08-14-25 Interview - Travis Bockenstedt of Pinnacle Advanced Primary Care on Insurance Premiums

Episode Transcript

Speaker 1 (00:00):
We're going to get into it with Chief experience Officer
from Pinnacle Advanced Primary Care, Travis Bock Instead.

Speaker 2 (00:05):
Travis, welcome back to the show.

Speaker 3 (00:07):
First of all, thanks for having me, Mandy. You know
I nerd out on this.

Speaker 1 (00:10):
Yeah, nobody knows more about this than Travis. Okay, I
can say that with complete authority. No one knows more
about this than Travis. Let's start at the beginning. Why
are we going to see rates go up in these
small group markets specifically?

Speaker 3 (00:22):
So, really, like any product or service that's related to healthcare,
you need to spread out the risk, right. So I
think a lot of people think of insurance as like
a debit card with no limit, but somebody has to
pay for it at the end of the day.

Speaker 4 (00:36):
So, you know, we're seeing.

Speaker 3 (00:38):
Over utilization of healthcare services. GLP ones are now making
up ten percent of claims administrative overhead.

Speaker 4 (00:46):
So there are multiple factors driving that up.

Speaker 3 (00:49):
And something to keep in mind that thirteen and a
half percent that's compounding.

Speaker 4 (00:53):
Right, You get us this year and we do another
hike next year. Think about that.

Speaker 3 (00:57):
So there's a lot of factors driving up the cast
of care, and we as consumers are not taking responsibility
to really think about the cost of care.

Speaker 2 (01:06):
We can't just take responsibility for ourselves. Colorado government.

Speaker 1 (01:10):
We now are paying for abortions, We're now paying for
gender affirming care, We're now paying for IVF. Now we
can argue about the morality of paying for all of
these things, but the reality is is they are all
very expensive. GOLP one's charged to insurance. It's my understanding
that's like one thousand dollars a month.

Speaker 3 (01:30):
Its high as fifteen hundred a month per person. I mean,
that's insane, it's outrageous. And no matter what we see,
a lot is mandating plans to cover things, right, and
we know anytime the government mandates something, a lot of
times they don't know how to fund it. They have
no idea how it's going to be paid for. So
at the end of the day, that hits the consumer's lap.

(01:52):
That's why we are seeing that huge increase in healthcare.

Speaker 1 (01:56):
So let's talk about the difference between traditional insurance and
what you guys do for small businesses at Pinnacle as
a direct primary care provider.

Speaker 2 (02:05):
Let's start with how.

Speaker 1 (02:06):
Each works and then we can kind of talk about
what you know, the difference is there absolutely.

Speaker 3 (02:12):
So let's just start with if you are a business
with fifty or less employees, you are not necessarily bound
by ACA regulations and how you have to structure the plant.
So let's talk about a few creative ways to get
rid of this thirteen and a half percent increase. First
and foremost, you do not need a BUCA. You do
not need a Blue Cross in ETNA or whatever they

(02:33):
change their names to every single year. That is not
something you need, but that is what health brokers are
selling across the state r right. So let's talk about
a few smart alternatives. Number one, Direct Primary Care, a
membership based primary care model that literally provides ninety percent
of your team's everyday help and wellness needs.

Speaker 4 (02:53):
We don't do life, limb and eyesight.

Speaker 3 (02:56):
That's for er urgent care, but all the stuff getting
your blood work, stand healthy. We are one of probably
thirty dpcs across the state of Colorado. Google it in
your area and our membership rates start at about sixty
nine dollars a month, So think sixty nine bucks to
have ninety percent of your employees everyday healthcare needs met.

(03:16):
Let's talk about the question I always get, what if
someone on my team gets hit by a bus.

Speaker 2 (03:21):
Or has a heart attack, or has a.

Speaker 3 (03:23):
Heart attack or something like that. So now we are
talking major medical. When we think of insurance or major medical,
it is to prevent people from going into bankruptcy if
they have a major medical event. Unfortunately, seventy percent of
people in bankruptcy or medical debt have insurance. Most people
don't have five thousand dollars in the savings account to

(03:44):
cover that deductible.

