186. Stop Overpaying for Your Health Insurance: EOBs, Tiers & Avoiding Bad Bills

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Welcome to Medicine Redefined, a podcast focusing on helping you reclaim ownership

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of your health.

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I'm Dr. Darsha, and I'm Dr. Ultima Shraja, where your hosts, hair to challenge conventional

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practices and uncover the stories behind pioneers shaping the future of medicine.

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Our conversations not only focus on the individual level to dissect common practices for health

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optimization, but also zoom out to enhance systemic change.

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Join us as we look to break the status quo, move the needle forward, and put the help

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back in health care.

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Hey guys, before we dive into today's conversation, I have an exciting update.

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My new practice, refining health and performance, is officially launching soon.

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It's a practice built around health, longevity, and performance.

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The Medicine 3.0 approach we talk about every week here on this podcast.

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And here's the best part.

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So you can work with me from the comfort of your home.

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So if you'd like to learn more or join the weight list, visit refininghealthrx.com.

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All right.

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That's going to be episode.

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All right.

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Ladies and gentlemen, back here with another progress note.

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This one is Ultima Shraja's idea, talking about insurance negotiations.

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Ultima Shraja.

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Take this off, man.

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Why are we talking about this?

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Yeah, buckle in, man.

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I'm pissed off.

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So I guess I'll start with a little bit of a story.

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And then I initially wanted to just kind of complain about this.

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I did complain about it to my better half.

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And I thought, well, listen, if I'm having difficulties with this, maybe a lot of people

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who are not in the industry or not on behind the curtains.

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And how can we make it actionable for people?

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So the story goes like this, right?

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My wife and I, we both have employer-sponsored plans, health insurance, this is.

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And we all know how much we live health insurance.

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And this is all going to be about.

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And my plan for my institution was something that I was on for a while for myself for

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the last year and a half.

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My daughter and my wife until she finished her training until June 30th were on her plan.

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It was more economical, it would be more sense.

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The benefits worked out better that way.

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As a June 30th, she switched over the entire family is now on my plan.

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So just for context, her plan was blew off through the shield, I'm on that note.

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Now there is an allergist that we had to get our daughter into sea and we had never seen

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her part of June 30th.

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We were actually waiting for July 1st for her to be on my plan to be able to see that

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because this allergist was tier one in my plan.

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And we'll talk about all of this stuff, why that makes sense and why that matters.

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And she was tier three on the prior plan.

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And so at tier three, the out of cost was too much, it didn't quite make sense.

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So we made sure we waited till July 1st and we saw them.

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And so we had a couple of visits at this point they've treated us.

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And I get these bills coming the last couple of months at home.

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You know, I'm just ignoring them because it's $180 per visit.

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And I say, no, I can't be at my specialist co-paste $30.

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I know what the visits cost is completely covered.

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And so I'm just ignoring them.

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At one point, Amelia, my wife says, hey, can you look into this, please, they keep sending

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it.

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I was like, no, they'll figure it out.

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No, I gave them the insurance.

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I'm the one who went to that first visit.

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I explicitly communicated with the front office staff, so I didn't figure it out.

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Well, I don't know why I did this.

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But anyways, I was driving to the gym and I was like, I'm going to go ahead and call them

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anyway.

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And so I get to the billing office and I speak to them and say, listen, your wife is

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not covered under Edna.

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She's covered in her Blue Cross Blue Shield.

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No, that's not true.

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That ended you in 30th.

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We switched over.

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It's like, no, it's showing her she has active coverage of Blue Cross.

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And they actually paid for this claim.

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And then this is your responsibility, right?

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Because it's against tier three.

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And so this is your out of pocket cost.

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It's like, well, that makes no sense.

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We eliminated it.

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She has Edna coverage.

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And so this lady on the other side tells me, hey, listen, you need to call Blue Cross

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and figure it out.

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Because if she has two active coverages with two separate systems, and that's really

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the only way this could probably happen is you have two completely parties who are not

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communicating with each other, right?

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Edna, Blue Cross, two big players.

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And she's actually not covered by Blue Cross.

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Blue Cross is actually going to try to recoup the payment from us because nobody wants

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to pay.

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And we have to pay them back because they paid us.

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And then Edna actually has to pay out the claim, which is us.

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It's like, okay, well, that's how it's great.

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Take care of it.

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And she's like, no, actually, you have to call Blue Cross and let them know at the

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mistake.

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I was like, why do I have to call Blue Cross?

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You want money from me?

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You call Blue Cross, right?

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And it was well, no, actually, it's a, if we can't communicate with them.

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At that point, I was like, is he serious?

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Wait, so the man can't, they can't take, they can't talk due to hip-hop, but they

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can take money.

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Right.

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Right.

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Right.

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And this is going to come back to him.

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I just, at some point, you know, like, when you're having a communication, I don't like

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often playing the physician card.

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At that point, I had to and I was like, man, this doesn't make any sense.

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I understand what you have to do.

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So can you please just run this claim and just like, no, sir, like, I will take the information

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from you for your insurance company, but you have to call.

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And I said, okay, let me understand that you want money from me.

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I have to settle claim for you.

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Some other random company paid you who I care nothing about, right?

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So you have to give their money back illegally.

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Otherwise, they're going to come after you, not me, but you want me to call them.

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And she was like, yeah, because you have to.

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And I was like, okay, how about this?

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How about you just take my right information and you bill it and then we'll figure it all

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out.

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And so my wife being the, the gentle soul she is and doesn't like any conflict and controversy

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and she's from Southern California, she decided Blue Cross and she took care of it.

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So we, we solved that problem.

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But I thought about all the people who, anybody else who would have been in my situation

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and you mentioned, you don't have a lot of this.

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And I actually have four or five stories of these were last decade that have had these

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types of experiences where they would have just taken that.

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Now you know that time is really our most valuable asset.

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And so that took time that pissed me off.

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And I think it was somebody else.

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They might not even had the idea to call and say, look, actually, this is not my responsibility.

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Even though the other person kept saying and you have the incorrect insurance.

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So that's where we are.

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I'm going to try to make lemonade out of this situation, hopefully for people as I say.

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So I like it.

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I like it.

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Man.

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Rough.

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Sounds rough.

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I think I'm one of those in the camp where I see that and I'm like, man, is this worth

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the energy, right?

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And I think we're like, we're at a point now as attendings where how do we reconcile the

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principle behind it?

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Because I would probably still call it because there's a lot of principle behind it versus

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being like, you know what, I just not going to, I'm not going to deal with the same worth

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it.

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Yeah.

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But okay.

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So let's go through this because we, what was it?

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Maybe five, maybe a little bit more six, seven episodes ago.

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We had, oh my god, what was the name of it?

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Thank you, bit.

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Yeah.

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Yes.

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Yes.

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Yes.

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Yeah.

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We had him come on, talk about insurance.

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Beautifully kind of took us through it.

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But we're going to go even more in depth now.

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I think and talk about more about nuance and relate it back to this story.

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So you know, I can never get these terms straight.

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And so I think any of the pre-med and medical students out there, this would be a good refresher

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hopefully if they did learn it.

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But take us through, you know, insurance 101, what are some of those terms that we have

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to know about when it comes to the co-pay and money and understanding, meeting a certain

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amount of money before you can then do XYZ?

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What does all that mean?

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Sure.

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Yeah.

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Any consumer of healthcare, right?

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So I think important terms, just so you can speak the language, we always talk about terminology,

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you have to be able to understand it.

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So when you call and you try to advocate on your behalf, you know exactly what it is that

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they're saying on the other side and you can actually have a clear conversation.

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So premium is the term that most people think about.

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This is what you have to pay monthly to have insurance.

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Everybody has a premium, you know, whether there's, if it's employer-sponsored or not,

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it's, there's a portion that you're paying, maybe the employer is paying, if you're paying

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100% by yourself, that's your monthly premium.

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And this applies to all insurances, car insurance, home insurance, all that stuff.

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Your deductible is what you pay first before the insurance starts sharing and contributing

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to your plan.

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And so people might have heard of something called a high deductible healthcare plan and

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those might be something that people who don't need a lot of healthcare resources, young

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people might engage in where they have a $5,000 deductible.

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They're like, hey, the first $5,000 of pretty much everything except emergency services,

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I'm going to pay out a pocket that includes doctors, vids, and so on and so forth.

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Co-pays, it's a fixed fee per visit and that might be, so the specialist, your, your

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primary care, it might be 20 bucks for your co-pay.

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And it doesn't matter whether or not you've met your deductible.

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This is something you're paying every single time and other procedures can have co-pays as

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well.

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Not to be confused with co-insurance, which is a certain percentage of the cost that you

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have to pay after you meet your deductible.

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So if you have a $500 or $1,000 family deductible and then you can have your co-pay, which might

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be 20 bucks for that primary care, well, usually we'll just, let's say $50 co-pay, you

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still might have a 20% co-insurance.

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So if that visit costs $200, you're still paying $40 on top of your co-pay.

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So that's another important one.

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Other ones out of pocket, maximum, as the phrase suggests, this is your annual ceiling

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after this is all the money you'll pay out after that, all the cover services are at 100%.

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So you have to be really sick or really use your healthcare resources in order to get

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this.

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These numbers are in the 15s or 20,000 somewhere in that range, sometimes a little

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bit lower, but rarely.

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And then last, the important one kind of will suggest is your network.

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The network is important.

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So people might have heard in network, out of network, and I think, you know, even within

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network, tiers, as I alluded to in that first story that I said, that's really important.

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So your tiers are your preferred providers that you have to see.

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So somebody might be in network, but they might be a tier three provider.

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And a tier three provider, you are taking a lot more of the cost as the patient, whereas

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a tier one provider is a preferred provider and you want to go say that it's going to be

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less out of pocket costs.

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That every system is tier based on in network, but there are horizon being the classic

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New Jersey.

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It's the largest health and sure for most patients and they're often have tier based system.

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So those are some of the main ones.

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Anything that I miss that you could think of that that you always have a question about?

