Health Insurance Success Stories

Matt Allen (00:05)
Welcome back to another episode of Talking Shit. Shit, of course, is an acronym for straight health insurance talk. I am Matt Allen and I am joined today by Aaron Miller.

Aaron (00:16)
Let's go red legs.

Matt Allen (00:18)
red legs. They're turning that run different.

Aaron (00:20)
Are you wearing a club shirt?

Matt Allen (00:22)
I got a cup shirt on, yeah. One that won the series, baby. Yeah. This is

Aaron (00:26)
That's nice.

Matt Allen (00:27)
it's all of the wins that they had. It's the date and the runs. It's the the score.

Aaron (00:35)
That's pretty sweet.

Matt Allen (00:37)
every win they had that year. Yeah, my daughter got it for me. It's pretty sick.

Aaron (00:41)
That's a great shirt.

Matt Allen (00:42)
Yeah. all right. So what are we talking about today?

Aaron (00:49)
Well, I was looking through some of our our old videos and essentially this was back when we had you know, I was using a GoPro and we were posting and basically to the Abyss, which you know we're starting to get away from that. We're starting to get some some real traction. So I figured we'd bring some of these old stories back to light. And so I have three stories here. I'll I'll read the the title

And we can dive into what the situation was and you know the titles aren't always too good to be true. I think these are real life examples of what a broker, what client success, what you know, some knowledge can do to help your healthcare experience.

Matt Allen (01:34)
So we're talking success stories.

Aaron (01:37)
We're talking success stories, absolutely. With health insurance. Yes, it is. Yes, it is.

Matt Allen (01:38)
With health insurance. Surprisingly. It's it's possible, basically. Okay. All right.

Aaron (01:45)
All right. The first one we got today is I saved fourteen thousand dollars a year for life. And this is referring to a lady who essentially was just going down to the basement of the hospital to get her. Was it an MRI or was it ultrasound? What was she doing?

Matt Allen (02:05)
think it was actually an E K G, so

Aaron (02:07)
EKG.

Matt Allen (02:09)
this woman

She had a valve replacement, I believe it was, and they needed to do routine checks on it. And when she needed to get health insurance,

She was looking at an affordable care act plan because she had a pre-existing condition, but her valve was in good shape. And so she actually looked to the private coverage instead because she's like, My heart's good to go. it is a pre-existing condition, and these private plans have a 12-month wait on pre-existing.

But she was comfortable with that because she had just gotten her heart taken care of. It was good to go. But she had to have these maintenance check-ins on her heart. So whether it was an echocardiogram or if it were some type of chest MRI, she needed to have essentially imaging done at routine intervals just to make sure, hey, is everything cool? Is everything good? And on the out of the ACA plans, you might think, well, why didn't she just go with the ACA plan?

It covers pre-existing conditions. She would have been covered for it. Well, her and her husband's income was so high that they didn't receive a tax credit on the ACA. And the imaging facility and her cardiologist and her cardiologist's office, none of them accepted any ACA plan. They were out

Aaron (03:42)
Wow.

Matt Allen (03:43)
of network for all of it.

So that's one of the tricky things and one of the drawbacks of these ACA plans is they'll tell you, and it is l it written in the law, this has to cover your pre-existing condition. It has to. But that doesn't mean they can strong arm every healthcare professional that they have to accept the insurance. Because these ACA plans, what they're saying is, hey, we are going to reimburse.

Health insurance companies are saying we're gonna reimburse medical providers this amount of money when you when you receive this amount of care. So

Aaron (04:20)
Sure.

Matt Allen (04:21)
an affordable care plan will say, Hey, if my person needs an echocardiogram and they have our insurance, we'll pay, let's call it twelve hundred dollars. We'll pay the the provider twelve hundred dollars for that echocardiogram. Well, that's probably way too high, but

Probably for an ACA plan more like 300. Let's say 300. Hey, we'll pay 300 for this echocardiogram. Now as an imaging facility that I run, I have to think, hey, if we get $300 for performing this service and reading this echocardiogram and giving care to this patient, are we gonna make enough money as just to subsist as a business on a $300 per visit? And the majority of them say, No, we're not.

