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I'm gonna say she'll leave it if I don't stop drinking wine So I switched to whiskey and I'm feeling fine Drinking that smoke smoke whiskey No more wine Street burger, baby you try the ride Welcome back everybody. It's great to have you here. I know we like to have fun and have a good time here at the Two Promises podcast, but we also like to engage in productive social discourse as well. Currently, insurance has been quite the hot topic in the news and in the media and the public mind.
Last December, there was a tragic assassination of UnitedHealthcare CEO, Thompson. And these events have really put a major public concern to the forefront of social policies. There's concerns regarding systemic issues within the healthcare system in the United States, insurance concern, access to mental healthcare, and as a result of the tragedy, security concerns have gone up. There's a lot more posturing going on for security in multiple industries.
So, yes, some of those major changes that have occurred is companies, not just in the insurance industry, but across the domain. They're increasing their security systems, their security measures and policies. It's also brought a lot more advocacy aiming to improve access, affordability and transparency in health insurance practices. And I personally have gone through some issues getting access to health care and I know that many other people have as well.
So it's a very important issue to me and part of what I'd like to do today is introduce an industry expert who can help people who are struggling with getting coverages for the right concerns that they have, help them understand the system a little bit better and hopefully help them get them the care that they need and deserve. So today I would like to introduce our special guest speaker. She is a powerful woman of many talents.
She has doctorate degrees in computer science and electrical engineering. She is an author, a ghostwriter, an entrepreneur, and a health insurance industry expert. So I would like to introduce Dr. Amelie Berry. Welcome to the show. It's good to be here. I appreciate it. Thank you for inviting me. Excellent. Yeah. If you'd like to go ahead and introduce yourself to the listeners, they'd be happy to hear from you.
name is Amelie and as Brett and I discussed, you know, I've been in the healthcare and health insurance industry for the last several years. I actually had a business in Florida dealing with health insurance that I recently sold. saw they're running on the wall that there was going to be problems with Medicare and Medicaid and a lot of people getting miles. And a lot of my clients actually really suffering from the health insurance industry. So I couldn't think good contents keep going.
in that industry making money from it knowing that other people were suffering. We've talked about security, we've talked about cyber security, physical security. So now let's dive into the insurance stuff. because that's another form of security that people need, isn't it? Right? Yeah, and it's a scary thing out there right now, especially with all of these changes. And I think that people are reading the news every day and Medicare, Medicaid might be under threat.
In the US, there's about 72 million recipients of Medicaid right now. So that's a huge number of people. On top of that, there's about 66 billion people on Medicare. both these programs are under threat. So when you're talking with, that's almost 130, 140 million people on two government supported healthcare programs, not to mention the number of veterans on VA programs and the threat of those being cut, the threat of ACA being cut, that serves about 60 million people in our country.
So what, we're over 240 million people through three government programs, well four government programs. a lot of people and yeah, I'm definitely hopeful that we can maintain those programs. Nobody has interrupted any types of access to the care for the benefits that they're receiving. But again, there's, if government goes into default or anything like that's a concern. I was reading an article the other day about, you know, the security and bank accounts and Is it accessible?
Can people pull out of it? And just like you said, you know, there's just a lot of fear and a lot of concern right now. And good ways that we can combat fear is to equip people with education and giving them the knowledge base so that they can replace whatever those fearful and anxious thoughts are with a truth. So, yeah, share. You've done a great job pointing the painting.
the concerns that everyday Americans have, and the concerns that are very realistic that people deal with whenever it comes to navigating insurance systems. My insurance was denied whenever I paid into it my entire life. It happened to me. So I completely understand that there are gaps and fears there.
So that's why I'd really love to hear from you on what, what types of tips and tricks you might be able to offer our listeners on if they do experience a denial or things they can do to maybe prevent those denials. What kind of advice would you like to share with us? I think that there's a few different facets to that. First of all, it depends on your healthcare provider, right? Because some doctor's offices are great. They're going to go to bat for you.
They're going to submit that pre-authorization, right, three or four times. And it might be that the insurance company denies it the first time. And a lot of doctors would just be like, well, you were denied, sorry. know, the other thing is that if the doctor goes back and fills out more information, then that's why that person needs that prior authorization.