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No, I think those are red.

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I think those are the ones that most of us hear about, you know, when we go to these

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visits or when we talk to patients, I think, yeah, thinking there's up.

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Yeah.

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And it's really important to, I think, really understand that because I think when you're

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not only when you're picking a plan, but also when you're choosing who to go see, like

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for you, this doesn't matter as much because, you know, patients really get to pick that

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they're getting to see you.

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I mean, maybe they heard they were so awesome.

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That's the inpatient rehab they picked.

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But oftentimes when you're going to see an outpatient clinician, you need to understand

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these things before you go see that doctor, certainly the in network and out of network

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stuff.

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And I think Vince talked a lot about most of his stuff as out of network and we can talk

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about reimbursement if that's necessary.

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So I think that's an important one other things that come to mind that people need to understand

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is something called an EOB, the explanation of benefits.

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Anytime you utilize healthcare resources, you go to a doctor, you have a procedure

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00:11:19.440 --> 00:11:22.320
you go to a hospital, you're going to get an EOB in the mail.

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And that is not a bill, right?

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And Bill and his invoice that you have to pay out an EOB is not that, even though it

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00:11:28.600 --> 00:11:31.640
might look like an invoice.

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So this is a receipt from your insurer.

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It shows what was billed, what the plan allowed, what they paid and what you might owe.

246
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But that's not, they're not asking you for money.

247
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It's just breaking down the charges and like a lot of times you'll see like contracted

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charges, waived off, reduced, etc.

249
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But it's in detail of everything that happened.

250
00:11:50.280 --> 00:11:55.640
This is an important thing for people to look at because this is where you can catch mistakes.

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00:11:55.640 --> 00:11:59.040
This is where you can pick up poor billing practices, you know, refer back to with Leah

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Houston talked about.

253
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These are things that are important for you to look at at least a couple of times before

254
00:12:06.760 --> 00:12:08.560
we just kind of shred them.

255
00:12:08.560 --> 00:12:16.000
So you can make a or you can have an informed discussion debate to your point about energy

256
00:12:16.000 --> 00:12:17.000
and principle.

257
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I've shared this story before, I think with Peter Venezuelan when he came back way back

258
00:12:20.400 --> 00:12:27.160
in the day about when I was at Hopkins and we had the institution sponsored plan.

259
00:12:27.160 --> 00:12:28.160
And do you remember this?

260
00:12:28.160 --> 00:12:29.160
Does it talk about that?

261
00:12:29.160 --> 00:12:30.160
I think I did.

262
00:12:30.160 --> 00:12:35.360
This is during pregnancy and for those who don't know, during pregnancy, prenatal visits

263
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are covered 100%.

264
00:12:36.360 --> 00:12:39.920
I remember Amelia went to her routine.

265
00:12:39.920 --> 00:12:45.080
I think prenatal maybe 12 week follow up or something where the visit, they asked us

266
00:12:45.080 --> 00:12:49.080
if anything was wrong and she said, hey, listen, I've been a little nauseated lately, totally

267
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part of the process.

268
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That's not what she went to the doctor for.

269
00:12:52.560 --> 00:12:56.560
And then the way they coded it, nausea was a primary diagnosis.

270
00:12:56.560 --> 00:13:00.480
And so the whole visit kick back and I think I had to pay 110 bucks or something.

271
00:13:00.480 --> 00:13:01.480
And I was like, yeah, that makes sense.

272
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This should be 100% covered.

273
00:13:03.720 --> 00:13:07.760
And it was maybe nearly 11 months of fighting back and forth until eventually I had to

274
00:13:07.760 --> 00:13:13.680
broker a call between like management and the insurance company to try to understand

275
00:13:13.680 --> 00:13:17.120
that the codes needed to be just swapped.

276
00:13:17.120 --> 00:13:19.760
First had to go a second, second had to be first.

277
00:13:19.760 --> 00:13:23.680
And that's not something that I think, well, it definitely is not something that should

278
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have taken all that energy.

279
00:13:24.680 --> 00:13:29.440
This is a principle thing that I just, you know, and I was a really important lesson

280
00:13:29.440 --> 00:13:32.880
for me to learn because I think that's where I kind of learned on how to communicate and

281
00:13:32.880 --> 00:13:35.120
how to cover your ass, so to speak.

282
00:13:35.120 --> 00:13:36.120
Yeah.

283
00:13:36.120 --> 00:13:39.560
But one thing I'll say is anytime you have an issue where you think that something's

284
00:13:39.560 --> 00:13:42.200
in dispute, ask them to put your account in hold.

285
00:13:42.200 --> 00:13:45.000
People are often concerned they're going to send it to collections, just say, hey, listen,

286
00:13:45.000 --> 00:13:46.280
this is being debated.

287
00:13:46.280 --> 00:13:47.440
This is something they're working through.

288
00:13:47.440 --> 00:13:49.680
Can you just request to put the account in hold?

289
00:13:49.680 --> 00:13:52.000
They should do that for you.

290
00:13:52.000 --> 00:13:56.040
As long as you're actively making a good faith effort towards doing that, and if you're

291
00:13:56.040 --> 00:14:00.440
calling and you're speaking and you're advocating and you have meticulous notes, that's something

292
00:14:00.440 --> 00:14:02.440
that's really important to do.

293
00:14:02.440 --> 00:14:03.440
Gotcha.

294
00:14:03.440 --> 00:14:04.440
Nice.

295
00:14:04.440 --> 00:14:05.440
Okay.

296
00:14:05.440 --> 00:14:09.120
Do you, how do people figure out these numbers for their premium deductible?

297
00:14:09.120 --> 00:14:12.200
Let's say they signed up for something and they're like, shoot, okay, I don't know.

298
00:14:12.200 --> 00:14:16.080
I want to go see the kind of colleges I'm going to see a sportsman doc.

299
00:14:16.080 --> 00:14:17.080
How do I know?

300
00:14:17.080 --> 00:14:18.080
How do I find out this information?

301
00:14:18.080 --> 00:14:19.960
Is it through the insurance website?

302
00:14:19.960 --> 00:14:22.520
Do you recommend artificial intelligence at this point?

303
00:14:22.520 --> 00:14:23.520
What do you suggest?

304
00:14:23.520 --> 00:14:27.400
Now, AI probably wouldn't have unique stuff for their plans.

305
00:14:27.400 --> 00:14:31.600
I don't think that AI is going to have access to them, I mean, especially not the employer

306
00:14:31.600 --> 00:14:33.240
sponsor plans.

307
00:14:33.240 --> 00:14:36.320
That type of data and those are discounter rates a lot.

308
00:14:36.320 --> 00:14:41.400
So for the monthly premium is going to be something that when you signed up, you're going

309
00:14:41.400 --> 00:14:43.000
to have a good sense of what that's supposed to be.

310
00:14:43.000 --> 00:14:46.760
So if you're going to help care.gov, if it's going through your employer, you've gotten

311
00:14:46.760 --> 00:14:47.760
that information at a time.

312
00:14:47.760 --> 00:14:52.880
If not, you can ask your human resources person or go back to healthcare.gov and just look

313
00:14:52.880 --> 00:14:57.600
up to what that initial plan that you agree to.

314
00:14:57.600 --> 00:15:02.800
The seeing different doctors, which are copays are, so this is important.

315
00:15:02.800 --> 00:15:07.000
Every single person, when they're signing up, it's required by law to have something called

316
00:15:07.000 --> 00:15:09.200
a summary of benefits and coverage.

317
00:15:09.200 --> 00:15:13.640
It's a booklet that has all the information and all the details about all the things

318
00:15:13.640 --> 00:15:15.320
that we just talked about.

319
00:15:15.320 --> 00:15:20.000
And you have to walk through this before you're actually comparing plans to see what's

320
00:15:20.000 --> 00:15:23.640
going to be more suitable and what's going to be appropriate for you and your family.

321
00:15:23.640 --> 00:15:25.880
This is where you're going to see all those copays.

322
00:15:25.880 --> 00:15:30.880
What it's going to cost you to go see a PCP, primary care versus specialist in those copays,

323
00:15:30.880 --> 00:15:34.240
what your co-insurance is going to be, deductibles out of pocket max.

324
00:15:34.240 --> 00:15:38.720
It's also going to have if it's tier-based system, every single one of those numbers for

325
00:15:38.720 --> 00:15:41.280
tier one, tier two, tier three.

326
00:15:41.280 --> 00:15:44.680
And if there are out of network benefits, how much is that?

327
00:15:44.680 --> 00:15:49.280
Oftentimes, if there are out of network benefits, unless it's a really good plan, they're

328
00:15:49.280 --> 00:15:54.640
going to be at a much more reduced to reimbursement rate from the insurance company.

329
00:15:54.640 --> 00:15:59.520
So, for instance, tier three might be where the insurance company pays only 70 percent

330
00:15:59.520 --> 00:16:03.800
of the visit and an out of network might be only 50 percent, right?

331
00:16:03.800 --> 00:16:06.600
But now you can go, now you can go see events.

332
00:16:06.600 --> 00:16:11.160
You can see people like Dr. Marquesi and Reimbursed and get a super bill.

333
00:16:11.160 --> 00:16:16.320
So that's a document that every single person gets, and you have to look at that.

334
00:16:16.320 --> 00:16:19.800
And I recommend people to kind of just save it, save it on your computer, save it on

335
00:16:19.800 --> 00:16:20.800
your phone.

336
00:16:20.800 --> 00:16:22.040
It's just, it's such a long document.

337
00:16:22.040 --> 00:16:25.720
It's hard to kind of remember, right, or take screenshots of it, and just those key

338
00:16:25.720 --> 00:16:26.720
points.

339
00:16:26.720 --> 00:16:30.320
So, when you go to the doctor's office and say, oh, your copay is actually $70 and

340
00:16:30.320 --> 00:16:34.000
it's like, oh, no, actually, like, this is my specialist copay, what's going on?