Because they can charge Medicare, they can charge group plans, they can charge private plans, they can charge self-pay patients, they can charge all of those people more money and actually subsist and stay in business. They can't survive, or maybe they just don't want to take the lower reimbursement rates from these ACA plans. So the ACA, will it cover your echocardiogram right away? Absolutely it will. But it's only gonna reimburse healthcare providers a set amount of money.

So not all healthcare providers are going to accept it. So you may have to go to Joe's imaging shed behind the Walmart because it's the only place that

Aaron (05:45)
Sure.

Matt Allen (05:46)
accepts the ACA. Very tongue in cheek on that. Obviously, there are legitimate places that accept ACA plants. But for this particular person, she needed routine imaging for her heart valve. I think it was echocardiogram. Maybe it was a mix of both. Whatever it was.

ACA plan not accepted where she was gonna go and she was like, Well, I'll just d do an ACA and I'll pay out of pocket for it. The ACA out of network charge, it was like $18,000 a year for all the imaging.

Aaron (06:17)
Wow.

Matt Allen (06:19)
And so she's like, Hold on, I have insurance. Like, don't I get a discounted rate or whatever? Because she had an insurance that was a major medical, qualified health plan, affordable care act.

She had to get the out-of-network insured rate. That's what she had to be charged. That's the legality of it. She couldn't do

Aaron (06:39)
she couldn't even do cash pay at a network.

Matt Allen (06:42)
cash pay because by law, do you have a qualified health plan? You can't be self-pay. We will keep your insurance on file, and we know you have insurance, and we know we don't take this insurance. So now we get to charge you our out-of-network max rate.

And so she's looking at this like, okay, the only reason I'd be on the ACA is cause my pre-existing would be covered. Now you're telling me I actually have to pay more because I have insurance just because you're out of network. So instead, what did we do? Let's talk the success story.

Pivot over here. All right. We did a non-marketplace private plan. Did it have a 12-month waiting period on pre-existing? Absolutely. But it also did have benefits for echocardiogram and MRI. We just need to wait the 12 months before the benefits would pay. And you might be like, well, that's BS. I'm not gonna pay for a health insurance if it's not gonna, you know, pay for my pay for the things that I need. Well, she was covered for everything else. All other doctor visits, all other urgent care, all other if she had careful.

cancer,

if she got a stroke, if she needed an organ, everything just outside of the heart issue. That's the thing that had the 12-month wait. The insurance was still good for everything else, but the reason that we went there was it was cheaper than the ACA and it didn't have any network restrictions. And once that 12 months was up, she'd start getting benefits for this imaging. But in the meantime, for that 12 months, you alluded to it.

Because these private, non-marketplace plans aren't qualified health plans, they're not part of the ACA, she was allowed to go straight to that imaging center and negotiate that self-pay discount. If you have the ACA and you're out of network, you're gonna get charged the max rate. But if you have a private non-ACA plan, you are allowed to access self-pay cash pay rates. So that same $18,000 a year.

She was able to negotiate it and get it for four grand.

Aaron (08:46)
Wow.

Matt Allen (08:47)
So that's how she saved fourteen grand a year for life, because they need to do this imaging for the rest of her life. Once she gets on Medicare, she'll save even more money. she's just not quite there yet. But right away.

We switched to a non-marketplace plan. She had no network restrictions, a lower premium, a better deductible, and she was able to be self-pay on those things. Yes, there was a twelve month wait for the hard valve, but she made it through perfectly fine. And she actually this is a story from like five years ago. She actually just had to have her hard valve replaced again. And this private plan covered the whole thing because it was after the twelve month waiting period.

So she we we did her very well. She would have been stuck in an an ACA plan. So what she could have done alternatively is she could have changed her provider. She could have gone to a different cardiologist. She could have, you know, reworked it. But she's like, these are the people that actually put the heart valve in. I want to keep going to them.

They know what's going on. They have my charts. They have everything. They just don't accept the ACA. 'Cause she got the heart valve replacement while they were still on group insurance. They were on some really nice PPO through her job. Now they're looking at ACA and the provider's like, We don't take that. And so that's just a way that we saved her fourteen grand a year for life.

Aaron (10:07)
Wow. Yeah, I mean so did she end up choosing that ACA plan, realizing this and then switching middle of the year, or was this a a pre switch conversation?