I've heard of people that basically had stage four cancer and it took them six months to go through the whole prior authorization process to just get a PET scan which would have told them where the cancer was in their body because it's a full body scan. It's a $14,000 test, right? Well, most insurance companies aren't going to do a prior authorization on that unless people have gone through all the other tests which means that they've had an x-ray, they've had an ultrasound, they've had a...
And if it's a stage four cancer, every day is going to count and that six months can take somebody's life, right? Because they're not getting determined what their actual diagnosis is in time. Now people can go to their insurance company and if they've been denied a second time, they can ask for a review. It doesn't mean that the insurance company is going to do it, but they might. Otherwise you have to escalate. And what that means is going to the Department of Insurance in your estate.
the state medical board sometimes because if your doctor's not doing their job and filing complaints sometimes you've got to go to the news media and that's just unfortunately the way that it is right now one of the very sad statistics that's out there is that there are a of companies that use third-party services to automatically deny these prior authorizations and that's about 30 % of all prior authorization requests are getting denied and these are by billion dollars corporations, right?
So these companies basically go out there, they do an analysis, and they have these algorithms and companies, all the major insurers. So we're talking Aetna, we're talking Cigna, we're talking UnitedHealthcare, we're talking, you know, Blue Cross Blue Shield. They're all going through these third party services that are just basically doing automatic denouncements, right? Because they're saving companies money.
One company out there says that for every dollar that they spend with this company, they're going to save the incurrer $2 on the back end by doing these automatic denials. So there are companies, which are for-profit companies, are basically out there to deny you the service that you were paying for.
And it doesn't matter if you're on the Medicare side of things too, because if you have a Medicare Advantage plan, there are a lot of companies that basically have the automatic denial system, or they basically have a staff program, right? So it might be that you go to your doctor and you say, you know, I've had this pain in my side for a while and the doctor looks at it says, okay, well let's do an x-ray.
Well, the doctor isn't doing the x-ray because he thinks that that's the best diagnostic tool. That's the step that the insurance company has told him that he has to do first. The x-ray doesn't show anything, then you've got to go and get an ultrasound. Oh, well the ultrasound doesn't really show anything. We've done your blood work, nothing was really showing. You are you sure you still have this pain in your side? Well, yes, then you've got to go get an authorization for CAT scan.
Usually that's when they deny. start right because the two other tests are low level they're very easy they're very pain. I went through this personally recently. I had my CAT scans denied by my insurance company they're like no you already had one last year like well a lot of things can change in a year so then of course I had to submit again and got it approved. A lot of people don't realize this that they can change their insurance certain times of the year.
Now for Medicaid recipients, there's only once a year that they can change their insurance provider and they have to do it usually on their state's portal, their state Medicaid portal. For Medicare, people usually can get what is called a special enrollment period. So they can change their insurance during the middle of the year outside of annual enrollment period if they have certain requirements.
So let's say that they went from just being healthy to having high blood or diabetes and they qualify for what's called a chronic special needs plan. So then they're allowed to change their insurance.
If you're stuck in the ACA, unfortunately you're stuck unless of course, you know, for some reason you lose that coverage because you're unable to pay for it or you end up qualifying for Medicaid, but then lose your Medicaid and go back on an ACA plan or if you get a fair cut, people don't have to allow. your employer coverage if it's more expensive because I've seen people are spending $1400 a month. and they could get an ACA plan. over 50 % loss. So you can investigate those options.
Navigate the... You have to be the battering ram and just keep going at those insurance companies and escalating it, especially if your health is on the line, because that's one of the things that I think every year we hear all these stories in the news about how somebody died because they're insured and you catch the cancer in time because they kept getting denied or, you know, they were denied life-saving surgery.
And to be honest, and I've told a lot of people, I wasn't surprised when the UnitedHealthcare CEO was surprised that it hadn't happened sooner. And that's a sad thing to say. So one of the things that I always tell people is that these companies are posting record profits pretty much every single quarter. And the reason for that is because they're making the money. And the reason that they're making the money is because they're basically denying service to people.