341
00:16:34.000 --> 00:16:37.240
And you'll find out that maybe that's not what they are.

342
00:16:37.240 --> 00:16:40.560
A classic example comes to mind is some of my colleagues that I practice with, they're

343
00:16:40.560 --> 00:16:44.800
family medicine trained, but then subspecialize in OMM.

344
00:16:44.800 --> 00:16:47.520
And so if they're billing as OMM clinicians, they become specialists.

345
00:16:47.520 --> 00:16:48.920
They're no longer primary care doctors.

346
00:16:48.920 --> 00:16:52.240
So even if somebody's seeing them as a family medicine doctor, if they're seeing them

347
00:16:52.240 --> 00:16:57.840
in that wrong location where they're practicing osteopathy, now their copay, seeing the same

348
00:16:57.840 --> 00:17:03.120
doctor can be $25 in one family medicine clinic where they're the primary care doctors,

349
00:17:03.120 --> 00:17:06.280
but in a different clinic where they're serving where the clinician is wearing a different

350
00:17:06.280 --> 00:17:08.080
hat, it could be completely different.

351
00:17:08.080 --> 00:17:10.120
So you got to, you got to really know that stuff.

352
00:17:10.120 --> 00:17:11.120
Gotcha.

353
00:17:11.120 --> 00:17:12.120
Okay.

354
00:17:12.120 --> 00:17:16.240
And then when it comes to requesting a hold on the account, does that mean you then actually

355
00:17:16.240 --> 00:17:17.240
can't use your insurance?

356
00:17:17.240 --> 00:17:20.920
What if you have to go to a follow-up appointment or something a week after that's a great

357
00:17:20.920 --> 00:17:21.920
question.

358
00:17:21.920 --> 00:17:25.600
No, no, no, it would be for that specific account with that specific clinician.

359
00:17:25.600 --> 00:17:29.960
So let's just say you came to see me in clinic and we had a bill with us at dispute, you'll

360
00:17:29.960 --> 00:17:31.560
say, hey, just put this hold on account.

361
00:17:31.560 --> 00:17:37.840
So my billers, my companies that you outsource to, they're not sending it to collections.

362
00:17:37.840 --> 00:17:39.920
No collections rarely ever affects your debt.

363
00:17:39.920 --> 00:17:44.200
You have to really not make a good effort for a long, long time for something like that

364
00:17:44.200 --> 00:17:46.520
to happen, but that would be the purpose of that.

365
00:17:46.520 --> 00:17:49.120
It doesn't affect your insurance at all.

366
00:17:49.120 --> 00:17:52.000
Like it would not affect at the level of lacrosse or anything.

367
00:17:52.000 --> 00:17:55.280
So it would, it's not like putting a pause on that at all.

368
00:17:55.280 --> 00:17:56.280
Cool.

369
00:17:56.280 --> 00:17:57.280
All right.

370
00:17:57.280 --> 00:17:58.280
Awesome.

371
00:17:58.280 --> 00:17:59.280
Let's move down then to plantites, right?

372
00:17:59.280 --> 00:18:03.600
So oftentimes on this podcast, we're talking about DPC, DPS, these are just like cash-based

373
00:18:03.600 --> 00:18:04.600
practices, right?

374
00:18:04.600 --> 00:18:07.760
But within the insurance model, there is each of them.

375
00:18:07.760 --> 00:18:08.920
There's PPL, right?

376
00:18:08.920 --> 00:18:10.160
So let's go through those.

377
00:18:10.160 --> 00:18:14.160
What do each of those, what are the different plant types and what benefit is there to

378
00:18:14.160 --> 00:18:15.160
each of those?

379
00:18:15.160 --> 00:18:16.160
Yeah.

380
00:18:16.160 --> 00:18:17.160
So yeah.

381
00:18:17.160 --> 00:18:21.000
So PPL was a preferred provider organization.

382
00:18:21.000 --> 00:18:24.520
This is, so I'm going to go with, from most flexibility to least.

383
00:18:24.520 --> 00:18:27.800
This is the one that's going to typically have outdoor network benefits or are usually

384
00:18:27.800 --> 00:18:29.800
going to be covered at lower rates.

385
00:18:29.800 --> 00:18:32.720
These are the types of plants like Medicare, it's typically a PPL, I think about that.

386
00:18:32.720 --> 00:18:37.560
Even though that's a federally funded program, they have state plants as well.

387
00:18:37.560 --> 00:18:41.760
So PPLs are favored, they are a little bit more expensive, you're paying a bit of a premium

388
00:18:41.760 --> 00:18:47.280
to not have, or have a wider network and see whoever you want.

389
00:18:47.280 --> 00:18:52.160
And EPO is an exclusive provider organization, slightly more restrictions.

390
00:18:52.160 --> 00:18:57.480
It's typically, you can only see people in network, but they have a larger network.

391
00:18:57.480 --> 00:19:00.640
And you don't need referrals from a primary care doctor.

392
00:19:00.640 --> 00:19:07.200
POS, point of service, is an HMO like, but you can go out of network with referrals.

393
00:19:07.200 --> 00:19:13.440
It has somewhat mixed rules, again, slightly restrictive, but not as much as something called

394
00:19:13.440 --> 00:19:16.240
an HMO, a health care managed organization.

395
00:19:16.240 --> 00:19:19.000
This is the one that's classic, you have to stay in network.

396
00:19:19.000 --> 00:19:22.520
You often, if not always, have to pick a primary care provider.

397
00:19:22.520 --> 00:19:25.640
And every single time you want to go see a specialist, you have to reach out to your primary

398
00:19:25.640 --> 00:19:28.040
care provider who has to get a referral.

399
00:19:28.040 --> 00:19:32.480
This happens with us all the time where patients come to see us and like we're hunting down

400
00:19:32.480 --> 00:19:34.800
their primary care doctor five minutes before the appointment.

401
00:19:34.800 --> 00:19:39.320
But we can't see you, even if you're setting in the office, because you didn't get a referral.

402
00:19:39.320 --> 00:19:42.840
And that's the most, like it's a gatekeeper type model.

403
00:19:42.840 --> 00:19:48.440
The big systems on the west coast, Kaiser, comes to mind, they have an HMO based system,

404
00:19:48.440 --> 00:19:51.320
and they have this network where you can only go within the Kaiser model.

405
00:19:51.320 --> 00:19:53.320
It's really frustrating for a lot of people.

406
00:19:53.320 --> 00:19:54.320
Gotcha.

407
00:19:54.320 --> 00:19:55.320
Cool.

408
00:19:55.320 --> 00:19:56.320
Great explanation there.

409
00:19:56.320 --> 00:19:57.320
Yeah.

410
00:19:57.320 --> 00:19:58.320
I actually never really heard of EPO and POS.

411
00:19:58.320 --> 00:20:02.240
I'm guessing those aren't as common or I don't know if all insurancees, do they offer

412
00:20:02.240 --> 00:20:03.240
those?

413
00:20:03.240 --> 00:20:04.720
Like, or is that specific unique bootie?

414
00:20:04.720 --> 00:20:05.720
They're insured.

415
00:20:05.720 --> 00:20:06.720
No.

416
00:20:06.720 --> 00:20:07.720
Far less common.

417
00:20:07.720 --> 00:20:08.720
Far less common.

418
00:20:08.720 --> 00:20:09.720
POS is probably a little bit more common.

419
00:20:09.720 --> 00:20:11.120
EPO is far less common.

420
00:20:11.120 --> 00:20:13.560
Sometimes EPO and PPO can be interchangeable.

421
00:20:13.560 --> 00:20:14.760
People will just look at that.

422
00:20:14.760 --> 00:20:19.080
And because EPO is so wide, people might not recognize that, hey, this is just a really

423
00:20:19.080 --> 00:20:23.200
large in network as opposed to a their outer network benefits and people might not even

424
00:20:23.200 --> 00:20:24.200
pay attention to that.

425
00:20:24.200 --> 00:20:25.200
Got it.

426
00:20:25.200 --> 00:20:26.200
Okay.

427
00:20:26.200 --> 00:20:27.200
Cool.

428
00:20:27.200 --> 00:20:28.200
All right.

429
00:20:28.200 --> 00:20:30.800
Let's move on to how to essentially read your plan.

430
00:20:30.800 --> 00:20:33.200
Are the specifics that you're looking for?

431
00:20:33.200 --> 00:20:36.640
Obviously, this is going to be case-to-case basis, but I think you have a good general outline

432
00:20:36.640 --> 00:20:41.480
here as far as, you know, what the, what the ordinary average show should really be looking

433
00:20:41.480 --> 00:20:42.480
at.

434
00:20:42.480 --> 00:20:43.480
Yeah.

435
00:20:43.480 --> 00:20:49.240
So, coming back to that, the summary, the benefit summary that I talked about, again,

436
00:20:49.240 --> 00:20:54.560
saving that, putting it on your computer, oftentimes now, especially in 2025, all of the

437
00:20:54.560 --> 00:20:57.480
big players are going to have online portals as well.

438
00:20:57.480 --> 00:21:01.280
I think that's really important is that if you can create an online portal, this is a

439
00:21:01.280 --> 00:21:02.280
great place.

440
00:21:02.280 --> 00:21:06.440
If you have access to computer, which most people do, if not phone, they have apps as well.

441
00:21:06.440 --> 00:21:09.640
The apps tend to be a little bit clunky, but the online portals are pretty good because

442
00:21:09.640 --> 00:21:13.480
well, one, you can access the summary of benefits coverage if you don't have it.

443
00:21:13.480 --> 00:21:17.680
Two, all the EOBs should automatically route to there, even though they're going to send

444
00:21:17.680 --> 00:21:18.680
it to you at home.

445
00:21:18.680 --> 00:21:21.760
But if you ever had a question about a claim, you can just go take a look at the EOB and

446
00:21:21.760 --> 00:21:24.880
exactly what happened and then compare that to the bill that you're actually getting from

447
00:21:24.960 --> 00:21:27.920
your clinician or your provider.

