It’s a health insurance strategist’s perspective on healthcare from Noor Ali on this episode of the Perspectives on Healthcare Podcast with Rob Oliver. Dr. Noor is from New York but went to Bangladesh to do her medical training (including internal medicine, surgery, and OB/GYN.) Upon returning to the US, she had trouble with licensure and committed herself to honing her expertise on health insurance. Currently living in Florida, she is a member of the millennial generation (Generation Y.)
Here are 3 things that stood out as Noor Ali gave us a health insurance strategist’s perspective on healthcare:
- Quality healthcare involves having desired treatments covered at a reasonable cost. Insurance isn’t meant to cover everything but to mitigate costs.
- There is a triangular relationship in healthcare involving insurance companies, healthcare providers, and patients. Patients often end up losing due to coverage limitations. Providers also face challenges as insurance companies may not adequately reimburse their efforts.
- Podcasts and educational resources are empowering patients to understand insurance better, which leads to better utilization and less fear of insurance companies.
You can connect with Noor Ali through the website and links below:
Website http://www.drnoorhealth.com
Twitter https://twitter.com/DrNoorHealth
Facebook https://www.facebook.com/DrNoorHealthcareAdvisor/
Instagram https://www.instagram.com/dr.noorhealth/
LinkedIn https://www.linkedin.com/in/drnoorhealth/
Here is the transcript of Noor Ali, a health insurance strategist’s perspective on healthcare:
Introduction to Noor Ali
Rob Oliver: Thank you and welcome to another episode of perspectives on health care today’s perspective comes from Noor Ali She is a medical doctor and surgeon who has become a health insurance Expert she is from Florida and is a millennial Dr. Noor welcome to the podcast.
Noor Ali: Thank you. Thank you so much Rob for having me in for this exciting opportunity
Rob Oliver: Absolutely. I look forward to hearing your perspective. So let’s jump right in with this Tell me about yourself and your role in healthcare, please.
Noor Ali : Sure. So originally grew up in New York City. I went to medical school abroad in my home country in Bangladesh There I did an accelerated medical program for six years where I trained in internal medicine general surgery and ob-gyn So I came out on the other end pretty much knowing how to treat everything head to toe on any human being which was pretty, pretty exciting. And I was pretty young when I was able to do that. But my talent really was in surgery, in general surgery. And I enjoyed doing that a lot back when my home country in Bangladesh. When I moved back to the States after I had gotten married and it was time to settle back here, I really struggled with my licensing exams. So the process for foreign graduates like myself, we don’t have to go through medical school again, but we do have to pass our licensing exams, which is a series of steps. So step one, the content was basic sciences, which was very, very far removed from my surgical practice. And I had been in practice for a couple of years before I came back. So I really had a challenge with that. And I failed step one by one question, which was about three points. And that really just put a wrench in my career, going from being a superstar, high-performing surgeon to being really nothing, to being a high school graduate on paper. Cause remember, I never went to undergrad in America. So that was a huge challenge for me. And a lot of things happened in between and I had to reinvent myself. I needed a win. And when I had this opportunity for health insurance, I really just took it and I said, I gotta make this work. And it was foreign to me at the time too, Rob, because in my country, in Bangladesh, there is no health insurance system. It’s really pay per fee service. So it was a bit of a learning curve for me to learn this industry. But now I can proudly say I’ve been doing this long enough that I can call myself a health insurance expert. And what I really aim to do is solve health insurance problems.
Rob Oliver: Okay. Maybe you can talk about this a little bit. I feel like in medical treatment, the health insurer has actually become one of the most powerful partners in this, not just from a payment perspective, but from the limitations on payments. So I’ve said this before, but one of the first questions that happens, the doctor finds out what your diagnosis is, and before they begin the plan of treatment, they say, what kind of health insurance do you have? And your insurance determines the plan of treatment. So can you talk a little bit about that process and talk a little bit about what happens within that dynamic?