Yeah, and that is just just awful. Absolutely awful. A couple of things that you said that I kind of want to ping on just great, great reminders is one, you are your greatest advocate. So be loud, be strong, keep sticking up and speaking up for what you believe is right and to get the treatment that you know you need. And then two, persistence wears out resistance. Keep keep it at it. I said, Hey, we got it in now. All right, fine.
Resubmit or how can we work together to what is the cause of the denial? How can we fix this? What needs to happen so that we can get to that? Yes, that we need so that we can get the treatment. And I know friends, very good friend of mine, his wife was recently diagnosed with cancer right after like stage four, right after they had their, their next child and It was a surprise, it was tragic, and whenever it's caught late, sometimes you don't have the time to get to wait six months.
Like you need that stuff now because that is what you should... The best time to fix it would have been years before, whenever it first started or before. Yeah. And then second best time is right now. things that I'd like to tell people about that is that sometimes it's a matter of changing your provider because if your primary care provider is not going to bat for you and they are not submitting.
authorizations or the responses to denials in a timely manner that will affect the outcome for you because some of their offices are really busy. Excuse me. And what happens is that, you know, they might have one gal in their office submitting all of the insurance claims and all the prior authorizations and that's the least thing on her priority list. We might be number 30 that she's got to get to that day and she didn't get to it so she might get it to the next day of the day after.
So if your provider's office can't handle that for you, then you can ask them, well hey look how do I do this myself? If they're just going to give you resistance. before you actually sign up and change your primary care provider. Do you have people that specialize in doing these prior authorizations and submitting to the insurance companies?
Because if it's just some girl or not to be sexist here or somebody in the back office, right, that's had no training and she's just sitting there trying to navigate the system, that's probably going to end up in a denial. But just for information for people, like there's Oscar Insurance Company, which is an ACA plan. And in 2020, they rejected 66 % of payment requests in Florida. Super shocking, super shocking statistics. about this, how often do health insurers deny patients claims?
And people who Google the article sends you the link so that you can post it in the show notes. But it really demonstrates a lot of the statistics showing where claims are getting denied and things like that. So people have that information because if you feel that you've received an automatic denial, you can go back and have them challenge that.
The other thing is, and a lot of people don't know this, is that doctors that have lost their medical license or have had their medical license suspended sometimes will be hired by these health insurance companies to review these prior authorizations, right? So maybe it's been submitted three times now and it's actually in front of a medical license. He's there working for the insurance company. So you've asked for a review by a medical doctor. Well guess what?
That might be the guy or the gal that's going to look at your prior authorization and determine whether or not you're going to get that test or that procedure. That's pretty mind boggling. Very mind boggling. is, absolutely. And the problem is that insurance commissioners for the various states depends on the state, you know, whether or not they're actually going to be advocating for the people, the consumers in this case, or whether they're advocating for the insurance company.
We know that in some states, they're more insurance company friendly than they are for the actual consumer. And again, you know, you have to look at that. And also, at any time, look at the data for your respective insurance company. Sometimes they publish this information in their stockholders' reports, their shareholders' reports, but you have to dig for that information.
And if you don't have the energy, if you've been sick for a while, there's people that have autoimmune disorders and they can't even get out. to try and go through this information and advocate for themselves can be very difficult. But that doesn't mean that there isn't somebody in their local community that won't help advocate for them. It's just a matter of finding and connecting with those people. That's great. I like a of those points that you just made.
I'm just going to kind of re-synthesize those a little bit, distill them little bit. So we talked a little bit about doing that research up in the van. Hey, I might need to get a new provider. What are some key questions that I need to ask? Hey, do you have somebody who specializes in insurance claims? Do you have somebody who is knowledgeable and does, has the background and the experience to word these things the right way to apply for these, these treatments?
the right way that the insurance needs to see. So you're asking the right questions before you decide that you're going to switch providers and go into somebody else. If you're not asking those questions, you might end up with the same problem. And then that last little point that you said, ask for help. Like I know a lot of times whenever you're in a dark place, you're ill, you're not feeling well, asking for help isn't the first thing that comes to mind.