448
00:21:27.920 --> 00:21:28.960
This is also a great place.

449
00:21:28.960 --> 00:21:33.600
A lot of times I know Edna has a good portal, Blue Cross has a decent portal too, where you

450
00:21:33.600 --> 00:21:35.000
can search providers.

451
00:21:35.000 --> 00:21:39.600
So if you had a question to see if somebody's covered in network or outer network, this

452
00:21:39.600 --> 00:21:41.320
is a great place to check that.

453
00:21:41.320 --> 00:21:48.880
Now caveat with that is oftentimes they are not updating or a doc might work at multiple

454
00:21:48.880 --> 00:21:53.320
locations and only one of the locations is showing in network and another location

455
00:21:53.480 --> 00:21:56.680
for just the way that they structure their billing.

456
00:21:56.680 --> 00:22:02.680
It could be that that's one doctor in a or one provider that you're seeing in a large

457
00:22:02.680 --> 00:22:07.600
practice and it's actually being being billed at an NPI number, which is a provider identification

458
00:22:07.600 --> 00:22:13.800
number on a different NPI and that's why your doc is now considered out of network.

459
00:22:13.800 --> 00:22:16.040
These are also things that's happened to me.

460
00:22:16.040 --> 00:22:20.680
So it's really that summary of benefits coverage that is going to give you all the information

461
00:22:20.760 --> 00:22:26.440
that you need, whether it's preventative visits, labs and imaging, mental health benefits,

462
00:22:26.440 --> 00:22:31.600
PT, OT, pharmacy, well pharmacy formulae is a little bit different and we could talk

463
00:22:31.600 --> 00:22:35.320
about that if you want to, but I think that setting up the portal is important.

464
00:22:35.320 --> 00:22:40.520
Oftentimes it'll give people ID cards as well and having those electronic ID cards,

465
00:22:40.520 --> 00:22:44.480
I think is also important because sometimes the ID snapshot also has just really high

466
00:22:44.480 --> 00:22:50.880
yield, out of pocket, maximum deductible, copays, people think people can reference those

467
00:22:50.880 --> 00:22:51.880
quickly.

468
00:22:51.880 --> 00:22:52.880
Gotcha.

469
00:22:52.880 --> 00:22:53.880
Cool.

470
00:22:53.880 --> 00:22:54.880
Awesome.

471
00:22:54.880 --> 00:22:55.880
Anything else?

472
00:22:55.880 --> 00:22:56.880
What else?

473
00:22:56.880 --> 00:22:58.960
I know you have labs on here, DME, which is something that's up our alley as rehab

474
00:22:58.960 --> 00:23:00.280
docs that we look at.

475
00:23:00.280 --> 00:23:01.280
Mental health services.

476
00:23:01.280 --> 00:23:03.760
I think that's something more and more people are looking into as well.

477
00:23:03.760 --> 00:23:06.680
Are these things that are usually typically covered or?

478
00:23:06.680 --> 00:23:12.480
Yes, so the mental health service, when I was thinking about that example of, so if

479
00:23:12.560 --> 00:23:19.480
you think about a lot of times, mental health providers can be licensed social workers and

480
00:23:19.480 --> 00:23:29.560
they might be, it could be part of a bigger practice where the psychiatrist's NPI is being

481
00:23:29.560 --> 00:23:34.840
used to build the, or the whole practice has a one NPI and you might be seeing a certain

482
00:23:34.840 --> 00:23:39.680
clinician who might be in different practices and they're not directly peeling.

483
00:23:39.680 --> 00:23:44.880
The other one that actually comes to mind is if you're seeing PAs, PAs often build under

484
00:23:44.880 --> 00:23:46.680
physicians.

485
00:23:46.680 --> 00:23:52.360
So your PAs might have a certain provider ID and you keep putting that person's provider

486
00:23:52.360 --> 00:23:56.280
ID and it's showing up as covered, but if the billing is actually happening under the

487
00:23:56.280 --> 00:24:01.960
physician who has not covered, that could be a challenge for you because now you're

488
00:24:01.960 --> 00:24:06.200
getting a bill because that's how it's happening even though you're seeing a certain doctor.

489
00:24:06.200 --> 00:24:10.160
So I don't know how often PAs are in the mental health field.

490
00:24:10.160 --> 00:24:14.240
I don't think this, I think the licensed social worker is something that comes to mind.

491
00:24:14.240 --> 00:24:15.320
They're very, very common.

492
00:24:15.320 --> 00:24:18.960
It's nearly impossible to get psychiatrist these days, the rush practitioners typically

493
00:24:18.960 --> 00:24:22.240
have their own, their license to practice independently, at least in the state of New

494
00:24:22.240 --> 00:24:23.240
Jersey.

495
00:24:23.240 --> 00:24:28.280
Is that the case in Florida as well, yeah.

496
00:24:28.280 --> 00:24:33.520
But I mean, when in doubt, pick up the phone and I know I gave a little bit of love to

497
00:24:33.520 --> 00:24:37.200
the portal's online, but pick up the phone and call and get that information ahead of

498
00:24:37.200 --> 00:24:38.400
time.

499
00:24:38.400 --> 00:24:46.640
I think as annoying as this is, the safest way to do it is it's always better to call the

500
00:24:46.640 --> 00:24:50.480
doctor and find out with a doctor if they're accepting your insurance or not.

501
00:24:50.480 --> 00:24:52.680
They should have the most updated information.

502
00:24:52.680 --> 00:24:58.640
If not, the doctor should do the work for you and this is not exclusive just to the physician.

503
00:24:58.640 --> 00:25:01.560
This could be for physical therapy, occupational therapy.

504
00:25:01.560 --> 00:25:05.680
The reality is they want your business.

505
00:25:05.680 --> 00:25:12.880
They should look into your insurance benefit to see what tier you are and what your

506
00:25:12.880 --> 00:25:14.760
responsibility is going to be.

507
00:25:14.760 --> 00:25:15.920
The same thing with dentists.

508
00:25:15.920 --> 00:25:18.120
When you call, you say, hey, are you guys covered?

509
00:25:18.120 --> 00:25:21.280
If they really don't care, they'll punt and say, you have to call your insurance and find

510
00:25:21.280 --> 00:25:22.280
out.

511
00:25:22.280 --> 00:25:23.280
I have noticed that.

512
00:25:23.280 --> 00:25:25.960
I've gotten that from patients sometimes they just don't care.

513
00:25:25.960 --> 00:25:30.000
They're so busy or you just get somebody really nasty at the front desk and they're

514
00:25:30.000 --> 00:25:33.680
not interested in doing their work, but it is their responsibility to kind of check.

515
00:25:33.680 --> 00:25:35.200
I shouldn't say it's the responsibility.

516
00:25:35.200 --> 00:25:39.360
Secondly, your responsibility as the consumer because at the end of the day, it's on you

517
00:25:39.360 --> 00:25:44.400
when something doesn't cover it, but they should be doing that because that's kind of just

518
00:25:44.400 --> 00:25:48.360
the way that things at least work in this country to my knowledge.

519
00:25:48.360 --> 00:25:53.680
Have you ever had that experience where you've called and tried to see if somebody's covered

520
00:25:53.680 --> 00:25:56.840
and they said, now you got to call the insurance company and find out yourself?

521
00:25:56.840 --> 00:25:57.840
I don't.

522
00:25:57.840 --> 00:25:58.840
I haven't called.

523
00:25:58.840 --> 00:25:59.840
I have case management.

524
00:26:00.000 --> 00:26:00.840
With the inpatient.

525
00:26:00.840 --> 00:26:01.840
So a lot of it.

526
00:26:01.840 --> 00:26:07.440
I mean, as a consumer, like with your parents, anything like that, no, they take care of

527
00:26:07.440 --> 00:26:08.440
it.

528
00:26:08.440 --> 00:26:12.080
Or, you know, I think a lot of these larger networks will have now in service case management

529
00:26:12.080 --> 00:26:17.760
or in service, like people that will do more billing, like and Jack maltraden that sense

530
00:26:17.760 --> 00:26:21.520
when it comes to health insurance, admit types of stuff, yeah, I haven't had that.

531
00:26:21.520 --> 00:26:22.520
Yeah.

532
00:26:22.520 --> 00:26:26.840
Yeah, it's important to think it's like, remember, it is still a business and you're

533
00:26:26.840 --> 00:26:28.440
still a customer.

534
00:26:28.440 --> 00:26:33.160
And so if they don't do a good job there, one that could be actually a red flag, if they're

535
00:26:33.160 --> 00:26:37.840
not even willing to do a little bit of legwork for them to figure out if, you know, what your

536
00:26:37.840 --> 00:26:41.320
responsibilities and you're going to get bad service off the gecko, maybe you need to go

537
00:26:41.320 --> 00:26:43.280
to somebody else and they lose that patient.

538
00:26:43.280 --> 00:26:44.520
They lose that customer.

539
00:26:44.520 --> 00:26:47.040
I hate saying it that way, but that's what it is, right?

540
00:26:47.040 --> 00:26:50.400
This whole situation is just a business.

541
00:26:50.400 --> 00:26:54.000
Absolutely is, man, going through that right now with a couple of patients as we speak,

542
00:26:54.000 --> 00:26:58.360
I'm getting emails, but phone about it comes for service and trying to make things happy

543
00:26:58.360 --> 00:27:00.920
even though they're not going to react candidates and stuff.

544
00:27:00.920 --> 00:27:05.920
Like you said, it is a business in the end and unfortunately that's how it is, but the

545
00:27:05.920 --> 00:27:10.920
tough thing to say on the inpatient side, what do you mean, give me some, give us some

546
00:27:10.920 --> 00:27:11.920
cases.

547
00:27:11.920 --> 00:27:17.520
Yeah, so you know, our hospital is known to be one of the best down here in Florida,

548
00:27:17.520 --> 00:27:21.480
especially the one specific one that I work at, some of the best therapists that we work

549
00:27:21.480 --> 00:27:22.480
at.