Speaker 4 (03:45):
I guarantee it, Mandy that they don't have that there.

Speaker 3 (03:48):
So how do we provide a more affordable major medical option?
Health shares are a really great way to go. There
are two types Christian health ministries. So if you align
that way and you want that type of health share,
go that direction. There's also nonprofits. We work with one
called Zion out of Utah. You are talking cutting family

(04:09):
premiums in half.

Speaker 1 (04:11):
How do that work, though, Travis? How does a health
share work? And I think this is what people are
concerned about. This is what I it's, you know, what
we're kind of in the devil. I know is better
than the devil. I don't when we're talking about this stuff.
So let's break down some of the confusion about how
health share actually works and how it's different than the
traditional insurance with the big deductible and twenty percent on

(04:33):
top of that.

Speaker 3 (04:34):
Right, So a health share is really going to cover
the basics of your major medical needs. So I'll give
one example. One of our physicians needed a hip replacement.
It costs twenty six thousand dollars cash pay out the door.
She paid her twenty five hundred dollars portion to Zion,
and Zion sent her a debit card to pay for

(04:55):
the rest of the twenty six grand directly to the
surgical center.

Speaker 4 (04:59):
And the surgical.

Speaker 3 (05:00):
Center was like, amen getting the twenty sixty grand, So
that I'm not insurance?

Speaker 4 (05:04):
Is it taking a cut from that?

Speaker 2 (05:05):
Right?

Speaker 3 (05:06):
So that's an example of a major medical expense where
it doesn't work. Is let's say you have you know,
maybe type one diabetes and you know, so there are exclusions, right,
That's how they bring the cost down because they have
to manage the right funds.

Speaker 1 (05:23):
And let's be reel about this, Okay, there are always
going to be people that are going to be forced
into the system that we already have correct because of
their underlying conditions or things like that. So when we're
talking about stuff, and you know you have a listener,
you know you have a medical condition. You've got to

(05:43):
ask those very specific questions for your own benefit. You
know what's wrong, you know what's happening, what happens if
you're diagnosed with type one diabetes or something when you're already.

Speaker 2 (05:52):
On the plan.

Speaker 3 (05:54):
So the key with the health Share is once you
get in healthy and something happens to you after that,
that's not marked a pre existing condition. And they don't
mark everything as a preexisting right, there are exclusions there.
But what we're really talking about is we have the
set it and forget it mentality with the US healthcare system.
We are not taking ownership of our own health and wellness.

(06:15):
We are not asking the basic question of how much
does this cost? Reason being as we made healthcare so complicated,
nobody knows the true cost of care.

Speaker 4 (06:23):
Mandy. If someone said to you it's going to be
five thousand dollars for your tire replacement, you would be like,
you are I almost said a.

Speaker 3 (06:29):
Bad word, but you are crazy, bes crazy, right? And
because you know those are around five hundred two thousand
bucks for the car. So that's the thing too, is
I don't want to blame the consumer altogether, because the
system makes you ignorant for a reason.

Speaker 4 (06:45):
Correct, They just don't want you to know.

Speaker 2 (06:47):
So when people sign up.

Speaker 1 (06:48):
And by the way, we got one question, Mandy, is
this stuff available for individuals to purchase. Absolutely, you can
buy a family membership, you can buy an individual membership
and then tack on a meed share. You guys, that
is what I would do. We have phenomenal insurance through
the VA because Chuck is a disabled veteran so and
he's a retired disabled veteran. So that is why that's

(07:09):
the only reason I'm not doing this because I would
prefer to get my healthcare like this. So, Travis, when
someone comes into your office and they say, Wow, I've
got a sore throaty a strip test, can you guys
knock that out?

Speaker 2 (07:21):
What does that look like? Walk me through that experience.

Speaker 3 (07:24):
So, first and foremost, in a direct primary care practice,
that visit is included and more than likely that quick
in office test will cost you nothing.

Speaker 4 (07:32):
Right wow, So let's just talk about right now.