You feel isolated, you feel alone, you feel scared. But ask for help. There are people that cared. Your life is valuable. We do value life here. I value life. And we are concerned for you. We want you to live. We want you to live purposely. And we want you to live in a way that you're thriving. So ask for help. There are people, there are resources within your circle of friends, within your community that can help you and can get you the resources that you need.
Do you have any resource recommendations that someone could start at or? anything like that that you might be able to share. Sometimes if they go to the Department of Insurance because they're getting pushed back, they will give them the information. I personally, and this is my personal experience, was that I was on social media and I complained about, know, I've been denied again for this test. And there were so many people that came forward and said, hey, you know, what can I do to help you?
Or, hey, here's this phone number, try calling these people. you know, who's your insurance company? This is, you know, what you can do in this situation. And all of the insurance companies have different procedures, right? So sometimes it's just a matter of, and I know it's so hard and you're not feeling well and you're in bed or, you know, you don't want to be talking to that person on the phone.
But if you're as sweet as pie to that one person and you get them on the phone, they will bend over backwards to help you. And sometimes you can just make that one friend at the insurance company. to make all the difference, right? Just calling their customer service people. A lot of them have social workers now so that you can contact them, especially if you have an expensive care list, right? Because let's say that you have a lot of issues going on.
So companies like Humana and Cigna and Aetna, I know all have social workers that will help chronic special needs patients with their care and help them manage and can help them navigate the system. Also just sometimes being nice to your doctor's office. And I know that it sounds terrible, but just taking them in a fruit basket and be like, hey guys, look, you know, I'm sorry, I'm not feeling well. I'm cranky. I might have been rude on the phone.
I didn't mean to be, but I really need to get this authorization please. I really need this test. And sometimes it's just, you know, squeaky wheel gets the most grease, but you gotta attract those flies with a little honey and then with your vinegar, right?
I like the way you put that yep squeaky wheel gets the grease, but hey you add a little honey too that that'll go a long way that is that's right and that's something that I will say I have worked on but I still would probably need to work on is whenever I went through my episode I really struggled with emotional control and I mean I had to get paid money for it you know what I mean but I had to get other services
to basically be that advocate, that intermediary for me because I was having so much issues on my own, just dealing with my own self and I'm not proud of it. It was a very not good place in my life. did a lot of things that I look back on and I'm not proud of. That wasn't a good time for me.
Yes, I needed help and I was seeking help and those barriers were real and they were there, but I'm... grateful that I have been able to get over some of those humps and now like you said just every day if I can just make that consistent effort to whenever I'm engaging with customer service people on in any area health care whatever it is I'm doing is hey just plant those good seeds of optimism of being kind being caring being considerate that can help raise
everyone's everyone's vibrational frequency if you will and you know people will be a lot more motivated to help somebody whenever they are very kind and in a good mood. Customer service is the hardest job and so having been in the insurance industry, I've had 10 clients in a row call me and they've got this complaint and that complaint and they're asking me questions.
like they could have just looked up the information for themselves but they're just being, you know, a 70 year old baby that day and it gets frustrating for me. But then if I get that one person that's on the phone, thank you so much. You've been a big help today. I didn't know what I was going to be able to do with this and you've been... And they just are glowing, thanking you. And that one person makes all the difference.
So I know that I take that attitude into every call that I make for my own health care. If I'm calling my insurance company or my doctor's office, I'm always going to be nice to them because I know that they've dealt with lot of very other cranky, sick people that day. And you get that back because that kindness is repaid to you. I don't think that it's ever not repaid. Absolutely right. And that's a big, thing that I believe in.
it's been kind of talked about in a lot of different ways throughout a lot of different cultures, law of selling and reaping karma, whatever you want to kind of describe that as, but that universal law of, Hey, whatever energy you're putting out, whatever you're selling, whatever you're, you're doing and actively engaging in that will be returned. So if you've got that good attitude, you are being helpful, you are being kind, you are being considerate.
you're training people how you would want to be treated, then that will be returned. It is just a fact of life. It is the way that the world works. And if you don't believe it, I encourage you to give it a shot. Try it out. Try it in your own life and, and see. mean, So I read this interesting article last week and this girl was talking about dating. But it applies in this circumstance too. And she was saying that, you know, a lot of people are very specific and dating.