Noor Ali: Yes. Thank you, Rob. What a fantastic question. And you’re right, the insurer insurance company has really become the power player in this scenario. So let me just zoom out a little bit and demonstrate. the key players in this situation, right? We’ve got three key players. We’ve got the insurance company, we’ve got the provider, your doctor and nurse practitioner, whatever integrative care provider, and then you’ve got you yourself, the patient, right? And it’s this triangular relationship. And in my experience, it’s always the patient that ends up losing because we’re at the mercy of really your health insurance company. And even your doctor is at the mercy of your health insurance company because he may have this plan of treatment. that may not be covered by your plan in which can you may not be able to afford that treatment and now look who’s screwed right. And then we also have doctors suffering as well because insurance companies simply don’t pay them enough money for their efforts or they don’t pay out on time in which case doctors have to cut their contracts with insurance companies and again it’s the patient that suffers because one year your doctors in network and the next year you find out they’re not. So you’re absolutely right that they have become a position of power in this dynamic and relationship. And what I aim to do is that I’ve never claimed to really fix the broken system or uproot from the bottom, but really I advocate for the patient and the customer in this relationship to figure out what is going to serve you. What can we figure out in which situation do you have the most wins? So that’s really what I help to do is identify what your challenges are and connect you with a health insurance plan that’s going to solve that.
Rob Oliver: Yeah, and it sounds to me like what you’re doing is almost an assessment of the patient to find out what are your needs, what are the things that you are likely going to be included in your plan of treatment, and then how do we find an insurance product that’s going to cover the items that we’re talking about. Is that properly understanding what you’re working on?
Noor Ali: Yes, precisely. The step one when I speak to any clients is really just understanding, you know, where are you? Where are you at? What is your situation? What do you need? What do you think of as quality health care? And then leveraging that situation to connect with the best product or the best plan.
What does Quality Healthcare mean to you?
Rob Oliver: Okay, wonderful. Well, you’ve led me right into my next question, which is, what does quality health care mean to you?
Noor Ali: Yeah, and that’s a wonderful question. It’s interesting that you’re posing it to me because that’s what I ask my clients all day long. What does quality And then, and then whatever that is, I helped to craft and find that. So to me, quality healthcare is when an insurance plan covers what I want it to cover. And if that means I’m trying to have a baby and I need that maternity costs to be affordable to me, to have all of those visits covered, that’s quality to me. If you’re a young 20s male, you don’t care about maternity coverage. You wanna know that if I hurt myself playing basketball, I’m not gonna have big out of pockets or experience medical bankruptcy. So that answer is different for everyone and it’s really important to pay attention to what situation they’re in life and then find a plan that fits that. And a great example that I’d like to use all the time is if you’ve got a couple, right? And the wife’s having a baby and she needs awesome maternity, the spouse doesn’t necessarily need to be on that plan. You don’t need to pay excess premiums for 12 months for the both of you just because she needs to have. a great maternity cover. So things like that, you got to keep in mind and think outside of the box on how to leverage your situation and define what quality healthcare is at every season of your life.
Rob Oliver: It’s really interesting to me because the World Health Organization, when they talk about quality healthcare, one of the things that is mentioned is accessibility, that you have to have access to quality healthcare. And what you’re talking about is the fact that just because a form of healthcare exists in your neighborhood or in your vicinity doesn’t mean that you necessarily have access to it if you don’t have the right insurance. Am I properly framing that?
Noor Ali: Yes, yes. Access is a great point, Rob. I’m glad that you mentioned it. When we think of the global perspective that World Health Organization has, what they’re trying to say is if someone needs healthcare, they have to be able to get it. No questions asked. We know we’re reducing or minimizing barriers such as cost, transportation. racial or social determinants issues, all of that. But you’re right. And what you’re referring to specifically is healthcare in America, right? You can have a great health insurance plan, but if your network is limited or you have a doctor that you love, but they don’t take your health insurance, that’s still not defined as access. So you’re absolutely right about that. And that is another question that I take into account for my assessments. You can have an amazing health insurance plan, but where do you wanna use your health insurance? Where are you taking it? Do you travel for work? You know, is it are you only staying limited to your network, your locality, your geographical region? Yeah.
Can you give me an example of quality healthcare?
Rob Oliver: And I mean, it’s what you’re talking about is so applicable for me personally, because here in the city of Pittsburgh where I live, the city is divided in half. And there are two insurance, two types of insurance. And if you have this insurance, you have access to half of the hospitals in the city. If you have a different insurance, you have access to the other half of the hospitals. And I had to literally choose my health plan based on where my doctors were and which ones were covered in that. So I think it’s really important understanding that you’ve got. So can you give me an example of quality healthcare? And I think you’ve done that a little bit, but I’ll leave you to it.
