beyond the lookout for something that they call junk plans or short short term plans in the marketplace. They look too good to be true, and oftentimes they really are. They will put maximums on

things like surgical benefits. I've seen one as low as like four thousand dollars a year for your total surgical maximum. And I can promise you you can't have surgery anywhere in the United States on anything for four thousand dollars. I mean my appendectomy was thirty six thousand dollars ten years ago, so that's you know, not going to cover you for anything. So those are the things that I

think I would be on the lookout for. I also am a huge proponent of Health Savings account and h r A UM add ons to high deductible health plans. It's a great way for you to save money and have a higher deductible without having health plan, try and save for you in premiums. Yeah, that's UM. I love h A S two for people who are familiar in h S A is only you can only get it

with a high deductible health care plan. But after usually around two thousand dollars that you put in, you can invest the rest and you can use it just like a retirement account, which is great. And it's tax free on all medical like all qualified medical expense, so it's great.

We did we I wanted to ask you about this because we had somebody in our group asking about so she was diagnosed with a some kind of healthcare thing and anticipated some medical costs rising, but she loves her hs A, and so she was she was contemplating do I go to the lower deductible plan because I do expect rising medical costs, or do I hold to my h s A and keep investing there, maybe use the funds there, because she didn't know like how much this new thing would cost as brand new, So like any

advice for maybe somebody kind of dealing with with that in general, being like I might have to go to the like I might have some medical stuff this year, but I really love my h s A any deciding factors. I'm a strong proponent of self ensuring whenever possible, I mean, and the ability to I strongly believe most people should push the deductible as high as they can manage um and lower their premium and then just self save the remaining money and hs A if they have that available

to them. I'm not as big of a proponent of h r A S but because that money is then owned by the employer and not by you. But like you said, the h s A is money that you can roll over. You can invest it if the market is doing well, that money UM could really be worth even more. It's also tax free and a great wave for you to continue to build your own way to

de risk your healthcare. However, if you really feel like you're going to have increasing needs in health services, I think it makes a lot of sense to look for a more comprehensive plan and pay the extra money to get more benefits. Yeah. I mean, and you're only restricted really for a year for whatever plan you have, so if you choose wrong, you can always change it the next year too. Yes, absolutely, and there's a good reason

for adding more to that. Emergency savings. Is the hr A the same as f s A or those different

so UM flexible spending accounts are a little bit different. UM. They normally covered like dependent daycare UM, and they do sometimes have like health insurance coverage, but usually those are ruled into an h RA and HRA differs from an hs A and the fact that an HRA is an employer owned account that the employer UM puts money in and the employee can also submit money, but that money is owned by the employer and when the employee leaves, that money is retained by the employer. And if it's

not used in the year. It also is still retained by the employer UM, so it's a benefit and it's something that employers do to offset employer risk UM. So it is a good option. But it's not employees, it's not the employee's money, and it doesn't have cash value. Yeah, okay, but both of them can be used to pay for qualified health expenses, and there's a lot of qualified medical expense a lot almost anything you can get at CBS

almost anything. Yes, absolutely. And I actually used my hs A to pay for my child's travel back from college to go to a health employment Wow. So and that was validly covered. Yes. So your HC has a lot of flexibility around what it can cover to support UM your health insurance needs, health care needs. And you don't

have to pull those funds out immediately. You can wait and let it grow if you don't need it, Like I've saved with KAI all of my UM everything I paid for that pregnancy that I you know, got a bill and paid for and have an itemized receipt for whenever I want, I can take that money out of my h s A and submit that receipt whenever. So it's great. You can let the stock market pay for your medical treatment, like, just let it grow, let it

pay for it, and then take the money out. I'm just clarifying that Kai is three years old and you're saying you could submit for reimbursement from your hs A like three years after giving birth. Yeah, because I had the hs A while I was on that the plan. Yeah, let's just say, you just got to be careful with an agent, say when the when the stock markets not doing that great, that you're not paying more ease than you are earning from the stock market, so you have