Speaker 3 (07:35):
If you do not have a primary care position on
retainer for you that you cannot reach today, you end
up in the er.

Speaker 4 (07:42):
And urgent care.

Speaker 3 (07:43):
Right, so that simple little test now just cost you
five hundred dollars to go there, right, Yes, So half
the problem is is family medicine is no longer valued
like it used to be.

Speaker 4 (07:55):
Why seven minute visits with my doctor eight weeks to
get to you. That's a joke. So you end up
in the er urgent care. So that's just one example
we do.

Speaker 3 (08:04):
Most dpcs do blood work a full panel nineteen dollars
and fifty cents out the door.

Speaker 1 (08:08):
And that panel, by the way, on my insurance costs
forty five dollars.

Speaker 2 (08:12):
And that's just my copay.

Speaker 1 (08:14):
Yeah. It's like when you start to see and they
have a big I'm assuming you still have the big
price list on the wall for your basic for your basics,
when you see how much this stuff costs wholesale, which
is what they charge you at a direct primary care,
they're charging the wholesale prices, Like, what does it just
cost to get that test done without all the you know,
administrative overhead and paperwork and all that stuff. You will

(08:37):
be shocked, you will be horrified, you will be angry
at how much the paperwork in the middleman jacks up
the prices you know. So a couple questions, Mandy, sorry,
just tuned in. Is Zion appropriate for anything in Colorado?
I'm looking at one of these direct doctor things, but
scared to pull the trigger. My main fear is having

(08:57):
the proper coverage if something happens. So let's walk through
another example. So I get done with the show today
and I have a direct primary care and I have
Zion and I walk out and.

Speaker 2 (09:09):
Have a heart attack.

Speaker 1 (09:10):
So I get taken to the hospital and the ambulance,
I get all my stuff done. What does that look like,
how does that billing process work? And where does Zion
kick in? What goes on there?

Speaker 3 (09:20):
So, like any emergency, you're going to present to the
er urgent care, well the er in this case immediately
or call nine one one, right, They're going to get you.
They're going to stabilize you, and they're going to bring
over that iPad where you sign your life away. Right right,
You're gonna say I'm a cash pay member and then
you're going to have a family member or once you
get stabilized, call Zion and they will start the membership

(09:42):
team will start processing that claim for you right away.

Speaker 4 (09:44):
Right.

Speaker 3 (09:45):
So certain health shares do operate from a claim standpoint,
if you will, similar to what you would expect with insurance. Right,
So there's that there. Now let's just talk about the
fear factor here. How many of us listening right now
go to a facility and we are like, please Jesus,
do not send me a surprise bill. Yes, that happens

(10:05):
all the time in a cash pay system. It is
that they quote you the price, you pay it, you
are done. So there is a beauty to that, I
would say, the unknown. If we just continue to ignore
this and feed into the system, what are we doing?

Speaker 4 (10:23):
Right? So you know the businesses, if you guys are.

Speaker 3 (10:27):
Listening, DPC support coffee shops, blue collar workers.

Speaker 4 (10:32):
I got a trucking company. We have law firms.

Speaker 3 (10:35):
I mean they're almost embarrassed when they call and they're like,
I want to do the right thing for my employees,
but I can't afford it.

Speaker 4 (10:43):
What do I do? Right?

Speaker 1 (10:44):
And that is in my mind like being a small
business owner and you get like a core group of
great employees, right, you want to keep them, But there
comes a time when you can't match salaries of a
big company, you can't match benefits of a big company.
And this is a great way to provide care for
your employees that is affordable for you, affordable for them,

(11:05):
and I happen to think of much higher level of
care because of the personal service of direct primary care.
If somebody asked, what about children, they do not provide
care for children.

Speaker 3 (11:14):
Correct, Oh, it's full scope family medicine. Yeah, so you're
talking little's doing pediatric care.

Speaker 4 (11:23):
All of that.

Speaker 3 (11:24):
Think back forty years ago, that family doctor who knew
you and your family. That's what we're restoring, and unfortunately
family doctors are getting burnout. Would you want to interview
twenty to thirty guests.

