920: A Masterclass in Health Insurance Benefits with Dr. Noor Ali

Pete Mockaitis
Noor, welcome to How to be Awesome at Your Job.

Dr. Noor Ali
Pete, thank you so much for having me. I’m a huge fan of the show, a huge fan of the Golden Nuggets, so this is a huge opportunity and privilege for me. Thanks.

Pete Mockaitis
Oh, thank you. Well, I’m a huge fan of you and all the money you’ve saved me on health insurance premiums since we’ve discovered you about a year or two ago. So, why don’t we get oriented? So, you are Dr. Noor Ali, so you’re a doctor but you’re not practicing medicine, and instead you’re doing health insurance. What’s the story here?

Dr. Noor Ali
Correct. Correct. This gets a lot of people. I am. I’m a medical doctor, I trained in my home country in Bangladesh. My background is internal medicine and general surgery. And if you know anything about this tiny little country of Bangladesh, it’s very, very low resource. We’ve got a whole lot of people and not a whole lot of medical practitioners. So, I’m actually trained to treat any human from head to toe, so I can do anything from a C-section, to a delivery, to a general surgery case, to a heart attack, to a stroke.

Pete Mockaitis
All right, but you’re not doing that now.

Dr. Noor Ali
I’m not doing that now.

Pete Mockaitis
Maybe on an airplane if there’s an emergency, you’ll be the person.

Dr. Noor Ali
Right. I’ve been doing health insurance for about five years now, Pete. Now, the process for foreign physicians like myself, if you’re familiar, is we don’t have to go through medical school again when we come back to the States. We have to pass a series of licensing exams called the USMLE. Now, the first of those series of exams is, step one, the content is basic sciences. And at that point in my career, I was a superstar, rock star surgeon and there was a huge disconnect for me.

So, I studied for about two years and I missed it. I failed the test by one question which was three points at the time, and it really put a damper in my career. I went into this deep kind of depression, I lost all sense of professional identity, and I didn’t really know what to do with myself, and I just needed a win at that time.

So, on paper, I just looked like a high school graduate, Pete, because I never went to undergrad. I went straight to medical school, this accelerated medical program from high school, so I was struggling to find jobs. And the only opportunity I got was a sales role at this health insurance company and I just took it because I just needed a win in my life. So, that was the connection between going from a clinical career to insurance, but I’ve been doing it for five years, and I’ve really made a career for myself.

Pete Mockaitis
Well, I’ll tell you, it was my producers who found you originally because I was thinking, “I want to talk to an expert on health insurance, both for the show and for me. So, please find this person,” and you won. Like, you are a health insurance expert who is also a doctor. And it’s funny because those often don’t go together because I’ve had many conversations with doctors, “So, like, what’s the insurance going to do with this? Or how much is this going to cost?” Like, “Boy, I don’t know that. That’s a tricky one.”

Dr. Noor Ali
Yeah, they don’t teach you that in medical school, right? They don’t teach you the insurance part.

Pete Mockaitis
So, you’ve got both, and so it’s funny. Health insurance is confusing even the doctors. And I remember, I even took a course in college, it was David Sinow, and it was called Personal Wealth Management and it was a very popular course. It’s about measuring your money for finance majors, like the personal side of things. And we talked a little bit about health insurance stuff, and it was a little tricky then.

But then, in practice, I remember I was in a nonprofit board meeting, and we were just taking the steps, like, “Okay, let’s really get health insurance locked in for the employees.” And so, someone did the research and we had these options. And it was so funny because, here we are these board members, who have some pretty cool accomplishments in the world of finance and leadership and running things, and all of us are just like, “Oh, boy, I don’t know. I don’t know,” and it was striking.

So, what’s going on here, Noor? Are we just dumb or what’s going on? Is it super complicated for everybody?

Dr. Noor Ali
It is. It is because there are so many players in this game, Pete. If we zoom out a little bit and if we think like, “Well, why is it so darn complicated? And how come other countries have it together and we don’t?” We’ve got a capitalist economy, we’ve got big players in insurance, we’ve got smaller groups, we’ve got employers, and then we’ve got private companies just kind of like making up their own rules in everything.

And then in 2008, we have an administration that says, “Well, let’s try to clean it all up. We’re going to do the Affordable Care Act, and we’re going to try to house everything under one federal platform,” but that still doesn’t eliminate the private sector and all of these key players. So, because there are so many people in this mix, it makes it really complicated because you don’t know where to start, and you don’t know where to go.

Pete Mockaitis
Okay. That’s great. It’s not just me and my fellow board members. It’s tricky for everyone, including doctors, and it is just because that’s the system that we have with all the different players. So, here we are, talking from a US context. Tell me, when it comes to US healthcare and health insurance, is there any country that’s awesome on every dimension?

I’ve heard that the US flourishes when if something really gnarly happens to you, we’ve got a whole lot of high-tech great stuff to give you a good outcome with that. So, in that dimension, the US is great on healthcare. But on many other dimensions, we’re not so great. How do we stack up and how do you think about that?

Dr. Noor Ali
Yeah, great question, and it always depends on who you’re asking and who you’re having the conversation with. I’ve lived and worked in Australia, I visited the UK, Canada, I have this recurring conversation, and people ask me all the time, “Well, what is it with the US versus other countries? And, exactly, how do we stack up?” And it’s always in any situation like this, especially when it comes to healthcare, there’s going to be two sides of the coin, and whoever you’re asking, their perspective is going to be different.

