Sign Massachusetts Banking Medical History Later

Industry sign banking massachusetts medical history later

[Music] good afternoon from palmer but good morning from fort lauderdale because mark what time is it yours it is have sex as they say it's really early and mark has gotten up very early to do this webinar for you guys so i think that's a lot of kudos that he deserves for that well thank you for joining us thank you everybody for being there i know it's like a lot of you are back to normal on the vessel at least working with or without guests on board so we really appreciate you guys taking the time to join us today for this uh what is we believe is a very interesting topic for any crew member yard that is either based in the us or planning to visit the u.s correct mark is that like that's what we're talking about yeah and there is and i've been doing a bit of like a pre-tape with mark so there's a lot of things that i didn't know and i and i don't normally think that i'm well informed so please pay attention and make sure we ask any questions in the chat we're available again this webinar is recorded so you can look it back and we'll end with a nice uh file handout from from mark and mhg to make sure that all the tips are on one sheet so you have that with you but before we get started let's do the formal introduction and the formal introduction means that what are we talking about today we're talking about the explanation of the us healthcare system from the perspective of a foreigner the terminology required documentation and the common pitfalls and we're doing that with our partner while has been a member of a crew he supports us a lot so we thank you for that mark and then he's the director of the yacht division at mhc you want to say anything more about your role mark no just um you know it's been it's been a wonderful journey uh working in this in this business i've gotten me so many great uh captains and crew over the years it's really become a globally extended family so i'm happy to help in any way i can fantastic well we appreciate a lot that you're doing this for us today especially this early in the morning at least you've got a long day ahead of you right right it's friday it's friday and so again repeating explanation of the u.s healthcare system from the perspective of foreigner and i will stop this now and i'll launch your presentation mark so you can take it from there uh guys i'll pop up anytime i see something in the chat that is relevant so that i can have a little chat with mark we're gonna have two polls as well at a certain point uh for to see what you to ask you to well we don't think it's a difficult question but let's see if you know the answers uh let's start the presentation mark it's all yours uh thanks oh and appreciate again everybody joining and giving us the opportunity to hopefully give you the opportunity to have a as pleasant a possible experience if you come to the us and you need to seek medical care it is a very complicated system here in the u.s it's fairly unforgiving if you don't know the rules and so a lot of crew captains will find themselves kind of as this slide is showing in that you end up going around in circles trying to navigate the system understand terminology try to figure out you know what what you need to do in terms of procedure-wise to get your either your claim properly taken care of whether to simply make an appointment perhaps with a specialist or a certain type of procedure that you need done so there is an awful lot to learn today is not to make you an expert by any stretch today is really to educate you about some of the basics to educate you as ono mentioned in the beginning about some of the pitfalls that you can encounter and then also to field your questions because uh you know here in in fort lauderdale although i do work with uh crew and and different types of insurance all over the world we start to get used to the way it works in the u.s and so it's all always good to hear um from others who don't come here when they have questions about something that i would take for granted um so we really would invite you to ask as many questions as you like and as always said you can email us or call us after the fact and happy to discuss that further so need to move to the next slide here we go so just a quick bit about mhg for those of you that may not know us we started back in 1991 at that time a large yacht was was kind of today's tender i guess you could say but in 1999 is actually when we've had our first group of yachts that we provided health insurance to i didn't join the company until 2005. but i've been there ever since they they can't get rid of me it seems like but we we work in a large number of different types of insurance um but our specialty is of course marine crew and my specialty in specific is is yacht crew and we provide uh uh pretty much anybody who's on a floating object we can provide them with insurance for their staff or their crew or their or themselves we've got a number of us we've grown quite a bit over the years we're up to roughly 35 employees we have an office the main office here in fort lauderdale um but we also have a fully staffed office in the isle of man and in hamburg and we also have some representation um in the other parts of the world so we are pretty much 24 hours a day just based on our geography um but we do actually close during the day in each of our various jurisdictions so i just want to get a first glimpse to kind of give me an idea how to structure the rest of the presentation and this is where i'll need ono's assistance is just to do a quick poll and finding out how many of you have actually used the healthcare system before good okay and so i got like uh the i don't have that paul mark i have the poor about the doctors and the medical males like i am here like completely trying to help you but like okay let's let's do this in the chat guys can you check please how many of you have used use healthcare system just chat yes or no to me it's going to take them a few they got a 10-second delay it's going to take them a few seconds to get back to us what would you expect how many of them would have used the the u.s healthcare system you know i think that there's probably some um you know that it's very obviously very common for vessels to spend some time in the u.s throughout the course of the year um not everybody um has the opportunity to use the health care system luckily um but typically there's been some exposure maybe even through a fellow crew member that had to do that so yeah well uh so steve and deceiver said yes then we've got someone says no so we're still we're at two third at the moment yeah it's a little bit yeah basically a mixed um yeah it's a pretty pretty pretty mixed group that we're having yeah yeah i'm seeing so i've got another nose i'm at 50 percent at the moment so i think i think you can i think we can expect like that's like 50 50 people today yeah that's great that's that's kind of perfect actually um kind of goes in line with what i what i had hoped would be a mixed um mixed audience to talk about um because you know even though you have used it before um it doesn't necessarily mean that it went well um or maybe it did and that's great news but there's still um it seems like in the