to watch it. Like when you invest it. If you invest just a few thousand dollars, sometimes the bees end up being more than your earning, so you want to put it out cash. Um Yeah, yeah, yeah, you always wanna. Obviously, if you're in a high fee investment account, it sometimes makes more sense to just pull it out sooner. Mine is in very low fee index funds that I have easy access to, so I feel good about it that they're the same funds in my retirement accounts are in

so I feel good about that. But okay, so back to open enrollment. Give us like, like, is there a checklist that we can do to get ready for open enrollment, any like pre homework that we can do well. I mean, just making sure that you understand how much to spend in health care for the previous year is important. A lot of times we lose track of how much that

is because the equation is so complicated. But if you have an idea of how much the total charge amounts were for all the services that you UM took on throughout the year, at least a rough amount UM, that will help you to be able to evaluate plans as

you're looking at them. The next thing is to ensure that when your employer, if you have your health insurance to your employer when they published their open enrollment availability of plans, take the time to read through the options UM, maybe in a little bit more depth than you have the best UM and given what you might you know have picked up from us talking today, start thinking about what type of plan would make the most sense for your family UM and what you know financial ability you

have to support it UM. And then lastly, like think about what your family is going to be like in the next year or how you want it to be UM so that you're prepared for it. If you have healthcare coverage that doesn't have great obstetrics, UM, and you're planning to try and have a baby, then you might want to have some thought about that when you're going into looking at planned documents. I mean, any final tips on just ways we can maximize this opportunity when it

only comes around once a year? How do we get the best possible? And my mind is gonna go to like the least expensive for the best thing. And you've given us a lot of tips already, but any any final thoughts on how do we maximize this annual opportunity? Well, so make sure you so. Health care Health insurance literacy is like a particular like has a particular place in

my heart and mind. Right now. I feel like we are very smart consumers as Americans, but we haven't taken the time to educate ourselves on some basic terms and knowledge about health insurance. And I know why. It's not like the forefront of our minds all the time. UM, But as you begin to become a greater consumer of health care services, it's important to educate yourself on all of those terms. What's it inductible? What's coordination of benefits? Um?

What's a co pay and why does it matter? And you know how our surgical benefits covered and what are possible exclusions? What is an exclusion? Um? That type of information will really arm you as you're heading into the open enrollment season and having to choose what is really a pretty big financial choice for your family in the next year. Do you have any recommendations on like good

websites or resources where people could become more health insurance literate? Well, so, believe it or not, UM, the Affordable Care Act websites are great about explaining a lot of these terms because their job was to take a population that didn't have benefits or HR department and help them become more literate for accepting and UM and identifying an insurance plan for themselves. UM. So I find that the marketplace is a great place

to find information. There are also a ton of websites out there which our patient advocacy sites that are all about raising literacy UM And there is a website called quizzify dot com that I really love that has a lot of videos that helps to raise your your knowledge level not just about health insurance, but also about health care itself and the different types of choices that you may have to make. That's amazing. Yeah, because there's so

many like add ons to it. You've got the dependent care f s A or the h R A or or do we go ages A or multiple high deductible plans, and there's so much And for the longest time, I think, maybe even sometimes still I still confuse deductible and premium. Like I have still confused the two words, and you're not Americans are still don't know the like aren't able because why you only really think about it once a year. So yeah, definitely, well you know what I think about

every week. I never have to be reminded of this terminology, sometimes multiple times a week, multiple yes, multiple times a week. The bill of the week. That's right, it's time for the best minute of your entire week. Maybe a baby was born and his name is William. Maybe you've paid off your mortgage, maybe your car died and you're happy to not have to pay that bill anymore. That's bill Buffalo Bills, Bill Clinton. This is the bill of the week.

