Why does your doctor bill one amount, but your insurance pays something completely different? In this episode of the Take Care podcast, Melody Mulaik breaks down one of the most confusing parts of healthcare billing and explains why the number on your bill is rarely the number your physician receives.

Using a real listener question, this episode walks through how insurance contracts work, how in-network and out-of-network status is decided, and why Medicare rates play such a big role in what doctors are paid. Melody also explains the real costs physicians carry behind the scenes and why the gap between charges and payments exists in the U.S. healthcare system.

If you’ve ever looked at an Explanation of Benefits and thought, “This makes no sense,” this episode is for you.

In this episode, Melody discusses:

• 00:00 – Why insurance doesn’t pay what your doctor charges
• 00:27 – How doctors negotiate with insurance companies
• 00:56 – In-network vs. out-of-network explained
• 01:21 – How insurance companies decide what they pay
• 01:55 – What Medicare rates really mean
• 02:40 – Medicare allowed amounts and patient responsibility
• 02:55 – Why insurance might pay more or less than Medicare
• 03:17 – Percentage-of-charge contracts (and why they’re rare now)
• 03:43 – Why charges still look so high
• 04:09 – The real costs of running a medical practice
• 04:29 – Why billing and reimbursement are separated in U.S. healthcare
• 04:51 – How this affects what patients ultimately owe

Take Your Healthcare Advocacy Further

Navigating the healthcare system doesn't have to be a solo journey. For deeper dives into the topics we discuss on the show, plus exclusive "insider" tips delivered straight to your feed, subscribe to Take Care Newsletter.

• Subscribe to the Take Care Newsletter
• Connect With Melody on LinkedIn
• Got a Healthcare Question? Ask Melody Now.

You went to the doctor, paid your copay… and then a separate lab bill showed up. Why does this happen?

In this episode of Take Care, Melody Mulaik explains why lab work is often billed separately from your doctor’s visit, how insurance companies classify lab services, and why those charges may apply to your deductible instead of your copay.

You’ll learn the difference between preventive and diagnostic lab tests, what questions to ask before getting bloodwork done, and how to check your insurance so you only pay what you truly owe.

This episode helps you make sense of unexpected lab bills and avoid paying more than you need to.

In this episode, Melody discusses:

• 00:00 – Why lab bills often arrive separately from your doctor visit
• 00:41 – Doctor visits vs lab services: why they’re considered different
• 01:37 – How lab companies and outside processing work
• 02:08 – How insurance plans “bucket” lab services
• 03:01 – Copays, deductibles, and how labs are billed
• 03:41 – Preventive labs vs diagnostic labs explained
• 04:28 – When labs during an annual visit become diagnostic
• 05:03 – Asking if your lab is in-network
• 05:53 – Finding out where your labs are sent
• 06:14 – Mixed preventive and diagnostic labs in one visit
• 06:49 – Asking for cost estimates before bloodwork
• 07:29 – Why you should always verify lab bills with your insurance
• 08:00 – Final reminders on validating what you actually owe

Take Your Healthcare Advocacy Further

Navigating the healthcare system doesn't have to be a solo journey. For deeper dives into the topics we discuss on the show, plus exclusive "insider" tips delivered straight to your feed, subscribe to Take Care Newsletter.

• Subscribe to the Take Care Newsletter
• Connect With Melody on LinkedIn
• Got a Healthcare Question? Ask Melody Now.

Filling a prescription seems simple until you’re faced with multiple options, insurance rules, and cost differences that aren’t always explained.

In this episode of Take Care, host Melody Mulaik answers a listener’s question: Where should I get my prescriptions filled? Melody walks through the pros and cons of local pharmacies versus mail-order prescriptions and explains how to decide based on urgency, cost, insurance coverage, and personal preference.

This episode helps you understand that there’s no one-size-fits-all answer and that you’re allowed to mix and change options as your needs evolve.

In this episode, Melody discusses:

• [00:30] Why this question is more complex than it sounds
• [01:00] In-person pharmacies: grocery store vs freestanding locations
• [01:35] The advantage of same-day and 24-hour pharmacies
• [02:00] Why access to a pharmacist matters, especially for new medications
• [02:45] Mail-order prescriptions and why they’re usually 90-day supplies
• [03:10] Cost savings and convenience of mail-order medications
• [03:45] Insurance considerations and mail-order contracts
• [04:30] Why you don’t have to choose just one option
• [05:00] How to decide what works best for your situation

Take Your Healthcare Advocacy Further

Navigating the healthcare system doesn't have to be a solo journey. For deeper dives into the topics we discuss on the show, plus exclusive "insider" tips delivered straight to your feed, subscribe to Take Care Newsletter.

• Subscribe to the Take Care Newsletter
• Connect With Melody on LinkedIn
• Got a Healthcare Question? Ask Melody Now.