550
00:27:22.480 --> 00:27:27.400
And so when it comes to rehab hospitals, just like any other hospital, the goal is to

551
00:27:27.400 --> 00:27:28.400
fill beds, right?

552
00:27:28.400 --> 00:27:33.160
The goal is to try to maximize the number of beds because that keeps your admissions

553
00:27:33.160 --> 00:27:38.160
up that you have more discharges and keeps revenue flowing and keeps money flowing.

554
00:27:38.160 --> 00:27:42.120
When you sound a lot of the times or rehab patients are actually, if they're second or third

555
00:27:42.120 --> 00:27:47.320
times through that door, eventually there comes a point though where that rehab patient

556
00:27:47.320 --> 00:27:50.240
no longer will benefit from our services, right?

557
00:27:50.240 --> 00:27:54.040
I mean, they've just plateaued in function or they get sent out to the hospital.

558
00:27:54.040 --> 00:27:56.560
They're just not a good candidate overall.

559
00:27:56.560 --> 00:28:01.680
But to the families, it's, oh, bring them to rehab because there's always that hope.

560
00:28:01.680 --> 00:28:05.720
They can always try, but let's be honest, sometimes it's a, it's almost like a vacation

561
00:28:05.720 --> 00:28:10.880
for the family where they don't have to take care of their loved one at home.

562
00:28:10.880 --> 00:28:15.040
And so sometimes they get a break, the therapist and our staff will kind of take over and, you

563
00:28:15.040 --> 00:28:20.760
know, whether it's a week or two, but what we have to, when I deny those patients, right?

564
00:28:20.760 --> 00:28:24.880
Because a lot of times we have liaisons and a marketing team that will go out and say,

565
00:28:24.880 --> 00:28:27.040
hey, this patient, are they a good candidate?

566
00:28:27.040 --> 00:28:28.360
My eyes, they're not.

567
00:28:28.360 --> 00:28:34.040
And this is a, a decision that I make alongside the therapy team after talking to them.

568
00:28:34.040 --> 00:28:36.600
But then the family gets upset, right?

569
00:28:36.600 --> 00:28:39.040
And so now it's really a customer service type thing.

570
00:28:39.040 --> 00:28:43.960
So in the back of my head is, do we accept a patient that's not actually a great candidate?

571
00:28:44.240 --> 00:28:46.120
It quote, unquote, saves face for us.

572
00:28:46.120 --> 00:28:51.080
They're also good marketers and they are a good word of mouth family to go and tell other

573
00:28:51.080 --> 00:28:54.360
families, hey, this is why you go to this hospital because they take care of you and they're

574
00:28:54.360 --> 00:28:56.080
nice and et cetera, right?

575
00:28:56.080 --> 00:29:00.920
So I mean, in the end, it's still heavily, heavily, heavily a business.

576
00:29:00.920 --> 00:29:05.640
And we're just trying to work our magic within that system, essentially, but yeah, that's

577
00:29:05.640 --> 00:29:08.640
kind of what, what I've gotten through right now, so.

578
00:29:09.560 --> 00:29:10.560
Yeah.

579
00:29:10.560 --> 00:29:16.360
You know, the upside there is, at least I think, correct me for wrong.

580
00:29:16.360 --> 00:29:22.880
I often talk about the business of medicine on the outpatient side sometimes, well, oftentimes

581
00:29:22.880 --> 00:29:29.720
drives to practice medicine here, aside from admitting a patient, I don't think that's

582
00:29:29.720 --> 00:29:30.720
going to be the case, right?

583
00:29:30.720 --> 00:29:34.120
Because they're still going to get good quality care if they're there.

584
00:29:34.120 --> 00:29:35.120
Correct.

585
00:29:35.120 --> 00:29:36.120
Yeah.

586
00:29:36.120 --> 00:29:39.040
Regardless, if they're going to come, we're going to still provide the best care, right?

587
00:29:39.040 --> 00:29:44.000
But then there's also metrics we work about, send out rates, patient satisfaction, discharge

588
00:29:44.000 --> 00:29:45.000
admissions.

589
00:29:45.000 --> 00:29:49.520
You know, there's just a lot of other metrics within the metrics that we try to hit.

590
00:29:49.520 --> 00:29:54.400
That physicians have to hit that our leadership, each and every one of the roles has to hit.

591
00:29:54.400 --> 00:29:58.160
And obviously, these are measuring like a quarterly basis, monthly basis, yearly basis,

592
00:29:58.160 --> 00:29:59.160
right?

593
00:29:59.160 --> 00:30:02.360
So those are all things that are on the back of our minds when we look at the specific

594
00:30:02.360 --> 00:30:04.760
job that we do.

595
00:30:04.760 --> 00:30:08.320
Give an example of some metrics from the inpatient rehab unit that you might have to

596
00:30:08.320 --> 00:30:09.320
pay attention to.

597
00:30:09.320 --> 00:30:10.320
Yes.

598
00:30:10.320 --> 00:30:11.320
People don't know.

599
00:30:11.320 --> 00:30:15.080
So for me, probably the two most important are the patient satisfaction.

600
00:30:15.080 --> 00:30:19.560
And so, you know, patients get a survey at the end, just rating their experience.

601
00:30:19.560 --> 00:30:24.560
A lot of the influence comes from the physician because of, you know, obviously where they

602
00:30:24.560 --> 00:30:29.600
take care of, did we solve their issues, but also the rest of the staff, the therapy team,

603
00:30:29.600 --> 00:30:33.800
all of that goes into the engagement of the physician or sorry to the patient.

604
00:30:33.800 --> 00:30:35.480
Secondly, acute transfers, right?

605
00:30:35.480 --> 00:30:41.440
So we want, this is across the board of anywhere any in patient system is acute transfers.

606
00:30:41.440 --> 00:30:47.120
So when a patient gets sick from a rehab hospital, because remember for the, for the audience

607
00:30:47.120 --> 00:30:52.280
of rehab hospital, yes, it's still a hospital, just like any other, but it has less resources.

608
00:30:52.280 --> 00:30:54.280
So we are not ACLS certified, right?

609
00:30:54.280 --> 00:31:00.120
So we do not, we can, we can, we're BLS certified, so we can do CPR, but when it comes to heavy

610
00:31:00.120 --> 00:31:04.240
cardiac meds and full resuscitation, we're unable to do that.

611
00:31:04.240 --> 00:31:06.240
So we have to send the patient out.

612
00:31:06.240 --> 00:31:12.600
So keeping our send out rate low is another good metric of knowing like, hey, we're doing

613
00:31:12.600 --> 00:31:14.560
everything we can for this patient.

614
00:31:14.560 --> 00:31:17.440
We're actually taking good patients for rehab.

615
00:31:17.440 --> 00:31:22.560
Now that's also monitored again, something called CMI, which is, which is case mix index.

616
00:31:22.560 --> 00:31:26.640
And that, the higher the number, that is the more sick a patient is, you know?

617
00:31:26.640 --> 00:31:33.320
So a patient, let's say, a 1.6 or 1.8 CMI is somebody with diabetes, COPD, maybe a leg

618
00:31:33.320 --> 00:31:35.880
amputation, heart failure, all these things.

619
00:31:35.880 --> 00:31:42.560
Whereas somebody with a 1.3 might just be a fever fracture, let's say obesity and hypertension.

620
00:31:42.560 --> 00:31:43.560
That's it, right?

621
00:31:43.560 --> 00:31:47.680
So, yeah, less complexity from medical, less complex, exactly.

622
00:31:47.680 --> 00:31:54.240
So the higher your CMI in a hospital, the more of a budget you essentially get for a send

623
00:31:54.240 --> 00:31:55.240
out rate.

624
00:31:55.240 --> 00:31:58.720
Because now you're expected to have some patients that have to go back to the hospital and

625
00:31:58.720 --> 00:32:00.080
after they come to rehab.

626
00:32:00.080 --> 00:32:03.400
So these are kind of the metrics of the numbers that are always in flux that we kind of have

627
00:32:03.400 --> 00:32:04.680
to keep in mind.

628
00:32:04.680 --> 00:32:06.960
Re-emission rates are always a big thing too, right?

629
00:32:06.960 --> 00:32:11.960
So you discharge a patient in what, in the next 30 days, how likely are they to actually

630
00:32:11.960 --> 00:32:13.520
go back to the hospital?

631
00:32:13.520 --> 00:32:17.360
So, you know, from anything we do, from a mission to discharge, our metrics are getting

632
00:32:17.360 --> 00:32:19.920
influenced in some sort of way.

633
00:32:19.920 --> 00:32:20.920
Yeah.

634
00:32:20.920 --> 00:32:24.040
Yeah, it's interesting.

635
00:32:24.040 --> 00:32:25.040
It is all interesting.

636
00:32:25.040 --> 00:32:28.280
You know, we try to do the best that we can within the system that we are.

637
00:32:28.280 --> 00:32:30.200
So, you're talking about acute transfers.

638
00:32:30.200 --> 00:32:33.480
That actually reminds me of something I didn't talk about that I think is important is

639
00:32:33.480 --> 00:32:34.480
emergency visits.

640
00:32:34.480 --> 00:32:40.840
So, oftentimes, you know, in the case of an emergency, people will know that anything, anytime

641
00:32:40.840 --> 00:32:45.040
you, it doesn't matter where you are, in network, out of network, if you go to the ER, it

642
00:32:45.040 --> 00:32:46.040
is their responsibility.

643
00:32:46.040 --> 00:32:47.920
But the ER is, you're going to get good care.

644
00:32:47.920 --> 00:32:51.760
They have to, these are the laws, at least in this country, they have to take care.

645
00:32:51.760 --> 00:32:54.480
That doesn't mean that you're not going to get a bill for it later.

646
00:32:54.480 --> 00:33:00.120
So, network doesn't matter almost exclusively, it's going to be covered.

647
00:33:00.120 --> 00:33:01.120
Here's the catch, though.