So, if we use the example of the Affordable Care Act, I’m going to refer back to this again because that’s what is popularly known. Well, that’s where you go to get your health insurance, HealthCare.gov. Well, it’s not designed for everyone. If you put the population of America on a graph and you divide it into four quadrants, the population that’s winning with the Affordable Care Act is the lower income and chronically ill. If you’re higher income or generally healthy, you’re not getting a good deal here.

So, similarly in other countries, whatever system that they have or they implement, it’s going to be great for one population and it’s going to alienate another. So, the short answer, Pete, is there’s no magical solution, there’s no one country where 100% of the population is happy, and I don’t think that’s ever going to happen.

Pete Mockaitis
Well, that was my next question, and you answered that lovely. I’ve heard some people say, “Oh, my gosh, Obamacare,” the name also used for the Affordable Care Act, ACA, they say, “Oh, my gosh, this is awesome. I’m saving so much.” And then other people say, “This is terrible. My last plan did so much more and I paid less.”

And so, there are some strong feelings on both ways, but I think you summarized it rather well. It’s like if you’re lower income and/or chronically ill, you’re better off now that the Affordable Care Act exists. And if you’re on the other side of that coin, you are personally worse off but maybe you feel good about how you’re contributing to the health of others, or maybe you don’t.

Dr. Noor Ali
That’s exactly right, Pete. Exactly.

Pete Mockaitis
Okay. So, thank you, that’s that story. Now, I want to get into one of the main reasons I wanted to have this conversation because this topic is different than a lot of our other episodes. I’ve heard people say, many times, “Oh, boy, I’d love to start my own business or do my own thing, go out on my own, but, oh, I’m with this company and they’ve got great health insurance. I really need the health insurance. I’ve got a family of four,” or maybe even someone with a chronic condition within that.

“And so, I guess I gotta stay put.” To what extent is that assertion accurate versus poppycock versus something in the middle?

Dr. Noor Ali
I’m going to lean more towards the poppycock for that situation because that’s absolutely not true. Now, historically, traditionally, employers were the best source to get health insurance because the larger your corporation is, the risk can be diluted more, the actuarial risk can be taken down, and the company can offer greater benefits to their employees. In addition, if the corporation is doing well, they can sponsor more towards your premium.

So, your out of pocket, what is coming out of your paycheck looks less and less. So, I am not at all denying that you can get excellent healthcare from your employer in a large corporation. However, that is not the only place to get health insurance. There is an entire whole other world out there, outside of your employer, where you can purchase your own health insurance. And in this specific situation that you stated, Pete. I want to pick that apart a little bit.

You mentioned a family of four where one person has different needs than the other, and that’s something that I want to hone in on, it’s something that I do for some of my services is to really analyze that. What is the risk and the needs for each of the person in their family if only one person out of a family of four has a greater need? The entire family does not need to be on a policy.

Pete Mockaitis
Well, actually, Noor, that was the huge insight that you gave me that’s resulted in my own personal savings. Thank you again for that. Because you said, “Oh, okay, so you think your wife might get pregnant again. Okay, well, then some plans are really great for that but they’re expensive all the time versus you and the other kids could be on this less expensive plan, and then she’d be on a separate.” I was like, “Oh, wow, wait a minute. One family, two different plans.”

Dr. Noor Ali
“What?”

Pete Mockaitis
Yeah, it was funny. My brain was like, “Wait. We’re still a family, right?”

Dr. Noor Ali
Right, “I don’t have to divorce my wife for this, do I?”

Pete Mockaitis
“We could still file our taxes jointly, right?” I was like, “Oh, of course. Of course.” I just never thought of it that way. And so, you opened my eyes and some savings, so we’ll talk about that. That’s cool. So, then maybe I know there are so many different kinds of plans, and things change. And this may be out of date a few months, but just for a snapshot.

Okay, here we are, December 2023, let’s say we don’t even know the value our employers are giving us or what we’d have to really shoulder if we went out on our own. Can you give us a taste for what does it cost, say, an individual who’s fairly healthy, let’s say 40 years old, versus an individual who’s not so healthy, 40 years old? We’ll do two-by-two. An individual, a family of four, healthy, unhealthy, very roughly speaking, what might we expect in the range of monthly premiums if we’re shouldering it all on our own for pretty good health insurance?

Dr. Noor Ali
Okay. Well, considering that there’s no subsidy here, so no ACA government plan subsidy, a full premium price plan for a healthy 40-year-old man can range anywhere from 350 to 450 a month. We should land somewhere right in the middle, and say roughly $400 a month.

Pete Mockaitis
Now, that sounds low. Are these ACA, Affordable Care Act plans, HealthCare.gov?

Dr. Noor Ali
It could be. So, it depends on what market we’re shopping. So, if we zoom out a little bit and back up the starting point when researching a plan for yourself is, “What market do I shop in? The public healthcare marketplace, which is the ACA Obamacare, or the private healthcare marketplace?” So, the public healthcare marketplace is entirely income-dependent.

So, that same healthy 40-year-old man, if he makes anywhere between $20,000 to $55,000 a year, he can qualify for a sliding scale subsidy from the government where they’ll pay a portion of his premiums. If he does not qualify for that subsidy and exceeds that subsidy-qualifying threshold, then his premiums can look anywhere from 350 plus.

Pete Mockaitis
Okay. Thank you. Now, let’s get a taste for an unhealthy person, if someone says, “Hey, I’ve got some stuff that I’ve got to deal with ongoing medications, condition.”