Matt Allen (10:17)
She

I believe she had come to me with plenty of time before her switch.

Aaron (10:23)
Okay.

Matt Allen (10:24)
And I had looked at ACA plans, I'm like, I don't think any ACA plans are gonna be accepted at your doctor. And we called over there and we verified and they're Yeah, we don't take any of that. We don't take any of those. And it was like, Okay, well if she comes in there with one, what's the pricing gonna be? And that's where she found the eighteen thousand dollar price tag. Yeah.

Aaron (10:44)
I mean, so for anyone out there who's currently on an ACA plan, in this same exact situation, you could switch to the private right now.

Matt Allen (10:53)
Depend you know, but you have to be careful with that. You you could. Absolutely. But you have to be careful with that because if she eventually need to have that heart valve replaced again. And so you have to be very comfortable with that twelve month waiting period. Very comfortable

Aaron (11:09)
Yeah.

Matt Allen (11:09)
with whatever's going on. And sometimes people sometimes you know, people get really concerned about that. They're like, Well, I've got bad allergies and I've got depression and hormone replacement therapy.

Well, I got pre-existing. That's not for me. I can't do it. And you kind of got to zoom out and you got to take a beat. You got to say, well, are you going to have a $30,000 allergy surgery? No. Are you going to, you know, is your hormone replacement therapy going to cause you to be in the ICU for two days? Well, no. It's a medication and maybe one or two doctor visits a year to check in on that medication. So if that's not covered for just a year.

It's not really that big of a deal. You know, it there's not

Aaron (11:51)
Right. Right.

Matt Allen (11:52)
some huge hole in your plan. It's okay on day 366, all that stuff's covered again. So it's

Aaron (11:58)
Yeah.

Matt Allen (11:59)
it's just kind of, do you have a pre-existing condition? Absolutely. And I don't want to downplay it, but it's not going to lead to a large medical bill because it's not covered. So this really isn't that big of a deal, financially, health insurance-wise.

Aaron (12:12)
Yeah.

No, that makes sense. I mean, people don't realize the bind they get put in with some of these qualified health plans. I mean, that's I think the takeaway I'm getting.

Matt Allen (12:23)
Well the terminology makes you think like this is the only legitimate path to get my health insurance coverage. It's a qualified health plan.

Aaron (12:32)
Right now.

Matt Allen (12:33)
It's part of the Affordable Care Act. It's a major medical, whatever the hell you want to call it.

But all of those plans have massive restrictions that nobody wants to talk about, that nobody's pointing out. And yeah, you can go outside of qualified health plans, you can go outside of the ACA, and you're gonna have a way better plan in the majority of ways, but you're still gonna have some drawbacks. It's just the majority of people don't need everything in the qualified health plan. They're they're they're overpaying with a too high deductible and a too narrow network just

to have this qualified health plan when you can save money over here and go wherever you want and negotiate self pay if you want and and save on premium. It's just it's got that twelve month waiting period. So it's just there's it's all trade-offs.

Aaron (13:23)
all

trade-offs. Alright, let's go to the next one. I slashed

Matt Allen (13:28)
Yeah.

Aaron (13:29)
my health insurance costs from eighteen hundred dollars a month to eighteen cents a month.

Matt Allen (13:34)
Alright, I remember this one. This one won't take too long. This is about my dad, actually. my dad

This was gosh, this was like ten years ago. This was pre-COVID. No, it had to be like eight years ago, because I was I was doing health insurance and I was helping him out, and he was just they lived in Illinois, and everybody wants Blue Cross Blue Shield of Illinois. And back then, eight years ago, the marketplace, it still had pretty good plans, but nobody really knew what they were doing. Even though the ACA had been around almost a decade, people still were like confused on how it worked. And my dad was one of those people. My dad is self-employed, and so he and my stepmom he

He wanted to get a Blue Cross Blue Shield of Illinois PPO. And they had those. Those were available. And so he signed up for one. And it was like $1,800 a month for the two of them. They're in their like late 50s. I think my dad might have been early sixties. And I was just and he it's killing him. It's crushing him. Cause he's self employed, but he's only making, I don't know how much he's making, just above the tax credit threshold, actually.

So I do know what he was making. Now he's self-employed

Aaron (14:40)
sure.