I mean, every week we invite our listeners or our guests to share with us their bill of the week, and we know you have one for us, So let us let us know it alright. So I didn't realize this until the very beginning when we started here, but I picked something a little bit boring. Um, So I'm not sure if because you should want to switch me out, people are just going to get more bang for their buck on the info on this episode. That's exactly something

they didn't expect. Yeah, and I'm that weird person to gets super excited about all of this, So I don't even notice that you're bored, um why you're here. But um, I when you said bring in something that's like a bill or or bring in a bill, I I thought about, Um, these explanations of benefits that we always get in the mail after we have a medical service, and they always say, this is not a bill, and I think it's really interesting, Um,

some of the things that can be written on these bills. Um. So I a friend who also works in the healthcare industry and recently had a baby, and she received an explanation of benefits, which is from your health insurer, from your pair, not from your provider, telling you how they adjudicated the claim that you're providers sent to them to your doctor sent them acclaim, they adjudicated it, They put together this beautiful display that's super complicated about how they

paid the provider so that you can see what you might ohe and she was looking over her explanation of benefits and noticed that her normal, healthy delivery, natural childbirth delivery was coded as a level for emergency and she didn't understand why, so she called health enture and she found out that the doctor's office that you know, the provider that she had gone to for her delivery, that's how they upcode it to get the higher rate associated

with level for emergency childbirth. And they do it for everybody, and oh my goodness, so welcome to the US health care system. And of course the insurer had um missed it um and they went back and readjudicated the claim, which caused, you know, a lot of headache for her because then the provider tried to balance bill the remainder to the patient, and then she had to involve insure again. So I thought that might be a little interesting tippit about not a bill, So I actually hurt you rather

than that's not boring. I mean, I'm fired up over here. Balanced it something that we don't talk about. That is yeah, it's also it's not a bill, but it is a headache I have. So I have a bill from my uh first birth that it's like hundreds something dollars. And I was switching insurance because I was part of a

layoff eight weeks before I gave birth. So I was switching from my insurance which was my coverage, to my husband's insurance and had something very close of a point meant some blood work or something very close to the switch. And so they submitted it to both or or the wrong one and they rejected it. And they are they have me in like collections for this thing that should be covered by insurance, that is covered by insurance, but

they just can't figure out who it's covered by. And I was like, I can tell you who it's covered by if you tell me the date, and so they just haven't. It's not their priority and they don't care about me. So every time I call, they're like, you know, you have something in collections with us, and I'm like, no,

I don't. It's so interesting that you that it's that you talk about it like that, because um, this this is something that we in the industry are really interested in right now, Like the experience of health care payments from the patient or members point of view is so negative that we don't even know where to begin to improve the process, either providers or health insurers. I would have to call every single day to that office to make them care enough to to do something about this,

and I don't have the time. I mean, think, think about when you have to call an airline twice and how negative your reaction is to that, and how much airlines work to try and stop you from having to make those two phone calls. But in health care industry, it's so disparate, and there's so many different connection points that we've not been able to create that level of service.

And we haven't needed to because until the last two decades, patients weren't really a significant part of the equation, so none of the systems were built to do that. I mean, I love your this is not a bill. This is amazing, This is this took quite a turn in this Bill of the Week segment, and and I am I'm feeling the fire in my value right now. So I'm going to turn it back to our listeners and tell you if you've out of this is not a bill, or this is totally a bill, or a bill. You don't

have to pay a bill. You do have to pay whatever it is. Visit Frugal Friends podcast dot com, slash bill, leave us your bill. Even if it gets me fired up, it's a good thing. It makes me feel alive. Now it's time for the line. So today, in our vulnerable part of the show, we are all going to share what's an interesting health insurance experience you had and what did you learn from it. This is just an extenuation

of the Bill of the Week segment. I think, I know, I know, I give Okay, I'll expound on it though, But so, Eileen, why don't you go first an interesting health insurance experience you've had and what you've learned to give me yours or somebody you've witnessed. I'll tell a positive one in which a weird instance of my health

plan lead to a very positive outcome for me. So, right after I got married ten years ago, like like literally the week after, I woke up with like pains in my lower abdom I am the child of a doctor, so I knew immediately I had a pennicitis, but I wasn't on my husband's insurance plan, and before that I was I was running my own business, so I didn't really have insurance. UM, so I was uncovered and I

hadn't rolled on to his plan yet. And I went to my doctor and he was like, yep, pennocidas, we need to go to the e R. And I was like, well, I'm not at my husband's plan yet. Is there something else you can do? And he was like, no to the R. But I was like, uh, well, like I'm weren't suying, I work it out today, And so he gave me these really strong antibiotics and sent me home.