u.s almost every uh encounter with the health care system is different because of the human element because of the type of care that you might be receiving and so on so forth perhaps different insurance that you might have had previously versus uh the next time you visit the us so we're gonna go through some of the basics um you know again uh talking about the terminology talk about required documentation common pitfalls you know one of the biggest things that i always say is that insurance isn't insurance in other words just because you have insurance doesn't mean you have the same thing that everyone else has when it comes to private insurance as a non-american of course most crew are used to a socialized care system that works completely differently than it does here in the u.s it's much simpler to use it's much more user-friendly than the u.s system and we don't uh you don't have these kinds of foreign terms for lack of a better word that we have here in the u.s and you know the other thing to keep in mind is that the u.s health care system is a for-profit business and that is a a point that makes it just that much more challenging to work through when it comes to settling a bill that you have maybe even unknowingly incurred so let's talk a little bit about some of the terminology first and then we'll get into the rest of these these items so the first one i think probably most people are familiar with and aware of which is a what they call the deductible often especially in the uk and in europe it's called excess and so what that is is that um you know you purchase insurance or your vessel has purchased insurance for you and they pay a premium of course for that insurance however most plans when you go to the doctor they do not immediately pay for that first dollar of coverage of insurance you as the crew member or you as the vessel owner depending on the circumstance will have some additional amount to pay besides the again the premium that is for the cost of the insurance that you would pay to a doctor or hospital before the insurance starts to pick up costs now that's not always the case again depends on the kind of care excuse me the kind of care that you're receiving and potentially the plan that you have but it's important to just know that sometimes you will have a balance due from a doctor or hospital right up front or they may send you a bill later could be a month later it could be longer that you surprisingly owe them say 250 maybe a hundred dollars maybe 500 depends on your plan and all that sort of thing but that's what that is it's it's some amount that you have to pay um even though you have insurance from the very beginning the next one is called co-insurance might look like coinsurance but it's actually co-insurance and and what that means is that you're going to help the insurance company pay any bill that you encounter at a doctor's office typically you are the person who is going to be responsible for 20 of that so say you have a visit and the cost of the treatment is a thousand dollars u.s the insurance is going to pay 100 of that and you're going to pay 200 of that that's in addition to if you have a deductible to meet so if the bill was a thousand dollars again let's say and you have a 250 deductible you'll have to pay that 250. that leaves 750 now out of that 750 the insurance is going to pay 80 percent of that so you'll be able to pay an additional 20 which is 150 so in that scenario you paid 400 out of the thousand dollar bill that you owe even though you had insurance and that's just how it works here in the u.s now there are ways to avoid co-insurance and we'll be talking about those in a minute but again the idea here is that the insurance company wants you to help them to pay the bill even though you've already paid them premium how is that different from my co-pay well if you think back to the last slide we were talking about co-insurance on a percentage basis copay is a fixed amount so typically it's for a visit for the sniffles or for common cold or maybe a minor rash or something along those lines where you're just going to walk into your gp as um or a regular doctor and they're going to look at it and they're going to say yes you need a script for this or yes you need to rest and do that if you have a insurance with a copay plan you would simply pay a flat fee for that visit it might be traditionally it's around 35 so no matter what that cost actually is to the insurance company you pay 35 when you walk in the door and that's it you should not anticipate any further bill and any further responsibility that's what a co-pay is again helping the insurance company pay for a bill that you're already paying them for insurance to have changing now to uh in network so let's talk for a minute about what that means in the network because it's kind of makes you think of the television basically the network is their buddies and that's kind of an easy way to think about it the insurance company has made friends with a lot of doctors and hospitals in the u.s for example and because the insurance company has made friends with those doctors and hospitals they have agreed that no matter what treatment you have at their facility the insurance company is going to pay an exact amount for that kind of treatment and they've agreed on every different kind of treatment that you could get an exact price that they would pay for each one of those different treatments that's different if it's a doctor who is not a buddy of the insurance company and there are plenty of those and so in that scenario we'd be looking at what's called out of network i think i've got that as my next slide let me just check nope i don't okay so let's say that so let's talk about that auto network so so they are your those are people who are not friends of the of the insurance company necessarily the reason why you want to avoid doctors and hospitals in the us who are not friends of your insurance plan is because it's going to expose you as a crew member to potentially large medical costs that the insurance company will not pay and the reason is because on the simplest form those doctors and hospitals are not the insurance companies friends they don't have a contract that explains how much they're going to charge for every treatment that you could possibly get so it's an advantage to the doctor or the hospital because then they can charge whatever they wish and unfortunately you are left holding the bag as the as the crew member or the patient but the bad news is in addition to that is that you're probably going to run into issues with the claim process and we'll talk about that a little bit later when we talk about the required documentation so one of the best things you can do when you are coming to the us and this is something particularly for captains or pursers to to kind of note when you start the journey across um to come to the u.s and even maybe the caribbean that would be a bad idea reach out to your insurance professional your broker your agent uh whoever and say we are going to be in bravovich in west palm beach can you give us a list of four or five half a dozen doctors that are in the nearby area that are a part of our insurance plan that are in the network why is that important well because things happen and they happen