Speaker 4 (11:37):
A day in the show?

Speaker 3 (11:38):
Nobody wants to talk to that many humans in a day,
let alone a doctor. Right, So we've made it first
and foremost a great place for them to practice medicine
and in return they can provide amazing care to people.

Speaker 1 (11:50):
This texter has two text messages, Hey Travis John here,
Travis does a great job educating people on the process.
I see doctor Lynch down in the Springs, been a
member for four years rate program. And then he continued
by saying, I wait a minute, where did it go?
Example echo cardiogram through a normal insurance over five thousand
dollars through this program under two hundred bucks. Now, let's

(12:13):
talk about that for a second, because if you do
need an EKG or you need an echo cardiogram.

Speaker 2 (12:17):
You are going to pay.

Speaker 1 (12:19):
It'll feel like maybe you're paying more upfront right there,
because you're like, here, it's two hundred bucks to get
this test. But does that go to also helping people
be better stewards of using their healthcare?

Speaker 3 (12:32):
Absolutely, because what the insurance companies are doing are doing
a fake markup discount, right, So you really think you're
you're saving money at the end of the day, it's
a bit of an illusion, right And once again, that
two hundred dollars is going straight to the facility. You've
paid your bill and you're not going to get a
surprise medical bill at the end of the day. Right.

(12:54):
The other thing I want to make clear, just because
it's cheaper does not mean you're getting less quality of care.
Some people ask me, they're like, Travis, did your doctors
go through medical school?

Speaker 1 (13:03):
It's like, yes, I've met multiple of their providers and
they're actual, super smart, incredibly nice doctors who have mds
behind their name. Maybe there's some doos in there as well,
I don't know, but yeah, somebody just said, I own
a small company with offices in Cincinnati, Arizona, Utah, and
New Mexico.

Speaker 2 (13:23):
Will this insurance work? And let's not call an insurance.

Speaker 1 (13:27):
I want to be clear that we're not using the
word insurance because it is a completely different animal.

Speaker 3 (13:33):
Keep in mind, health insurance is just that they are
not healthcare companies. I don't know the last time a
Blue Cross rep slapped on an exam glove and walked
in and said, let's go, bandy, It's United Healthcare for
your exam.

Speaker 4 (13:46):
Right, It's just a is what it is.

Speaker 3 (13:49):
Pinnacle is a healthcare company and that is what we provide.

Speaker 4 (13:53):
Now, if you're someone listening.

Speaker 3 (13:54):
That has a distributed workforce across the country, we belong
to a billing platform called HINT, and HINT has unified
twelve hundred independent dpcs across the nation and put them
on one billing platform. Now we all set our own rates, right,
it's free market, all within twenty to thirty bucks a
month of each other. So you can create a seamless
DPC experience across the nation if you want for your team.

Speaker 1 (14:17):
And this is what I love about Travis he's going
to tell you all about Pinnacle Advanced Primary Care because
they're amazing and they're here locally.

Speaker 2 (14:23):
But he's not afraid to say you can find someone
in your area. But you guys also do a lot
of telehealth as well, don't you.

Speaker 4 (14:30):
We do all dpcs.

Speaker 3 (14:32):
You actually get your doctor's contact information. So doctor John Dygert,
if your kiddo has an ear infection on a Saturday,
that message is going directly to his personal phone and
he's going to pick up, do a video visit, talk
through the scenario, and send a script to get it
taken care of. So virtual care is a huge aspect
of the program that we do, and over half of

(14:54):
our care can be done that way. One thing to
keep in mind, hospital systems make you come in the
door because they get to charge you facility fee and
those fees are really key to their revenue, and you
don't make as much money as you do with a
telemedicine call.

Speaker 1 (15:08):
So let me ask these two questions, because I think
these are the kind of questions somebody said, Look, do
they offer chiropractic nutritional care, checking your hormone levels, everything
you need medically? I mean, do you guys do chiropractic there.
I don't know about that.