Matt Allen (14:41)
and he's got write-offs and whatever, and they care about your adjusted gross income. And so his AGI was like three grand above the threshold.

Aaron (14:49)
Yeah.

Matt Allen (14:50)
And nobody had ever explained the tax credit threshold to him.

He just always assumed and he was always told because nobody wanted to do the work that that wasn't for him. He doesn't qualify for Obamacare. Are you kidding me? He's self

Aaron (15:04)
Mm.

Matt Allen (15:05)
employed. He lives in the burbs. He doesn't qualify for ACAA. Kidding me? And I took a look at it and I was like, Well dad, take let me see your tax return from the last time. I all I need is this number. You don't have to show me how much money you make. Just this just this one line item. What do you what is it? It was like sixty seven thousand.

And at that time, the AGI line for a family of two, way back then, was like sixty-four thousand. And I was like

Dad, I think you might want to look into this a little bit. Can you scrounge up three grand more in write-offs or can you give one of your employees a bonus or can you like put more money into an IRA like three grand worth or whatever? Because I think I think we can save a lot of money. And so what he ended up doing was working with his accountant. How his accountant didn't know this is absolutely embarrassing and mind-boggling. But his accountant didn't know this back then.

We ended up I ended up talking to his accountant, I'm like, can you just make it sixty-four instead of sixty-seven? Can you put some more money into a traditional IRA? Whatever it was. We got his taxable income down to sixty-four thousand. That same Blue Cross Blue Shield PPO went from eighteen hundred dollars to eighteen cents a month. Like legitimately

Aaron (16:16)
Yeah.

Matt Allen (16:16)
eighteen cents a month. My dad's like

They still want the eighteen cents. He ended up writing checks just to be a whatever. He wrote

Aaron (16:24)
Sure.

Matt Allen (16:24)
eighteen cent checks with you know fifty cents stamp on the envelope. But

yeah, like it went from eighteen hundred to eighteen cents. So so even if even if let's pretend he just didn't work a few weeks out of the year to save that three grand.

He was he eventually came out twenty one grand ahead, same plan. And he had no idea he was a little pissed off at his accountant. but his son was there to save the day and

Aaron (16:52)
Yeah.

Matt Allen (16:54)
And it was just wild and he didn't really believe me at first because I kinda had just started in health insurance and he's like, This doesn't seem right and he did his own research and he talked to his accountant, he hasn't had his accountant who didn't know about tax credits apparently, had his accountant look into it and it ended up all being legit and we saved him money, he kept his coverage and Yeah, it was great.

Aaron (17:16)
Wow. And I mean between then and now we got advanced premium tax credits and now we're back to the the hard line. And so people go ahead.

Matt Allen (17:26)
Well so advanced

premium tax credits, that just means they advance it throughout the year. Are you talking about the enhanced? Yeah.

Aaron (17:33)
enhanced, that's the word I was looking for.

Matt Allen (17:35)
So that was just through twenty twenty and twenty twenty five, yeah. So back then, right. Back then they had the the cliff, the subsidy cliff. That was always what the legislation was.

That's just what it was. It was four hundred percent of the federal poverty line. If you were a penny over, you didn't get any assistance. That's how the legislation was o originally written. The enhanced credits came about as a measure with the pandemic, the American Rescue Plan Act, the Inflation Reduction Act, that eliminated the subsidy cliff. So yes, we are back to having 400% federal poverty line. Yeah.

Aaron (18:09)
Yeah.

So if you're a CPA or a CFP or any laundry list of letters, like this is perk your ears up. I mean that's it's big time.

Matt Allen (18:20)
And it's not overly

complicated. I think people people allow themselves to be intimidated by this idea, but it's just what's your modified adjusted gross income going to be for the year you need the coverage? Is it below four hundred percent of the federal poverty line? And is it above a hundred and thirty eight percent of the federal poverty line? 'Cause that's the Medicaid threshold. If you're in there, you get a tax credit.

And healthcare.gov or working with a broker or using Health Sherpa, whatever tool you use, calculates it for you. You don't have to do any sort of calculation. So this isn't we can make it as complicated as you want, but that's all it is. And if you're a penny over 400% of the federal poverty line, you can still get an affordable CAREC plan. You're just not going to receive a tax credit, so you're going to pay full price.