Dr. Noor Ali
So, the sad news is no insurance company wants to take on this unhealthy person with all of this stuff because insurance, even though they’re dealing in the business of risk, they don’t want to take on that risk. They just want to take your monthly premiums and want you to never use your insurance again. So, the best market to shop for someone who has major preexisting conditions is going to be Obamacare, ACA, public healthcare marketplace because this is a guaranteed issue platform. They’re not going to ask you about those preexisting conditions.

However, I should note that there are degrees of risks and preexisting conditions. The example that I like to use is an asthmatic. If you’ve got asthma and you’ve got a little inhaler that you have to use here and there, maybe an Albuterol once a day, versus that same 40-year-old man with asthma who is a smoker, overweight, has to go to the emergency room to get nebulized every time he has an asthma attack are two completely different risk profiles. So, it’s worth assessing that risk profile to see, “Hey, is my preexisting condition really as bad as I think it is? Can I still get a plan that’s less and shop for an insurance company that’ll take me, insuring me for less?”

Pete Mockaitis
Okay. Well, in that very unhealthy situation, if they are going on HealthCare.gov, are they still in that 350 to 450 range because…”Hey…”?

Dr. Noor Ali
It depends on the income. It depends on the income. So, if the income is 20,000 or less, you can qualify for Medicaid, which is free healthcare in your state. Anything between 20,000 to 55,000 roughly, you can get a sliding scale subsidy, and your plan can be anywhere from zero dollars up to 350 plus, depending on that subsidy in tax credit.

Pete Mockaitis
Okay. And women, do they pay more because of pregnancy and these sorts of issues?

Dr. Noor Ali
Women pay more just because they’re a higher-cost to insure. They have a whole set of organs that cost a lot to maintain. So, in general, a 40-year-old woman is going to cost more to insure than a 40-year-old man.

Pete Mockaitis
And we were saying 350 to 450. What is it for a woman?

Dr. Noor Ali
Similar range but maybe a little higher, depending on the deductibles and max out of pockets could be higher. So, I would still say maybe these plans for a woman would be starting in the high 300s or 400s.

Pete Mockaitis
Okay. So, if we have a family of four, would I just multiply that number by about four?

Dr. Noor Ali
Ish. So, children cost less and there are so many factors here. I hate that I’m even giving numbers because if someone hears this and they find there are some inconsistencies, I don’t want to be attacked here because children are going to cost less to insure but there are so many variables that go into finding this, calculating this monthly premium – zip code, age, risk factors, where you live, the cost of living there, the medications that you take, if we’re calculating monthly premiums. But children usually cost anywhere from $75 to $200 monthly premium, depending on age and where they live.

Pete Mockaitis
Okay. Well, so this is informative. So, just to make things simple, I‘m just going to say 500 times three-ish, so you might call $1500-ish of premium per month times 12 months, we might be talking about $18,000-ish of a family’s budget, which is potentially more than the rent and/or the groceries for people if they’re on their own.

So, I think, to the extent of, if that statement, “I can’t leave my job. I’ve got to have the health insurance,” real versus poppycock, I think the answer is, well, it may very well be $20,000-ish a year of an issue if the employer is paying it all versus not. So, that’s how I spin my perspective, it’s like, “Well, hey, if you can clear $20,000 extra doing your own thing, then you might be fine. You just got to take that factor into account is that health insurance provided by an employer is a real benefit of substantial economic value but it need not handcuff us.”

Dr. Noor Ali
Right. Correct, Pete. And you mentioned that the employer is paying all of it. There’s hardly ever a situation where the employer pays all of it. They’re paying 50-70% of it perhaps, but the rest is coming out of your paycheck so often people don’t pay attention to it. You are paying for it. You just don’t notice it as much.

Pete Mockaitis
Thank you. Thank you for sharing that. Okay. So, now what’s open enrollment? We hear a lot about it around this time of year. And what’s the deal?

Dr. Noor Ali
Open enrollment is the time of the year where insurance companies open up their arms and say, “Come sign up, enroll into our plans for the next year, you can get health insurance now.” It’s significant because it’s a sensitive window. You can only sign up for health insurance on the public healthcare marketplace typically November and December of every year for coverage for the following plan year.

Pete Mockaitis
Now, what’s that about, Noor? Why can’t we just buy something whenever we want to buy them?

Dr. Noor Ali
Because, we’re going to go back to the concept of risk, insurance needs to calculate how much risk they’re taking on for 2024, do that actuarial analyses, and run their numbers and reporting. So, people are signing up all year long, and they’re not doing any type of preexisting clause. They’re taking on random levels of risks at random levels of the year, and an insurance company cannot run its business taking on that risk.

Pete Mockaitis
Okay. Duly noted. So, then, if, let’s say if we got fired, or we left our job in the middle of the year, are we just out of luck, we’re just going to go uninsured until November-December?

Dr. Noor Ali
No, that would be a special qualifying life event. So, there are a series of circumstances, we’re in the middle of the year, if you just decide to move, you get married, or you just lose your job, or get terminated and have no longer have access to benefits, those would qualify you to be able to sign up for a plan on the public healthcare marketplace using the special enrollment period. I do have to point out though, on the private side, there are no special enrollment periods. You can sign up all year round.