Well like by midday, my husband had mostly sorted everything out, and I went ahead and went to the e R and that I had a pennicidas And the next morning I had an appendeck to me through the e R. And when it all got sorted out in the end, the way I had been admitted to the e R and the way that they coded it, um, my surgery ended up being an emergency surgery and on the United Healthcare plan at that time, they covered it a hundred percent.

So even though my appendectomy, which slightly ruptured and became like a really big deal, was like a seventy thousand dollar event, I paid zero dollars and after that happened, that plan realized the flaw of their set up and changed the plan for everyone next year. But a bit, a bit of knowing, like if you know the details and you know how to work the plant, then you can really do well. That's the lesson. Well, I mean you didn't. You didn't do that well because you had

a partially raptured apend. But there was a silver line and doing great, great, it was good, like health was that was question? Oh my god? Wow, Um, I no longer have an appendix either. I lean bodies. I have no idea. That was when I was younger, And I should ask my parents how how that whole insurance they worked out? But yeah, finding ruptured appendices. I don't know how you say that. It's such a traumatic experience for like parents, Like you think your kids just oh, I

have an upset stomach. You always have an upset stomach when you don't want to eat broccoli or when you don't want to go to bed, and then that could be ruptured appendix. Yeah, like how do you know the different? Though? So this is not meant to be medical advice. I'm

not a doctor, sure, not a door. But a lot of the time an appendix can it can be more indicative of an X if you have them jump up and down and it hurts worse, or if when when you push in on it and it hurts worse when you let go and not when you push in, that can be an indication of AIS. But again, that clinical not a doctor. This is not a bill, this is not a podcast. This is not a podcast. I'm like an executive at a health care payments company, like, yeah,

don't go with what I said. But well, and this is anecdotal. But for me, I was vomiting a lot, and you take me to the doctor. Yeah, yeah, yeah, lots of vomit. Okay, So I'll expound on mine a smidge. So uh so, yeah, I'm still like quote unquote in collections. It's not like on my credit report. So that's why I'm not like calling every day. They are quote unquote working on it. But so in that switch, I learned

something really interesting. So we were on my works plan because they covered health insurance a hundred percent, you didn't get to pick. Yeah, I mean, they're the choices were very limited for what you got to pick because they paid for it. I think you had single or family essentially, And I switched to my husband's plan when we lost that instead of going into Cobra, and I was eight weeks away from my delivery and my bill, my total

out of pocket went down. So I had already paid for my entire pregnancy delivery everything I'd paid in installments, and they sent me a refund, which also makes this like hundred and fifty dollar bill like that much more infuriating.

I was like, you sent me money back? What? So I think I didn't even realize that the plans could cost different, Like it could be a different cost depending on what you're insure is so that is something that I would ask my doctor me, like, Okay, if I'm on this plan, what is the total package of my pregnancy and delivery going to cost? If I am on this plan, what is it going to cost? I didn't realize it had to do with the network. I didn't

realize until you said that at the beginning. I would have never asked my oh B the billing department that, but that would have been something to factor in along with monthly premium payments, So like, does it make more sense to pay a little bit higher in a premium to get this lower cost for the pregnancy versus paying a lower premium to paying more for the overall care. I didn't even know to think that. So if you

are pregnant, there you go. Definitely, Like those negotiated rates that they have with met with between directory services and providers are very different from insurer to insure, and like United can walk into almost any doctor's office and say, for the benefit of being a part of our network, we will offer you a sixty sixty of what you charge to start, right, And a smaller directory would be like, what do we have to give you to be in

our network? Like, it's a totally different negotiation, you know. So um, you know you want to be a part of the you want to be with the bigger you know, negotiator or get a significant discount on premium um for a less significant allowed like allowed amount of negotation negotiation. So mhm, so interesting. Jill, Wow, Well here you go.

