In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I’m joined by Niki Chamberlain, a self-employed mother of three from Amarillo, Texas, who made the move from traditional health insurance to Sedera Medical Cost Sharing and direct primary care.

Niki and her family had spent years dealing with high premiums, large deductibles and coverage that still left them paying significant healthcare costs out of pocket. Eventually, they decided to try a different approach. Then came the test nobody wants.

During a family ski trip, Niki’s son suffered a serious accident that left him with a broken femur, a long ambulance ride, surgery, a hospital stay, physical therapy and eventually a second procedure. For the first time, Niki had to find out whether the medical cost-sharing model they had chosen would actually work when her family needed it most.

Her experience offers a firsthand look at what being a cash-pay patient really means, how medical bills are handled and what happens after a large healthcare need is submitted to a sharing community.

Niki and I discuss: • Why her family moved away from traditional health insurance • How direct primary care fits alongside medical cost sharing • What happened when her son broke his femur on a ski trip • What it was actually like entering a trauma center as a cash-pay patient • How cash-pay discounts changed the hospital bill • How Niki submitted bills and receipts through Sedera • Why understanding your Initial Unshareable Amount matters

As a self-employed family, Niki and her husband had tried traditional health insurance but kept running into the same problem: expensive premiums, high deductibles and significant costs even when they used the coverage.

They eventually chose a combination of direct primary care for routine healthcare and Sedera Medical Cost Sharing for larger, unexpected needs.

For everyday care, direct primary care gave the family a simpler relationship with their provider and predictable cash pricing. The health share remained in the background for the kinds of medical events nobody plans for.

Several years after joining Sedera, Niki’s family was skiing when her son suffered a major accident and broke his femur in two places.

The situation included hours with ski patrol, a three-and-a-half-hour ambulance ride, a Level II trauma center, surgery, a metal plate, multiple nights in the hospital and months of follow-up care.

It was also the first time Niki had ever needed to use the health share for a major medical event.

One of her biggest concerns was the same concern many people have when considering medical cost sharing: What happens when I tell the hospital I’m a cash-pay patient?

The answer was far less dramatic than she expected. Her son received the care he needed, and the hospital automatically applied a substantial cash-pay discount before sending the final bill.

After the accident, Niki opened a medical need with Sedera and began submitting receipts and bills as they arrived.

That included expenses from ski patrol, physical therapy, follow-up appointments and the hospital itself. Once the family reached its selected Initial Unshareable Amount, eligible expenses associated with the medical need were shared according to Sedera’s membership guidelines.

Niki had chosen a $2,500 Initial Unshareable Amount, meaning her family knew in advance how much they were prepared to be responsible for before sharing began.

Her son later needed a second surgery to remove the metal plate, along with additional physical therapy and follow-up care. Because those expenses were connected to the original medical need, they continued through the same sharing process.

One of the biggest misconceptions Niki’s story addresses is the idea that a cash-pay patient must walk into an emergency room with enough money to pay the entire bill before leaving.

She received medical care first, bills came later and Sedera provided a needs coordinator who remained involved throughout the process. Niki describes having the same person available as bills, invoices and reimbursements moved through the system.

She also found the medical bills themselves easier to understand because she could clearly see the services provided, the cash-pay discount and the amount actually owed.

Being a cash-pay patient means healthcare providers are not billing a traditional insurance company for your care.

That does not necessarily mean paying every medical expense upfront. Depending on the provider and situation, bills may arrive afterward, and cash-pay discounts may be available.

For someone using medical cost sharing, those expenses can then be submitted according to the sharing community’s guidelines. The bigger idea is that cash-pay patients have the ability to ask about pricing, compare providers and take a more active role in how their healthcare dollars are spent.

Niki Chamberlain is a co-owner of Chamberlain Contractors in Amarillo, Texas, where she and her husband, Matt, work on residential and commercial construction projects. She is also a wife and mother of three whose family moved away from traditional health insurance to a combination of direct primary care and Sedera Medical Cost Sharing.

Her experience navigating her son’s serious ski accident gives her a firsthand perspective on what medical cost sharing actually looks like when a major healthcare need occurs.

Connect with Niki:

Company: Chamberlain Contractors Phone: 806-584-6010 Address: 817 South Bryan St., Amarillo, TX 79106

To learn more about individual health insurance options, Medicare planning and healthcare consumer strategies—or to schedule a consultation—visit: www.core360benefitsgroup.com

 Subscribe to Bill of Health:

 Apple Podcasts: https://podcasts.apple.com/us/podcast/bill-of-health/id6794142312  Spotify: https://open.spotify.com/show/033USIRkymMFYmmTDDzyAi  Facebook: https://www.facebook.com/people/Bill-Filer-MedicareHealthLife-Insurance-Core360-Benefits-Group/61568058486052/  LinkedIn: https://www.linkedin.com/in/billfiler/  TikTok: https://www.tiktok.com/@billfiinsuranceguy

Be smart. Shop smart. Protect your wealth.

This podcast is provided for educational purposes only and should not be considered legal, tax, investment or insurance advice. Individual circumstances vary, and listeners should consult qualified professionals regarding their specific healthcare and financial situations. Opinions expressed by the host and guests do not necessarily reflect the views of any insurance carrier or affiliated organization.

00:05 Why Making a Healthcare Change Feels So Difficult 01:18 Welcome to Bill of Health 02:08 Meet Niki Chamberlain 03:10 Why Niki Left Traditional Health Insurance 05:23 Direct Primary Care + Medical Cost Sharing 08:26 The Ski Accident That Put Their Health Share to the Test 12:10 How Niki Submitted the Medical Bills 16:36 Choosing an Initial Unshareable Amount 21:55 Jargon Jar: What Does Cash Pay Really Mean? 23:59 Five for Fighting With Niki Chamberlain

The post Her Son Broke His Femur — Did Their Health Share Actually Work? With Niki Chamberlain (Bill of Health Ep.10) appeared first on Core360 Benefits Group.