Pete Mockaitis
Okay. So, I’m also curious to the notion of public versus private, and employer-sponsored versus individual. I’ve had the experience, I remember in Chicago, when we made the shift from my wife’s health insurance to, “Okay, I’m getting all the health insurance,” there were some plans that I just could not access if I was not associated with an employer, which I thought was wild, it’s like, “I am willing and ready to pay outrageous amounts for my health insurance premiums. I’ve already steeled myself for that reality.”

And then it’s just like, “Oh, no, you just can’t have that plan. That has all the really cool doctors, or whatever.” And I thought that was so weird. What’s the deal with that?

Dr. Noor Ali
Can you tell me a little bit more about that though before I answer?

Pete Mockaitis
I think it was something like a Blue Cross Blue Shield, Gold or Platinum Choice, Select. I don’t know.

Dr. Noor Ali
Who said you couldn’t have it though? Was it an employer, a group, or what?

Pete Mockaitis
Well, there was one plan that my wife had, and it was pretty sweet in terms of it had vast numbers of physicians and network and all that. And then, as I looked at HealthCare.gov, it was just like, “No, that’s not on the menu.”

Dr. Noor Ali
Yeah, so that’s going to be public versus private markets. So, the public healthcare marketplace, Obamacare, typically doesn’t have PPO networks, which is going to be those higher-quality plans that you’re talking about. You can only get those when you are part of a big employer, a group plan, or you go on the individual market and you basically get a private insurance plan. So, that’s one of the biggest detriments of plans on the public healthcare marketplace, is they don’t have PPO options in most states.

Pete Mockaitis
Not one, not a PPO to be had in most states on HealthCare.gov?

Dr. Noor Ali
Correct.

Pete Mockaitis
And for those who are not familiar, what do these letters PPO mean?

Dr. Noor Ali
PPO stands for Preferred Provider Organization. It’s pretty much like it sounds. It’s a higher-quality access for the benefits that you have. So, Pete, you can have the most awesome health insurance plan in the world, cost zero dollars, free, co-pays, all that stuff, covers you head to toe, but if you can only see the doctor that’s 30 miles away and has availability six months later, what good use is that plan?

So, the network of access to providers, that’s what the letters PPO, HMO, EPO stands for, is where and how you can use your benefits of your health insurance policy. And you always want to choose a PPO because that’s a higher quality.

Pete Mockaitis
Okay. So, PPO is the best. Is HMO the worst?

Dr. Noor Ali
You could say that.

Pete Mockaitis
And what does EPO stand for? What’s that do?

Dr. Noor Ali
Something just in the middle, Exclusive Provider Organization. It’s a mix of HMO and PPO where you can see the doctors you like to, but again it’s a much limited and smaller network.

Pete Mockaitis
Okay. And how can I know the network I can access in advance of getting a plan?

Dr. Noor Ali
Well, when you look at the plan, you’ll know what network it’s on, but I think that one of the advices that I like to give that’s relevant in the situation is it’s always better to stay in network with the plan instead of finding a plan around the doctor that you love. Does that make sense? Because just to fit a plan around a provider, you might get really screwed in every other benefit, but if you have a plan that works in terms of benefits for you, then going along with the network and benefits of that plan is going to be more beneficial.

But when you’re exploring and researching plans, you’re always going to know what network that is, whether that’s HMO, EPO, or PPO.

Pete Mockaitis
And I think that’s sort of the tough pill that I guess we just have to swallow, is that if you’re fond of three distinct doctors in different specialties for…it’s like, “Oh, I want to get a plan that covers all of those.” Well, the odds are not in your favor, unfortunately, to pull that off. Although, in the case of some private plans for either individuals or corporations, you might have better luck there in terms of, “This is a premium offer that happens to include your three favorite specialists in different domains.”

Dr. Noor Ali
Precisely.

Pete Mockaitis
Okay, that’s good to know. So, Noor, if we’re young and healthy, do we still need health insurance or is that a waste of money?

Dr. Noor Ali
Am I allowed to laugh and scoff in response to that?

Pete Mockaitis
Yeah.

Dr. Noor Ali
Okay, I’m laughing and I’m scoffing but I’m trying to keep it together. Yes. Yes, Pete, you absolutely do need health insurance, and the best time to get it is when you are young and healthy because that’s when you are the lowest risk, the most desirable to health insurance companies, and they’re willing to insure you for a lot less cost, and willing to give you a lot more benefits. So, that is the best time to get yourself some good insurance.

Pete Mockaitis
Well, yeah, and I know someone who is young and healthy, and then she got cancer, and it was so sad and startling and unexpected, and so then she had a heap of medical bills. And so then, they were doing some benefits and some fundraisers and some donations. And someone who was curious and courageous enough to pose the question, “So, did she not have health insurance? Or how do these bills kind of end up mounting so high?”

And then the person said in reply, “Of course, she didn’t have health insurance. She’s young and healthy. Why would she spend money on health insurance?” And so, I like that you’re presenting this, the opposite point of view strongly because that’s how I think about health insurance. It’s like, “Would you like to not go bankrupt if something terrible happens to your health? If the answer is yes, and you live in the United States, having health insurance is, unfortunately, a necessary thing that you need to enjoy that privilege.” That’s where we are.

Dr. Noor Ali
Exactly. Yup, that’s exactly it. You’re right.

Pete Mockaitis
Okay. So, if we should all have it, tell us what are some of the clever ways we might go about saving on health insurance?