quickly and we don't think a lot of times about insurance as the first call of action when we get hurt or sick all we think about is gosh i want to feel better gosh i want to get better and we just go to the first place that we find on google um again that's that's a a potentially dangerous situation from a financial perspective as a crew member or a captain um and and so if you have that list and you you know just keep it in the in the crew mess or in the in the folder that has all your other documentation about your insurance plan um that will really pay off in the end because you'll know immediately if someone cuts their finger oh we're going to go to palm beach urgent care right over here on flagler street and all we have to do is show them our insurance they already know about it they already know what the coverage is and i'll be able to just get treated and walk out and probably not have any further issues we never want to say that you won't have further issues and again we'll talk about that a little bit later but the main main thing is just to make it as prepared as possible for your arrival to the u.s and in the event that you need medical care at some stage while you're here so the out of network providers again not friends necessarily with the insurance company have the ability to charge whatever they wish and the insurance company will not necessarily pay whatever that doctor decides to charge i think i've got that as well as another tournament that we'll speak about in a minute huh so this is a repricing discount that sounds like a very bizarre term but this is one where um those friends of the insurance company they've decided that because they're friends they're going to charge less for the same treatm nt that you would get from the doctor down the street who is not friends um with the insurance company you can call it a discount you can call it a um you know a friend friendly discount i mean it's that's what it is it's it's designed so you see a bill for a thousand dollars and you'll get that bill potentially in the mail then what's going to happen next is the insurance company is going to review that claim or review that bill they're going to see that oh this doctor's a friend of ours therefore we've already agreed that we only have to pay 300 for this treatment so the insurance company sends a check to that doctor for three hundred dollars even though the bill was a thousand and the doctor says oh that's right that insurance company is my friend i'll only charge them three hundred dollars and the other seven hundred dollars disappears magically it is not your responsibility to pay the additional 700 if that sort if that arrangement is in place between the insurance company and the doctor even though you got a bill for a thousand dollars in your hand the fact that the insurance company paid three hundred dollars because their buddies means that that 700 goes away and that's what a repricing discount means you'll see that on a form that we call the eob which is the explanation of benefits that comes from the insurance company once they review that bill so the bill goes from the doctor to the insurance company the insurance company reviews it they say oh yep we're going to pay 300 they put it in the computer it spits out a piece of paper called an eob which is an explanation of benefits as i said and that will come to you and what it will say is that we got a bill sir or ma'am we got a bill for a thousand dollars but because he's our buddy we're only paying 300 and you don't have to pay the rest and that's how that's how that works what's that called usual reasonable and customary okay so this is the doctor who is not a friend of the insurance company the bill is a thousand dollars the insurance company says well if we were using my friend's doctor they would only charge the patient 500 for this and you're charging a thousand dollars for this we don't see any reason why you should be charging a thousand dollars for this other than you're not our friend so we're not going to pay you more than that we're only going to pay you 500 and then guess what the rest of it remaining 500 becomes your responsibility as the patient as the captain as the crew member potentially as the vessel owner depending on what the what the medical treatment is for and so this is the pit one of the pitfalls about understanding that it's really important in the u.s to make sure that you're using a network doctor a doctor who's a friend of your insurance plan because of this clause right here and the urc is the term that is used kind of universally on all types of international insurance plans it stands for usual reasonable and customary charges um again it doesn't mean that um they won't pay a claim that's that's outside of that boundary but they certainly are not obligated to as an insurance company and you might be thinking well why would that be the case that a doctor would charge such a different amount for the same treatment even if it's across the street literally from each other and the answer is i'm going to go back to what i said earlier in the u.s health insurance oh i'm sorry health care is a for-profit business the market will bear whatever people are willing to pay and so it could be you know it could be that the doctor that is charging more has more credentials it could be that they have a specialized degree that you know is specific to that type of treatment but that may not make a difference to the insurance company um so and that's something that again you just have to be aware of and alert of that you might be facing additional costs if you run into a situation where you're being charged more than what the doctor next door would charge for the same treatment covering a lot of ground here i hope that if you're having um comments or questions about what i'm covering that that you're able to jot down a quick note that we can that we can come up to earlier there is a lot as i say a lot of terminology in the u.s healthcare system it takes you know even someone who who lives and breathes this every day like we do it takes a lot of dedication to stay on top of understanding all the various facets of health insurance in the u.s all the various terminology the changing ever-changing landscape not only politically but just legally if some of you may remember about obamacare that came in to the u.s a number of years ago now kindness still is it's it's so uh unfortunately convoluted um but but it is really a lot of information to to understand and keep track of so i encourage you to keep a little note um you know each time you have a question or an issue and again always feel free to follow up with us or with your other insurance professionals that you work with who may have also have experience in the us healthcare system because the more knowledge you have the greater the chance that hopefully you're not going to get stuck with a financial obligation that you didn't expect and hopefully it's not going to be a big one and that's what this is patient responsibility this is what you owe the doctor after your insurance company has paid their part which could be zero by the way so that's again very important uh to understand what insurance you actually have what coverage do you actually have um in your plan maybe you only have coverage for