In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I’m joined by Mike Markland of Atma to discuss Individual Coverage Health Reimbursement Arrangements (ICHRA), also referred to as CHOICE Arrangements, and how they are changing the way businesses offer employee health benefits.

Rather than purchasing a one-size-fits-all group health plan, an ICHRA allows employers to establish a defined contribution that employees can use to purchase qualifying individual health insurance. This gives employers greater control over their benefits budget while allowing employees to choose coverage based on their own health, financial situation and preferences.

We also explore how ICHRA can fit into a broader employee benefits strategy, including direct primary care, medical cost sharing and supplemental benefits, along with how companies like Atma help manage enrollment, administration and compliance.

Mike and I discuss:

• What an ICHRA is and how CHOICE Arrangements work
• Why employers are exploring alternatives to traditional group health insurance
• How defined contributions can help businesses manage their benefits budgets
• Why employee choice can lead to more personalized healthcare decisions
• How Atma simplifies enrollment, payments and administrative responsibilities
• Where direct primary care and medical cost sharing fit into a broader benefits strategy
• What employers and employees should consider before transitioning to an ICHRA

An Individual Coverage Health Reimbursement Arrangement (ICHRA) allows employers to contribute a defined amount of money toward an employee’s qualifying individual health insurance rather than purchasing one group policy for everyone.

Instead of being limited to a handful of plans selected by their employer, employees can shop for individual coverage that better reflects their healthcare needs. The arrangement also provides tax advantages when established and administered according to applicable requirements.

Traditional group health insurance requires employers to select coverage for an entire workforce, even though employees may have very different healthcare needs.

ICHRA changes that relationship by allowing employers to establish their contribution while giving employees more control over the coverage they purchase.

The transition also doesn’t mean employees are left to figure everything out themselves. Education, plan comparisons and enrollment assistance remain important parts of helping people make informed choices.

Managing individual insurance policies for an entire workforce might sound more complicated than administering a traditional group plan, but technology can help reduce that workload.

Atma supports ICHRA implementation through enrollment assistance, premium payment coordination, reporting and administrative services. Rather than requiring employers to manage numerous individual insurance payments, the process is designed to function much like the familiar group benefits model.

ICHRA can also serve as the starting point for a broader discussion about employee benefits.

Depending on an employee’s needs and eligibility, employers and benefit advisors may explore additional options such as direct primary care, supplemental benefits and medical cost sharing.

These options are not interchangeable with traditional insurance, but they illustrate why a personalized benefits strategy deserves consideration instead of automatically renewing the same plan each year.

A Health Reimbursement Arrangement (HRA) is an employer-funded benefit that reimburses employees for eligible healthcare expenses under established rules.

Traditional reimbursement models can involve collecting receipts, submitting documentation and waiting for expenses to be processed.

With a properly administered ICHRA, much of that work can be handled through technology and a third-party administrator, including qualifying premium payments, enrollment verification and required documentation.

Mike Markland is the founder and CEO of Atma PMF, an employee benefits organization specializing in ICHRA solutions and alternative benefits strategies. His background includes payroll, professional employer organizations (PEOs) and traditional employee benefits.

Connect with Mike: LinkedIn: Mike Markland Company: Atma PMF

For direct inquiries, contact Mike through his LinkedIn profile. A complete public direct email address was not independently verified.

To learn more about individual health insurance options, Medicare planning and healthcare consumer strategies—or to schedule a consultation—visit: www.core360benefitsgroup.com

 Subscribe to Bill of Health:

 Apple Podcasts: https://podcasts.apple.com/us/podcast/bill-of-health/id6794142312  Spotify: https://open.spotify.com/show/033USIRkymMFYmmTDDzyAi  Facebook: https://www.facebook.com/people/Bill-Filer-MedicareHealthLife-Insurance-Core360-Benefits-Group/61568058486052/  LinkedIn: https://www.linkedin.com/in/billfiler/  TikTok: https://www.tiktok.com/@billfiinsuranceguy

Be smart. Shop smart. Protect your wealth.

This podcast is provided for educational purposes only and should not be considered legal, tax, investment or insurance advice. Individual circumstances vary, and listeners should consult qualified professionals regarding their specific healthcare and financial situations. Opinions expressed by the host and guests do not necessarily reflect the views of any insurance carrier or affiliated organization.

00:00 Why Traditional Employee Benefits Need a Disruptor 01:21 Introducing ICHRA and CHOICE Arrangements 03:05 Meet Mike Markland of Atma 05:15 What Is an ICHRA and How Does It Work? 08:15 How Atma Handles Enrollment and Administration 10:13 What ICHRA Means for Employers and Employees 15:45 Addressing Compliance and Administrative Concerns 17:48 Combining ICHRA With Other Healthcare Alternatives 24:03 Jargon Jar: Understanding Reimbursement 25:43 Five for Fighting With Mike Markland

The post What If Your Employer Let YOU Choose Your Health Insurance? With Mike Markland (Bill of Health Ep.9) appeared first on Core360 Benefits Group.

In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I’m joined again by Richard Walton, CEBS, of Sedera for part two of our conversation about medical cost sharing and healthcare alternatives.

Episode 7 covered the basics of how health shares work. This time, we get more practical and dig into the questions that usually come up once someone starts seriously considering whether to leave a traditional insurance plan.

We talk about preexisting conditions, what it really means to become a cash-pay patient, how Sedera helps members negotiate medical costs and why health share members are not expected to navigate large bills entirely on their own.

Richard also explains how medical cost-sharing communities think about financial stability and why consumers should look closely at a health share’s track record, rules and reputation before making a decision.

Richard and I discuss:

• What to consider before leaving an employer-sponsored health plan • How health shares handle preexisting conditions • Why becoming a cash-pay patient does not mean navigating healthcare alone • How medical bills and scheduled procedures can be negotiated before or after care • Why knowing the true price of healthcare can change the way you spend • How health share communities approach financial sustainability • Who may be a good candidate for medical cost sharing

Preexisting conditions are one of the first concerns people raise when they begin exploring medical cost sharing.