Dr. Noor Ali
Yes, great question. I want to offer a little bit of insight on the young and healthy thing because this is a fallacy that I see a lot in the young and healthy population is, first of all, they think they don’t need health insurance. So, that’s mistake number one. You absolutely do. But the second thing that I notice is they go for the plan with the lowest premium and the highest deductible because that just makes sense in their head, it’s like, “Well, I hardly ever use it to go to the doctor and use it, why would I pay more in premiums?” whatever.

So, in that situation, what’s happening is, let’s say you have health insurance for two years, and, finally, something happens and you need to use your health insurance plan. You have a $200-a-month premium and you have a $10,000 deductible. That’s a typical low-premium, high-deductible plan ratio. So, for two years, you paid your insurance company $200 a month, and when you finally need health insurance because you got into a car accident or got diagnosed with cancer, you are going to have to pay the first $10,000 of bills before your insurance company is going to step in and pay anything.

So, you just ensured in that situation that you are paying, not your insurance company. So, that’s completely like the opposite psychology that you should be using as a young, healthy, low-risk person when selecting your health insurance plan. The better strategy, in my opinion, is, “What is the lowest deductible that I can afford with a comfortable premium?” And that may be 250-300, just a little bit more per month but if and when you need to use your health insurance benefits, you want to make sure that you are spending less out of pocket and your insurance is stepping in with those bigger bills.

Pete Mockaitis
Okay. So, let’s talk about some of these words. This is like everything you want to know about health insurance but were afraid to ask. Premium, deductible, co-insurance, what do these words mean?

Dr. Noor Ali
Premium is the amount of money that you have to pay per month just for having your policy. Whether you use it, you never use it, you have to pay the premium. If you work for a big corporation, that’s typically divided up into your bi-weekly paychecks, comes out of the paycheck, but it’s traditionally calculated as a monthly premium.

Pete Mockaitis
All right. And then what is a deductible?

Dr. Noor Ali
A deductible is the amount of money that you have to pay in addition to the premium before the insurance will start paying out on your benefits. Now, typically, most insurance plans only offer preventive care before the deductible. Most insurance out plans don’t offer a whole lot.

Pete Mockaitis
Okay. And then what is a co-insurance percentage?

Dr. Noor Ali
Co-insurance is, after you meet that deductible, is the percentage of bills, medical expenses your insurance company will pay.

Pete Mockaitis
Okay. So, if it’s an 80%, then I’ll pay through my deductible, and then I will still be on the hook for 20% of what happens above and beyond that.

Dr. Noor Ali
Correct, until you reach your max out of pocket.

Pete Mockaitis
Okay. And so, max out of pocket, is that just what it sounds like, it’s like, “I will not part with any more money than this in a year?”

Dr. Noor Ali
Yes, it’s a value that states that once you pay your insurance company this amount, they’re obligated to cover the rest of the bills.

Pete Mockaitis
And is that in addition to on top of the premiums?

Dr. Noor Ali
It’s always on top of the premiums, yes.

Pete Mockaitis
All right. Very cool. What is a co-pay?

Dr. Noor Ali
A co-pay is very similar to the co-insurance. It’s either/or. Your plan can either have a co-pay or a co-insurance. And a co-pay is a fixed dollar amount that you pay for medical services before the service. So, that can be a $20 co-pay to see a doctor or specialist that you would pay that before you even see the doctor.

Pete Mockaitis
That’s good. And what’s funny is I’ve learned from experience that co-pays are actually good. Like, I want to have $50 co-pay to see a specialist as opposed to not having one because then the neurologist might be like, “Yo, that’s actually $450 to talk with me for half an hour.” It’s like, “Oh, oops, I’d rather have a $50 co-pay.” So, co-pays are a good thing that we want to see across a broad array of services. Is that accurate?

Dr. Noor Ali
I would say, in this economy, having a fixed co-pay is going to be much better than a co-insurance percentage because of the example that you just stated. You want a fixed dollar amount rather than a percentage of a big bill.

Pete Mockaitis
Okay. There you go. And then the network tells me who they are willing to give money to. And so, if I go out of network then the plan might specify, “Well, hey, you have no benefits or fewer benefits.” Is that accurate?

Dr. Noor Ali
Yes, less benefits.

Pete Mockaitis
Okay. So, we want in-network for good savings, and so we should research in advance who is in the network. And sometimes that’s harder than you think to determine because it’s like, “Oh, yeah, we take UnitedHealthcare.” But UnitedHealthcare has many, many plans underneath this brand name, this company. So, how do you recommend we do great research on getting clear answers on, “No, for real, who’s in the network, who’s not in the network?”

Dr. Noor Ali
Yeah. Well, every insurance plan will have their network directory, but, honestly, those are updated every 30 days. Sometimes they’re not accurately updated. So, the best and fastest way is to call up your doctor that you like, your provider, your hospital, your urgent care, and say, “Hey, do you guys take this plan? Are you in network?” Just ask the question.

Pete Mockaitis
Okay. Thank you. And you, that’s one of the services you and your team provide. You do a little bit of the groundwork, a little bit of the hustle, on behalf of your clients, right?

Dr. Noor Ali
Yes. Yes, I do. So, if you are a client of mine, and you just want to know, “Hey, where can I go?” I’ll happily do that for you.

Pete Mockaitis
And, honestly, that is just so huge, thank you, because this stuff is so complicated it makes me groan. So, this is part of why it took so long for us to get onto a microphone together is that you do some of that work, and that is awesome, and at no cost. And I’m trying not to be too much of an advertisement for you, but I can’t resist. I think you’re awesome. So, I don’t have to pay you any extra for that. How on earth is this financially workable for you, to do all this legwork, and be paid nothing to do it, to have it done?

