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Against the Grain with Dr. Chad Edwards | Oklahoma City Prolotherapy| Podcast 8 – Part 4
Brian Wilkes: Because it’s the only way they can make money. They can’t cover it anymore because the way it’s set up.
Chad Edwards: Exactly.
Brian Wilkes: Let’s go back to this, so you’re going to have to get covered. Now you’re mandated to pay money for insurance, so what do I do?
Chad Edwards: Right, and again, I think everyone should have health insurance.
Brian Wilkes: Of course.
Chad Edwards: I mean, that’s part of a sound financial plan.
Brian Wilkes: But now you’re forced to have it. Not forced, you’re paying.
Chad Edwards: Well, you’re forced to have health insurance that meets certain criteria, and therein is my problem. I don’t even remember all the criteria for it, but it meets all of these criteria and the problem is is that what I’ve seen is you end up paying so much for it that it’s no longer affordable for the people that I see on a daily basis. I see average, middle income, middle class kind of people.
Brian Wilkes: Folks that fit the category that we’re talking about.
Chad Edwards: Right. I don’t see patients that are the poverty patients, because my patients have to pay cash when they come.
Brian Wilkes: Yeah, okay, so I want to get to that.
Chad Edwards: Yeah.
Brian Wilkes: Okay, so I like using my example because I am a patient of yours, okay, so this is how I do it, and you can look up my credentials online if you want to evaluate whether I’m trustworthy or not. This is how I do it. I have a health savings account. In that health savings account rather than a PPO, and that’s important. The difference between a health savings account and a PPO would be in a PPO you pay a …
Chad Edwards: Fee for service.
Brian Wilkes: Fee for service, so meaning that you are probably covered in a provider network, and your premiums are fairly high.
Chad Edwards: Let me interrupt you for one second. Provider network means that there is a contract between the medical person, the doctor or the clinic, the lab, the X-ray whatever, and the insurance company. They’re in a contract with them that says that they’re going to agree to basically be controlled by the insurance company and accept payment accordingly.
Brian Wilkes: Correct.
Chad Edwards: In exchange for that, the insurance company will send them money. Then you also have out of network, meaning we can take your insurance, but we’re not going to sign a contract with that particular insurance company, which is what I usually recommend, but we’ll talk about that in another podcast for sure.
Brian Wilkes: Got you, so you have this PPO plan, that I would say … I don’t have the statistics, but most people that work for a company probably have a PPO. I would say with a higher premium payment, that means month to month how much your health insurance costs you. Then you probably have a low deductible, lower deductible, and you can balance those two. You can choose, but I would say that most Americans probably have a lower … I’m sorry, it depends on what you want to do. If you want your premiums to go down, you get a higher deductible.
Chad Edwards: That’s right.
Brian Wilkes: It depends on what you want to do, but that’s one option in the PPO option. I would say a good vast majority of your patient visits, this is the catch on the PPO, are covered. Covered is a little clever word that insurance companies use, because think about it in your own plan. If I’m paying $400 a month … I would say I’m paying $800 a month for a family, and if you have your own business, that’s what you’re paying, or more. That’s for healthy people, middle class people, let’s say you went to the doctor, okay? You pay $800 a month for as much as you go to the doctor. I can almost assure you, and I don’t have the statistics, at least in my family, there’s no way that we spend $800 a month on medical stuff.
Chad Edwards: That’s exactly right.
Brian Wilkes: No way.
Chad Edwards: But you’re paying for the person that has high risk for the other stuff.
Brian Wilkes: But I’m paying for them.
Chad Edwards: That’s correct.
Brian Wilkes: I saw that and I said, “Hey, I’m going to go a different way.” I have a health savings account, which basically says I can … I basically say, “Hey look, I am going to pay a lower premium,” but my health savings account is not going to cover every doctor’s appointment. My health savings account and my option within my health savings account is a high deductible, so it might be like 10 grand per person in my family. Then everything after that is covered 100%, but I’ve got to pay the first 10 grand.
Chad Edwards: Right.
Brian Wilkes: That first 10 grand means even a visit to your office, but my premium might go to $200. Does that make sense?
Chad Edwards: It doesn’t go down that much, though.
Brian Wilkes: Yeah. In a health savings account, I can take money that I make and put it in a non-taxed fund, hence the name health savings account.
Chad Edwards: Right.
Brian Wilkes: If I make $10, I can put $2 a month and I’m not taxed 30% on that or whatever the tax rate is.
Chad Edwards: Right. That’s right.
Brian Wilkes: That’s what a health savings account is. The equation is non-taxed health savings account to which I can pay, now follow me here. This is tough for most people. Follow me. I can pay pre-taxed money directly to you, $200, whatever my appointment is, which I’m automatically getting a benefit from because it’s not taxed. I can pay you $200 from that health savings account, non-taxed money. I pay that to you. Let’s say I pay $200 every month to Chad and Revolution Health. I go to the doctor once a month, I pay $200. Think about this.
Pre-tax money, $200, health savings account that you set up, and instead of $800 premium, my premium is $400 a month, and we don’t have something catastrophic happen to us. Now I want to talk about catastrophic here in a second. Okay, which one would you take? Better care at $600 because you’ve got the $200 and then I’ll say a premium still, $400 a premium, $200 directly to you in cash from a health savings account directly to the doctor. I don’t expect any co-pay, because in a health savings account I can hit that deductible in a year of $10,000 if I go to the doctor enough, and then they pay 100% after that.
Chad Edwards: Right.
Brian Wilkes: The equation is, health savings account, $600 a month. That’s one example and that’s being very nice to insurance providers.
Chad Edwards: The numbers?
Brian Wilkes: Very nice to the numbers. I feel like Donald Trump. Very nice. I am very nice. I’m a very good guy. These numbers are very good. Trump makes you believe that everything he says is true. We got $600 on the health savings account. We got $800 on the PPO. Tell me what I’m missing? I’m netting $200 right there.
Chad Edwards: When it’s done properly, you’re not missing anything.
Brian Wilkes: Nothing.
Chad Edwards: That is absolutely the way to go. The problem is is that we’ve been so conditioned to think that, “Oh, you don’t take my insurance. That’s not covered. I can’t do it.”
Brian Wilkes: Right.
Chad Edwards: That’s just the end. It’s a black and white deal, and that’s not the case. One, you have … Most insurance plans have out of network benefits, meaning if you’re in network, it’s a PPO, then you either have a co-pay or a co-insurance. If you go to the doctor and it’s $100 allowable charge, in other words, the doctor may charge you $200, but the insurance says that, “We’ll only allow $100,” but in network they would pay for $100. You would pay, on most of them what I’ve seen, is a co-insurance, so usually like 20% and the insurance pays 80. They’ll pay a doctor $80 for that $100 bill, and then you would pay $20 out of your pocket. If you’ve got an out of network, usually it’s double that. In other words 80-20 versus 60-40.