Health shares do not handle them the same way traditional insurance does. Richard explains that Sedera uses a graduated sharing approach for certain preexisting conditions, allowing the amount eligible for sharing to increase over time.

That makes it especially important to understand the specific membership guidelines before joining. Every person’s situation is different, and no one should assume a health share works exactly like an insurance plan.

Operating outside a traditional insurance network can sound intimidating, but cash-pay healthcare does not mean paying every large medical bill upfront or negotiating everything by yourself.

For emergencies, the priority is getting care. Once the bill arrives, Sedera can help review and negotiate the cost before payment.

For scheduled procedures, members can request a good faith estimate in advance and compare the price with other options. In some cases, moving a procedure from a hospital to an outpatient facility can significantly reduce the cost without changing the physician providing the care.

The goal is not to become an expert in medical billing. It is simply to understand that you have options and support.

Healthcare prices are often treated as if they are fixed, even though they can vary dramatically from one provider or facility to another.

Richard’s point is simple: consumers already know how to shop. If you would drive to another town to save $1,000 on a vehicle, you can apply the same mindset to healthcare when the situation allows it.

Tools, direct primary care providers and medical cost-sharing communities can help make those comparisons easier.

Long-term sustainability is another important question for anyone considering medical cost sharing.

Sedera operates as a nonprofit medical cost-sharing community rather than an insurance company holding large reserves. Richard describes the model more in terms of ongoing community cash flow, membership size and the ability to manage large medical needs as they arise.

Consumers should still do their homework. Look at the organization’s track record, understand its guidelines and talk with people who have experience using the model.

Traditional insurance uses the word claim. A claim is a contractual request for payment under an insurance policy. Health shares use the term need.

A need is a medical event, illness or injury for which a member asks the sharing community for financial assistance according to the organization’s guidelines.

The language reflects an important difference between the two models: insurance is based on contractual coverage, while medical cost sharing is built around voluntary community sharing.

Richard Walton, CEBS works with Sedera and has spent more than two decades in the employee benefits industry. His work focuses on medical cost sharing, direct primary care and alternative approaches to paying for healthcare.

LinkedIn: Richard Walton, CEBS Email: rwalton@sedera.com Phone: 806-679-0816 Sedera: www.sedera.com

Interested in exploring Sedera medical cost sharing through Core360 Benefits Group?

Use the Core360 Sedera affiliate link: http://www.1enrollment.com/950517

To learn more about individual health insurance options, Medicare planning and healthcare consumer strategies—or to schedule a consultation—visit:

https://core360benefitsgroup.com/

Subscribe to Bill of Health:

Apple Podcasts: https://podcasts.apple.com/us/podcast/bill-of-health/id6794142312 Spotify: https://open.spotify.com/show/033USIRkymMFYmmTDDzyAi Facebook: https://www.facebook.com/people/Bill-Filer-MedicareHealthLife-Insurance-Core360-Benefits-Group/61568058486052/ LinkedIn: https://www.linkedin.com/in/billfiler/ TikTok: https://www.tiktok.com/@billfiinsuranceguy

Be smart. Shop smart. Protect your wealth.

This podcast is provided for educational purposes only and should not be considered legal, tax, investment or insurance advice. Individual circumstances vary, and listeners should consult qualified professionals regarding their specific healthcare and financial situations. Opinions expressed by the host and guests do not necessarily reflect the views of any insurance carrier or affiliated organization.

00:05 Welcome Back to Bill of Health 02:07 Why Bill Believes Health Shares Deserve a Look 05:01 Why Health Shares Don’t Need a Network 06:13 How Preexisting Conditions Are Handled with Health Shares 12:48 Why Paying Upfront Can Lower Healthcare Costs 13:44 What Happens When a Cash-Pay Patient Goes to the ER? 17:08 Can Health Shares Be Financially Sustainable? 20:12 Jargon Jar: Claim vs. Need 23:43 Who Is a Good Candidate for a Health Share? 25:00 How to Explore Your Options

The post Can You Really Leave Traditional Health Insurance Behind? (Bill of Health Ep.8) appeared first on Core360 Benefits Group.

In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I’m joined by Richard Walton, CEBS, of Sedera to talk about an alternative that still flies under the radar for many consumers: medical cost sharing.

Richard spent years working in traditional employee benefits before moving into the health share space. We talk about what a health share actually is, how it differs from traditional health insurance and why consumers frustrated with the current system are beginning to look outside the insurance model for other options.

We also get into the role of cash-pay healthcare and direct primary care, why health shares are designed primarily around larger and unexpected medical needs, and what families, self-employed individuals and employers should consider before deciding whether the model fits them.

Health shares are not insurance, and they are not the right solution for everyone. The goal of this conversation is to understand how the model works so you can make a more informed decision about your healthcare.

Richard and I discuss:

• What a health share is and how medical cost sharing works• Why health shares are different from traditional health insurance• Common misconceptions about health sharing and why due diligence matters• How becoming a cash-pay patient can change the way you shop for healthcare• Why direct primary care and health sharing can work well together• How health shares may fit freelancers, families and self-employed individuals• What to consider before deciding whether a health share is right for you

A health share is a community of members who voluntarily contribute money to help with eligible medical needs according to established sharing guidelines.

Instead of paying premiums to a traditional insurance company, members contribute to a medical cost-sharing community. That community then helps members with eligible larger and unexpected healthcare expenses.

The distinction is important: medical cost sharing is not health insurance, and sharing is governed by the organization’s membership guidelines.

One of the biggest differences is how consumers interact with healthcare.

Traditional health insurance often places a third party between the patient and the provider. Health share members generally operate more like cash-pay patients, which can encourage them to ask what something costs, compare options and make decisions based on value.

That does not mean consumers have to navigate everything alone. Health shares can provide tools and support to help members understand pricing and manage medical expenses.