Dr. Noor Ali
Yeah, that’s a great question. Well, Pete, to be honest, I did raise my price just a little bit since we worked together. Not a whole lot, but, yeah, it’s one of the concierge services that I provide. So, for all of my clients, things like claims, customer service, I’m happy to do that for the life of the policy just because I know how onerous it can be for you, and how easy and convenient it is for me. It’s not a big deal to me at all. The way I get compensated is through the insurance company that I end up connecting you with. They pay me a portion of your premiums for my commission. So, don’t worry, I’m taken care of.

Pete Mockaitis
That’s right, yes. And so, in a way, it’s interesting. You’ll pay the same amount, whether we go to HealthCare.gov or you, right?

Dr. Noor Ali
Correct.

Pete Mockaitis
And yet, when we go through you, we get these extra benefits and services.

Dr. Noor Ali
Correct, yup.

Pete Mockaitis
And it’s just the healthcare provider, or the health insurance provider, who has a slightly shrunk profit margin, and I don’t mind.

Dr. Noor Ali
Me neither.

Pete Mockaitis
Sorry, health insurers. I think they’re doing okay and then giving a little slice to you, so that’s win-win-win. Okay. So, then tell us what are some of your favorite tips for saving on health insurance or healthcare expenditure overall?

Dr. Noor Ali
Yeah. Well, when it comes to finding and researching your plan, I think doing a needs assessment and risk evaluation is huge. That’s really where I start the journey whenever I speak to someone and they come to, asking, “Where do I even start?” So, some of the things that I’m going to be looking at is, “Where do you live? How much money are you expecting to make? And what is your medical or health risk profile?” And because of my strong medical background, it’s very easy for me to do that assessment quickly.

So, once I kind of profile your risk, then we decided, “Okay, public market, private market,” and there’s a type of a plan that I specialize in and I advocate for, and it works really beautifully for people in the healthier and wealthier bracket and on the private side, and it’s called a medically underwritten health insurance policy.

And this model is a pre-2008 or pre-Obamacare era where if you’re generally healthy and you’re earning too much to qualify for any government subsidies, we can underwrite you medically into a high-quality PPO health insurance plan that’s going to last you a lot longer and mirror the quality of a corporate package, or a major medical plan, at a fraction of the cost.

Pete Mockaitis
That’s cool. Okay. So, then we’ve got a great plan. Well, now tell us, how do we work it so that we don’t have unfortunate unexpected medical expenses along the way of living and using that plan?

Dr. Noor Ali
I love it. I love it. This is one of my favorite questions to answer because working your insurance plan, or milking it, is exactly what you should be doing. So, the first things to note is make sure you take advantage of all of the preventive care. Insurance companies don’t want to spend money. It’s more beneficial to them to keep you healthy. And how do we keep you healthy? Go to the doctor at least once a year, get your preventive, your annual wellness checkup so you’re not surprised with cancer because that’s what’s going to cost them and that’s all they care about.

So, take advantage of all the wellness and preventive benefits that your plan has at the very least. Then if you need to use your plan for services, start at the lowest tier, which is going to be virtual therapy and care. That is very accessible to you. You could do it from home. Now, they have trained physicians that they’re designed to send prescriptions to your nearest pharmacy without you leaving or doing anything, and they’re billing at a lot lower rates.

So, don’t go running to the emergency room for a cough and cold, stomach ache, or UTI, or yeast infection for women. Start with a virtual visit. That’s going to save you tons of money, it’s very convenient, and it’s going to help on the insurance backend.

Pete Mockaitis
Okay. And one of the other cool benefits of insurance—I can’t believe I said that sentence, cool benefit, okay, but I believe it—is that when you get medical bills, the explanation of benefit statements, it’ll show you, “Okay, hey, normally, we charge this much money for the services, but because you have this insurance, we’ve pre-negotiated a rate between them. And so, now it’s discounted and then your benefits cover this amount.”

So, it’s sort of like, “We knocked it down from, I don’t know, 500 bucks if you have nothing, to 320 because we pre-negotiated,” to, “Oh, hey, you have some insurance benefits,” so then you might be left with, like, 80 or something at the end. So, that’s kind of cool. But what can be tricky is, do they call it balance billing, is, like, “Oh, yeah, I am on the hook for a little bit after everything, and, oops, it’s more than I thought it would be.” How do I prevent that from happening?

Dr. Noor Ali
What I know about balance billing is that it’s difficult to predict unless you request estimates, or, “Hey, tell me exactly what you’re going to bill to insurance,” and that involves communications with the billing department before you seek services, which can be challenging in emergency situations, so I don’t have an actual answer on what to do after the fact.

Pete Mockaitis
Certainly. So, after the fact, good luck, but what you can do to prevent that is, ideally, you talk to them, you get the estimate. And I’ve heard that, even if you do get that surprise, you can ask and say, “Hey, I was really surprised to see this given that you’re in network, and I see the insurance paid this. So, what can you do for me?” And sometimes, they’ll just, “Oh, yeah, cut in half,” just like that. This happens.

Dr. Noor Ali
That’s a great strategy, actually, and negotiation is something that should never be left off of the table. Now, typically, negotiation is a strategy that’s used for cash-pay patients, people who don’t have insurance, they say, “Hey, I wasn’t expecting this much. What can you do?” And you always want to offer cash because facilities would always rather be paid upfront immediately than wait 30 to 90 days for a claim to process and for insurance to pay them. But now, we’ve seen it working also with insurance. If you can combine having insurance and still negotiating and re-pricing down your patient responsibility, you can do better than that. That’s amazing.