648
00:33:01.120 --> 00:33:08.440
And I think Marty McCarrick talks about in his book is, is, let's say, you have an emergency.

649
00:33:08.440 --> 00:33:11.840
So that code situation they're talking about, somebody's got a code blue, your heart's

650
00:33:11.840 --> 00:33:13.680
literally stopping.

651
00:33:13.680 --> 00:33:17.840
And they're getting taken by the ambulance to the hospital.

652
00:33:18.000 --> 00:33:22.840
Well, just that night, the anesthesiologist who's going to intubate, you happens to be

653
00:33:22.840 --> 00:33:24.720
out of network.

654
00:33:24.720 --> 00:33:29.200
And all of a sudden, you're going to get a really large bill for the code and the intubation

655
00:33:29.200 --> 00:33:32.520
that came down, hopefully you've recovered and bounced back and went to rehab and now

656
00:33:32.520 --> 00:33:33.520
you're home and thriving.

657
00:33:33.520 --> 00:33:38.320
And you got this massive bill because somebody to lose a moonlighting was the physician

658
00:33:38.320 --> 00:33:43.560
fees and the consultation fees for that specific clinician and maybe the ER doc and the team

659
00:33:43.560 --> 00:33:47.520
were out of network, even though the hospital's up to street from you and network.

660
00:33:47.520 --> 00:33:51.800
And so these are things that are really important, you know, ground versus air is another

661
00:33:51.800 --> 00:33:52.800
really big thing.

662
00:33:52.800 --> 00:33:57.600
I think oftentimes, so I work in there, you know, Cooper trauma is, is a regionally phenomenal

663
00:33:57.600 --> 00:33:59.280
trauma center here.

664
00:33:59.280 --> 00:34:03.360
And oftentimes a really big traumatic case is something like a spinal cord injury or

665
00:34:03.360 --> 00:34:06.040
massive brain injury from down the shore.

666
00:34:06.040 --> 00:34:10.440
They're getting flown in that helicopter bill, which is not necessarily in network.

667
00:34:10.440 --> 00:34:16.040
And especially if your plan doesn't cover helicopter flights, I could be $25,000 flight

668
00:34:16.040 --> 00:34:18.400
that was necessary to save your life.

669
00:34:18.400 --> 00:34:21.720
But, you know, these are all things to kind of think about and, you know, I come back

670
00:34:21.720 --> 00:34:22.720
to Vince's point.

671
00:34:22.720 --> 00:34:26.560
I mean, these are things that you're going to have to, I mean, that sucks.

672
00:34:26.560 --> 00:34:30.880
I don't really have a work around that other than wear helmet, I suppose.

673
00:34:30.880 --> 00:34:35.200
But, you know, safe for responsible driving, no texting, et cetera.

674
00:34:35.200 --> 00:34:37.720
But yeah, those are arguments that you're going to have to make.

675
00:34:37.720 --> 00:34:40.800
Those are things that you're going to have to try to prevent for.

676
00:34:40.800 --> 00:34:45.280
But in all seriousness, even having conversations with your loved ones, you know, you don't

677
00:34:45.280 --> 00:34:46.280
have kids yet.

678
00:34:46.280 --> 00:34:51.720
But when we had our daughter, one of the first things that we thought about, okay, all right,

679
00:34:51.720 --> 00:34:53.440
what are all the hospitals?

680
00:34:53.440 --> 00:34:57.480
Which hospital do we want to go to in case we have an emergency, like JSM allergies?

681
00:34:57.480 --> 00:35:00.280
And if we ever have antiflexus, where are we taking her?

682
00:35:00.280 --> 00:35:02.400
You know, we consider, okay, listen, chop is here.

683
00:35:02.400 --> 00:35:07.880
Yes, we want to balance coverage and, you know, whether something is in network with

684
00:35:07.880 --> 00:35:10.040
also excellent care.

685
00:35:10.040 --> 00:35:12.640
And you know, think about all these things.

686
00:35:12.640 --> 00:35:16.400
This has happened with my family members, my parents, like they've had to go to the

687
00:35:16.400 --> 00:35:17.400
ER.

688
00:35:17.400 --> 00:35:20.680
We had a really bad visit at where my mom ended up in the hospital one time.

689
00:35:20.680 --> 00:35:23.880
And I remember telling the rest of my family, do not ever go to that hospital again.

690
00:35:23.880 --> 00:35:27.880
Not because it was not covered and because of those reasons, because the quality of care

691
00:35:27.880 --> 00:35:28.880
that we got.

692
00:35:28.880 --> 00:35:32.800
And if you ever have an emergency, go to this hospital because, you know, they have better

693
00:35:32.800 --> 00:35:36.440
services and they have a better trauma team and they have better cardiovascular treatment.

694
00:35:36.440 --> 00:35:40.280
If they need to convert a non-surgical case into a surgical case, they can do that more

695
00:35:40.280 --> 00:35:41.280
easily.

696
00:35:41.280 --> 00:35:42.960
They don't have to transfer out.

697
00:35:42.960 --> 00:35:47.560
So these are conversations that people should be having and be attacking it from multiple

698
00:35:47.560 --> 00:35:48.560
lens.

699
00:35:48.560 --> 00:35:54.760
Again, from a financial lens, probably more so even than the actual health lens because

700
00:35:54.760 --> 00:35:59.480
the number one reason for bankruptcy in this country is medical debt.

701
00:35:59.480 --> 00:36:01.960
And we got to try to avoid that where you can.

702
00:36:01.960 --> 00:36:06.280
So I think this co-cumst of mine from Martin Rooney talks about, you know, if you failed

703
00:36:06.280 --> 00:36:07.920
to plan, you plan to fail.

704
00:36:07.920 --> 00:36:09.960
So you can only do so much here.

705
00:36:09.960 --> 00:36:11.920
And so that's one of the things you could do.

706
00:36:11.920 --> 00:36:16.720
I like that, man, because I mean, we all have control if we want.

707
00:36:16.720 --> 00:36:19.920
I think the issue is we're told by a system like, hey, you're never going to figure it

708
00:36:19.920 --> 00:36:20.920
out anyways.

709
00:36:20.920 --> 00:36:21.920
So what's the point?

710
00:36:21.920 --> 00:36:22.920
Right?

711
00:36:22.920 --> 00:36:23.920
And I feel like I'm almost victim of that, too.

712
00:36:23.920 --> 00:36:27.400
It's kind of like, whatever, like I'm healthy right now.

713
00:36:27.400 --> 00:36:32.400
But again, this is all the knowledge for a rainy day, for when that day ever comes.

714
00:36:32.400 --> 00:36:35.160
And so always important, just kind of learn it now.

715
00:36:35.160 --> 00:36:36.160
And it's coming.

716
00:36:36.160 --> 00:36:37.160
Yeah.

717
00:36:37.640 --> 00:36:38.160
Right.

718
00:36:38.160 --> 00:36:41.160
For every single person, it's coming if it's not for you, it's for a loved one, your

719
00:36:41.160 --> 00:36:42.160
parent, your kid.

720
00:36:42.160 --> 00:36:44.160
I hate to say it, but it's coming.

721
00:36:44.160 --> 00:36:45.160
Yeah.

722
00:36:45.160 --> 00:36:46.160
It's a great point, man.

723
00:36:46.160 --> 00:36:50.360
And I think that's where that, that the principle of principle, right?

724
00:36:50.360 --> 00:36:55.120
And actually, you know, even if it is $100 and we can easily afford that, it's going

725
00:36:55.120 --> 00:36:58.040
through it the first time, because if you can do it once, then you know you can do it

726
00:36:58.040 --> 00:36:59.040
forever.

727
00:36:59.040 --> 00:37:00.040
You're more knowledgeable.

728
00:37:00.040 --> 00:37:04.240
You can handle when it gets worse and you can just navigate the system a lot more easily.

729
00:37:04.240 --> 00:37:05.240
So totally agree.

730
00:37:05.240 --> 00:37:06.240
Yeah.

731
00:37:06.520 --> 00:37:11.120
I did what I was going to say to kind of build off that.

732
00:37:11.120 --> 00:37:12.120
Yeah.

733
00:37:12.120 --> 00:37:15.400
As much as, you know, for the last five years, we've been talking about improving healthcare

734
00:37:15.400 --> 00:37:21.760
practices and brought amazing people on here to reflect policy change.

735
00:37:21.760 --> 00:37:25.120
That stuff is going to take a long, long time.

736
00:37:25.120 --> 00:37:29.120
But taking agency of your health, that's really easy to do now.

737
00:37:29.120 --> 00:37:30.120
I shouldn't say easy.

738
00:37:30.120 --> 00:37:32.320
That's much simpler to do.

739
00:37:32.320 --> 00:37:35.520
And then so that's my hope is people walk away from this and it's like, okay, listen,

740
00:37:35.520 --> 00:37:38.120
yeah, I can sit here and wait for the system to get better, which is going to take a very

741
00:37:38.120 --> 00:37:39.120
long time.

742
00:37:39.120 --> 00:37:40.200
Maybe it never does.

743
00:37:40.200 --> 00:37:41.200
But here's what I can do today.

744
00:37:41.200 --> 00:37:42.760
Here's action look for me.

745
00:37:42.760 --> 00:37:43.760
Yeah.

746
00:37:43.760 --> 00:37:44.760
Agreed.

747
00:37:44.760 --> 00:37:46.600
I did want to ask you about tears, right?

748
00:37:46.600 --> 00:37:50.120
Because at the start of this episode, you mentioned how, you know, you're supposed to be

749
00:37:50.120 --> 00:37:52.120
tier one, but they were tier three.

750
00:37:52.120 --> 00:37:53.120
What are the tears?

751
00:37:53.120 --> 00:37:54.960
Why does it matter?

752
00:37:54.960 --> 00:37:55.960
Yeah.

753
00:37:55.960 --> 00:37:58.280
It's all contracting based stuff.

754
00:37:58.280 --> 00:38:02.680
So it's really interesting how this happens, especially on the limelight a lot.