Aaron (19:13)
Yeah. Yeah. All right. Ready for story number three?

Matt Allen (19:18)
Let's crank it.

Aaron (19:21)
Alright, this is a good one. I tore my ACL three times and made four thousand dollars. Now,

Matt Allen (19:29)
Okay.

Aaron (19:30)
i that's an aggressive title, frankly. But

Matt Allen (19:33)
Yeah. Clickbait.

Aaron (19:35)
a little bit of clickbait. But let's talk about this one. How is that even how how does that work?

Matt Allen (19:41)
So the tour of the ACL three times, I I didn't know this guy. He was not a client for the first two tears. So it's

Aaron (19:49)
Okay.

Matt Allen (19:50)
not like because I did it three times, I w won a lottery and I got four grand. It was simply

Aaron (19:54)
Third time the charm.

Matt Allen (19:57)
the third time that he did it. He was playing with his daughter, I think, in the yard. He was a former athlete and he had torn his ACL twice and now he was like a dad bob dad

screwing around in the yard with the kid and he's like, boy took one pivot with his foot planted toward. It was the same same knee, all three times.

Aaron (20:17)
Ooh.

Matt Allen (20:19)
And in Indiana, one of the big hospital systems is called IU Health, and he w he went to IU Health 'cause he had he had coverage with us. What he had with us was he had a private

individual health insurance plan and then he had a cost sharing plan. He had one of the Christian cost-sharing plans. So he had both. He had great coverage. and the idea behind combining both was to have no network restrictions, meaning he could seek care anywhere for anything. And the most he would owe was five thousand dollars by putting those two things together. So and it was way cheaper than the ACA. So he initially went to IU Health

which he's more than welcome to on the private plan. And they were quoting him out like sixty grand for the whole thing. Like the the prehab, the actual surgery, renting the room, the anesthesia. That didn't include his physical therapy afterwards.

that was just to actually get the thing done. And IU Health is notorious for high prices. So if that seems crazy to anybody listening to this, it is crazy because Indiana is crazy with healthcare costs. You would think with our low cost of living, healthcare would be line in line with that. It's not.

So instead, what we luckily have in Indianapolis, we've got this place called Wellbridge Surgical. And so this is a cash pay surgery center that's in one of the suburbs of Indianapolis. It's in Zionsville, Indiana. And they just post their pricing right on their website if you need a surgery.

And so if you look up like a like the most complicated and intense ACL surgery you can on there. this was a few years ago, so they may have updated their pricing. Please just check their website, they are transparent about it. But at that time it was something like thirteen grand. And that's for like the most complicated thing with like an allograft and I didn't know what he needed. If it was the third time, I assumed it was all bone on bone by then.

Aaron (22:17)
Right.

Matt Allen (22:18)
So I assumed he needed the the most intense one. And so he looked at sixty grand and and sixty grand at IU Health. His insurance would have paid about fifty thousand of that.

Because he has an 80-20 plan and then he's got this surgical benefit. And I'll explain more about that when we talk about Wellbridge. But essentially he would he would be on the hook for 10 grand. But then we had that cost sharing plan, we had that Christian plan, and that would have limited it to five. So all told he would have had a $60,000 bill, would have been able to go to IU Health, he would have owed five grand. And he was pretty okay with that. He's like, but he

Aaron (22:53)
Yeah, not bad.

Matt Allen (22:55)
just checked in with us and he's like, Can we do better? Like five grand for sixty thousand surgery at IU?

Health, like I'm I'm good with that, but what else we got? So I told him about Wellbridge. And it was $13,000. And he's like, well, they don't take insurance because they don't. So I I don't want to pay $13,000 for this. I'm like, hold on. You don't have to. What you do is you get on their 0%, which I that they had at the time, I'm not saying they have that necessarily now, but they had a zero percent like six-month financing thing.