Pete Mockaitis
Certainly. And that also having an estimate in advance is huge for your negotiation, it’s like, “Hey, wait a minute. You said it was going to be this.” Like, “Oh, yeah, but we also had to do an ultrasound.” It’s like, “Well, why wasn’t that in the original estimate?” It’s like, “Well, you didn’t click the CPT code for an ultrasound estimate.” It’s like, “I didn’t know I was supposed to do that.” “Okay, fair enough. Just knock off 300 bucks.” Okay, just like that.

And when it comes to pricing, the way I think about options, or how do you think about it? When I’ve narrowed down to a few options or plans, I kind of like to play with the numbers, and say, “Okay, if I use no health insurance, how much cash should I be out over the course of a year? If I had a horrific accident, shattering dozens of bones, multiple surgeries, how much would I be out the year, so like the out of pocket plus the premiums and all that?”

And then what do I really expect to happen, like, “Okay, I’m going to go to the doctor a couple times and then maybe check in with this or that”? And then I look at those three total out-of-my-pocket cash amounts across the scenarios, and across the options, so it takes a while to make a call, “Okay, which plan is really my best option? Oh, that plan doesn’t exist next year, oops. Do it again.” Is this a good way to go? Or what’s a faster, easier, smarter way to assess the different plans and which one is optimal for me?

Dr. Noor Ali
That’s a fantastic exercise, Pete, and I wish that more people were more savvy like you to do that determination. The quicker faster dirtier way would just be to call me and I do that for you.

Pete Mockaitis
All right, thank you.

Dr. Noor Ali
But, yeah, if you’ve got the skills, go the Pete-route, but if you don’t and you’re below average, then you can give me a call.

Pete Mockaitis
Well, I would say, for all my savvy, I’ve still made mistakes and had unexpected medical expenses. Oops. So, learn in those lessons. Well, tell us, any other tips, tricks, things to do or not do when we’re buying or using our health insurance?

Dr. Noor Ali
Yeah, really just take some time to get to know your policy. Some really high-level things you got to know about your health insurance is the monthly premium, how much are you paying just to have your plan, your deductible, your max out of pocket, and really cool special little things. That’s a very personal thing to find out. Like, if you love going to the chiropractor, really know your chiropractor benefits.

If you’ve got a kid who’s active in sports, what is your accidental policy like? How much is it going to cost if your kid is going to break a leg? So, know those common situations and scenarios that’s important to you. Understand what that out-of-pocket liability is going to be. And if you don’t know those answers, reach out to the person that helped you get your plan. They’ll have those answers. And just have a mental note on that.

I’d also say to do pretty frequent assessments and evaluations even if it’s not every year. If you have a major life change, that’s a good time to evaluate your health insurance policy, “Is it still working for me?” If you’re having a baby, that’s an important time. If you have a move or a life change, that’s an important time. But, also, if new products come out on the market pretty often, so understanding, “Am I paying the lowest that I could pay? Are there any new products out there that’s going to be a better fit for my needs?”

Pete Mockaitis
That’s great. And, tell us, what about these so-called health-share programs, like Liberty HealthShare, Samaritan Ministries? How should I think about those?

Dr. Noor Ali
Yeah, that’s going to depend on a lot of things. So, I’ll tell you my opinion on health-sharing plans. So, the first thing to understand is they’re not true insurance products, so it’s not insurance at all. And the value of insurance is going to be that max out of pocket, that clearly defined number that says, “Hey, I gave you my insurance card.” There’s worst-case scenario, cancer, all bones shattered, “This is the most I’m going to pay. Don’t ask me any more questions. That’s a contract between you and your insurance company.”

So, that’s one thing that I find to be lacking in most health-sharing plans. And the second factor that impacts a lot of people is many health-sharing plans are based on faith which require some lifestyle commitments that not everybody is prepared to commit to. So, if it aligns with your lifestyle, and you’re okay with that model, that’s fine.

The third thing I’ll say about health-sharing plans is it’s very non-traditional, it’s a healthcare alternative, it’s certainly trending, but if you come from a corporate background where you’re used to a traditional healthcare model with fixed co-pays, where you don’t have to negotiate or do any type of self-advocacy or patient advocacy, you might not like that model because there’s a lot of standing up for yourself, paying first, and then negotiating and re-pricing down, and then hoping that your health-sharing plan kind of kicks in with the rest of the bills.

Pete Mockaitis
That’s what I’ve heard. I guess my personal take is I know friends who’ve had great experiences. Like, some, I think it was a premature child, and that’s a nightmare, and them saying, “Well, hey, we’re here for you in your time of need, sir. And this is your time of need,” and he just starts crying, like, feeling super supported by them, it’s like, “Wow, great. That’s really cool.”

And there are others who say, “I don’t know if I trust that they’re really going to have my back when it’s there.” And, yes, there could be some faith things that may or may not jive with your values, beliefs, wisdom, tradition, lifestyle stuff. So, there’s that.

What do we think about vision, dental, these kinds of health insurance matters?

Dr. Noor Ali
This depends on your level of usage. If you don’t go get your eyes checked once a year, or you don’t wear glasses or contacts, do you really need vision insurance? No, probably not. If you are using eye care, and you actually buy glasses and materials, I think there’s value in vision insurance. Similarly, for dental, if you’re just going in for cleanings twice a year, you could probably be better off paying for that out of pocket at your local dentist.