Noor Ali: Quality healthcare to me is when what I want covered is covered at a reasonable price. There’s a few myths that I talk about or that I like to bust, especially after being an industry expert in health insurance. Insurance is not meant to cover everything. It’s meant to mitigate your costs. And that’s a huge point, especially when we really look at the cost of healthcare in our country compared to other countries globally. services are billed at the highest rates that they’ve ever been billed before, right? So, you know, an x-ray could be anywhere from 50 to $5,000, depending on where you go, for the same x-ray of the same body part, perhaps with maybe higher technology, but the outcome when we read that x-ray is about the same, right? So we want to think about What is a reasonable out of pocket for you where you’re like, yeah, you know what? I’m okay to pay ten dollars for that x-ray or yeah, I can afford seventy five dollars for that x-ray. So Quality health care is when what you want to be covered is covered at an affordable rate to you So we want to look at those things like out-of-pocket services copays deductibles max out-of-pockets and it’s a very individual You know income based Revenue based answer for a lot of people.
Rob Oliver: I’ve got kind of an out of left field question for you, and hopefully you won’t get mad at me for this. But I have a friend of mine who talks about health insurance and says one of the reasons that health insurance and our expectations of health insurance are so high is when they began to cover prescription drugs. Because if we were paying out of pocket for our prescription drugs, I feel like we would take a lot less of them or we would be much better off. much more aware of what it is as opposed to if you have a, you know, a three, five, $10 copay on a medication, you’re not really aware of the cost that’s coming into that. What are your thoughts about that idea?
Noor Ali: That’s very interesting. Yeah, to isolate because the pharmaceutical industry is a huge, you know, conglomerate in itself. And you’re right, you know, I haven’t actually thought about this as an isolated kind of discussion topic is the role of big pharma. in healthcare and insurance itself and how it impacts our care-seeking behavior when getting prescriptions. I know from my perspective when a customer or client comes to me with a very expensive medication, my first thought is, well, how do I find a lower cost or free solution to help get them access to that? If you zoom out and zoom out and zoom out a little bit more, it’s going further away for the model of prevention and maintenance and more towards the allopathic model. So it’s very interesting. I don’t think I have a direct thought on, you know, what that could possibly mean, but that is a very intriguing discussion.
What do you wish people understood about your role in healthcare?
Rob Oliver: Okay, wonderful. Well handled. So what do you wish people understood about your role in healthcare?
Noor Ali: For me being a medical professional in the health insurance industry, I just wish everyone had a bit more of an open mind. And I think that’s happening more and more as we are- more delving into this era of education and empowerment. I think about myself four years ago, before I entered this industry, I myself really struggled with my health insurance plan. I thought it was a scam, you know, much like a lot of America thinks that the insurance industry is a scam. When I had my first visit in January of a year, I remember, and I hadn’t met my deductible, I was furious. I was like, what do you mean I have this bill? What do you mean it’s not covered at a hundred percent? So just kind of that lack of education and understanding and awareness for insurance itself, I think we’re turning the curve where we’re getting better at it. But that’s what I wish for my colleagues in healthcare as well as customers who kind of write off this industry as kind of a BS or scam is take some time to understand it a little better. When you understand what you have, it empowers you to use it better, makes you feel better about it. And it doesn’t make you feel as mad when something isn’t covered at 100% or to your expectation, because you understand what your policy is. Oh, OK, my insurance is meant to cover 80% of that bill, so I’m expecting a 20% bill. Then you’re not so mad about it anymore. So I just wish for a little bit more open-mindedness around the insurance industry.
Rob Oliver: Sure. And yet, at the same time, I will say this, that I mean, this is my personal theory, and there’s no reason. I feel like the insurance companies have an algorithm. that kicks out one out of every four or five claims just for the sake of saying, hey, let’s see if we reject this, are they actually going to come back and try and appeal this, or can we get away with not paying it? And I don’t know, I would imagine that that’s not accurate, but sometimes it’s how you feel because things get rejected for no reason. Can you talk about how that process affects the way that people look at health insurance?
Noor Ali: Yeah, Rob, that’s a great question. And I don’t have any data to support or refute that. Maybe it’s true, maybe it’s not, I honestly don’t know. But I would say, you know, find an advocate for either advocate for yourself if you’re well versed in the industry, but most people are not. And that’s, you know, one of the services that I provide. So when I work with my clients for health insurance, they have my services for the life of their policy, helping with these specific issues such as getting claims through, making sure that… you know, they’re not wrongly denied and doing kind of that legwork and customer service work to make sure that they’re paid what they’re owed. So I don’t have any, you know, valid data against that reasoning. Maybe it’s true. Maybe it’s not. But my response would be to either advocate for yourself if you know about health care. And if you don’t find an advocate, like myself or someone else.