You didn't have to put any money down. And so he went there and he got it done there because he liked the doctors more. He liked the setup more. And they just they they put you in and they they get you out. It's like a conveyor belt of just awesome surgeons that work there, super low complication rate, super low infection rate, all this stuff. a wonderful facility. And then we took that $13,000 bill afterwards and see we submitted it to his insurance for reimbursement.

and so on his eighty twenty plan

Of thirteen thousand, he got about eleven thousand back, something like that, because he owed the twenty percent and they paid the eighty. So it's like ten five right around there. So let's pretend he owed twenty five hundred after that. His insurance reimbursed him ten five and he's got the zero percent financing, so he's just making his payments with that. They just cut him a check, ten thousand five hundred. You had an injury. even though the facility didn't accept insurance, his insurance said, Hey, if you go get medical care, we will.

Pay. We prefer to work with the provider. They'll they'll just work directly. You have an insurance card, they'll work with the provider. But if they don't accept insurance, we will still pay because it is medical care by a licensed medical provider. Okay. So, but that's not all he had with the private.

Aaron (24:46)
Okay.

Matt Allen (24:47)
He had the 80-20 plan for injury, but then he also had this thing called a surgical indemnity plan. And his brand of surgical indemnity.

There's no deductible on these types of plans, and they pay a set amount based on the care that you received. And so he had a very robust surgical plan and

That pays in addition to his 80-20 plan. And so an ACL tear, full reconstruction, it's about a mid-tier surgery. So he he wasn't getting the max benefit, but he certainly wasn't getting the min. He was getting the middle benefit. And it was a benefit of about $6,500 for that.

Aaron (25:27)
And

so for people hearing the word indemnity for the first time, that just means that there is you got something done and you get cash directly, a set amount of cash.

Matt Allen (25:38)
So that makes it seem too much like that's that's not incorrect. But you don't need to do this reimbursement thing. An indemnity plan will pay your doctor directly by just you just handing them a card.

The indemnity is meaning when X event occurs, you receive Y dollars in a benefit. That's all

Aaron (26:03)
Okay.

Matt Allen (26:04)
indemnity means. This happens, you get this amount, and you get a set amount. If the doctor charges more, then you owe the difference. If the doctor charges less, you still get that amount. That's how the insurance is is is run.

What I'm saying by the reimbursement thing is, is even if the doctor is saying, hey, we're not going to accept that, we're just going to bill you, you still get that set amount. You still get

Aaron (26:29)
I see.

Matt Allen (26:30)
paid out that set amount. So at this facility, he submitted it into the insurance. Well, we submitted it for him. He got $10,500 off his 80-20 accident plan.

And then he got a $6,500 check off his indemnity plan because his indemnity plan said, hey, if you get a mid-tier surgery, inpatient or outpatient by someone in network or out of network, you get sixty, five hundred dollars. Well, that's what the ACL surgery and repair was. So he ended up getting $10,500 and $6,500. He ended up getting $17,000. And he owed a six-month 0% financing total bill of $13,000. So on his third ACL tear, he went to Wellbridge and he owed $49.

Or excuse me, he earned four grand. And it's not like he just pocketed it and whatever. He still needed to pay for his physical therapy for six months to rehab that. And the four grand basically covered the whole thing on that. So he got out, torn ACL, third time, really bad, six months rehab, all that, and he didn't owe anything.

Aaron (27:33)
Wow. Just kind of the I mean, navigation of it all. Like that's it it's that's plain on expert mode, right? I mean let's not pretend like it's not, but

Matt Allen (27:45)
That's not a normal thing that most people should be able to do and understand.

Aaron (27:50)
No.

Matt Allen (27:50)
Absolutely.

Aaron (27:52)
So that's where I mean, you know, we have dead dedicated client success, right? Like that is

Matt Allen (27:58)
Absolutely.

Aaron (27:59)
you know, textbook why that exists. Because people, you know, don't encounter this stuff on a daily basis. You know, they don't know

Matt Allen (28:07)
Right.

Aaron (28:08)
how to navigate.

Matt Allen (28:09)
And people might be thinking, God, that sounds really good for him, but I that sounds like too much. I don't wanna have to do that. I w I

Aaron (28:16)
Right.

Matt Allen (28:17)
just wanna I just I just wanna hand in my card and I owe what I owe. And that's perfectly fine. He could have gone to IU Health and it would have been much more streamlined, he just would've owed five grand. Over here he made four grand. And this was a guy who was willing to do that, and I'm not saying he had to do all that stuff. All he had to do

was we we told him about Wellbridge. He wanted an alternative. We told him about it. He went in for the consult and they looked at him they go, Yeah, this thing's super torn up. He had his image

Aaron (28:45)
Ha ha.