uh certain things maybe you don't even have coverage in the u.s and you didn't realize that you're there on holiday that that would be very very bad um we have seen that happen and so you know the patient responsibility is is what is left whatever that might be whether it's 100 20 whether it's a copay as we mentioned earlier um a deductible an excess all those different things could potentially be above usual reasonable customary there's so there's a lot of different ways uh unfortunately that you can find yourself having to pay money that you didn't anticipate and and i also want to make a very good point here and again this is not necessarily just for captains but i think it's an important way to help when you're when you're guiding your crew a lot of a lot of crew feel that the vessel owner will take care of them and we'll bring this up again a little bit later the doctor or the hospital or the nurse or the urgent care facility or wherever your your gp wherever you're going to seek care they don't care whether or not the vessel owner is responsible in the end the only thing they care about is that you were the person who came to get the care therefore you they are holding responsible for settling that bill they don't care if you have insurance you are responsible for settling that bill if the insurance pays it for you great but patient responsibility is a really important issue here in the u.s because that is something that is binding and when you when you go in to a doctor's office in the u.s i don't care where you go the first thing they're going to do is give you paperwork to complete and every single doctor every single facility the paperwork that you are completing is going to require your signature that says no matter what you're responsible to settle whatever bills you incur at that facility whether you have insurance whether you think someone else is actually liable for the cost it does not matter you are the one and so the burden lies um on your shoulders as the patient to make sure that at the end of the day whatever is owed to that provider is settled so it's a big responsibility it really is and and again it's something that you have to take on your own shoulders in the u.s particularly um to make sure that that that's taken care of and we'll talk about what happens if you don't luckily um it doesn't go on forever generally speaking when it comes to how much more mr insurance company how much more do i have to keep paying even though i'm paying you premium or your best owner is paying you premium well luckily it's spelled out in the plan and it's called the out-of-pocket maximum so it's the most that you are going to have to pay and and then your health insurance is covering it 100 for all your covered benefits so again we talked about copay we talked about coinsurance we talked about deductible all of those things will total up to an out-of-pocket maximum that you would have to pay in a year and then you don't have to pay anymore this is something that you are very unlikely to encounter frequently but it definitely is something that you will welcome if you are hospitalized in the u.s for any duration i want to give you a little bit of i don't want to scare everybody but i want you to have a little bit of apprehension about the u.s healthcare system because of the fact that it is so dangerous from a financial perspective most crew captains who and people who don't visit the us don't understand just how expensive getting treated here in the u.s can be as an example let's talk about locally here in fort lauderdale broward county broward general hospital is the most likely place that that crew and captains will go in the event of an emergency if you're anywhere in the fort lauderdale area broward general hospital is not fancy they're very good but it's a regular old hospital here in the u.s and you're going to well exceed ten thousand dollars your first night your first night in the hospital and that's not including if you're an icu intensive care unit it is very very easy to get into six figures of medical costs in the us before you even know it if you are hospitalized and so having this out-of-pocket maximum is very welcome news um for those who may not be aware that their plan has that they're thinking oh my gosh i'm responsible for 20 20 of this bill and it's over a hundred thousand dollars i'm going to be out 25 grand that's typically not the case that's typically not the case um there is usually a limit uh it's usually a few thousand bucks um maybe five thousand but it's you're not going to find yourself in in dire straits typically with uh having to meet just huge amounts of additional costs by being hospitalized so i hope that provides you at least a little bit of comfort um about about the the cost of care in the us is that your insurance company recognizes that at some stage here um you're going to be really snowed under with cost and so you have to um you got to be thinking about about that stuff so here's a good one to finish this up oh no hopefully you've got this one [Laughter] well i first want to say that you really scared steve good we're and and yes i've got this one doctors in the ears can always tell you how much the procedure costs i'm starting the pool which means you're going to see it in your chats and the there's only true falls or i don't know and uh so no guessing do you know is it true is it false or do you really don't know doctors in the us can always tell how much your procedure costs so far we're like the first answers are coming in so i'm waiting for a few months yes and we're at 50 15 now for between true and false let's see where we're heading people are like and i'm giving them a few more seconds to answer this one so far so good 50 50 true or false what's the answer mark the answer is false yeah in fact it is almost never that a doctor can tell you how much it costs for what they are doing to you at that very moment um it really is bizarre again the u.s healthcare system is a mess um so why doesn't the doctor know well i'll tell you why the doctor doesn't know um because he is isolated he or she has isolated themselves from the billing process why because he's got enough lawsuits on him already so do you know but i'll give you the final answer oh yes it's true sixty percent said sixty six percent said false sixty percent through six percent i don't know so most of you guys had the correct answer very good no no you know it's it's it's funny they they may know um but they don't want to tell you but typically they don't know and the reason is because of the number of layers in the u.s healthcare system so typically let's talk about a brief example you walk into a doctor's office and the first person you see is the receptionist at the front desk she's the one she or he is the one that's going to give you the clipboard with the six pages that you have to sign and fill out all the information signing your life away um that you complete all your information all that sort of stuff that then gets handed off to somebody else probably who types it into a computer system at the same time somebody else in that office is picking up the phone to call your insurance to see what kind of coverage you have whether or not they're a friend of the insurance company or not so on and so forth and