Against the Grain with Dr. Chad Edwards | Oklahoma City Prolotherapy| Podcast 8 – Part 5
Brian Wilkes: That’s a good point.
Chad Edwards: If you’re out of network, then you pay 40%, insurance pays 60. Some are 50-50, there’s 70-30, there’s all different kinds of insurance plans and different things.
Brian Wilkes: You can massage it and play with it, and see what’s best for you and your family depending on what your health is, your age is, all that good stuff.
Chad Edwards: Right, so you can still get covered, you can till get some reimbursement for that once your deductible is met.
Brian Wilkes: Yeah, so let’s just unpack this whole thing because I think we’ve talked about it a lot. It’s fairly technical, right?
Chad Edwards: Yep. It is difficult, extremely nuanced.
Brian Wilkes: Right, and on purpose. It’s kind of like the stock market.
Chad Edwards: It’s crazy.
Brian Wilkes: They do “sophisticated” things so you don’t really don’t know how their stock improved or not. You just don’t really know. Oh, we’re so smart.
Chad Edwards: Right.
Brian Wilkes: Don’t worry about it, but really they’re not that smart. They’re as confused as anyone else. Maybe even more-so. That’s kind of how the medical system is, right?
Chad Edwards: Yeah.
Brian Wilkes: In fact, if they were concerned about consumers acquiring information, studies have been done. There was a study that was done many years ago that I read about. It’s mutual funds and 401K plans, mutual funds within 401K plans at businesses. They were trying to, I guess it was in the late ’80s, they were trying to get more people on the mutual fund in companies. There was a problem. People weren’t investing, weren’t doing those things, so they added more options. They had 2 or 3 options within mutual funds so they added 10. Instead of the numbers going up in investing in 401K plans, they went down, and then they tinkered with it. The more simple that they made it, the more people that enrolled. They went back to 2 well thought out, easily unpacked options, and 401K plan subscriptions went way up.
Chad Edwards: That’s right. Right.
Brian Wilkes: The medical system knows what to do. They’re not idiots.
Chad Edwards: Right.
Brian Wilkes: They just don’t want you to know. They know what it takes to make you know.
Chad Edwards: You know, part of the problem is is that … I used to work at a large clinic here in Tulsa.
Brian Wilkes: Nameless.
Chad Edwards: It’s a good clinic, but it’s traditional inside the box, thinking traditionally, all in network insurance, blah, blah, blah, blah, blah. If a patient had called and said, “Hey, I want to come see Dr. Edwards, and I want this lab, this lab, this lab, how much is that visit and those labs going to cost me?” It would be impossible for them to tell them.
Brian Wilkes: Isn’t that crazy?
Chad Edwards: Part of it is because you don’t know what “level” of office visit it is until the doctor’s done.
Brian Wilkes: Yeah my dad used to say, “Boy, you don’t know your butt from a hole in the ground.” That’s probably going to get edited, but that’s a great thing to say about medical [crosstalk 00:28:15]. We got Marshall over here. He’s rolling his eyes. He’s like, “Oh my God.”
Chad Edwards: If you go to get your oil changed in your car and so you call Jiffy Lube or whomever, so you call these guys and you say, “I want to get my oil changed. How much is it going to cost?”
Brian Wilkes: We don’t know.
Chad Edwards: They say, “We won’t know until after we do it.” Are you kidding?
Brian Wilkes: Even then … That’s a great example, so even then you get your bill, you pay it there, and they say, “We’re probably going to send you some more bills.” Why? “We really don’t know.”
Chad Edwards: They’re not going to tell you that. You’re just going to get a bill 3 months later, and you’re going to say, “What’s this for?”
Brian Wilkes: “Yeah, we used synthetic oil.” Well, I didn’t ask for synthetic oil. “It doesn’t matter. That’s the way we do things.”
Chad Edwards: Yeah.
Brian Wilkes: What?
Chad Edwards: Yeah, and your insurance plan didn’t cover that.
Brian Wilkes: Right.
Chad Edwards: It was refused because it was you didn’t have a prior authorization.