Matt Allen (28:46)
sent over. And they're like, Yep, we can do this. We can get you in next Tuesday. They could also get him in a a lot sooner than IU Health could. IU Health was pushing it out a few weeks. They could get him in that next week. So that was another added benefit. But once he got the bills

They they were super simple setting up the financing, 0% interest for six months on 13 grand. He just took a picture of the bill.

We contacted Wellbridge to let them know, hey, this is the billing that we need. We understand you don't accept insurance, but he has a reimbursement style insurance, so we just need an itemized medically coded bill for the services you're rendering. Then we

Aaron (29:23)
Mm.

Matt Allen (29:24)
took that bill and we filed the claim for him through his insurance. He didn't have to do anything. Then the insurance just cut checks and sent them directly to his mailbox.

That's a that was his full participation as in it. Was basically just showing up. Was well it was looping in his health insurance agent. Because a lot of people skip that step. They just go to IU Health and they Well, five grand, all right. And that's okay. But he was like, Do we have better options, Matt? Yeah, we got better options. Go here.

Aaron (29:55)
So cool. I mean, to turn a situation like that into a success story, I mean is is awesome.

Matt Allen (30:03)
he was so

bummed out he tore it for the third time. Yeah.

Aaron (30:05)
Ugh

Any good news. Just give me any good news.

Did I I feel like I remember you saying something about the surgeons like at Wellbridge also do surgery at IU Healthy? It wasn't a there there's some overlap there.

Matt Allen (30:23)
So

there's a lot of medical professionals who have exclusive contracts with hospital systems. They sign like a contract out of school. Hey, I'm gonna work within IU Health. But then there are some surgeons, anesthesiologists, some specialist doctors who are 1099. They're just independent contractors, they work for themselves and they go wherever

Services are needed. And so a lot of the people who work at Wellbridge and do the surgeries, they're there as independent contractors. They'll also be the surgeon at IU Health potentially for you.

Aaron (31:07)
Huh.

Matt Allen (31:08)
So a lot of people are like, yeah, well, I'm paying 13. I'm probably gonna get worse care than 60.

It's just totally not the case. There's way lower rates of infection, way lower rates of needing to come back in, complications, and you get in quicker and you get out quicker. And I think they have data now because they've been around for years, data of like recovering quicker for their patients. Because it's all they do. It's not a hospital that's doing all these different things. It's an outpatient surgery center. That's all we do here. And so it's able to be streamlined to do just that. Just to get people in, get

them the best care possible and get them out. That's why they have lower overhead and that's why they charge you less. And they don't have

Aaron (31:51)
Wow.

Matt Allen (31:52)
to deal with all the insurance fiasco. So yeah.

Aaron (31:55)
Love it. That's what we have today.

Matt Allen (31:59)
Love it. This has been another episode of Talking Shit. Shit, of course, is an acronym for Straight Health Insurance Talk. I am Matt Allen.

Aaron (32:08)
And I am Aaron Miller.

Matt Allen (32:10)
Thanks for your time.

Why should I check whether my doctors accept a plan before enrolling? Covering a condition doesn't mean your doctor takes the plan. In one client's case, her cardiologist and imaging center accepted no ACA plans at all. Confirm with each provider's office before you enroll, not after.

Can lowering my income by a small amount really change my premium? Yes, because the ACA tax credit stops entirely above 400% of the federal poverty level. In one case, a couple about $3,000 over the line got their taxable income under it with their accountant. Their premium dropped from about $1,800 a month to nearly zero.

Do surgery prices really vary that much? They can. One client was quoted about $60,000 for an ACL reconstruction at a hospital system. A cash-pay outpatient surgery center with posted prices charged about $13,000. Price lists change, so check current prices directly.

Can my insurance pay if a facility doesn't accept insurance? Some plans reimburse you for care from a licensed provider even when the facility doesn't bill insurance. You pay the facility, then submit an itemized, medically coded bill for reimbursement. Whether this works depends on your plan's terms.

What does a broker do after I enroll? A good broker keeps helping after the sale. That includes comparing care options, gathering itemized bills, filing claims, and answering coverage questions. PlanShaman clients have a dedicated client success team for this.