then a nurse or someone else comes out to to bring you into the room sit there for half an hour if you're lucky maybe 15 minutes if you're really lucky maybe two hours if you're not so lucky and then the doctor finally comes in and the doctor says so what's wrong with you today and you tell him and he says hmm looks like you need this or that and the other and so go do this go do that i'll write you a script for this and have a good day and he walks out and then you go back to the oh sorry go ahead oh no yeah i i just i got a question i thought like when they're when they're engaging they're like francesca's asking would you say that the same applies within the canadian healthcare system just a quick like site step i would say not as not as often i i would say that you know and and definitely of course you know in canada they have the health national health system as well uh it's kind of a hybrid system you know you can certainly seek private care obviously in canada um but i think that you know if you're dealing with a private uh doctor in canada they would be able to tell you how much it cost if you're going through the whole the national health system you don't even care anyway what it costs so okay well thank you for the answer sure of course yeah yeah so um so then getting back to our scenario so the doctor has seen you you walk out you go back to the front desk and the lady says i've checked with your insurance um you know we'll send you a bill and you're like uh can i just pay it now and they say well no you can't because we don't know how much you vote and that is that's a typical scenario and so they they'll bill you unfortunately what they don't realize is that you don't have an address or the address that you gave them is not where you're going to be by the time the bill arrives and so that becomes an issue down the line again with the whole idea with patient responsibility and we'll talk about the the common pitfalls a little bit later but it is it is very very strange in the us that it's really the only type of service that you can receive in the u.s which is health care that you do not typically know what the cost is before you get the treatment um you know if you if you're going to go and have your car worked on they always give you an estimate before you have the work done to tell you this is what we expect in the u.s it's rare that you would get that for any kind of procedures that you would see in the hospital it would be major procedures generally where you might get an estimation of cost before you have it done typically you just don't know and so that's that's really where the challenge uh it lies um i want to move on but i also want to mention to you and again for steve he's going to lose his hair after i say this one but but the the leading cause of bankruptcy in the united states guess what it is it's healthcare costs the leading cause of bankruptcy in the entire united states is healthcare costs you would not believe that if you didn't hear it but it's true so it's really important um to be on top of it and make sure that you understand how your insurance works and what bills you may or may not be incurring all right so we're going to move on now to documentation [Music] the first one is just a quick summary so you go to the doctor you have insurance and maybe the doctor is not a friend of the ins rance company so they're going to make you pay the bill right then well in that case you're going to have to go through basically all the steps here that you see on the screen you're going to have to complete your insurance company's claim form you're going to have to make sure you have a copy of the itemized bill or bills in other words you need something that explains what did the doctor do to you what was wrong with you um and what was the prognosis or at least something along those lines so that the insurance company knows what what it is that you're sending them you'll need the copy of the receipt showing that you paid the bill you may may need to provide medical records to the insurance company depending on again the scenario was this an illness if it was an illness related visit very likely that the insurance company will want medical records from that visit from the doctor it is not feasible unfortunately to get the medical record the day that you're there the reason is because the doctor is going to scribe all those medical notes from your visit some time down the line it could be that day it could be the next week could be a couple of weeks we don't know but the key point is is that that's something that you may have to follow up on as uh later to get the medical records to provide to your insurance company sometimes the insurance company can get those records from the doctor but typically it is the most efficient way if you as the patient are able to get the medical records from that doctor and then present them to your insurance company that's really again going back to the patient responsibility that we talked about earlier it is not the insurance company's responsibility to get medical records from the doctor to process your claim it is your responsibility as the patient to make sure that the insurance company has the information that they need to properly process your claim and the last one is uh again the medical records we just mentioned were kind of illness related could be for an accident but typically not if you have an accident then a lot of insurance companies require some sort of a questionnaire for you to complete as to what happened you know why did why did you show up at the eer with a broken leg and a twisted leg and a twisted arm or whatever it is um because there are probably um exclusions in your insurance contract that may or may not be triggered by whatever it is that you did or whatever someone else did to you which is also important remember that in the us and and actually in the abroad if you are injured or damaged by another person then that other person or that other person's insurance may actually be liable and and pick up the cost so that your plan doesn't have to now again just to reiterate patient responsibility means that even if there's another insurance company that's supposedly liable for your bills you may still be stuck paying them first and then chasing that other insurance company to get reimbursed we have seen that happen in the u.s you know unfortunately here in fort lauderdale south florida in general people have an appetite for hitting people who are walking and riding their bicycles uh with their cars um and so you know it's probably something similar with uh with scooters um in palma or st martin for sure or any part the other parts of the caribbean scooters are very dangerous by the way don't ride them um but it's it's something that if someone else hits you and causes you to have medical injuries they're responsible for that but of course again you know it's it's you are the one who's incurring the cost so at the at the bottom of the tail is is you as the patient that is going to have to make sure those bills are satisfied however that may be um but those are the five kind of typical items of documentation that you would need um after you have a visit in the u.s with a doctor particularly one who is not in network again not a friend of the insurance company