I have not interacted with health insurance very much, so I yeah, I've had a lot of different types of plans current Lee though I am on like a medical sharing plan, so it similar to our bill of the weak segment. This is not a bill. What I have technically isn't insurance. It's more of a fail safe. And and what I've what I've learned in what little interaction I have had in getting quotes for insurance is I

got a fend for myself. I gotta be scrappy. And the last appointment that I went to, I mean, I I really don't go to the doctor. It's kind of a problem, but it's worked for me so far. And I did have to go to the dermatologists this year. We are not doctors giving medical I'm telling you, dotal, this is my anecdotal personal experience. Don't don't do what I do or what I say when it comes to this. I did have to go to the dermatologist this year.

I did that felt like I'm caring for myself. I'm actually going to see someone for a concern that I have. But it wasn't in network. So I was just like, I'm self pay. I'm just gonna tell these people I don't have insured. I wonder I was wondering if they treated you as self pay that they did. They did, and I'm gonna and so here's my lightning round is what did we learn so this is kind of like

medical insurance adjacent. They did tell me up front what the cost would be just to go in for the visit, but that any minor procedures or care that they provided to me in the exam room would be quoted to me in the exam rooms. I'm like, okay, this is all new, let's try it out. So I did need to have some procedures done in the exam room. They were like, like it split, they did it super fast,

and they just verbally told me the prices. So I'm sitting here just like okay, yea and mentally calculating it, like yeah, we could do that, we could do that, we could do that. Get out to the front desk and it's a different price. So then I'm standing there band aids all over the place like, uh, that's not what she told me, and they're like, yeah, that's what we told you. So then she had to get the doctor to come back out, and I'm not too proud, like yeah, I'll sit here and like fight back with

what you told me, but what I learned. So here's the Like, if there are any takeaways and anyone's like me going into the doctor's office, I wish I would have gotten it in writing or like taking a screenshot or something, because it felt so arbitrary, because she's like because even like the friend desk person was like, oh, well, we can ask, which tells me there might be different

prices that they're quoting to different people. So rather than my word against their word, I wish that I would have had them, Okay, what's the procedure, what's the price, what's the procedure? What's the price? And I didn't get it in writing. And the good news is is that that is federally mandated required as of January of this year for all self pay patients. They have to provide you with what's called a good faith estimate before the service UM. That was covered by the No Surprises Act

and was mandated into federal law in January. So from now on, if you're a self pay patient, UM, you should be receiving a good faith estimate from all providers for any scheduled apointment that scheduled um longer than three days away from today's day. Yeah, and again she told me, like before I said yes to each procedure, she told me a price. It's just my recollection of what she

told me. Which I feel like I would be the more accurate one in that situation because I'm the one paying it out of pocket and calculating it in my head right there on the table. So that was a bummer. But I think being a self pay patient is an interesting space to being in healthcare right now. Um, you can't really see a doctor that takes care Caid because they have most Favored Nation clauses in their contracts with them. But there's a lot of really great spaces where you

can self negotiate. I think that's incredible. That's good that you're doing that. Yeah, yeah, so, I mean it was reason in a ball at the end of the day, like it. But that's my like. Next time I go, I'm going to get them. We're not doing it verbal, You're putting it in writing for me. I ain't, no dummy. I learned to use the word good faith estimate and they are required to provide it for you. I love. Yeah. Well, Eileen, thank you so much. Uh. If anybody wants more health

insurance literacy or more from you, where would you direct them? Um? So I have a LinkedIn page with my name Eileen Doherty. Um, you can tell that it's me because it's got my picture on it. But I also have a blog called Eileen dot Healthcare and an email address. You can contact me through that blog if you'd like to. Awesome, Thank

you so much, Eileen. This has been very informative. I have written things down because I am going to need UH to do some reevaluating on our health insurance this year. So very very glad that we had this interview. It was entirely my pleasure. Thank you. Riveting right, Jill, I'm so glad you turned around at the gym and saw Eileen standing there with all the answers to your healthcare insurance needs and wants from a friendly face right here

in St. Petersburg, Florida. Yeah, this is definitely this is a question I had and I wanted answered, and that's why we did this. This is the episode nobody asked for but everybody's getting because I had the question. We don't shy away from boring complicated topics. You'll learn this about us and we'll still laugh. We'll have a few laughs along the way. But yes, I needed this too, So you know, we give ourselves what we need now,

what we want sometimes. Yeah, we don't show away from the topics that you didn't ask, so thanks for listening to them. Um. Many of you know that in addition to two episodes a week, we also have a private community for listeners specifically trying to pay off debt. If that's your one goal right now. We have a membership where we do monthly money challenges to keep you engaged and moving forward with your debt payoff. And we want to congratulate one of our members for a big win.