Brian Wilkes: Yeah, so at the end of the day what are we saying here? What we’re saying is your whole clinic operates on this mindset, and it operates successfully, so there’s a case study here for us to look at that is it’s healthy to have a one-to-one relationship with your doctor. Your doctor is accountable to you, you’re accountable to them, et cetera, and you’re paying them non-taxed preferably, pre-taxed dollars from the HSA, dollars directly to the doctor. You’re holding the doctor directly accountable for your care, but what we’re not advocating is just pure cash, meaning no catastrophic insurance. We’ll go back to that. You need catastrophic coverage.
Chad Edwards: Yep.
Brian Wilkes: If you suspect, obviously, the trick with insurance agencies is if you do suspect that you might get sick at some point, if you say that out loud anywhere, they have microphones, and they’ll deny you of … I’m fairly sure we’re in the Truman story with insurance … Insurance companies are the people watching.
Chad Edwards: Could be.
Brian Wilkes: Yeah, because you know from experience how surprising it can be at times for people that are healthy, that are going along. They get sick, they’ve paid insurance, maybe they’re 60 years old, they’ve paid insurance their whole lives. They have one condition their entire lives, and insurance says, “Oh, that’s not covered.
Chad Edwards: Right. When you go to the doctor and they say you have high blood pressure, they put that code in now under ICD-10, it’s an I-10 is the code, and that goes into your database out into the ether, and it stays there. They will be able to look at a list of diagnoses and see, “Oh, that was on the chart, that was on the chart, that was on the chart.” I’m not a conspiracy theorist, but that stuff’s out there.
Brian Wilkes: I don’t think it’s a conspiracy. I think it’s reality.
Chad Edwards: Yeah, yeah. True.
Brian Wilkes: I think if you look at it from a business standpoint, if I’m selling a product to one of my customers, I do a credit check on them, and it’s wild the amount of information I can get on them.
Chad Edwards: Oh, yeah.
Brian Wilkes: I think insurance people see it the same way. They want to know your background. They want to know where you’re going, and people that say … I’ve heard stories where people say, “I don’t smoke,” and then they say, “Okay,” and they give you a policy. Then they get some random person and you’ve got a $10 million claim for some treatment that you have. They’ll get some person from college like you and me, and they’ll say, “I saw him smoke one time.” It gets really hairy with insurance companies when they have to start paying.
Chad Edwards: Right.
Brian Wilkes: The point is is educate yourself. Make sure you have a tight policy. Make sure you read over it. Maybe even get your attorney to look over it, and make sure it’s for catastrophic, lower your premium rates, high deductibles at a rate you could sustain if you needed to, $5,000 out of pocket, $10,000, in the event that there’s a catastrophic at that point. Make sure it’s 100% past there and not 20% or whatever the case it.
Chad Edwards: Right.
Brian Wilkes: Make sure you have a good network, and also day to day be smart about it. Save money. Find a doctor that does cash one to one.
Chad Edwards: You can save money across the board, like MRIs. Some insurances will allow $1,500, which means that they’re charging $1,500, but through my clinic we’ve got an arrangement, an MRI, little over $500, a third of the price. [crosstalk 00:32:36] across the board, we can save a lot of money, and this is on just pure cash.
Brian Wilkes: Right. I love it. It’s a good show, Chad. We could talk about this all night long.
Chad Edwards: We will definitely have more stuff on insurance, how people can save money, how does insurance work? Because honestly I don’t think half the insurance people know how insurance works. It’s just incredibly nuanced. You got to do this job in order to understand how this stuff works, so we’ll have more.
Brian Wilkes: How could you not listen to this show? I mean, people, come on. You got to listen to this show.
Chad Edwards: You got to listen.
Brian Wilkes: You got to listen.
Chad Edwards: And tell your friends.
Brian Wilkes: Hey, see you guys in the next episode. Thanks Dr. Chad.
Chad Edwards: I’m here for you, Brian.
Brian Wilkes: See you.
Voiceover: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week where we’ll be going Against the Grain.