I want this and I want that. And they have this whole laundry list, right? Well, if all you keep seeing is these negative things, right? I keep meeting these kinds of jerks or these gold diggers or whatever the case may be, but maybe they're not looking for the right thing. So she called it the red car theory. you know, you don't really notice red cars. but if you're looking for red cars, you seem to notice a lot of them. So that's the same in life.
I think that, you know, if we're looking for something, well, I'm only needing really happy people and they're so helpful and that's your attitude. That's all you're going to find is really happy, helpful people. And it does really work. That's a great way to put it, absolutely.
I've heard kind of something along those lines and then there's a little story that I'd like to share of like an old man at the gate of a city and he comes up and you know, got a traveler passing by and the traveler looks at the old man kind of sitting there and says, hey, what's the city like? What kind of people should I expect? he's like, well, what kind of people were there where you came from? they were just the worst. They were terrible, awful. You know, they treated you horribly.
I just had to get out of there. They're, they're awful. said, people here about the same. Next traveler comes up. like, Hey, what should I expect here in the city? What are the people like? Well, what were they like where you came from? they were great. I loved my neighbors. Everybody was kind. We had a great community. Everything, you know, I'm, glad. I mean, I really enjoyed my experience there.
I'm glad I had it, but it's just time for me to move on and just kind of seeing what to expect in the city. And the old man looked at him and said, yep. That's about the exact same type of people that you're going to meet here. And I think it just goes to show like, Hey, what you're expecting, what those intentions you're putting out, what you're looking for is what you're going to take out of more in your environment.
you mentioned earlier that a lot of times, women see a lot of threats in the environment, a lot of, things like that. And I'd say that that's true also for people who've suffered from trauma or have been in a dangerous situations. There's like an evolutionary, whatever you want to call it. We've been. our body has adapted to defend itself.
However you want to describe that transformation and to keep ourselves safe, we're more likely to pick up threats than we are to pick up the good resources and the good things. So if you've suffered from trauma, that's going to be heightened and highlighted, but that doesn't mean that we can't develop our mindset. so that we can key in on those positives so that we can look for and seek the good and the things to be grateful for.
So that would be like one thing that I'm working on, I'd recommend just kind of in general is turning that focus down on the bad and turning that focus up on the good. Absolutely, I mean, they call it the law of attraction. Right? And there's a video, you can watch it on YouTube, there's a whole book about it. But sometimes it is just about what your vibration is. you know, I've been through a lot of personal trauma myself, was sexually assaulted.
And I know how women can sort of develop that mindset that, you know, like every person is a threat. And, you know, why do I even want to go out on a date and this sort of thing that part of it is that you just kind of to open yourself up to the fact that not everybody's like that. Are there a large number of people? Probably, but if you go through life just thinking that everybody is that way, you're not going to be a happy person, are you?
And I think that we come across a lot of people in life who are like, whoa, that person's super negative. Why is that person like that? We have that reaction to them that that's the vibration that they're putting out. It could be because of their life experiences, but sometimes if you just sit and talk with that person. They don't, they aren't consciously recognizing that they've put that out there.
And I've had conversations with older folks and you know, some of them went through the Vietnam War and they were treated badly when they came home and that developed their mindset that the entire world was against them. And then just to sit and have that conversation with these warriors, you know, that went through horrific things in Vietnam. And they're like, you know, I never looked at it that way. I just, you know, I just. I my shell and started living in it sometime in the 70s.
Here we are 40, 50 years later and they still have that shell, that wall built up around them and that negativity that they put out in the world. But then you meet other people that have been to war and things like that and they have a completely different mindset that every day is a gift and that every person is special. And they look and view the world differently. So we do sort of to adjust our mindset and it's not an easy thing because Basically, we have to reprogram ourselves.
We can get into all tangent about neuro-linguistic programming here, but we'll have to save that for another day. Totally understand. We'd love to have you back on DiveBupro and a lot of these topics. I really do like the turn that the conversation took. I really enjoy it. Just kind of wrapping things up a little bit. We've got a little bit more time, but before we, you know, conclude, I'd like to check in and see back to the insurance topic.