One strategy I can advise is, if you’re open to a dentist, any time a new dentist office pops up, they offer an introductory rate for cleanings and preventive care. Do a cash pay. Take advantage of that. Where dental insurance really has value is if you have horrible teeth that require continuous work, like root canals, bridges, fillings over and over again, those services are billed at much higher rates, and it’s valuable to have an insurance plan to take care of most of the bill versus you doing cash pay.

Pete Mockaitis
Oh, that’s good to know. So, the negotiated rates between dental insurers and dentists are much better than the cash rates. Although, a lot of dental plans I’ve seen, it seems like their maximum coverage is a little skimpy, it’s like, “Man, if things really hit the fan with my teeth, for tens of thousands of dollars, you wouldn’t really have my back to that level.” Unlike, out of pocket maximum health insurance, it’s like shatter 20 bones, “Okay, they’ve got a hefty bill and I don’t so much.”

And with the vision, I’ve learned that some of those vision insurance, you think, “Oh, I get a free pair of glasses,” whatever, but then if you buy glasses from an optometrist office, somehow all the lenses and all, sometimes somehow, even with the insurance benefits, it ends up being way more than buying them on, like, Zenni Optical, or Warby Paker, or some of these other places. So, you may be better off cash-paying for your eye exam, getting a valid prescription, and then just going to buy your glasses online, and forgetting a vision insurance benefit.

Dr. Noor Ali
Right.

Pete Mockaitis
Now, that’s just my own experience. Is that something you’ve observed within your clientele as well?

Dr. Noor Ali
Yes, and it depends on, again, the billing practices, where you live, how much they’re charging for those frames, all of those factors go into it. But I would say, if you are looking to stretch your benefits more, that strategy that you said is pretty great. Go get your eyes checked and get a prescription, and then shop around on an online provider to get it for less.

Pete Mockaitis
Okay. I read a juicy story about a health insurance provider using AI to deny a bunch of claims and end up getting into some trouble. And some lawyers mentioned a factoid, which I thought was intriguing, which said that, “Only 0.2% of people appeal a health insurance denial.” Is that accurate? Or, do you know? And/or what are odds of success if your health insurer says, “No,” and we say, “No, really, yes”?

Dr. Noor Ali
This is really interesting. I don’t have data to back up what I’m going to say but I’ll share my personal experience. I would say that factoid sounds right because, yeah, I would say that people don’t appeal it. However, my clients, I am absolutely tenacious when it comes to things like that. If an insurance company is denying a claim, I am so fast to appeal that claim before the denial letter even comes through. And that’s also a service that I provide and I like to do.

And, in my experience, what has happened that in that claims, denial, and appeal process, the bill from the hospital, or the emergency room, or whatever, somehow disappears because nobody wants to deal with that process. The insurance company doesn’t want to reopen the case and reassess, and the facility or the hospital writes that off as a lost expense because they say, “Okay. Well, we’re never going to get paid for this because our patient is not paying us, and the insurance hasn’t paid us, so we’re just going to file this away as an expense.” So, it actually works out if you actually appeal.

Pete Mockaitis
Okay. And you’ll do it for us, so that’s easy.

Dr. Noor Ali
Yes, exactly.

Pete Mockaitis
Cool. All right. Noor, wow, what a whirlwind. Any final thoughts before we hear about some of your favorite things?

Dr. Noor Ali
No, this has been a fantastic conversation. Thank you for your questions today, Pete.

Pete Mockaitis
Well, thank you. Well, now could you share with us a favorite quote, something you find inspiring?

Dr. Noor Ali
Yes, a favorite quote, I use this across every aspect of my life is by one of my favorite authors, Haruki Murakami, and he says, “If you read what everyone else is reading, you’ll think what everyone else is thinking.”

Pete Mockaitis
Oh, that’s good. Well, speaking of what everyone is reading, what’s a favorite book of yours?

Dr. Noor Ali
Good one. Okay. The Midnight Library.

Pete Mockaitis
And a favorite habit?

Dr. Noor Ali
Gratitude. With every step, with every breath, active, intentional gratitude.

Pete Mockaitis
Okay. And is there a key thing that you share with clients that they repeat frequently, they quote Dr. Noor often on?

Dr. Noor Ali
I’m going to pull something from my desk that’s for another business that I have for my company, Think Like a Woman, and I have my quote here. And my quote is, “There’s nothing more powerful than an ambitious woman aligned with her aspirations.” It’s from one of my quotes.

Pete Mockaitis
Okay. And if folks want to learn more or get in touch, where would you point them?

Dr. Noor Ali
My website, DrNoorHealth.com. What’s more entertaining is following me on Instagram because you can see my entire life unfold in stories. It’s quite entertaining.

Pete Mockaitis
Okay. And do you have a final challenge or call to action for folks looking to be awesome at their jobs?

Dr. Noor Ali
If you want to be awesome at your job, take a look at your health insurance benefits. Pay attention to what is coming out of your paycheck. If you are curious if you can do better, give me a call. Talk to me and let’s see what we can do for you.

Pete Mockaitis
Sure thing. Dr. Noor, this has been a treat. I wish you much luck and success in all your adventures.

Dr. Noor Ali
Thank you. Thank you so much, Pete. Thank you for the opportunity. I love this conversation.