it's possible that you would still need some of this documentation even when you use a network doctor because and and this is again due to the complexity of the system oftentimes what happens when you have a doctor visit is that a a form is generated at the doctor's office called a i don't know what it's called a health insurance something or another anyway it's it's a form also known as the ub40 by the way that simply has your basic information on it the same thing that they keyed in remember when you first walked into the doctor's office they key that into a computer yeah that's that's for filling out this form and the only thing else that they put on there besides your name your date of birth the date that came in to see you is a five-digit code and that five-digit code is called a cped code every treatment that you could get in the u.s has a five digit code and that five digit code tells the insurance what the problem was but it doesn't say how that problem started it doesn't say why did that problem exist in the first place it doesn't say have you had this problem before it doesn't say a lot of things and so if that happens if the insurance company receives that form even though it's a friend of the doc of the insurance company they still don't have enough information to figure out well should i should we pay this claim or or shouldn't we and so you may still have to fill out at least a claim form so that you can explain or an accident questionnaire to explain to the insurance company what happened why why were you there and that way they can properly handle your claim if you don't do these things by the way it just stalls everything um and typically what ends up happening is that three maybe six months maybe more down the line there's a fire burning that you just find out about all of a sudden and that gets everyone um everyone's blood pressure up uh because you know it was assumed that it was just paid and taken care of and it's been six months and why was i notified sooner um on and on and on and so you know it really is all about an ounce of prevention just like having that list of of insurance friends before you reach the u.s preparing these documentation or preparing to have this documentation when you are about to see a doctor or just right after you've seen a doctor is really money in the bank even if you don't end up needing it having it ready and having it completed is really a prudent thing to do um because again it's all about patient responsibility and and so that makes you makes you reliable so i think we've got another poll here oh no i'm here so just wait until like it's been quite a daunting scenario that you that you're putting out there again i'm hoping i don't want to scare people away but i hope that it makes you anxiously enough that you take action when you come to the u.s to prepare yourself you know yeah i think yeah that's what it's about that's what it's about and that's what insurance is about in general right to prevent you from all the things that could happen yes exactly um the poll do you think unpaid medical bills could impact your ability to re-enter the u.s and three answer opportunities yes no or i don't know the poll is out there and let's see what the question that what the answers are coming in let's give them a bit of time sure so so far it's a hundred percent on yes that might change we're not giving anything away let's stay at 100 i guess by the way let's see if it moves if anybody is like no that will not impact my ability to re-enter or i don't know um this looks like a very firm yes is that the correct answer yes it is you know i think that just based on how i've intimidated everyone about the u.s health care system they just assumed that yes obviously there must be a way yes it is it is possible um you know i i don't want you to lay awake at night thinking that because you went to the doctor once that that's going to prevent you from from coming back into the united states because it's very unlikely to be the case but it is possible you know it's particularly again a more significant scenario where you've had hospitalization um you know for more than a night or or um you know you've had significant amount of care in the u.s that that hasn't been um settled you know either either through your insurance or through your own um means or through from the vessel owner um you know whichever it may be it it's you know that the way it works in the u.s is for of course as americans we have what's called a social security number um and that is tied directly to our credit um and so it's really really um intimidating for us even as americans to have medical bills that are outstanding because it will actually impact our credit and we live on credit in the united states if those of you who may not know that but we do and so just because you have a medical bill that hasn't been paid can impact your ability to do just about anything else financially you may not be able to buy a car you may not be able to buy a home you may not be able to get another credit card there's a number of things that can happen um you know as a result of that so as an american we watch that very very carefully even though we're not worried about being able to come back to the country um we watch it very carefully because it's very potentially damaging to our financial livelihoods um and so because of the fact that all that is is kind of intertwined um and you know that can also make its way to um customs and border protection you know uh it can become uh information that they would have access to see um you know that someone has a substantial unpaid medical bills um and they're gonna say um no so it's something to again just being alert being aware don't lose sleep over it but but just know about that let's go through some quick pitfalls see we're getting closer to our hour here i don't want to put you all to sleep if i i don't have to but let's go through some quick pitfalls the first one as i mentioned earlier the vessel owner will cover me don't worry about it i'll just go to the doctor i'll leave and you know get my care because they're responsible and i don't have to worry about it very much not the case it is really important that crew understand that that they are the ones receiving the care therefore they are the ones responsible for making sure that that bill is settled um and and i just can't reiterate that enough not following up yeah that's a big one uh and again it's it's just because of the nature of what we do right i mean we're getting um busier and busier every day it seems like and of course if you're on a charter program and you need to see a doctor you go to the doctor and you get back to that boat as quickly as you can and you're back on back on duty and you're running up and down and and whatever and it just slips your mind frankly it's not that you don't have intentions a good intentions to to make sure that everything goes well but not following up is a huge pitfall when it comes to utilizing the health care system in the u.s because again bills will just show up from you don't know where you you didn't even know that you incurred that bill when you go to a doctor particularly a hospital for for significant care there may be four or five six different people that will see you for various