755
00:38:02.680 --> 00:38:06.440
Because Medicare is actually under a crossfire because they're cutting their reimbursement

756
00:38:06.440 --> 00:38:10.800
costs for a lot of different procedures, which is a big problem.

757
00:38:10.800 --> 00:38:15.640
A lot of the folks who are proceduralists in my specific field that they're doing, Medicare

758
00:38:15.640 --> 00:38:20.000
is just not paying enough to even cover the cost of goods.

759
00:38:20.000 --> 00:38:23.600
So to speak, forget even the physician's professional fee.

760
00:38:23.600 --> 00:38:27.920
And so oftentimes, you know, physicians aren't taking that specific insurance company.

761
00:38:27.920 --> 00:38:30.080
So why does that matter?

762
00:38:30.080 --> 00:38:36.880
Well, at tier one, you have better, the insurance company has contracted with certain practices,

763
00:38:36.880 --> 00:38:42.600
certain organizations, certain groups that, hey, we are going to funnel all our patients

764
00:38:42.600 --> 00:38:47.000
into you by having their lease out of pocket costs.

765
00:38:47.000 --> 00:38:49.440
And then the reimbursement rates sometime reflect that.

766
00:38:49.440 --> 00:38:50.520
Oftentimes, I actually reflect that.

767
00:38:50.520 --> 00:38:55.720
I think Vince talked about this too, which is it's such a honestly bullshit way to do

768
00:38:55.720 --> 00:38:56.720
this.

769
00:38:56.800 --> 00:38:58.400
And oftentimes it's interesting.

770
00:38:58.400 --> 00:39:03.880
I think that so when we talked about PBMs, you have this, you know, vertical alignment

771
00:39:03.880 --> 00:39:10.160
and it's the same idea is, Optum Pharmacy is owned by United Health Care.

772
00:39:10.160 --> 00:39:14.360
And so anybody who's in United Health Care, you have to go to Optum Pharmacy to get special

773
00:39:14.360 --> 00:39:19.560
medication, a credo, you have to get a special specialty medication from a credo, which is

774
00:39:19.560 --> 00:39:20.560
a blue crush product.

775
00:39:20.560 --> 00:39:21.560
And so you're paying that.

776
00:39:21.720 --> 00:39:27.080
So it's the same idea in a sense that you contract with certain people, you give them

777
00:39:27.080 --> 00:39:31.920
slightly better reimbursement rates and then most of the patients end up going to that.

778
00:39:31.920 --> 00:39:34.000
And they keep more money in their pocket.

779
00:39:34.000 --> 00:39:38.320
And then tier two, you disincentivize the patient to go in for some tier two, even if they're

780
00:39:38.320 --> 00:39:41.840
a world class clinicians or out of network world class clinicians and they're going to get

781
00:39:41.840 --> 00:39:46.640
best possible care because you don't have good contracts or reimbursements for them.

782
00:39:46.640 --> 00:39:52.680
And so what you see is a lot of people who physicians are stepping out of network.

783
00:39:52.680 --> 00:39:54.680
They're not taking insurance anymore.

784
00:39:54.680 --> 00:39:59.560
In fact, I mean, my prior practice, we're going to be out of network for everybody.

785
00:39:59.560 --> 00:40:03.880
And so Vince, Sassy, who've been on here, they talked about this as well, they're out

786
00:40:03.880 --> 00:40:04.880
of network.

787
00:40:04.880 --> 00:40:08.760
So if you have out of network benefits, well, you're one of the fortunate people who can

788
00:40:08.760 --> 00:40:12.440
potentially reimburse this with something called the super bill and get some of that

789
00:40:12.440 --> 00:40:13.600
money back.

790
00:40:13.600 --> 00:40:17.120
If you're not, then you either have to kind of pay out a pocket and hopefully you find

791
00:40:17.120 --> 00:40:20.520
value in that or you're going to be unable to see.

792
00:40:20.520 --> 00:40:24.120
So it's a similar idea that like, you know, maybe tier three, you can almost look like

793
00:40:24.120 --> 00:40:26.240
borderline out of network.

794
00:40:26.240 --> 00:40:27.240
Got it.

795
00:40:27.240 --> 00:40:28.240
Cool.

796
00:40:28.240 --> 00:40:29.240
Awesome.

797
00:40:29.240 --> 00:40:30.240
What?

798
00:40:30.240 --> 00:40:31.240
What now?

799
00:40:31.240 --> 00:40:32.240
Where do you want to go from here?

800
00:40:32.240 --> 00:40:33.240
Yeah.

801
00:40:33.240 --> 00:40:34.240
Well, I'll just recap, right?

802
00:40:34.240 --> 00:40:35.240
So I think important things.

803
00:40:35.240 --> 00:40:37.680
So I think first and foremost, the most important thing is to know your plan essentials.

804
00:40:37.680 --> 00:40:42.960
So get that booklet, the summary of benefits coverage, save it, have it accessible, have it

805
00:40:42.960 --> 00:40:46.640
on your phone, set up an online portal if you don't have that just so you can quickly

806
00:40:46.640 --> 00:40:49.480
reference and find providers oftentimes that's really helpful.

807
00:40:49.480 --> 00:40:54.560
But it's not going to be even if you find somebody that's a good step in, but pick up

808
00:40:54.560 --> 00:40:58.760
the phone and call, start with calling the actual provider you want to see before you

809
00:40:58.760 --> 00:40:59.760
call the insurance company.

810
00:40:59.760 --> 00:41:04.400
If you have extra time and poor, you're really, really cautious, then you can do that.

811
00:41:04.400 --> 00:41:05.440
Download the ID cards.

812
00:41:05.440 --> 00:41:06.440
Have your ID card.

813
00:41:06.440 --> 00:41:10.000
So I have actually running a, like a shared note on my Apple notes with my wife where I

814
00:41:10.000 --> 00:41:13.760
have, I don't want to tell people this, but maybe my password during there, maybe you're

815
00:41:13.760 --> 00:41:14.760
not, I don't know.

816
00:41:14.760 --> 00:41:15.760
But our ID cards are in there.

817
00:41:15.760 --> 00:41:16.920
Our prescription cards are in there.

818
00:41:16.920 --> 00:41:20.560
And if you want to put your summary belt and you can put all that stuff in there, you

819
00:41:20.560 --> 00:41:21.560
know, pre-visit verification.

820
00:41:21.560 --> 00:41:22.800
I'll be talked about that.

821
00:41:22.800 --> 00:41:27.600
Remember that the explanation of benefits is not a bill, but you should reconcile that

822
00:41:27.600 --> 00:41:30.960
if you are saving your EOBs with a bill before you pay.

823
00:41:30.960 --> 00:41:33.880
Oftentimes, and remember Chris Hutchins talking about this is, you know, they'll catch

824
00:41:33.880 --> 00:41:38.160
up where you have like a level five visit here or in a level three here.

825
00:41:38.160 --> 00:41:42.360
And if you know the insurance paid something, so let me, let me get actual tactical example

826
00:41:42.360 --> 00:41:43.360
for that.

827
00:41:43.360 --> 00:41:50.120
Let's say a provider billed $300 for a visit, but legally, they're only allowed to build

828
00:41:50.120 --> 00:41:52.600
150 for that visit.

829
00:41:52.600 --> 00:41:56.800
And that didn't get adjusted on the end on all of a sudden, you know, they're allowed

830
00:41:56.800 --> 00:41:59.640
to build 150 and the insurance pays 80%.

831
00:41:59.640 --> 00:42:01.480
Maybe let me use these are numbers.

832
00:42:01.480 --> 00:42:02.480
They allowed to build 100.

833
00:42:02.480 --> 00:42:05.040
The insurance pays 80% while your responsibility is 20%.

834
00:42:05.040 --> 00:42:09.280
If you look at that in the EOB, you know that you owe 20 bucks when that bill comes in

835
00:42:09.280 --> 00:42:10.280
mail.

836
00:42:10.280 --> 00:42:15.560
But if they forgot to make that adjustment from 300, well, 20% is all of a sudden they're

837
00:42:15.560 --> 00:42:18.640
going to send you bill for 60 because, you know, the adjustment didn't happen or something

838
00:42:18.640 --> 00:42:20.040
like that didn't happen.

839
00:42:20.040 --> 00:42:24.480
So that's how you can potentially reconcile that and these mistakes happen all the time.

840
00:42:24.480 --> 00:42:30.240
People don't check them and that's why they just automatically pay it, you know, vendors

841
00:42:30.240 --> 00:42:35.240
and pharmacies.

842
00:43:30.240 --> 00:43:39.880
So that's like these are kind of things that happen all the time and you can expect the

843
00:43:39.880 --> 00:43:45.880
people on the other side who are just picking up the baton to be smart or honestly, I hate

844
00:43:45.880 --> 00:43:51.320
to say that or care about, give a shit about how much, you know, medical debt is robbing

845
00:43:51.320 --> 00:43:52.320
you.

846
00:43:52.320 --> 00:43:57.720
So in that note, every single time you call for every single call, every bill, keep a claim

847
00:43:57.720 --> 00:44:02.160
action log, date time, person named department that you spoke to get a case reference if

848
00:44:02.160 --> 00:44:06.520
you can, what they promise your next step follow up date, save all that stuff.

849
00:44:06.520 --> 00:44:09.280
So you'll oftentimes people will call and they'll say, oh, I'm just looking at my internal

850
00:44:09.280 --> 00:44:10.280
notes.

851
00:44:10.280 --> 00:44:12.040
Well, now you got your internal notes running here.

852
00:44:12.040 --> 00:44:15.880
So when you call back and he said, I spoke to Chris this on this day and we said this

853
00:44:15.880 --> 00:44:19.240
and he said, this was going to happen all of a sudden, they're taking you seriously and

854
00:44:19.240 --> 00:44:24.440
you can just expedite that call, no when to take the escalation ladder.

