12-6-24 - 7am - Health Insurance Hate

Episode Transcript

Speaker 1 (00:01):
Morning boys.

Speaker 2 (00:02):
Hey Mike, I don't wish death or evil upon anybody,
but I will say I just went through it with
United over a claim.

Speaker 1 (00:11):
For my son. He was hurt in a football.

Speaker 2 (00:15):
Game back in October and had limited feeling and movement
below the waist. Well, instead of going to the hospital
out by Keensburg, we came back to the hospital closest
to the house. They tried to deny the claim first
because the injury happened at an opposing.

Speaker 1 (00:36):
High school that wasn't his own.

Speaker 2 (00:38):
Then they denied part of the claim because they said
he didn't need a CT.

Speaker 1 (00:43):
Scan of his spine, which he absolutely did.

Speaker 2 (00:48):
They finally decided to pay up about, oh, I don't know,
two days ago.

Speaker 1 (00:55):
So yeah, healthcare in America is a joke.

Speaker 2 (00:58):
But I'm sure his claim will he paid out expeditiously.

Speaker 1 (01:02):
Have a great day, fellas.

Speaker 3 (01:05):
See, that's the insanity. So they initially denied the claim
because it a kurt at a high school other than
the high school where he goes. It's health insurance, it's
not workers comp It's not like it was it was
he was he on the job site or not on
the job site?

Speaker 4 (01:24):
That that makes was he performing active job duties or not.

Speaker 3 (01:28):
Yeah, I mean it's just insane. I truly despise the
healthcare industry in America. I do you know Tamer's dad
used to warn about uh. I mean, you know, he
he did some studying in Europe, so he knew what

(01:51):
socialized medicine was like, and it was one of his
big bugaboos. And here we are just slowly, you know,
tumbling our way right into socialized medicine. But it's it's
actually I would say the current state of health care
in this country is worse than socialized medicine. You take

(02:16):
some smaller countries, some more homogeneic countries, you know, Sweden
or Denmark or Taiwan, that are smaller, much more homogeneous,
that they're able to they're able to make it work.
The National Health Service in the United Kingdom broke and delays,

(02:39):
denial of treatment horrific. So it depends on a lot
on the side of the country. It depends a lot
on the just the healthfulness of the country. And then
you think about all of the illegalaliens and the migration

(03:01):
of peoples into a country that have a completely different
standard for their own personal health care, and soon the
cost begins to skyrocket.

Speaker 1 (03:14):
I have.

Speaker 3 (03:18):
One of my doctors want me to switch and try
a different sleep medication, so I did. Now I want
to give you an exam. I'll just tell you it's
it's Cuvivic. Cuvivic is a new class of sleep medications
as opposed to ambition, which is almost like putting the

(03:42):
brain in a hypnotic state. Cuvivic is works on it.
And the doctor explained it to me, and I've since
forgotten the explanation, but I remember that the zobodem, the
ambient drugs work by putting the brain in a hypnotic state,
which is which allows you to get into a deep

(04:02):
rem sleep. But these new class of drugs, and I
forget what the the actual name of the drug is,
but the brand name is Cuvivic. Well, Cuvivic costs something
like fifteen hundred dollars per month for thirty pills. Yeah,

(04:26):
I think it's more than fifteen hundred dollars a month,
but it's it's an outrageous amount and my insurance company
would not cover that medication. So I appealed it and said, look,
chronic insomnia, I've been taking these other drugs for well
over you know, fifteen twenty years, and the doctor wants

(04:50):
me to try this because it's less stressful on the brain,
and Lord knows, there's enough stress on my brain as
there is. And so with the condition, with a diagnosis
of chronic insomnia, do you need to cover this? And
to their credit, they approve the coverage within forty eight hours.

(05:14):
But you want to know what the kicker is? How
much you think they'll pay dragon fifty Let's just say
I think it's more than fifteen hundred. Let's just say
it's fifteen hundred dollars a month for a thirty day supply.
How much do you think they would they would cover?