Richard describes direct primary care as a natural complement to medical cost sharing.

Routine and predictable healthcare can often be handled through a direct relationship with a primary care provider, while the health share is designed to help with larger and less predictable medical expenses.

For consumers who are comfortable taking a more active role in their healthcare, combining the two can create a very different experience from a traditional insurance plan.

Health sharing may be worth exploring for self-employed individuals, freelancers, families facing expensive traditional coverage or employees looking at alternatives to their employer plan.

It is not automatically the right choice simply because it may cost less. Preexisting conditions, membership guidelines and the way eligible medical needs are shared all need to be understood before making a decision.

Richard’s advice is to compare the models side by side and determine what actually makes sense for your family, healthcare needs and budget.

An Initial Unshareable Amount, or IUA, is the amount a health share member is responsible for paying toward an eligible medical need before the community begins sharing expenses.

It can sound similar to an insurance deductible, but the two should not be treated as interchangeable. How an IUA applies depends on the health share’s membership guidelines and structure.

Richard Walton, CEBS works with Sedera and has spent more than two decades in the employee benefits industry. His work focuses on medical cost sharing, direct primary care and alternative approaches to paying for healthcare.

Connect with Richard:

LinkedIn: Richard Walton, CEBSEmail: rwalton@sedera.comPhone: 806-679-0816Sedera: www.sedera.com

Interested in exploring Sedera medical cost sharing through Core360 Benefits Group?

Use the Core360 Sedera affiliate link: http://www.1enrollment.com/950517

To learn more about individual health insurance options, Medicare planning and healthcare consumer strategies—or to schedule a consultation—visit:

 Subscribe to Bill of Health:

 Apple Podcasts: https://podcasts.apple.com/us/podcast/bill-of-health/id6794142312 Spotify: https://open.spotify.com/show/033USIRkymMFYmmTDDzyAi Facebook: https://www.facebook.com/people/Bill-Filer-MedicareHealthLife-Insurance-Core360-Benefits-Group/61568058486052/ LinkedIn: https://www.linkedin.com/in/billfiler/ TikTok: https://www.tiktok.com/@billfiinsuranceguy

Be smart. Shop smart. Protect your wealth.

This podcast is provided for educational purposes only and should not be considered legal, tax, investment or insurance advice. Individual circumstances vary, and listeners should consult qualified professionals regarding their specific healthcare and financial situations. Opinions expressed by the host and guests do not necessarily reflect the views of any insurance carrier or affiliated organization.

00:00 Healthcare Needs a Disruptor01:07 Why We’re Talking About Health Shares02:26 Meet Richard Walton04:01 What Is a Health Share?05:05 Health Share Misconceptions and Due Diligence06:05 The Rise of Healthcare Alternatives06:57 Health Sharing vs. Traditional Insurance09:03 Becoming a Cash-Pay Healthcare Consumer11:24 Shopping for Healthcare Like Everything Else12:51 Routine Care vs. Major Medical Expenses13:15 How Sedera Handles Routine Care15:27 Pairing Health Sharing With Direct Primary Care16:37 Options for Freelancers and the Self-Employed18:17 Jargon Jar: Initial Unshareable Amount20:38 Five for Fighting With Richard Walton22:00 The DPC + Health Share “Cheat Code”23:12 Is a Health Share Right for You?24:31 Saving Money Beyond Traditional Insurance24:55 Richard’s Contact Information and Part Two Preview25:22 Learn More and Final Thoughts

The post Health Insurance Isn’t Your Only Option — The Health Share Alternative (Bill of Health Ep.7) appeared first on Core360 Benefits Group.

In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I’m joined by Melinda Lacy, MSN, APRN, FNP-BC, of Direct Family Healthcare in Harrisonville, Missouri, to talk about how direct primary care works and why more patients and employers are paying attention to it.

Direct primary care uses a membership model rather than traditional fee-for-service billing. Patients pay a predictable monthly fee for access to primary care, often with longer appointments, easier communication and more help navigating the cost of labs, imaging and other services.

Melinda also shares real examples of how price transparency and cash-pay options can make a significant difference. In one case, a patient facing roughly $2,600–$2,700 for two MRIs was able to get them for about $1,400 by using a different imaging option.

The goal isn’t to replace every part of the healthcare system. It’s to give patients another way to access primary care, understand their options and make decisions that fit both their health and their finances.

Melinda and I discuss:

• What direct primary care is and how it differs from traditional fee-for-service medicine
• Why smaller patient panels can mean more time and access for patients
• How cash-pay pricing can lower the cost of labs, imaging and other healthcare services
• Why you may be paying more through insurance than you would by asking for the cash price
• How direct primary care can benefit employers and their employees
• Why having a financial safety net for catastrophic medical expenses still matters

Direct primary care is built around a membership relationship between the patient and the healthcare provider. Rather than billing insurance for each primary care visit, patients generally pay a recurring membership fee.

That model can give providers more time with patients and make same-day or next-day appointments, phone calls, texts and other communication easier to provide.

Melinda’s current practice, Direct Family Healthcare, is based in Harrisonville, Missouri.

One of the major advantages Melinda sees is the ability to help patients compare options before receiving care.

A doctor may recommend the right test or procedure, but that does not necessarily mean the first location offered is the most affordable place to have it done. Independent imaging centers, cash-pay arrangements and other options can sometimes reduce the cost substantially without sacrificing the quality of care.

Sometimes the most useful question a patient can ask is simply:

Employers are also beginning to work directly with primary care practices.

Giving employees easier access to routine and preventive care can help people address health problems earlier, spend less time waiting for appointments and potentially avoid more expensive care later.

For smaller employers especially, direct primary care can become another component of a broader employee health benefit strategy.

Prior authorization is the process in which an insurance company requires approval before it will cover certain medications, tests, imaging or treatments.

That can mean a provider has to submit information and wait for the insurer to approve the service before the patient receives it.