855
00:44:24.440 --> 00:44:28.640
So there are times where you just, you know, the first person, they're oftentimes just

856
00:44:28.640 --> 00:44:29.640
trying to beat you down.

857
00:44:29.640 --> 00:44:34.640
I feel like and eventually people do give up, just know when you have to escalate it to

858
00:44:34.640 --> 00:44:38.400
the billing supervisor to the practice manager, same thing with the insurance company, you

859
00:44:38.400 --> 00:44:41.760
know, take it to your supervisor manager and say, listen, hear my notes.

860
00:44:41.760 --> 00:44:43.920
This is my sixth call about this issue.

861
00:44:43.920 --> 00:44:45.680
I think it's time for us to escalate this.

862
00:44:45.680 --> 00:44:50.320
And if you need to, you can three way call like to resolve an issue.

863
00:44:50.320 --> 00:44:51.920
I think I already mentioned having insurance kit.

864
00:44:51.920 --> 00:44:55.880
I think the last one I let people say is like, don't let them gaslight you.

865
00:44:55.880 --> 00:45:00.120
Just like this person on my phone call, they will try to do that all the time.

866
00:45:00.120 --> 00:45:03.720
They will say, hip I has something to do with it, which absolutely doesn't.

867
00:45:03.720 --> 00:45:06.720
So you know, I'm tempted to have this person if she even knows what the hell hip I is and

868
00:45:06.720 --> 00:45:09.080
what it means and what stands for.

869
00:45:09.080 --> 00:45:13.400
And they will assume that you do not understand and you are less educated than them.

870
00:45:13.400 --> 00:45:16.920
And they will try to gaslight you about the situation when in fact, that's not true.

871
00:45:16.920 --> 00:45:20.360
I think if you follow this action plan that we talked about and you have meticulous

872
00:45:20.360 --> 00:45:25.920
notes and you understand your own situation, you are going to be the expert of your plan,

873
00:45:25.920 --> 00:45:26.920
not them.

874
00:45:26.920 --> 00:45:30.760
And if you don't get it, ask them to explain it over and over and over again, because

875
00:45:30.760 --> 00:45:32.840
you have the most to lose in this situation.

876
00:45:32.840 --> 00:45:33.840
Yeah.

877
00:45:33.840 --> 00:45:34.840
I like that.

878
00:45:34.840 --> 00:45:39.280
Is there a common theme that you see with your patients that come into the office that

879
00:45:39.280 --> 00:45:43.200
you kind of just wish which people knew every time they came into their office that you

880
00:45:43.200 --> 00:45:49.960
would see more of that, you know, that they aren't doing unawareness of what their

881
00:45:49.960 --> 00:45:52.080
plan is, what it offers.

882
00:45:52.080 --> 00:45:54.120
I like, I'll give the court later to that.

883
00:45:54.120 --> 00:45:58.800
The ones that are the most successful come in like I'll say, hey, listen, I think, I think

884
00:45:58.800 --> 00:45:59.800
I can do this procedure.

885
00:45:59.800 --> 00:46:02.040
I just want to make sure if I need a prior off to say no, I already called the insurance

886
00:46:02.040 --> 00:46:03.040
company.

887
00:46:03.040 --> 00:46:04.040
We're good.

888
00:46:04.040 --> 00:46:05.040
We don't need a prior off.

889
00:46:05.040 --> 00:46:06.040
Amazing.

890
00:46:06.040 --> 00:46:08.360
That's made my life so much easier because I'm happy to do the procedure.

891
00:46:08.360 --> 00:46:12.760
I just don't want you to get a bill for it or if there's an advanced procedure where

892
00:46:12.760 --> 00:46:15.560
they actually pick up the phone and call the insurance company and advocate on their

893
00:46:15.560 --> 00:46:16.560
behalf.

894
00:46:16.560 --> 00:46:21.520
One time the insurance, when we talked about this in daily of care, getting a test approved,

895
00:46:21.520 --> 00:46:25.640
getting a procedure approved, they'll just wait, wait, wait, and things just fall off.

896
00:46:25.640 --> 00:46:30.760
The patients who advocate for themselves, they do so much better and again, it's just

897
00:46:30.760 --> 00:46:37.920
the coming back to they don't anticipate people are going to be knowledgeable enough or

898
00:46:37.920 --> 00:46:41.800
have the time and energy to pick that up, but it's actually once you really understand

899
00:46:41.800 --> 00:46:44.280
your plan, you can kind of cut right to the chase.

900
00:46:44.280 --> 00:46:47.280
I think that's the biggest thing that I would just wish people did more.

901
00:46:47.280 --> 00:46:48.280
Yeah.

902
00:46:48.280 --> 00:46:49.280
Perfect.

903
00:46:49.280 --> 00:46:50.280
Love that.

904
00:46:50.280 --> 00:46:53.640
Well, I hope this helps.

905
00:46:53.640 --> 00:46:56.880
I don't know if I'm more riled up or less riled up at the end of this, but I'm sure I'm

906
00:46:56.880 --> 00:47:00.280
going to have lots more stories as type of shit happens, but I hope that really helps

907
00:47:00.280 --> 00:47:01.280
people.

908
00:47:01.280 --> 00:47:06.480
If you've had a bad situation like this where that you've successfully been able to overcome,

909
00:47:06.480 --> 00:47:07.480
we'd love to hear your story.

910
00:47:07.480 --> 00:47:12.080
So shoot us a message, hit us up on social media, and hopefully people can maximize and

911
00:47:12.080 --> 00:47:13.680
leverage the insurance for them.

912
00:47:13.680 --> 00:47:14.680
I think this is helpful.

913
00:47:14.680 --> 00:47:19.800
Let me tell you what I got on this at least because as a provider who's even like, nothing

914
00:47:19.800 --> 00:47:20.800
is transparent to me.

915
00:47:20.800 --> 00:47:25.120
And I also struggle with this is one, obviously, the terms make sense, right?

916
00:47:25.120 --> 00:47:29.720
Two is when you're signing up for insurance, understanding the terms now and seeing what

917
00:47:29.720 --> 00:47:34.160
best fits your budget, your lifestyle, your conditions, all that, right?

918
00:47:34.160 --> 00:47:38.840
So having a better understanding of that now when I go into the portal, when I look for

919
00:47:38.840 --> 00:47:43.160
a physician, I can understand in network, first out of network, what would make the most

920
00:47:43.160 --> 00:47:46.240
sense out of it and what those co-pays and all that would be.

921
00:47:46.240 --> 00:47:50.200
So now I just have a whole financial picture ahead of me and I can probably map out too

922
00:47:50.200 --> 00:47:55.320
or they're going to be follow ups, labs, just go to the booklet and see exactly what might

923
00:47:55.320 --> 00:47:56.640
be covered.

924
00:47:56.640 --> 00:48:00.920
And then from there, once you get the EOB, the explanation of benefits, really just going

925
00:48:00.920 --> 00:48:04.000
through it now that I have a better understanding and saying, hey, is it accurate?

926
00:48:04.000 --> 00:48:05.240
Is it not?

927
00:48:05.240 --> 00:48:09.920
If it isn't accurate, making that phone call, not letting them gaslight you, telling them

928
00:48:09.920 --> 00:48:11.400
what you know, you know?

929
00:48:11.400 --> 00:48:15.720
And then I think the key thing here, like you said, is keeping a detailed list of who

930
00:48:15.720 --> 00:48:17.480
you talk to the time, all the details.

931
00:48:17.480 --> 00:48:21.960
I think that's very huge because like you said, unfortunately, we live in a world where

932
00:48:21.960 --> 00:48:26.280
serious people will only take other people seriously if they are serious.

933
00:48:26.280 --> 00:48:28.000
So that's definitely key.

934
00:48:28.000 --> 00:48:30.200
But yeah, no, I think this was an awesome man.

935
00:48:30.200 --> 00:48:34.320
I learned a lot myself and I think other people will do.

936
00:48:34.320 --> 00:48:35.320
Awesome.

937
00:48:35.320 --> 00:48:36.320
All right, man.

938
00:48:36.320 --> 00:48:37.320
Until next time.

939
00:48:37.320 --> 00:48:38.320
All right.

940
00:48:38.320 --> 00:48:39.320
See you.

941
00:48:39.320 --> 00:48:40.320
Peace.

942
00:48:40.800 --> 00:48:43.680
Thanks for listening to the other episode of Medicine Redefined.

943
00:48:43.680 --> 00:48:46.800
If you enjoyed this episode, please be sure to check out some of the additional resources

944
00:48:46.800 --> 00:48:48.280
in the show notes.

945
00:48:48.280 --> 00:48:53.160
Please also check out our social media platforms where you can find more content like this.

946
00:48:53.160 --> 00:48:58.160
You can follow us on Instagram, Twitter, and TikTok at Med Redefined.

947
00:48:58.160 --> 00:49:02.080
We also want to thank our team for the production of this podcast, specifically Ethan Jewel

948
00:49:02.080 --> 00:49:06.680
and video, Harita Yapuri on social media, Zanablegmani on research, and Sarah Hahn for

949
00:49:06.680 --> 00:49:07.680
newsletter.

950
00:49:07.680 --> 00:49:11.520
Also, if you enjoyed the show, please be sure to subscribe, review, and share with anyone

951
00:49:11.520 --> 00:49:14.120
who you think will gain value from this as well.

952
00:49:14.120 --> 00:49:18.240
Now, time for the ever so important disclaimer.

953
00:49:18.240 --> 00:49:22.840
This podcast is intended for general public use and is for educational purposes only.

954
00:49:22.840 --> 00:49:26.720
It does not constitute the practice of medicine, nor should be construed as medical advice.

955
00:49:26.720 --> 00:49:30.720
No physician patient relationship is formed, and anything discussed in this podcast does

956
00:49:30.720 --> 00:49:32.720
not represent the views of our employers.

957
00:49:32.720 --> 00:49:36.520
We recommend that you seek the guidance of your personal physician regarding any specific

958
00:49:36.520 --> 00:49:37.520
health related issues.