Speaker 3 (15:22):
So a doo sometimes do osteopathic manipulation treatments with our
chiropractic light sort of. But let's talk about the visit problem.
Normal doctors are spending seven minutes with you. They have
about three thousand patients apiece and DPC we're talking maxing
them at seven hundred patients. They see six to ten

(15:42):
a day for an average of forty minutes. Well, you
want an hour and ninety minutes. It's the patient and
the doctor dictating that, not an insurance bill or a
coder minion.

Speaker 4 (15:53):
So you can talk about the stress you're having.

Speaker 3 (15:56):
You can talk about your in laws that are staying
in your basement that are driving you crazy, and I
need anxiety medication, right like, you actually have a one
on one relationship to go through your health history and
your health plan. Your family doctor can do a lot
for you, but they need the time to do it.
So we do lifestyle adjustments, We do help with hormone treatments,

(16:17):
all those things.

Speaker 4 (16:18):
In clinic, I'm going.

Speaker 1 (16:19):
To answer a couple of these questions. Somebody said, what
about dental. This is not a dental plan. You're going
to have to find something else there, Mandy, is this
health plan the same as concier service. It is same
exact sort of thing. Where are you in the Springs, Travis?
You've got three locations of Pinnacle Advance Primary Care? Where
are they?

Speaker 3 (16:37):
One at Shine Mountain, one at Briargate in the Springs,
and then our South Denver location is located in Centennial.

Speaker 2 (16:45):
Off Bronco Parkway right.

Speaker 3 (16:47):
Broncos Parkway, YEP, right across from there, and then two
a plug to Running Creek Dental. They have a membership
program doct does there ye, And there are a lot
of dentist office that do a fixed monthly membership fee
for basically what you would get for paying for insurance.

Speaker 4 (17:02):
So keep that in mind. There are dentists in the
market doing this too.

Speaker 1 (17:06):
I would say I have a lot of people asking
specific questions about Crohn's disease or things like that.

Speaker 2 (17:11):
I would urge you, I'm going to do this, Call Travis.

Speaker 1 (17:14):
I think call Travis because if he can't answer the question,
if it's a question about the metas heare, he can
direct you to the right person to answer those questions
for you.

Speaker 2 (17:24):
But I'm just going to say this allow your brain
to consider this.

Speaker 1 (17:29):
Don't be scared because it's different than what you've had before.
I would even say, if I was a small business owner,
I would go visit one of the offices. I would
schedule an appointment to come to the office, see what
it's all about. And let's ask that last question. The
Big Beautiful Bill made a big change to HSA accounts.

Speaker 2 (17:47):
What happened there?

Speaker 4 (17:49):
Amen For a decade we've been lobbying for this.

Speaker 3 (17:52):
Your HSA card will be DPC compatible as of one one,
twenty six, so the tax code now recognize it as
an eligible medical expense. So imagine a small monthly membership
feed to get all this value out of your HSA card.

Speaker 1 (18:07):
Now, that is fantastic, Travis, give your phone number out.
I put a link by the way on the blog
to Pinnacle Advanced Primary Care, so you can find the
phone number there if you're driving and you can't write
it down. But what is a phone number that people
can call and get more information?

Speaker 3 (18:21):
Yes, call our call or text our enrollment line at
seven one nine eight eight eight or eight five eight.
That's seven one nine eight eight eight or a five
eight texter call.

Speaker 4 (18:33):
It'll go directly to me and Emily.

Speaker 1 (18:35):
All Right, Travis, it's a joy to see you as always,
and you know, I'm like the biggest fan of direct
primary care because I think it's just a better way
to provide and consume healthcare. So I'm thankful that you
were able to make time to come on and talk
about this in light of the article that came out
earlier this week. And I will see you soon, I hope,
young man.

Speaker 4 (18:54):
Thank you for letting me nerd out with you.

Speaker 2 (18:56):
Ma'am be a good one, the absolute best.

Speaker 1 (18:58):
That's Travis Blocknstay, Chief Experience Officer in Putical Advanced primary
Care