Because direct primary care operates outside traditional insurance billing for primary care, many of those insurance-related administrative hurdles do not apply to the services provided directly through the practice.

Melinda Lacy, MSN, APRN, FNP-BC, is a family nurse practitioner at Direct Family Healthcare in Harrisonville, Missouri. Her experience includes pediatrics, intensive care, case management, family practice and women’s health.

Direct Family Healthcare directfamilyhealthcare.com Email: contact@directfamilyhealthcare.com Phone: 816-793-0071 105C W. Wall St., Harrisonville, MO 64701

To learn more about individual health insurance options, Medicare planning and healthcare consumer strategies—or to schedule a consultation—visit: www.core360benefitsgroup.com

Subscribe to the Bill of Health Podcast on Apple Podcasts, Spotify or wherever you listen to podcasts.

Apple Podcasts: https://podcasts.apple.com/us/podcast/bill-of-health/id6794142312 Spotify: https://open.spotify.com/show/033USIRkymMFYmmTDDzyAi Facebook: https://www.facebook.com/people/Bill-Filer-MedicareHealthLife-Insurance-Core360-Benefits-Group/61568058486052/ LinkedIn: https://www.linkedin.com/in/billfiler/ TikTok: https://www.tiktok.com/@billfiinsuranceguy

Be smart. Shop smart. Protect your wealth.

This podcast is provided for educational purposes only and should not be considered legal, tax, investment or insurance advice. Individual circumstances vary, and listeners should consult qualified professionals regarding their specific healthcare and financial situations. Opinions expressed by the host and guests do not necessarily reflect the views of any insurance carrier or affiliated organization.

00:00 How Healthcare Is Becoming a Subscription 01:13 Welcome to Bill of Health 02:54 Meet Melinda Lacy 04:07 What Is Direct Primary Care? 05:05 How Direct Primary Care Works Differently 06:22 Why DPC Providers See Fewer Patients 07:30 How DPC Helps Patients Navigate Costs 08:52 When Imaging Costs Thousands 09:12 Saving More Than $1,000 on Two MRIs 11:28 Lower Costs Without Sacrificing Quality 13:24 Stop Automatically Feeding Your Deductible 14:36 How Direct Primary Care Can Help Employers 17:23 The Future of Direct Primary Care 19:53 How to Contact Melinda Lacy 20:21 Jargon Jar: What Is Prior Authorization? 22:28 Five for Fighting With Melinda Lacy 23:28 The Biggest Benefit of Direct Primary Care 24:29 Why Catastrophic Protection Still Matters 25:27 Final Thoughts and How to Learn More

The post What If Your Doctor Worked for You Instead of Your Insurance? (Bill of Health Ep.6) appeared first on Core360 Benefits Group.

I discuss:

• What it actually means to be a smarter healthcare consumer
• Why healthcare shopping doesn’t have to be complicated
• Why the first price you see may not be the price you ultimately pay
• How shopping around can help lower healthcare costs
• When medical bill advocates and negotiation services may be able to help
• Why cash-pay patients and health share members should understand their options

The price you initially see for healthcare may not be the final price. Cash-pay discounts, prompt-pay discounts and other negotiated pricing can sometimes change what you ultimately spend. The important first step is simply knowing that you can ask. The same applies to where you receive care. Your local hospital may be the most convenient option, but it may not always be the most affordable.

A five- or six-figure medical bill can feel impossible to deal with on your own. Healthcare advocacy and medical bill negotiation firms can help review bills for errors, duplicate charges and opportunities to negotiate costs. You do not have to become a medical billing expert yourself to become a better healthcare consumer.

A chargemaster rate is essentially a hospital’s retail or sticker price. Think of it like a furniture store putting a $10,000 price tag on a chair even though negotiated buyers may pay significantly less. Insurance companies negotiate discounts from those prices, and cash-pay patients may also have opportunities to negotiate or access lower rates. The takeaway is simple: We don’t pay sticker.

To learn more about individual health insurance options, Medicare planning and healthcare consumer strategies—or to schedule a consultation—visit: www.core360benefitsgroup.com

For more practical healthcare tips, price-comparison strategies and consumer advocacy insights:

Subscribe to Bill of Health:

• Apple Podcasts: Bill of Health
• Spotify: Bill of Health
• Facebook: Bill Filer – Core360
• LinkedIn: Bill Filer
• TikTok: @billfiinsuranceguy

Be smart. Shop smart. Protect your wealth.

This podcast is provided for educational purposes only and should not be considered legal, tax, investment or insurance advice. Individual circumstances vary, and listeners should consult qualified professionals regarding their specific healthcare and financial situations. Opinions expressed by the host and guests do not necessarily reflect the views of any insurance carrier or affiliated organization.

• 00:00 What Is a Healthcare Consumer?
• 00:45 You Don’t Need to Be a Healthcare Expert
• 01:20 Why This Podcast Exists
• 02:00 Healthcare Doesn’t Need to Become Another Job
• 03:05 How to Become a Smarter Healthcare Consumer
• 03:45 Don’t Automatically Pay the Sticker Price
• 04:20 Start Shopping for Healthcare
• 05:00 Getting Help With Major Medical Bills
• 05:40 Health Shares and Cash-Pay Healthcare
• 06:05 Jargon Jar: What Is a Chargemaster Rate?
• 07:30 We Don’t Pay Sticker
• 07:50 Simple Steps Can Make a Difference
• 08:15 Subscribe and Follow Bill of Health

The post You Don’t Need to Be a Healthcare Expert to Stop Overpaying (Bill of Health Ep.5) appeared first on Core360 Benefits Group.

