August 23, 2023

Understanding health insurance benefits is stressful and you often find out you’re learning about them at the most vulnerable time – when you or one of your dependents are hurt or sick. This week’s episode of “Under the Coverage” highlights how to get in front of that problem by understanding what’s covered, now.

Tracey Bishop-Jeter, care navigator, senior, at Nova, joins our latest podcast episode, “Not in the Coverage.” Bishop-Jeter, who has more than 25 years of experience in various aspects of health care, including pharmacy and insurance, finds she is still learning about health benefits and wants to share what she has learned so far with everyone she can.

“I think understanding health insurance benefits is one of the most confusing things in life,” she said. “It can be the most stressful thing to learn, at literally the most vulnerable time in your life when you are sick or are not feeling well. Nothing worse than to have to try to understand or make sense of something when you are feeling your worst.”

Some of her advice includes ensuring medical facilities, practices and providers are in-network under your health insurance plan. In particular, she notes many people don’t realize providers can be individually credentialed and may not participate with certain health insurance plans even if the office where they work is in-network.

Another common point of confusion she sees among members – and has experienced personally – is not realizing certain medical tests, procedures or medications require prior authorization. This means the insurance carrier must approve them for medical necessity prior to the service being rendered. Another important point is just because your physician who orders a test is in-network, doesn’t mean that test or the provider who analyzes it and shares the results are automatically covered under your health plan.

People may not ask certain questions because they’re not aware they should or simply because they’re not feeling well.

“I think that’s so interesting because you listen to your doc,” Bishop-Jeter notes. “So, your doctor’s going to say, this is what you need. This is the medication you should take and you might not feel, you know, knowledgeable enough, experienced enough, comfortable enough to ask the question, ‘Why? What is it going to cost me?’”

If there’s one takeaway from this episode, it’s that there’s so much you don’t know about your health benefits unless you ask.

“I'm happy to be able to give that information to members when they call in and be amazed how relieved they are to know certain things that they didn't know before,” Bishop-Jeter said.

To hear more insights from Bishop-Jeter, listen to “Not in the Coverage.”

In 2022, Nova launched “Under the Coverage,” a podcast featuring people who spend their working days focused on health benefits and health care, to share their insider tips and information they wish every health care consumer knew.

How to Listen

New episodes – each 15 minutes or less! – are added regularly and are available on SoundCloud, Stitcher, Spotify, Apple Podcasts, Google Podcasts, Pandora, Amazon Music and TuneIn. You can also listen via digital assistants like Alexa, Google and Cortana. Just ask Alexa to, “play the Under the Coverage podcast on Apple Podcasts” (or wherever you get your podcasts).

Have an idea for a future episode or a question you’d like answered? Find Under the Coverage on X @UndrTheCoverage or email podcast@novahealthcare.com.