(05:34):
That's that's pretty close. It was somewhere between two and
three hundred dollars a month, so I would still be
out of pocket anywhere between twelve and sixteen hundred dollars
a month. Now, I'm in one of those plans where
it's tiered, so you know, for until I reach a
certain dollar amount, they only pay that. Then when I

(05:55):
reach a certain next dollar amount, they'll only pay that.
But when I reach the cat only when I reach
the cat catastrophic dollar amount, well, they fully cover the
costs of the drug. Well, I can only reach the
catastrophic dollar amount because it's so high over a period
of three years, which they don't do it because they
do it per calendar year. So I'm never going to

(06:17):
reach the catastrophic amount, so they're never going to cover it,
even though the ambient is fully covered at a zero
cost to me. But what now, get this? So I
wanted to try the drug. Now, the drug company itself
has a program because they obviously want people to start

(06:39):
trying to drug and they want to get as much
market share as they can. But I don't qualify for
the drug programs, you know, benefit because I'm at the
age where I have to. I have to. I have
to take Medicare because i heart won't let me stay

(07:00):
on their plan since I'm qualified for Medicare, so I
have to go on Medicare, so I can't take advantage
of that. So then we looked at good RX. Now,
think about this good What does good RX do? Good
RX simply goes out and negotiates for their members or

(07:22):
for anybody that wants to use their coupons. You don't
have to be a member, you don't have to be
a gold member. You can still use their coupons. So
then they negotiate their own price. Guess what the guess want.
The price through good RX is for Qvivic just using
a gold X, I mean a good RX coupon one

(07:47):
hundred and thirty five dollars a month. So rather than fifteen, sixteen,
eighteen hundred dollars a month, which is the retail price,
or versus the you know, eight hundred to one thousand
dollar dollars a month which is the insurance price, I
can go to this other group and get it for

(08:07):
one hundred and thirty five dollars a month. Now, think
about the spectrum of prices there that is ridiculous, and
that's because of the pharmacy benefit managers the PBMs, the
middlemen who negotiate drug prices on behalf of the insurance companies,
and they all get kickbacks. And by kickbacks, I mean

(08:31):
they get commissions, they get up a percentage of you know,
whatever they whatever they sell. It's stupid. Well, now let's
go to this assassination of Brian Thompson on Wednesday, killed

(08:53):
by a mask assassin. He's left his Manhattan hotel. He's
headed to the Hilton where they're having a finance conference
of some sort the bullet casings contain the words delay, deny,
and defend, which also had to form the title of
a book exposing common malpractice within the insurance industry. Go

(09:16):
google it, delay, deny, and defend health insurance industry. United
Healthcare is the largest insurer in this country. Do you
know what they made in profit last year? Three hundred
and seventy two billion dollars in profits with a B.

(09:38):
That's with the B, three hundred and seventy two billion,
almost half a trillion dollars in profits, through which an
estimated five they have twenty two holding subsidiaries, through which
an estimated five percent of the United States grow domestic

(10:00):
product passes every single day. That is a monster of
a company. Monstrous. That's why I see this story over
here on Drudge about he makes a million bucks a
year to be really, that's all you had, three hundreds. Look, somebody,
you need a new agent, You need a new employment

(10:21):
contract lawyer, because if you have if you're the CEO
of a company that's raking in three hundred and seventy
two billion dollars in profits and all you're making is
twelve million dollars, you don't have a very good negotiator.

Speaker 4 (10:32):
I'd like to think there's some kind of bonuses or
something involved in there.

Speaker 3 (10:35):
Or there's got to be something else I just can't imaginify.
And here's a jet right, yeah, exactly, Here, here's a
new G seven something. There's got to be something. So
The New York Times points out that, you know, all
the other insurance companies, you know, all expressing their condolences,
and you know, talking about how smart he was, and uh,

(10:57):
you know he was. And there are stories that talk
about again I want to mention his name because I
don't know the guy Brian Thompson, but there are stories
out there that describe him as one of the unique
individuals that recognizes that healthcare industry in this country is broken,

(11:21):
and that he knows that his company is way about.
In fact, they're the number one in terms of denials
of claims in the country, so they're the worst of
the worst, and they're making three hundred and thirty two
billion dollars through their company and all their subsidiaries. So
he knows the system, or he knew the system was broken,
at least according to some stories. I don't personally know that.