This is from Susan and this is from when we did the values based spending challenge back in September. She says, just thinking about my values with every purchase was so helpful. I did the challenge during the last seven days of September, and I didn't actually make very many purchases, but I thought about this every time. It's a very different mindset for me in a real game changer. One of my

values is work. I really love my job. I've been working a lot of hours of the last couple of weeks on a special project, so I decided to use a grocery delivery service for the week and spend a little extra so I could focus on working without needing to go to the store, which always takes longer than I think it should. Since I combined that with a strong meal plan, I may have even saved a little because I didn't make any impulse purchases because I wasn't

at the store looking at all the things. So congrats, Susan. That is a very great benefit. And that is something even from my mom. She doesn't listen to the show, but I told I gave her this recommendation once and she's like, I must have saved twenty books by doing this because I avoided the twenty and impulse purchases I make every time I go to the store. And I was like, Mom, if you have a problem with impulse spending, I have a podcast for you. Turnaround, Mom, listen to

the Frugal Friends. Yeah. So if you or your mom has a problem with impulse spending um and is trying to pay off debt. Then had to Frugal Friends podcast dot com slash club to see what else we offer in the Frugal Friends Club. See you all next time. Frugal Friends is produced by Eric Syrian. My mind is just on insurance and medical costs right now. Mm hmm yeah,

and how angering it all can be. That's one of the reasons too, why I think I don't I'm not as literate in this topic as I could be is because even as literate as you can become, it can feel as though there's still so much work to be done just fighting these these issues. It's like it's not a well oiled machine that we're dealing with and just

you know, understand how to add and subtract numbers. It's so complicated, and then there's so much fraud and in decency and headache and phone calls, and it just it feels a little bit like debilitating. It does. Yeah, it is unjust, and I think a lot of I mean, sometimes when we're dealing with an unjust system, we can just throw up our hands and say, well, I can't change it, so I don't know enough or I don't have enough skill to come out on top up, so

we just don't try. And so that's like the goal with these episodes. It's just to give you a little more knowledge, a little more confidence, and a little more boldness to try. Yeah, and do I feel the same way even after years of you know, being in personal finance, writing about insurance, like hearing experts like this talk about it like it still feels debilitating because then it comes

into time that I just don't have. It was super affirming for me to hear Eileen talk about we might be better off with the higher deductible and the lower monthly premium. I think because that's my circumstance right now, and I kind of always feel like, oh my making like the juvenile decision, thinking nothing bad is going to happen to me, although I do have that deductible saved as part of my emergency funds, so and so it's

just affirming. I think that's one major takeaway from from me because I've had that thought like, well, I pay much higher each month to get a lower deductible, but at the end of the day, like I might be spending more not actually saving anything. And that's only if there's a massive catastrophe. So I I think that helps to to know, Okay, be as armed and ready as possible, but also smart about what's going to be best for you individually, knowing that it's not a perfect system. Yeah

it's it's not perfect, but it's our system. It's what we've got, um so so take advantage of it as as well as you can. No, I think that's kind of the moral And you know what, all of those negotiating phone calls that we do and other aspects of our life will only serve us well for fighting these battles of medical costs and insurance coverages. And you know what, I think there's a part of me that needs to shift my perspective to this is such a hassle. I

don't have time for this too. This is a part of life, like I will probably monthly find myself in some sort of back and forth phone call, whether it's negotiating something, writing something, giving accurate information for something that was inaccurate. I think it's just that is a part of being alive. Yeah, that is my version of a pep talk Welcome to life on the podcast. It's real life.