reasons every single one of them could potentially produce an invoice that none of the others know about and that your insurance company doesn't know about so you have to follow up to make sure that that you know your bills are properly being handled sent to the insurance and and being paid um this is an interesting one paying upfront when you're in network why is that a pitfall well because remember in-network is the insurance company's buddy right it's a doctor that's a buddy of the insurance and they've agreed to pay each other um a fixed amount for for whatever care you got remember the example i said it was normally a thousand dollars but because they're buddies they agree to pay 300 and be done with it well the problem is if you pay up front you're going to be paying that doctor a thousand dollars and it can be challenging to get your 700 dollars back after the insurance company and the doctor whose buddy agreed that oh yeah he should have only he or she should have only paid 300 for this but they paid a thousand well another 700 of your money sitting in the doctor's office and they probably don't know how to reach you to give it back to you and you probably don't realize that oh my money's sitting there waiting for me to claim it um so it's a pitfall to try to avoid is is paying upfront now doctors and hospitals can be very pushy they can be very demanding um in other parts of the world too not just the us but they as soon as you show up for example if you are in uh nassau in the bahamas a doctor's hospital and you walk in there bleeding they're gonna give they're gonna want your credit card right now and they're gonna charge you two thousand bucks right up front they don't care um and and so you have to be not mean um but you have to be assertive when it comes to being asked to pay before anything even happens you want to be assertive and say call my insurance here's my id card because i'm a prepared crew member and i have my id card right here call this number i'll even dial the phone for you to let them call and make sure just how much do you really need to pay right now before um you you get seen by the doctor um it's it is an important thing when it's your money that you are potentially going to lose um because just because you paid insurance or i'm sorry just because you paid a doctor a thousand dollars doesn't mean the insurance company is going to pay you a thousand dollars back and that's important to know misunderstanding what insurance means well that's what i kind of said in the beginning is that insurance isn't always insurance every different plan has different features different characteristics different levels of coverage different terminology um different limitations and so it is really important to know what your coverage is on the plan that you have and i always say this as well it's really important not to rely on someone else telling you what you have because they probably don't know or they may misunderstand and and again and you're the one who's going to be relying on that advice to tell you what's covered and what isn't but you're the one responsible for the bill if you get one so it's really important to understand what your plan is and how do you do that i mean should all crew become experts at health insurance absolutely not please don't it's awful no no i love my job but but it's it's um it's complicated you know and your job is to to run the boat or to fix the boat or to clean the boat or to make it look nice for the boss so you need to reach out to your insurance professional this is the bottom line whether that's mhg whether that's whatever other insurance agency or broker that you might be working with make sure they explain to you how your insurance works because um and point it out to you so that you can read it yourself and understand what coverage you do or do not have um it really is really is key not being forthcoming what do i mean by that well tell the truth that's the funny thing the insurance company is not interested in working with a patient or a crew member who isn't telling the truth and they can tell almost always let me tell you we have seen so many times um and most people are good right most people are good heart and most people are truthful but it's it's very tempting sometimes to to not be forthcoming with information because it might potentially lead to your claim not getting paid or potentially might lead to someone else finding out about your medical history that you would prefer they didn't know about and so it is it's very easy to fall into that pitfall of not being forthcoming about information but i encourage you to be honest and be forthcoming as best you can keep it as private as you can absolutely you know we we live in the world of privacy in the health insurance arena so so definitely you have confidence hopefully you have confidence in in whoever your insurance professional is um that if you share information with them it will be kept with the utmost level of privacy and i and i'm confident about that for for the bulk of the industry um it is important um you know being being forthcoming and honest is really key when it comes to uh using your health insurance and the last one oh it's fine that'd be fine we all fall into that trap too um you know i went i've got insurance i went to the doctor the doctor said don't worry about it you know he'll build the insurance it's fine i don't worry about it just goes out of your mind really quickly probably not fine [Laughter] probably not fine it's really again an easy thing to fall into that trap a couple of real world examples just um real quick not going to spend a huge amount of time on them i see we're at our wetter hour oops i actually didn't include them so just again to be quick about it the i've kind of given a few examples already of um you know what typically happens when you visit a doctor's office the the most common thing we see is the after the moment the after fact um a month later two months later six months later more the bill shows up the most common reaction is frustration anger this insurance is garbage i can't believe they didn't pay my claim um you know things like that and and that's that's normal to be expected again you're caught off guard it's money you didn't expect to have to pay the letter might be written in nasty language you know we're going to send you two collections blah blah blah all of those things happen on a regular basis and and so the key there is really just to have to start to unwind the process and at mhg we are typically encouraging that to be done with your insurance professional's help fighting against a doctor's office or insurer directly is typically not ideal you'll run into scenarios where you might feel like you're getting the runaround you know they're not returning your call they're not answering the phone they're not giving you clear information and all those things could have legitimate reasons by the way for why that's happening but because of the scenario and what's happened you feel like you're being um taken advantage of basically uh and as i said it's a it's a for-profit business um so the insurance company is not thrilled about the fact that they have to pay your claim but they will um if it's if it's eligible under the contract um we definitely see that