Lyn and I discuss:

• Why employees and employers are both frustrated by rising healthcare costs
• How healthcare navigation helps people better use the benefits available to them
• Why some medical bills may be negotiable
• How cash-pay healthcare is creating more pricing transparency
• Why health sharing and other alternative models are gaining attention
• What a third-party administrator, or TPA, actually does
• Why direct contracting may become more important for employers

One of the biggest misconceptions in healthcare is that the number printed on a hospital bill is automatically final. Some medical bills can be negotiated, particularly outside traditional contracted insurance networks. GetAdvocacy works with consumers and organizations on healthcare advocacy and medical bill negotiation. When you are recovering from an illness, injury or procedure, challenging a bill may be the last thing you want to do. But you should not automatically assume there are no other options.

Traditional healthcare pricing can be difficult to understand because the original charge and the amount ultimately paid may be very different. Cash-pay models and healthcare shopping platforms are giving consumers more opportunities to see prices before receiving care and compare their options. Resources mentioned in this episode include:

• HealthMe
• MDsave
• Fair Market Health
• Tendo
• The Coral Platform
• Savvos Health

A TPA, or third-party administrator, helps manage and coordinate the moving pieces of a health plan. That can include claims administration, provider networks, pharmacy benefits, customer service and other components that keep an employer health plan functioning. Think of the TPA as a general contractor helping coordinate the administrative side of the plan.

Lyn Carter is Vice President of GetAdvocacy at Health Admins and has worked across multiple areas of the healthcare industry, including hospitals, insurers, benefit consulting, direct contracting and healthcare navigation. Connect with Lyn: Lyn Carter on LinkedIn Learn more about her work: GetAdvocacy

To learn more about individual health insurance options, Medicare planning and healthcare consumer strategies—or to schedule a consultation—visit: www.core360benefitsgroup.com

For more practical healthcare tips, price-comparison strategies and consumer advocacy insights

Subscribe to Bill of Health:

Apple Podcasts: https://podcasts.apple.com/us/podcast/bill-of-health/id6794142312 Spotify: https://open.spotify.com/show/033USIRkymMFYmmTDDzyAi Facebook: https://www.facebook.com/people/Bill-Filer-MedicareHealthLife-Insurance-Core360-Benefits-Group/61568058486052/ LinkedIn: https://www.linkedin.com/in/billfiler/ TikTok: https://www.tiktok.com/@billfiinsuranceguy

Be smart. Shop smart. Protect your wealth.

This podcast is provided for educational purposes only and should not be considered legal, tax, investment or insurance advice. Individual circumstances vary, and listeners should consult qualified professionals regarding their specific healthcare and financial situations. Opinions expressed by the host and guests do not necessarily reflect the views of any insurance carrier or affiliated organization.

00:00 Why Healthcare Frustrates Employees and Employers 01:10 Understanding Healthcare From Every Side 02:20 Meet Lyn Carter 03:45 How Healthcare Dollars Move Through the System 10:15 Where Employee Health Plans Break Down 12:05 How Healthcare Navigation Works 15:00 How Medical Bill Negotiation Works 17:05 You Can Negotiate Your Healthcare Bills 18:00 Why Cash-Pay Healthcare Is Growing 20:15 Why Health Sharing Is Gaining Attention 23:00 Jargon Jar: What Is a TPA? 24:10 Five for Fighting With Lyn Carter 25:10 Why Direct Contracting Could Be the Future 26:55 Lyn’s Advice for Choosing Health Insurance

The post Your Hospital Bill Isn’t Final — Why You Should Negotiate It (Bill of Health Ep.4) appeared first on Core360 Benefits Group.

But it doesn’t always have to work that way.

In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I explain why open enrollment should be treated more like a buffet than an all-or-nothing package. You can compare benefits, mix and match coverage between spouses and explore alternatives when the medical plans available through your employer do not fit the way you actually use healthcare.

I also explain why the most expensive or comprehensive health plan is not automatically the right plan for you. Some people genuinely need a “Mercedes” level of coverage because of chronic conditions, specialists or ongoing medical needs. Others may be paying for more healthcare coverage than they regularly use.

One alternative I introduce is combining direct primary care with a health sharing organization. For relatively healthy individuals and families, this approach may provide another option worth exploring outside of traditional employer-sponsored health insurance.

We also open the Jargon Jar to break down one of the most common open enrollment decisions: the difference between an HMO and a PPO.

I discuss:

• Why open enrollment decisions can have a major impact on your take-home pay
• Why you should not automatically accept the benefits presented by your employer
• How to think about open enrollment like a buffet instead of an all-or-nothing package
• Why couples can “divide and conquer” by comparing benefits from both employers
• How mixing medical, dental, vision and other benefits may save money
• Why the health plan offered to you may not match the way you actually use healthcare
• The difference between needing a “Mercedes” health plan and being comfortable with something simpler
• How direct primary care (DPC) works
• Why direct primary care can offer more access to a doctor or nurse practitioner
• How health sharing organizations work alongside direct primary care
• Why direct primary care and health sharing may be worth exploring for relatively healthy families
• The difference between an HMO and PPO
• How networks, referrals and out-of-network coverage differ between HMOs and PPOs
• Why getting a second opinion before open enrollment may help protect your paycheck

You do not necessarily have to choose every benefit your employer offers.

Think about open enrollment like a buffet: choose the benefits that make sense for you and your family, and leave behind the ones that do not.

If your employer’s medical insurance does not fit your needs or budget, it may also be worth exploring whether other options exist.

If both you and your spouse have access to employee benefits, compare them.

One employer may offer better medical coverage, while the other may have less expensive dental, vision or supplemental benefits.

Your entire family does not always have to be enrolled in the same plan. Comparing both benefit packages and mixing and matching where appropriate may help you get more value from the benefits available to you.

Not everyone uses healthcare the same way.

If you rarely visit the doctor and do not have chronic medical conditions, the most comprehensive and expensive plan available may offer more coverage than you regularly use.

On the other hand, if you or someone in your family manages a chronic condition, regularly sees specialists or needs coordinated medical care, a more comprehensive health plan may be worth the additional cost.

The goal is to understand what you actually need instead of simply selecting a plan because it is the default option.

