December 18, 2025 • 35 mins
LET'S TALK ABOUT ALTERNATIVES TO OUR BROKEN INSURANCE SYSTEM I've gotten SO MANY questions about Direct Primary Care and Med Share membership based health plans I'm bringing in experts for a healthcare roundtable at 2pm. I've got Dr. John Dygert, founder of Pinnacle Advanced Primary Care, Lisa Fagan, with Smith Medical, and Preston Guthrie with Zion HealthShare to explain how these programs are upending healthcare. We will discuss the nuts and bolts of how they work, why they are different than insurance, and the limitations for each. We will give a complete example of what a patient might expect when using these services and answer your questions about it. Click on each hyperlink above to reach each business, and rethink how your healthcare is paid for and delivered!
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
This last hour, we are going to talk about something
that I am so excited about on a daily basis
that I should work as the spokesperson for the freaking
industry at this point. Direct primary care, medical health share plans.
These are two things that you can use to change
your healthcare delivery life. Honestly, the current insurance system sucks.
(00:24):
We all know this. We know that the Affordable Care
Act is nothing like affordable. We know that it has
distorted the market even more. We know that everything is
too expensive. We know we have crappy plans that don't
get us access to our doctors and don't even kick
in until we spent ten grand a year. We already
know this. So what we're talking about today is an alternative.
And it's not like a pie in the sky alternative
like we should try this. This is working for so
(00:47):
many people already. So it is a healthcare roundtable about alternatives.
And joining me in the studio right now is the
founder of Pinnacle Advanced primary Care, doctor John Diger.
Speaker 2 (00:58):
Thank you very much for having How did you draw
the short.
Speaker 1 (01:00):
Straw to come here and talk about this today?
Speaker 2 (01:04):
I think I don't know. I think April just gave
it to me actually this time.
Speaker 1 (01:08):
Well, you guys both can talk about it quite eloquently.
Speaker 2 (01:11):
Thank you.
Speaker 1 (01:12):
I appreciate that.
Speaker 2 (01:13):
But I guess I got the long strike actually because
I'm the one who gets to talk about it.
Speaker 1 (01:17):
Oh, there you go. And also with us Lisa Fagan,
you've heard her on the show before. She is with
Smith Medical. They are a cash pay surgical center with
a delightful pricing menu. I went and looked at it today,
so I could, you know, plan my little touches and
nips and talks as I moved forward, a real idea
what things cost. And you know, I kind of want
(01:38):
to start with how you both ended up going in
a completely different direction. I'm gonna start with you, doctor Dager.
You're an MD, You're a medical doctor. You went to
medical school for all those years, then you get out
and you start practicing.
Speaker 2 (01:51):
Tell me about that experience. Well, I think part of
it just came out of necessity for me. I mean,
I was starting to get burnt out, and it was
because of the patients or the people I worked with.
It was because of the system. It seemed like you
would do two hours of clerical work for every one
hour of patient care and that wasn't what I envisioned
(02:11):
when I got into the industry. So about twenty fourteen,
so it's been more than a decade ago. I started
listening for alternative options and I listened to doctor Josh
Umber with Atlas MD out of Wichitak, Kansas. And actually,
in the same podcast that I learned about direct primary care,
I also learned about Surgery Center of Oklahoma, which is
(02:34):
a direct specialty care. And you know, it's the same
folks they do Smith Medicals. So I was like, man,
I want to be part of that. So I had
to finish out my contract at the little town I
was working at Kansas and Colby, and then I left
that and went right into direct primary care and haven't
looked back.
Speaker 1 (02:54):
What are the differences in how you get to practice medicine?
Speaker 2 (02:57):
Well, like I said, you had to do so much
paperwork and you had to do so much billing and
coding stuff that didn't really provide any value to the patient.
And you could tell that like no patient ever goes
to the doctor and leaves and says, Wow, they're so
good at coding.
Speaker 1 (03:15):
That's not what happened. Is it's magical, But.
Speaker 2 (03:20):
That's honestly that's what was in the forefront of your
mind when you were in the fee for service insurance
based system, as you had to make sure you connected
all the dots. You had to have certain points in
the history, you had to have certain points in the
review of systems and the physical exam in order to
meet a criteria for a level that you could charge
(03:41):
and then build the insurance company for the care of
the patient. And when you have that in the forefront
of your mind, you're not thinking about the patient, which
was disturbing to me. And that's the first thing I
noticed when I got into direct primary care is oh,
that was gone, Like you could just focus on what
the patient was telling you, listen very carefully. It was
like a carpentry term that I heard but back when
(04:03):
I was younger, which is measured twice cut once. It
was like that, so you could do a better job
when you're there with the patient, so you didn't have
to go back and you know, collect all the loose
ends later.