What do you think some of our biggest challenges are moving forward in that realm? think that the next six months are going to be really interesting. We have those and they're going through and they're cutting a lot of different expenses in the government. I'm not going to say one way the other how I feel about that. I will say that people are going to have to educate for themselves and for their health insurance. Now I've lived in the United States for a number of years.
I lived in Australia under socialized medicine for 14 years and I never say these words, but I actually believe that universal healthcare will end up costing our government less money than if we did have it. Because right now we have all of these insurers, they're all for-profit, they're very profit-driven, right?
And they want to increase that earnings per share for their shareholders, but that means that people's healthcare is suffering, and that's one of the reasons why healthcare is so expensive in our country. So, know, Medicare and Medicaid are cut. We're going to see a lot of people suffering. There are people that have what is called dual special need plans. So they have Medicare and Medicaid.
And that's really the only way that a lot of people get groceries is because a lot of these plans, through these insurers, issue a grocery card so that people can try to eat a little bit healthier because they might not qualify for EBT SNAP benefits. And it's scary sometimes at iPads. seniors and disabled people make their insurance choice based on that card and how much money they were getting a month from the insurer for that grocery card.
That was the entire basis for their health care decision. When I tried to point out, well, know, this company has some challenges with prior authorization and this and that. And that to me is really frightening. And if there are changes to ACA, the Affordable Care Act, we're going to see a lot of people that are basically going to be losing their insurance coverage and they have chronic health conditions. And then there's going to be an even greater burden on the state system.
So these next six months are really critical to the future of insurance in our country and that I tell people every day, make sure that you're paying attention to what's right now because this is going to not just affect you but your family and your economic stability for years to come.
I've seen people that you know didn't know how to navigate the Medicare system and one elderly couple they were in their 80s they lost their home they lost their life savings and they ended up homeless at 80 years old because they didn't realize that with Medicare they were going to be at 20 % of their medical expenses with no cap. So if you have a $500,000 cardiac event, well guess what? You're on the hook for $100,000.
If you have a million dollar cancer treatment, you're on the hook for $200,000. So a lot of people think, oh well, you know, I'm going to be fine with Medicare, you know, once I have it. And that's not the case. And that's why, you know, there's all these different products like supplements and then there's a Medicare Advantage plans which can provide a maximum amount of So, you know, here in Florida, there's one plan that basically $1,700, they've reached their max out of pocket.
And that worked to the advantage of one of my friends, his mother, he moved her down here from Tennessee, and she ended up in the hospital five times and in a skilled nursing facility. And once they hit that max out of pocket, they were done paying and she ended up having $3 million in medical bills. So people need to be really mindful of potentially a catastrophic... financial losses and that's what the Affordable Care Act too because people think well you know this deductible to me.
Well, no, you don't have your deductible. Once you hit your max out of pocket, you might end up having to pay a lot more than you think. So, you know, if your max out of pocket is $500,000 on your plan and you've had a $500,000 heart attack, well, guess what? You're going to have to pay a large share of that $500,000 even after you meet your deductible. That's absolutely, absolutely tragic concerning. And I mean, it really does highlight that there is, there is a big issue here.
There is a systemic issue here. Whereas where can we find the balance of, okay, yes, companies need to be profitable, but they also need to provide the services that they claim to provide for their customers and for the consumers. So there is, it is going to be very, it has been, it has been a rocky time to live in and like you said there's a lot of things going on right now that are creating more uncertainty and that are rocking the boat a little bit.
How that plays out obviously no one can tell the future. I am trying to be as optimistic as I can. I want to be optimistic and hopeful that people will see common sense that people will take the lesson learned from some of these tragic events and from the reality of the situation and that Pro consumer policies will be put into place. be going through my system of insurance. It ended poorly.
So that is a concern that I have for some things that are controlled by the government, just from what I've seen in my own life of how easy it was for just a small person, group of people, maybe even just one person, their unilateral decision to completely change. my life, my access to treatment, my access to healthcare, and there was no advocacy. There was no place that I could go to be a whistleblower, to declare fraud, waste and abuse, to do any of those things.