(11:46):
Now there are course ordinary and I think respectful things
to say in the aftermath of anybody that's assassinated on
you know, whether it's you know, you're a CEO or
you're a ditch digger doesn't make any difference to me.
There are just some certain social norms in which we
ought to recognize that look, this guy. There are also

(12:10):
stories about, you know, which always happens when you know
somebody of this of this stature, or of this notoriety,
when something bad happens to them, and then all the
bad things in their lives starts to come out. He
may or may not have been having an affair. He
and his wife may or may not have been living
together while pretending to live together. There be any number

(12:33):
of things, all of which I consider to be completely immaterial.
But that's the kind of stuff that starts coming out.
And then with social media, then you start getting things that,
again which I really do think are a little distasteful,
but I have to admit, are a little bit funny.
And what was the one line about thoughts and deductibles

(12:59):
to the family. Unfortunately my condolences are out of network.
Now you have to admit that's pretty damn funny, and
that pretty much sums up exactly how many people feel
because how many people have gotten exactly the same thing. Well,
you haven't reached your your deductible or you're deductible has
gone from one thousand dollars a year to eight thousand

(13:20):
dollars a year, and your policy has gone from eight
thousand dollars a year to twenty three thousand dollars a year.

Speaker 4 (13:25):
Well, just our talkbacker that left that talkback. Yes, whether
it may have happened to you personally or not. If
it hasn't happened to you, then you know a friend
or a coworker or a family member that it has happened.

Speaker 3 (13:37):
We all know somebody that this is happening too. But
there's a larger issue going on against one news anchors
reminder that mister Thompson was a human being with a family,
came this reply, The people who died because you know,

(14:00):
und Healthcare denied them coverage are also human beings with families.
And then Tim Poole, a podcaster that I happened to
follow on X acted as one of these how would
I describe it? Drawing attention to the controvers controversies that

(14:25):
had been generated during mister Thompson's tenure at United Healthcare,
the fact that United Healthcare had the highest claim denial
rates among major insurers at thirty two percent, or that
the AI model that United Healthcare uses to review policies
for elerty patients was known by the company to have
a ninety percent air rate, which had the effect of

(14:50):
overriding determinations made by the doctors by the doctors of
the very patients they insured. You see this as just
a total clue f United Healthcare has also been embroiled
in anti trust investigations by the DOJ and mister Thompson
guess what sold his stocks before the case was made

(15:13):
public That prompted a suit by the firefighter's pension for
fraud and insider trading. So then another personal X asked
this question. Was he about to take a plea deal
and reveal all about congressional favors that gained them their monopoly?

(15:33):
You see how all of this is intertwined. Even in
times of simmering anger on the part of a lot
of people against the few, the corporate class in this
country has always been pretty well protected from popular reaction
by a political culture that more often than not looks
past the excesses and gives them the benefit of the doubt. Now,

(15:58):
I'm not anti corporate. I you know, do I think
Google and Apple are huge corporations? Well, duh, I've made
a lot of money off Apple Corporation. But I expect,
and Adam Smith expected, that capitalism had to have a

(16:20):
moral foundation in order to really be effective and for
free markets to thrive. And I think we now live
in such a culture that government is so intertwined in
everything that we do, and it's a two way street.

(16:41):
United Healthcare, like any other company, doesn't want to be lunch.
They want to be at the table for lunch, but
they don't want to be the lunch. So they engage
with Congress, They engage with the administrative state to get
the rules regulations that they want to protect their rear ends,

(17:02):
to protect their asses, while they go out and do
everything they can to maximize their profits by denying claims
and doing all the things that you would think that
an insurance company would be. Okay, look, guys, we think
a reasonable rate of return is X whatever that is,
let's just say ten percent. We need a rate of
return of ten percent on everything that we do.

Speaker 5 (17:26):
Well.

Speaker 3 (17:26):
Instead, they don't care. They simply don't care. So the
fact that the murder of a CEO elicits such unbridled
celebratory reactions from ordinary just ordinary Internet users, just ordinary
Americans like our talk about whose son's injured, injured, partially

(17:49):
paralyzed for a while gets denied. Yeah, and again it's
because they're so intertwined with government, and government is so
intertwined with them. It's a two way street. Just yesterday,
I couldn't even tell you what the story was, but
the story started out something along the lines about the

(18:13):
federal government is considering X. And I remember thinking, at
the very moment they said the federal government is considering X,
I thought, my god, how infused is our society with
government now here? Maybe there's not enough government, or it's

(18:33):
the wrong kind of government because or maybe there's a
you know, maybe United Healthcare has gotten too big. Maybe
the entry into the industry has been has become so
exorbitantly expensive and difficult because of all the regulations and

(18:54):
the rules of the administrative state that they've killed off
the competition which allows it to become the largest in
the country. What was it, three hundred and thirty two,
three hundred and twenty two billion. What are three hundred
plus billion dollars. I'm not surprised that there is such
a backlash because I think there is an awakening going

(19:17):
on in America, and that awakening is this government and
big pharma, big healthcare, big tech, the cabal, big media
are out of control, and I think the populism that's
exploding can help fix some of that.