One alternative I introduce in this episode is direct primary care, or DPC.

Direct primary care is typically a subscription-based relationship with a physician or nurse practitioner. Instead of relying on traditional insurance for primary care visits, you pay a monthly membership fee and may receive greater access through appointments, calls, emails or text communication.

For some relatively healthy individuals and families, pairing direct primary care with a health sharing organization may offer another way to manage everyday healthcare expenses while having support available for larger medical needs.

Health sharing organizations are not health insurance companies. They are membership-based organizations in which members contribute toward eligible medical needs according to the organization’s rules and guidelines.

This approach is not necessarily right for everyone, but it is an option worth understanding before assuming traditional employer-sponsored medical insurance is your only choice.

An HMO, or Health Maintenance Organization, generally requires you to receive care within a defined network and typically uses a primary care physician to coordinate your care and provide referrals to specialists.

A PPO, or Preferred Provider Organization, generally provides more flexibility. You can typically see specialists without a referral and may have access to out-of-network providers, although you will usually pay more for that care.

HMOs often have lower monthly premiums because care is more tightly managed within the network. PPOs typically cost more but provide greater flexibility.

Understanding how you use healthcare, which doctors you want to see and how important network flexibility is to you can help you decide which type of plan makes more sense.

To learn more about individual health insurance options, Medicare planning and healthcare consumer strategies—or to schedule a consultation—visit: www.core360benefitsgroup.com

For more practical healthcare tips, price-comparison strategies and consumer advocacy insights

Subscribe to Bill of Health:

Apple Podcasts: https://podcasts.apple.com/us/podcast/bill-of-health/id6794142312 Spotify: https://open.spotify.com/show/033USIRkymMFYmmTDDzyAi Facebook: https://www.facebook.com/people/Bill-Filer-MedicareHealthLife-Insurance-Core360-Benefits-Group/61568058486052/ LinkedIn: https://www.linkedin.com/in/billfiler/ TikTok: https://www.tiktok.com/@billfiinsuranceguy

Be smart. Shop smart. Protect your wealth.

This podcast is provided for educational purposes only and should not be considered legal, tax, investment or insurance advice. Individual circumstances vary, and listeners should consult qualified professionals regarding their specific healthcare and financial situations. Opinions expressed by the host and guests do not necessarily reflect the views of any insurance carrier or affiliated organization.

00:00 Open Enrollment Is Coming — Are You Ready? 01:49 How to Protect Your Take-Home Pay 03:42 The Open Enrollment Mistake Bill Sees Over and Over 04:37 Open Enrollment is Like a Buffet 05:25 What Being a Smarter Healthcare Consumer Really Means 06:17 Divide and Conquer Your Family Benefits 09:20 Your Employer’s Health Plan Isn’t Your Only Option 09:55 Direct Primary Care + Health Sharing Explained 10:16 How Direct Primary Care Works 12:10 How Health Sharing Organizations Work 13:23 Rethinking Your Open Enrollment Choices 14:05 Jargon Jar: HMO vs. PPO 16:53 Open Enrollment Takeaways

The post Stop Letting Open Enrollment Choose for You — You Have More Options Than You Think (Bill of Health Ep.3) appeared first on Core360 Benefits Group.

In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I explain why becoming a smarter healthcare consumer starts with changing the way you think about where you receive care and how you pay for it.

If you have a high-deductible health plan, you may spend thousands of dollars trying to satisfy a deductible you never actually reach. Instead of automatically going wherever your doctor or health system sends you, I explain why it can pay to compare prices, ask about cash-pay options and consider different sites of care.

I share real-world examples of how the exact same X-ray, procedure or diagnostic service can cost dramatically different amounts depending on where you have it done. I also introduce MDSave, a healthcare shopping tool that allows you to compare upfront prices for procedures in your area.

We also open up the Jargon Jar to break down two important health insurance terms: your deductible and your maximum out-of-pocket, or MOOP.

I discuss:

• Why we need to start thinking of ourselves as healthcare consumers
• Why the price your healthcare provider quotes may be similar to a vehicle’s sticker price
• How high deductibles can change the way you should think about healthcare spending
• Why you may never actually reach your annual deductible
• When paying cash for healthcare services may save you money
• How I saved money by shopping around for an upper endoscopy
• How MDSave can help you compare healthcare prices in your area
• Why the site of care can dramatically affect what you pay
• How freestanding imaging centers and independent facilities may offer lower prices
• Questions to ask before automatically scheduling a procedure through your health system
• The difference between your deductible and maximum out-of-pocket
• Why copays may not count toward your deductible
• How to ask about cash-pay, prepaid and prompt-pay discounts

When your doctor recommends an X-ray, lab test, scan or procedure, you do not necessarily have to accept the first price you are given. I explain why healthcare prices can function a lot like sticker prices and why asking questions before scheduling care can potentially save you hundreds or even thousands of dollars.

Many people assume they need to run every healthcare expense through insurance so they can make progress toward their deductible. But if you rarely reach your deductible in a normal year, paying a lower cash price may sometimes make more financial sense than paying a higher negotiated healthcare price simply to accumulate deductible credit.

Where you receive healthcare matters. A hospital or regional medical center may charge significantly more for a service that is also available at a freestanding imaging center, independent lab or outpatient facility.

Before automatically accepting the location suggested by a scheduler, I encourage you to ask what other options are available and compare the prices.

One resource I discuss in this episode is MDSave.com. You can search by ZIP code and procedure—or use the CPT medical billing code from your doctor—to find participating providers and upfront prices in your area.

I am not compensated by or sponsored by MDSave. It is simply one tool consumers can use to start comparing healthcare prices.

Your deductible is generally the amount you must pay toward certain covered healthcare expenses before your insurance begins sharing more of the cost.

Your maximum out-of-pocket, or MOOP, is the maximum amount you are responsible for paying toward covered in-network healthcare expenses during the plan year before your insurance covers eligible expenses according to the terms of your plan.