What can medical providers do to improve the quality of healthcare their patients receive?
Rob Oliver: Yeah. And I think this is a really important message to get out to, you know, to the patients to say, it’s, it’s okay to file an appeal. make sure that when the insurance company rejects your claim, when they say no, whatever the situation is. So okay, what do I need to do that you can communicate with your doctor’s office or your provider, whoever it is that wrote the original script, talk to them and find out what information you can gather to make sure that you can properly appeal that so that you can get access to what you need. And sometimes I feel like people give the insurance companies a little bit too much power. And when that rejection comes, they just say, oh, it must not be covered rather than thinking about the appeals process. So anyway.
Noor Ali: 100%, Rob. Yeah, I definitely encourage that. In personal experience, too, I’ve had a lab bill because the vitamin D test wasn’t covered part of my routine. And I fought it, and I won. But you’re right. You should not write it off as, oh, this must just be a bill that I have to pay. Take a look at your policy. Should it be covered? If you’re not sure, call your benefits department. Find out and get details. If this is the documentation you want for an appeal, find out exactly what they’re looking for in that documentation before you submit and you get another 90-day runaround because, oh, this document’s not going to work. So I totally agree with you there, Rob.
What excites you about the future of healthcare?
Rob Oliver: OK, fantastic. What excites you about the future of health care?
Noor Ali: I think I touched on this a little before, but really patients, consumers, customers more aware. So podcasts such as yours that do such a great job of educating on the different perspectives, the different sides and facets of healthcare, helping patients become more aware and educated. I think that’s really exciting for me, because now we’re not so afraid of big insurance and big pharma. Now we have the tools and knowledge to, you know, fight a wrong claim or know where to shop for healthcare and not feel screwed.
Rob Oliver: Let me just say, I’m a person with a disability and within the disability community, especially when it comes to advocacy, there is the moniker, knowledge is power. And we have access to knowledge in a way that is unprecedented over past generations where you can literally Google almost anything. Now, part of the problem is that not all of the knowledge is 100% accurate, but you’ve got to parse through that, but you have the ability to educate yourself about what’s going on. So. Highly encouraged with that. Last question, what is one thing medical professionals can start doing today to improve the quality of healthcare?
Noor Ali: This was one question I didn’t immediately have the answer for. I had to like start, I had to stop and think about it a little bit. And I wanna give, I don’t know, more of a spiritual answer here. And I think it’s to be more loving of each other. of industries, of our peers, for our patients, just to have a little bit more of an open heart and love, because I feel like when I demonstrated that triad with the three key players, we’re always kind of on defense mode, like, oh, you’re the bad guy, or you’re the bad guy, and just pointing fingers, you know? Maybe just stop a little bit and say, okay, well, you know, at least I have a health insurance policy. Maybe it’s not covering this, but I do have good coverage for that. Or, you know, my doctor’s trying their best. It’s not my doctor’s fault my insurance doesn’t cover it, you know, or maybe the doctor can understand, well, this is the only insurance plan that this patient can afford. So let’s work with this. So just exhibiting a little bit more love towards each other, I think, can help increase better outcomes.
Rob Oliver: You know, it’s interesting because what you said was about increased love, and the first place that you went was with colleagues. And I thought that is very powerful There are times when you have different roles that are kind of pitted against one another or one therapist wants to do this, another therapist wants to do, and social work has a different, and there becomes some contention there. And at the end of it, what really needs to happen is, how do we serve the patient? We are all in the business of helping this patient get back to as healthy as possible and to living their life as they want to. as a team, we’re all on the same page and we’re all moving towards that. Let’s figure out how we can get along and appreciate and respect each other. And actually that is part of the reason why I started this podcast so that medical practitioners can listen and hear where their colleagues are coming from and see how their colleagues view things. And as a result, increase the respect that they have, the understanding that they have, and maybe it’ll just be an opportunity for everyone to get along a little bit better. So. Thank you so much for feeding into that. And I appreciate you being here. Listen, Noor Ali, I appreciate your time and I respect you. And I appreciate your perspective on healthcare.
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