Speaker 5 (19:38):
Earlier this week, Anthem, Blue Cross Blue Shield had announced
that they would not pay for anesthesia if surgeries were
taking longer than the standard expected time. So literally, you
are under in the middle of surgery and then they're
going to have to pull the anesthesia if it's not
going to be covered by insurance. That decision was reversed

(20:01):
after a huge outcry from the public.

Speaker 3 (20:05):
So I was trying to explain to Dragon because of
some of the text messages, Yes, sometimes you're better off,
which shows how stupid insurance is. You're better off telling
someone where is the Where's that? A second text? Yeah,
the second one? Eight nine four nine, Mike, I'm forty

(20:26):
three years old, healthy family of four one thousand dollars
per month five thousand dollars deductible per individual, So I
need to keep twenty thousand dollars in our HSA in
case we're all in a car accident. We've never made
a claim. I needed surgery on my wrist. I told
him I don't have insurance, so I paid eighteen hundred
dollars cash, including anesthesiology. What a joke. So Dragon's reading that,

(20:52):
he goes a wait, wait, man, I didn't know that
was a thing.

Speaker 4 (20:55):
You can just go to the doctor's off and say, hey,
I want to pay cash. How much is this going
to be.

Speaker 3 (21:02):
The reason that doctors will do that? Now, when it
comes to Medicare, you got to be careful because if
I understand this, and I may be wrong about this,
but a Medicare patient cannot pay cash or a doctor
cannot accept cash if you're a Medicare patient, because well,

(21:26):
because that's just the way Congress has written the rules.
I shouldn't say, Congress, that was stupid on my part,
because that's why the Centers for Medicaid Medicare Services has
written the rules. That's the way the administrative state has
written the rules. But yes, here's why. Oftentimes it's cheaper
to pay cash because now the provider, whatever that might be,

(21:52):
doesn't have to go through all of the claims process.
They don't have to wait for their money, and for
the money that they're going to get maybe less than
what you're going to pay in cash. So the doctor
agrees to take United Healthcare. United Healthcare agrees that here's

(22:12):
what they'll pay for certain procedures office visits. You know,
a wellness exam, or you've got a rash or a bruise,
or you've got a broken finger or whatever. Here's what
they over here for the for the provider, here's what
they know the insurance company will pay. So if you

(22:32):
walk in and say, look I got a jam thumb
or a broken thumb or whatever, you know, whatever it is,
but I want to pay cash. I don't want to
go through insurance, which saves you the claim against your
insurance and may actually be cheaper depending on what your
deductible is. So you pay cash. So everybody's a win.

(22:53):
Is a winner there, which shows how stupid this whole
thing is. I now, I wasn't aware of this. Fifty
two thirteen, writes Michael, there's an entire black market where
patients and families swap and trade cancer and terminal disease medications.
Some of the meds are thousands of dollars per pill.

(23:14):
My wife and I took care of a family member
on dialysis for five years. The kidney transplant came in,
and you see health required the COVID vacs. You mean
the covid JAB because it's not a vaccine required the
COVID vacts or it wouldn't be covered by insurance. I

(23:34):
can barely go on with the rest of the text
message because of how insanely maddening and how much that
pisces me off. They continue. The kidney worked great, but
the cancer returned fourteen days after the vacs and everything

(23:55):
went downhill from there. Speaking from experience also working thirty
years as a paramedic, the majority of chronically sick people
must utilize uninsured means to survive, and most died bankrupt.
This is absurd forty four to sixty seven Michael. My
husband didn't check a box about me not having other insurance,