Understanding the difference can help you make smarter decisions about how and where you spend your healthcare dollars.

To learn more about individual health insurance options, Medicare planning and healthcare consumer strategies – or to schedule a consultation – visit: www.core360benefitsgroup.com

For more practical healthcare tips, price-comparison strategies and consumer advocacy insights

Subscribe to Bill of Health:

Apple Podcasts: https://podcasts.apple.com/us/podcast/bill-of-health/id6794142312

Spotify: https://open.spotify.com/show/033USIRkymMFYmmTDDzyAi

Facebook: https://www.facebook.com/people/Bill-Filer-MedicareHealthLife-Insurance-Core360-Benefits-Group/61568058486052/

LinkedIn: https://www.linkedin.com/in/billfiler/

TikTok: https://www.tiktok.com/@billfiinsuranceguy

Be smart. Shop smart. Protect your wealth.

This podcast is provided for educational purposes only and should not be considered legal, tax, investment or insurance advice. Individual circumstances vary, and listeners should consult qualified professionals regarding their specific healthcare and financial situations. Opinions expressed by the host and guests do not necessarily reflect the views of any insurance carrier or affiliated organization.

00:00 Why We Shop for Everything Except Healthcare00:59 Becoming a Smarter Healthcare Consumer02:07 Why Where You Get Healthcare Matters03:25 Healthcare’s “Sticker Price” Problem04:08 The Deductible Realization05:01 How Often Do You Actually Hit Your Deductible?05:58 Questions to Ask Before Paying for Care08:00 Cash Pay vs. Building Your Deductible08:33 Using MDSave to Compare Healthcare Prices10:00 Why Site of Care Can Save You Money11:17 Don’t Let the Scheduler Choose for You12:15 Jargon Jar: Deductible vs. Maximum Out-of-Pocket13:17 What Is a Maximum Out-of-Pocket (MOOP)?13:44 Why Copays May Not Count Toward Your Deductible14:51 Final Takeaway: Shop for Your Healthcare

The post Stop Feeding Your Deductible – How to Save Thousands on Healthcare (Bill of Health Ep.2) appeared first on Core360 Benefits Group.

In the inaugural episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I introduce the mission behind the show: making healthcare and health insurance easier to understand so you can make informed decisions with greater confidence and control.

Drawing on more than 30 years of experience in banking, financial services, investments and financial education, I explain why health insurance should be viewed as an essential part of your overall financial strategy – not simply as a card you present at the doctor’s office.

I also share the deeply personal experience that shaped my commitment to healthcare education and consumer advocacy. While my late son, Cade, battled cancer, my family and I experienced the emotional, physical and financial strain that can accompany a catastrophic illness. That experience showed me firsthand how confusing and intimidating the healthcare system can become when your family is trying to focus on caring for someone you love.

Through future episodes of Bill of Health, I will help you understand insurance terminology, compare coverage options, prepare for Medicare, explore alternatives to traditional insurance and make smarter decisions about the cost and location of your medical care.

I discuss:

• Why healthcare represents a major financial blind spot for many households
• The connection between healthcare decisions and long-term financial security
• Why you should research healthcare services as carefully as other major purchases
• My professional background in financial services and financial education
• My family’s experience navigating cancer treatment and significant medical bills
• The mission and consumer-first philosophy of the Bill of Health Podcast
• The five core pillars that will guide future episodes
• How the upcoming “Jargon Jar” segment will simplify confusing insurance terminology
• What you can expect from the next episode on the “ghost deductible”

In future episodes, I will explain foundational health insurance concepts, including deductibles, copays, coinsurance and out-of-pocket maximums.

I will explore the Affordable Care Act marketplace, commonly called Obamacare, including subsidies, off-exchange coverage and alternatives such as short-term medical plans.

If you are approaching retirement or already enrolled in Medicare, I will provide guidance on Medicare Parts A, B, C and D, along with Medicare supplement options.

I will examine healthcare models such as health share programs, direct primary care and other developing alternatives.

I will share practical strategies for reducing healthcare expenses, reviewing medical bills, comparing sites of care and becoming a more informed healthcare consumer.

To learn more about individual health insurance options, Medicare planning and healthcare consumer strategies—or to schedule a consultation—visit: www.core360benefitsgroup.com

For more practical healthcare tips, price-comparison strategies and consumer advocacy insights

Subscribe to Bill of Health:

Apple Podcasts: https://podcasts.apple.com/us/podcast/bill-of-health/id6794142312

Spotify: https://open.spotify.com/show/033USIRkymMFYmmTDDzyAi

Facebook: https://www.facebook.com/people/Bill-Filer-MedicareHealthLife-Insurance-Core360-Benefits-Group/61568058486052/

LinkedIn: https://www.linkedin.com/in/billfiler/

TikTok: https://www.tiktok.com/@billfiinsuranceguy

Be smart. Shop smart. Protect your wealth.

This podcast is provided for educational purposes only and should not be considered legal, tax, investment or insurance advice. Individual circumstances vary, and listeners should consult qualified professionals regarding their specific healthcare and financial situations. Opinions expressed by the host and guests do not necessarily reflect the views of any insurance carrier or affiliated organization.

Chapters00:00 Healthcare’s hidden financial risk01:13 Welcome to the Bill of Health Podcast02:12 Medical costs and financial security03:16 The personal story behind Bill’s mission04:33 The five pillars of Bill of Health04:45 Health Insurance 101 05:05 The ACA Marketplace & Individual Plans05:26 Understanding Medicare Parts A, B, C, D Explained05:43 Alternatives to traditional insurance05:57 Lowering healthcare costs06:37 Introducing the Jargon Jar06:59 Previewing the “ghost deductible”07:11 Learn more and schedule a consultation

The post Your Healthcare is Destroying Your Wealth — How to Fight Back (Bill of Health Ep.1) appeared first on Core360 Benefits Group.

The post Bill of Health Podcast Teaser appeared first on Core360 Benefits Group.