When a hospital sends you a bill, most of us assume the number at the bottom is what we owe. But that may not be the case. In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I’m joined by Lyn Carter, Vice President of GetAdvocacy at Health Admins, to look at healthcare from perspectives most consumers never get to see. Lyn has worked across hospitals, insurance companies, third-party administrators, benefit consulting and healthcare advocacy. That experience gives her a unique understanding of how healthcare dollars move through the system, why pricing can be so difficult to understand and where consumers and employers may be able to save money. We talk about why even a well-designed health plan can fall short if employees do not know how to use it, how medical bill negotiation works and why consumers should not automatically assume the price on a hospital bill is final.
In This Episode of Bill of Health:
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
Medical Bills May Be Negotiable
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.
Why Healthcare Transparency Matters
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:
Jargon Jar: What Is a TPA?
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.
About Lyn Carter
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
Learn More
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.
Disclaimer
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.
Chapters
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
Podcast: Play in new window | Download