Speaker 1 (04:15):
At least I want to come to you because you
work with Smith Medical and Smith Medical is actually named
in part after doctor Kevin Smith, who I interviewed in
like two thousand and seven on my radio show in
Florida about the Oklahoma City Surgical Center, and that is
what you're named after. But how did Smith Medical Specialty
Care come to being here in Denver.
Speaker 3 (04:35):
Yeah, So two of our founders met doctor Keith Smith
through another company called HPA, which helps physicians stay private
instead of going into the healthcare systems. And they met
doctor Smith and they were like, this is incredible. Why
are you not doing this all over the United States?
And He's like, I'm just going to focus on this one,
but I'm welcome to give you the blueprint and help
(04:57):
you open it. So these guys were like, oh, let's
open one in Colorado. And doctor Smith sat on our
board for a little while and we asked him if
we could name our company after him.
Speaker 1 (05:09):
I love that. Yeah, he is so great. He's wonderful.
I mean, think about that for a second. Though. He
gave you like the keys of the kingdom by saying
I'll help you and tell you what you need to do.
That indicates to me that his motivation is far different
than some of the other motivations in medicine today, right.
I mean, his motivation is truly helping people and getting
them the healthcare that they need and truly deserve, absolutely
(05:32):
and we all work together, which is great. Now, I've
also got with us today from Zion health Share, and
this is the part Preston, We're going to get to
you in pretty good depth here in the second part
of the hour because a lot of people, I've gotten
so many questions in the last month about how direct
primary care works and how Zion health Share works with
(05:52):
all of this, so I kind of want to if
you could just give us a quick overview. We got
to take a break in about two minutes. Can you
give me like a thumbnail sketch of how health share
works to lay the foundation.
Speaker 4 (06:04):
Yeah, so, really, a health share is a community based
alternative to traditional health insurance.
Speaker 2 (06:10):
Right.
Speaker 4 (06:11):
It's a place that members can come together to share
one another's eligible medical expenses and needs. And unlike insurance,
it's built around transparency, right, simplicity, shared responsibility, rather than
focusing on profits and growth of the overall company.
Speaker 1 (06:29):
What are the big questions that I get? There's two
big big questions that people have. One they're like, tell
me about pre existing conditions, that's one of their concerns.
Speaker 4 (06:40):
Yeah, so there's one benefit and also it's kind of
a downside for some people is that, hey, we're not ACA.
We're not ACA compliance, so we are able to put
into our guidelines. There are some things that hey, you know,
we don't want you to come into our commun if
there are certain restrictions that don't make sense for a
(07:03):
community to take care of, right, and so there is
a look back period of twenty four months of Hey,
I is there something that you're actively you know, treating
or taking medication for. Then hey, that's not something that
we feel like this is part of the community's responsibility.
But we do have a waiting period, right, So if
you do come on and you've got something going on,
(07:24):
after the first year, there's a there's a twenty five
thousand dollars limit, and then that tears up after about
four years, and then that thing is no longer considered
pre existing we call them pre membership, but it's no
longer a pre existing condition, and now it's fully sharable
and it's something that hey, this is part of the community.
Speaker 3 (07:40):
Now.
Speaker 1 (07:41):
If somebody has a question specifically to that when they
call Zion, could you answer those specific questions about specific
health gift people are sending me their medical history and
I'm like, I am the wrong person to answer the
questions about whether or not that and I'm so sorry
you have that if that is going to be a thing.
But can they get those specific answers for you.
Speaker 4 (08:01):
Absolutely, So there's actually a couple of things you can do.
We have a fantastic sales team. We've got a member
education team that they're just literally sitting in the office
right now waiting for the phone to ring, so that
way they can answer those questions. But we also post
our guidelines, our member guidelines on our website. Anybody can
go and read through those guidelines. We actually require that
you read them before you join our health share so
(08:24):
that you don't feel like there's any sort of you know,
blind side situation for them, right, But absolutely if you've
got a situation that you want to understand a little
bit more, Hey, I've got this situation going on. You know,
when when I joined Zion, it was very much a like, okay,
well I've got this, and can I be part of
the kemp, you know, and it's it's it's a very
(08:46):
sympathetic conversation of like, hey, yeah, absolutely, let's chat about
this these situations. Hey, this may not be a good
fit for you, right, And in those situations that's where
it's like, you know what, I'm not a huge fan
of insurance, but insurance is there for the purpose.