insurance claims are paid every single day um but that process uh to unwind is is probably the most common example which i would say as example a is the bill shows up that nobody knew about and now we have to start that process of unwinding example b is probably the second most common and the example of that is that you as a crew member receive one of these explanation of benefits letters that i mentioned the other day or that i mentioned earlier that says patient responsibility the full amount whatever it is thousand bucks claim denied you know responsible patient thousand bucks again fire alarms bells everybody's upset and actually all that ever was needed was for you to complete the claim form that we mentioned earlier that is it it probably is equal to the first example of of having a bill show up six months later and claims flying is you get that explanation of benefits in the mail your claim's been declined this insurance is no good well actually it's fine you just need to fill out that claim form and send it back in and then they'll re-process it again and pay it so that's another reason why it's really important to start the process right away when you first have the visit to gather that documentation in case you need it and you can provide it to them ahead of time you don't have to wait for an insurance company to request a claim form from you you can be proactive hey that would be good be proactive and and provide them with that information upfront so that they already have it on file once the bill comes in they simply attach it to that claim form and they have a full picture right there in front of them that hopefully includes sufficient information for them to say yep looks like this claim is eligible let's get it paid and let's get it off our desks because that is that is their goal as well as your goal you want to get it off your mind they want to get it off their books as far as claims go they the insurance companies and now we're kind of getting away from the us but insurance companies do not want your claim sitting in on their desk for six months they do not they want to get it they want to review it and they want to pay it or they want to decline it and be done with it um and so it's as helpful to them as it is to you to provide them with the documentation that they need um to file that claim and of course in the u.s again it's just more complicated so that's why it's really emphasized or really important here is to provide that documentation the last example i can give you is typically well i had that on my other boat um and i know that sounds silly but what was covered on my other boat um is is so common um and so the example is uh going back to what i said earlier which is that you have to be aware of what coverage you actually have on your plan that you have at the moment insurance is not insurance everything is everything is very customized very individualized by a vessel even by individual depending on the type of insurance that you have and so in the u.s again in particular [Music] if you're seeking care and you are under the impression that something is covered because you have it on your other boat um but in actuality it's not um that that is a common thing that we do see is so you have to unfortunately that's going to be your responsibility to pay not much you can really do about that what's good news and i'll close with a little bit of good news if i can is in every situation where you have a outstanding bill whether because you have coinsurance because you have no insurance or some other reason in the u.s you always have the ability to negotiate and i know that again sounds almost immoral really but you do you have the ability to negotiate the bill we have seen a crew that have been able to achieve enormous discount and that's really important because uh when you're talking about thousands of dollars that you might have to pay a simple phone call with a little bit of honey and a little bit of sugar you might be surprised what you might be able to get um your costs down to so so that's that's a good thing about the us healthcare system mark and i think we've got one big question there so i'm gonna just watch your presentation that show with a full because it was your last slide right back yes that's it yeah perfect question there's like a big question from steve and he says like so dot i'm thinking of bringing my yard to south florida bradford survivors perhaps what to do to avoid this pitfalls it gives me a moment also to start saying that file with the tips right absolutely let's put that in here so guys there's a file now shared in your chat with the tips but i think it's let's take this one as a final question for you to answer before we say goodbye to everybody sure um yeah it's all about preparation steve it really is um just thinking ahead um with uh getting that list of you know the the few uh providers that are in your area uh like as i say you know ravich is a very very common uh destination for yachts of course and so having you know half a dozen uh locations that you can go visit as part of your plan can be and kept it in the crew mess or wherever or just tell the crew say you know we've done some research we have a list of vessel doctors that you can use as part of your plan um and so that way they they know about it before before it happens um and then we have this uh sheet that i don't know we'll be sharing uh that we've prepared as well it's just a five i think it's five bullet point um thing to help you prepare for these things and stay in touch with your insurance professional throughout the process encourage the crew to reach out to their insurance professional even if it's something simple like a cut you know i always say me and my team we always say don't ever hesitate to reach out to us because even if it's nothing we want to prevent it from becoming something and we are happy to do that and most insurance brokers and agents are happy to do that trying to work directly with an insurance company isn't always easy um you know you call the 800 number you're on hold for 20 minutes maybe it might be we want to avoid that and so so those are the things that you can do is really just to stay on top of the situation before it gets out of hand hopefully well thank you so much mark guys um this was not meant to be a depressing session but i think like it's all about pitfalls and good preparation i hope this has answered a lot of questions or has confirmed what you already knew which in both cases is excellent and mark thank you so much for doing this i i'm pretty confident that this webinar will be watched back several times by some people and um so again we're recording this so it's going to be on our website it's going to be on our youtube channel mark shall we just put the tips and tricks up as well just for people to find it there as well we'll do that as well so that they're available again everybody thank you very much have a wonderful afternoon and weekend for everybody in europe and mark have a wonderful day and weekend thank you very much and uh steve says thank you guys well people are getting some chats in that they find it very interesting so i think you did a great job mark thank you very much i'm gonna be where we gonna be out in five four three two one bye bye everybody you