So there's the concerns on that end of if it's so rampant and so easy, those are issues that would need to be addressed if we go to a Like you said, they pick a universal or government kind of provided healthcare, that is an issue that needs to be addressed. So on both sides, I see some serious concerns and challenges, but also opportunities. Go ahead. sounds scary. In Australia, they have a hybrid system, right?
So everybody pays 3 % of their income towards universal health care, which means that I can go to a doctor. When I was 16 weeks pregnant, had an emergency appendectomy. I didn't pay a dime. In that respect, that universal health care, 3 % of your income, when you stop and look at what people are paying for their health insurance right now, or what they're paying towards Medicare right now, that's an actual reasonable amount. think that that's why people get hung up on it.
But then there's also the private system. So you can have what they call the extras. You can have vision and dental, or if you want to go to a private hospital or see a private doctor, you can pay a little bit extra for that insurance. And, you know, it's not cost prohibitive to have the private coverage. it's a two-tiered system there in Australia.
Now, they do mandate that if anybody over the age of 30 at least have ambulance coverage because they don't cover that as part of the universal health. care system there. For a lot of people, think that that's a system that would work. mean, what we're spending on VA healthcare, Medicaid, Medicare and ACA right now, would basically be the equivalent in cost, if not less, if we were to go to more of a universal healthcare based system.
And that doesn't mean that quality of care is going to suffer. Now I survived my appendectomy. And for people that are on Medicaid, right now a lot of them have to go to doctors that take Medicaid and a lot of those doctors are seeing 80-90 patients a day. I have a friend that is a pain management doctor and he sees 70 patients a day. Now, can you effectively...
Right, I mean can you effectively treat anybody, manage their chronic pain conditions if you're seeing 70 patients in a day and you've got a 10 hour day that's seven patients an hour break that down. And all the back-end paperwork and everything that goes into health care in general, it's mind-blowing office and well that's the reason why. And you know a lot of people are going more towards these concierge type doctors where they're not taking insurance.
There's one doctor near me who takes about $300 a month right. As a concierge doctor I've got to pay him if I wanted to use him as my doctor but I have 24-7 access to him and the other doctors in the office so I can text on a know Sunday night say hey I'm you know showing signs of strep throat when I'm going be able to talk to them.
So private health care is probably the next part of the evolution and we might have to have that tiered system, but it's not sustainable the way that we are, particularly not with for-profit companies that are basically denying people coverage just arbitrarily or determining that, you know, like one lady I knew, fell and broke her hip.
Well, the insurance company determined that she was only going to get six weeks in a skilled nursing facility and that she could be back at home at the end of the six weeks, but she had other conditions, right? said no you're done at six weeks and we're not paying anymore beyond this six weeks.
Well she made it home she fell and her hip again the other hip right and then she died three months later and that was entirely right and you know I have a good friend who's a therapist you know I had her boyfriend this was three years ago he was in a treatment facility for substance abuse and he got 28 days and they said no you should have all the tools now to um
be able to go out and handle your drug addiction while three days later he was dead, right, after discharge because it was just an arbitrary decision made by their own. So we need to change the system. A lot of times that means people having to push and push and push with the insurance company. And sometimes it feels like you can't push any more than, you know, have a friend, have a loved one, co-worker, somebody call and advocate for you if you just don't have the strength to do it.
because I think that's the only thing that's going to get people over the line until the system changes. Absolutely. Thank you for sharing all that. We talked a little bit about the biggest challenges. Thanks for putting all that input in. What do you see in the opportunities? Well, know, while there's challenges, are there any big opportunities that you think that we might be able to look at or consider moving forward?
unless people repeatedly are calling and emailing and faxing their congresspeople. And, you know, Einstein said that the definition of insanity was doing the same thing over and over again and getting the same results.
While we've had people in Congress that have been there 20, 30, 40 years and we haven't seen a different result, we need to start advocating for those different results because, you know, the future of When you have 240 million people across, you know, for government health programs, right, Medicare, Medicaid, ACA, and VA. So that's a large percentage of our country that needs to start advocating for a better system. Absolutely. That's a good point.