(24:19):
so I got bills showing the cost before insurance. Unbelievable.
It does give some credibility to my patients who want
to be treated like they are at some all inclusive,
five star resort, so I get because I can't. I
can't use Iheart's health plant anymore. Interestingly, because Medicare doesn't

(24:40):
cover dental or vision, I can use Iheart's dental envision plant.
In fact, I just I was at the dentist dentist
yesterday getting my getting my six month cleaning and at
trays and stuff paid for by whoever the carrier is
on iHeart. I don't know, I don't care. So because

(25:03):
I can't on the health plan, I have to go
through Medicare. Of course, I have a supplement or a
gap policy or whatever you call it, and my son
in law, who is who is indirectly in the business,
takes care of it for me. So I just said, look,
I just want a plan where I don't have to

(25:23):
worry about paying anything. I just if I get hospitalized,
I just want to be able to walk out of
the hospital and not worry. So I pay a little
extra for that so I don't have to worry about it.
But what happens is every time I have any sort
of procedure or a doctor visit or something, I get
this statement from Medicare. As I was explaining to Dragon,

(25:44):
it shows the procedure or the office visit or whatever
it was, it shows what the doctor charges for that.
And again let's go back to it's a broken finger,
so the doctor for the X rays and everything else
that they're all itemized things, is a total of five
hundred dollars. Then the next column shows what Medicare pays

(26:09):
for that. And let's just say the total, not the
individual items, but the total is five hundred dollars. Well,
on what Medicare pays, the total might be one hundred
and fifty dollars. So there's a three hundred and fifty
dollars difference between what Medicare and I'm talking solely about
Medicare what Medicare pays. So when a doctor looks at

(26:33):
a Medicare patient, they're looking at, oh my god. So
now I've got a file with Medicare, and I certainly
hope that he has, you know, a medic gap or
an advantage or some sort of policy to cover that difference,
which of course that I do because I don't want to.
I don't want to pay that difference. That's what I
thought insurance was. For what Medicare pays doctors is an

(26:58):
absolute pit. But nonetheless, that's that's the system we're operating
under at some point this system is going to collapse.
And yes, it goes back to Obamacare and these stupid exchanges.
I have a friend who is on the exchange, and

(27:23):
when he tells me what he's paying for his insurance,
I have to bite my lip because I know what
I pay for my Medicare premium, which is higher than
you might think it is because of my income. And
then what I pay for my whatever the stupid plans called.
I never can remember whether it's a gap or an advantage,
but whatever I pay for that extra is still probably

(27:48):
ten times cheaper than what he's paying on the exchange
because of previous because of pre existing conditions, nobody else
will insuring, so he goes on under the extra change.
And again, and somebody else pointed this out on the
text on the text messages. This is sixty five thirty

(28:10):
five Michael in general healthcare, emphasizing the word care is
just fine in this country. Yes, why do you think
most people come to this country for medical treatment? Because
we have the finest doctors, we have the finest equipment,
we have the finest technology, We're the most advanced in

(28:31):
terms of health care. That's not the problem. The problem
are these systems that are built up around it. And
so when you've got I mean, you think about everybody involved.
Tammer's dad. Now, of course this has been a long
time ago, with principles the same. For a long time

(28:54):
he was a sole practice. Well he had other partners,
then he was a sole practitioner, and as he got
older he brought in another doctor. So you know, each
doctor had their own nurses. But then the clinic itself
had had one or two people who did nothing but insurance.

(29:15):
So you have two salaries just to process claims. So
whatever you get paid by a claim, if you get
one hundred dollars paid from an insurance company, you have
to deduct your overhead in terms of just figuring out
what your net profit is, you have to deduct the
costs of those staffers that take care of the claims.

(29:41):
So this is why both of my doctors, both my
primary doctors, have both chosen to go concierge. They don't
accept insurance. They are they're not a part of any

(30:03):
sort of network or anything else other than a private network,
because they're tired of being told by insurance companies how
to practice medicine. They're tired of having to do check
bock medicine. Okay, you came in with this, or my
diagnosis is this, and so I'm allowed to do these

(30:27):
five things if I want to get compensated at all
for seeing my patient. It's utterly absurd. Now I'm considering
talking about my sleep medication. I'm thinking about because it
when when I first I've tried it. For I'm in
my third month of trying this new sleep medication that's

(30:48):
costing me one hundred and thirty five dollars a month
versus the if I were going through insurance would cost
me an excent almost two thousand dollars a month. But
because I'm using good RX, it just costing me one
hundred and thirty five dollars a month. Now, initially I
thought it was working pretty well. I'm beginning to think
that it's not working nearly as well as the ambient was.