It's advocating for the changes that you want to see. If you aren't advocating for it, it's not being heard. There's no voices being heard. So yes, I'm in weekly conversations with my congressional office on a myriad of issues and healthcare is one of them. That's a big thing that I'm really hoping to find some positive improvements on. So I would...
Encourage you do the same if there's something that you're passionate about if it's a health concern, whatever it is doesn't necessarily have to be health related but Congress Won't make any changes unless they know that there's enough of a problem enough of their constituents are concerned about it and That's really the only way to get your voice heard and to get some of these big things done I would also recommend like getting into that if you've got
curious about something that went on that day. know I've said a lot, but the congressional record that will show you exactly what was debated, exactly what was said and exactly what was decided on because there is a lot of divisive media. There is a lot of divisive news. There are a lot of all of the, you know, the, the extremes is what generates profits. The extremes are what's making these media companies money. Right?
So whenever they have their ways to just kind of like, pull at emotions and pull at people's strings and get them all riled up either one side or the other, one way or the other, it doesn't help us to be able to process things intellectually without a huge cloud of our emotions involved. So you would be, I was very surprised.
So I feel like you would be quite surprised if you did kind of look at that congressional record and read it over and see exactly what was said versus what the newspaper headlines. said that they said. You might find yourself in for big surprise there. One of the things that ends, I'm not sponsored by this website at all, but it's called Ground News. And Ground News is a website that basically pulls from all different resources, right?
And it basically gives you a little meter, shows you whether it's left or right balanced. And I'll tell you this left, center, or right. So if you pick a particular topic, so let's just say US... politics, right? And then pulls up articles from all the different major news sources, whether it's AP, Fox, The Hill, and it's going to show you articles and it's going to tell you whether or not it's right or left based, things like that. And it's very good website.
I recommend to people that they basically have a look at it, right? Because it's going to tell you if your coverage is balanced or not on a particular story. So you can find sources that are side of what's called the mainstream media or the biased news media to find the, you know, balanced coverage so you're not being manipulated. And that's the thing, right? Because social media manipulates you, the news manipulates you, even YouTube and its algorithms manipulate you.
But ground.news is the website that I've come to really rely on for just finding more balanced coverage and things that has really opened up my mind about a lot of different things. that's fantastic. Thank you for sharing that resource. I'm definitely going to check that out and see. you the link. Awesome. And I think you can get 40 % off. I'll have to send you the link for it. Fantastic. Fantastic. All right. So, man, we've had, we've touched on a lot of really great topics.
We've seen some, some different views and different insights from across the spectrum.
as we wrap it up, one last little nugget out to, the listeners, what resources, I know you've recommended a lot, but just kind of the things that pop off into the top of your head that you want to just leave them with, they don't get anything else from, from, all the great talking points that we've had today, what resources would you recommend for someone who is struggling with their health or their insurance, insurance realm of their life?
First, you have Medicare or Medicare and Medicaid, find yourself a good insurance broker. Don't call a particular insurance company because they're going to try to get you to buy their particular plan. A good broker will know all the different plans, whether you're Medicare or Medicare and Medicaid, and they can help you to navigate the system. And they're going to be your first point of contact. If you're an ACA, Affordable Care Act person, recommend that you go and you get a broker as well.
The reason is because when you're calling a call center they don't care. They've sold you on whatever plan they've gotten their commission and then that's it they're done with you. Whereas a broker is going to help you if you need an advocate in the VA system really I think that you need what is it the veteran service officer to sort of help you navigate. people in-house at the VA, they try to help.
But sometimes, you know, they're just overworked and underpaid government workers, so they might not advocate for you. each particular branch, I know, has their own VSOs. Or you can go to the VFW. They have VSOs as well, and most of those people aren't going to charge to help you advocate for your own health care in that system. Excellent. Thank you so very much. These are great great pieces of advice and tidbits for people to practically use and put in their toolbox.
I would like to thank you again so very much for coming on the show. It was a pleasure recording with you and I'm excited to work with you in the future and get some more great episodes out. Thank you very much. Thank you for joining us today on this curious roller coaster of life. If this is your stop, please exit peacefully and enjoy the rest of your day. If you're ready for another one, just push play. Just a final note before you go, thank you and thank you for feeling.
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