(31:08):
So I'm thinking about going back, which doesn't cost me anything. Now,
think about big Pharma, Now, why do they charge that
much money for a medication. Well, one, they have all
their R and D costs that they have to recoup.
They have, you know, all the liability they have with
a new medication, and they've got to start getting market share,

(31:31):
and then Medicare and all of the supplement policies go
in and negotiate what they're willing to pay for that medication,
So they got to make up that difference somewhere. I mean,
it's it's all a big, giant once again scam. It's
just a big scam. Yeah, two zero five nine, Mike,

(31:52):
I had a prescription refill and it was much cheaper
using good RX instead of my insurance. It's all completely stupid. So, yeah,
it's not the care because I think we have some
of the finest doctors, some of the finest hospitals, some
of the finest facilities, and some of the finest break
times in the country. But what's the problem. Everything that

(32:14):
comprises that entire.

Speaker 6 (32:16):
System, Tom, from South Dako to medical insurance is just
a freaking mess. I went to Stedman's clinic for a
procedure that I paid out of pocket, supposedly not covered
by insurance, and they charged me in Medicare, which really

(32:38):
pissed me off because now I own Medicare more money
for a procedure I paid for out of pocket.

Speaker 3 (32:44):
What a bunch of crap. That seems like fraud on
the part of the provider, because if you were a
cash patient and you paid cash and then they charged Medicare,
then that's Medicare fraud because you've already paid for the

(33:07):
services based on their pricing to you, not the Medicare
I would I'd go to the provider. I'm not getting
legal advice. I'm just saying what I would do is
if I found myself in that situation, I'd walk back
into that provider's office, clinic, or whatever it is and say,
wait a minute, when I came in here for whatever

(33:28):
this procedure was, I came in here for a procedure
and told you I was a cash patient and I
paid cash, and then you build Medicare, you're double dipping.
You want to call Medicare and clear this up? Or
do you want me to call Medicare and clear that.
Oh here's a great example. Seventy one seventy one Michael

(33:49):
MRI for my neck. Inch Insurance paid twenty eight hundred dollars.
My co paid was four hundred and fifty one dollars.
Then another MRI for my neck at the same facility
I paid for out of pocket four hundred and fifty dollars.
So how much does an MRI really cost?

Speaker 5 (34:10):
You?

Speaker 3 (34:10):
See, that's the problem. Nobody Now they know because they
know what their cost is. They know what their cost
is based on Okay, if you're gonna pay cash, our
cost is let's just say their cost. Their cost is
two hundred dollars. So they won a two hundred and

(34:30):
fifty dollars profit on a cash paying patient. So they're
gonna charge you four hundred and fifty dollars. So they
make two hundred and fifty dollars on a two hundred
dollars procedure. But because they know what Medicare is going
to pay, they charge twenty eight hundred dollars because they
know how much they're gonna get reimbursed. Plus they have

(34:51):
to go through all of the process of processing the
claim and getting reimbursed from the insurance company, plus the
time it takes to finally get reimbursed. I mean, the
one thing that you used to drive me crazy, well
it drives anybody crazy that's in a service industry or
retail business. You provide a service, now you expect payment.

(35:18):
So you know, I would build my clients. Now I
had clients that you know, particularly businesses that paid their
bills within thirty days, and then I had individuals sometimes
did take me six months to collect for something I
had done nine months earlier. Absolutely crazy. Fifty two seventy seven.

(35:43):
By the way, the fifty five seventy five take six
shots of tequila. I actually avoid liquor anytime after say,
eight pm, because studies and particularly for me. Again, your

(36:04):
mileys may vary, but for me, alcohol horribly disturbs my sleep.
Oh yeah, it'll knock you out and then you'll wake
up in the middle of the night. So I avoid
alcohol after eight pm. So teqita is not the answer.
My family's currently shopping on the exchange for health insurance.

(36:25):
It's pretty much a scam. You know, the doctor you pay.
It seems to be anybody talking about whether you pay
cash or go through the exchange. It's a wash. I'm
not really sure i'd buy that.