Speaker 1 (09:01):
Exactly, and that's the thing, it's part of it. Oh,
I got to take a quick break. When we come back,
I want to talk about how this works, how all
three of these work together to create like a net,
a safety net, and I want to get into specific examples.
After we do this, we'll be right back. Keep it on, KOA.
We're going to give you a real life example of
what this actually looks like when you are a direct
(09:21):
primary care patient who needs a certain level of care
and how that works with the medshare because I think
an example maybe the easiest way for people to wrap
their heads around it, because the hardest part about this
is that it is nothing like what we've been doing, right.
That is why it's so hard for people to sort
of wrap their heads around, because we've all been brainwashed
(09:42):
into thinking that the way we're doing it is the
only way to do it, when in reality, it's a
much different situation. Manby are these folks paid advertisers? I
hope you just heard their commercial A moment ago, but
they are not in here. They did not pay for this.
I am not being paid for this. We are not
paying each other for this. I think this is so
critically important, and I'm hearing from so many people that
(10:02):
are being priced out of the insurance market that we've
got to do something different. And if you're thinking about
dropping coverage, don't do that until you go and talk
to Travis at chat or at Pinnacle APC dot com
about these various plans. He can connect you with all
of these things and really help you out. So I
want to start, doctor Dagert, We're gonna I'm coming to
you my Regen revolution where generative medicine has failed, even
(10:26):
though it hasn't in real life because I feel amazing.
But anyway, I come to you and I need your Like, dude,
your knees jacked? What do we do there? First of all,
do I need an MRI? I do I want to
get X rays? What's included? What am I doing here? Okay?
Speaker 2 (10:40):
Well, so you come to me with knee pain.
Speaker 1 (10:42):
I'm a member. I pay my membership fee every single month,
exactly right.
Speaker 2 (10:46):
Yeah, you come in, you say, doctor Daggert, I got
some knee pain. I say, well, I'm sorry to hear that,
mandy bunch of hop up on my table. We'll do
some history, We'll ask some questions about when it her, it's,
how it hurts, does it swell, that kind of thing,
and then a physical examination where we can get a
(11:06):
lot of information about what might be going wrong with
your knee. Sometimes imaging like you mentioned X ray MRI
would be appropriate, not always, but we can usually decide
that based on the history and physical exam.
Speaker 1 (11:21):
Let's say that you.
Speaker 2 (11:22):
Had arthritis, for example, which is a very very common
condition that causes pain in the knee. We could get
an X ray. We have radiology partners that we can
usually get an X ray for seventy to eighty five
bucks something like that, and then that would help us
in the diagnosis. We say, okay, we know for sure
(11:42):
now the pain you have is from arthritis. Well, there's
all kinds of different things you can do, and I
wouldn't just kneed your extend them to Smith Medical to
get a knee replaced exactly exactly you picked up them,
and so we could do oral medicareations, physical therapy. We
have great physical therapy partners who are also cash based
(12:04):
that we can send our patients to and they do really,
really well. We can do joint injections right there in
the office, so there's all kinds of treatment modalities that
we can offer. However, if those are not working and
we say, hey, listen, you're getting to the point where
this is really a quality of life issue. This is
limiting your mobility, this is, you know, limiting your happiness.
(12:28):
We've done everything else, why don't we go ahead and
consider thinking about knee replacement. And that's when we would
refer to Smith Medical.
Speaker 1 (12:36):
Now from the I want to talk about the financial
side of this transaction, because you've got a membership fee
that gets great access to your doctors, gets you plenty
of time with doctor Diegert. But if we're talking about okay,
we're going to do physical therapy, that would be a
cash pay physical therapy office, and I'm not asking you
for their price list. But the thing people need to
understand is everything is upfront. You know exactly how much
(12:57):
something costs before you commit to it, agree to it,
or go to it. So this is not like where
you're waiting to find out what your copay is going
to be when you get the bill later after you
go to physical therapy. This is all up front, which
for me is very very appealing. Now when you're talking
about imaging and injections and things of all that that
stuff costs extra. Correct.
Speaker 2 (13:19):
Yeah, imaging is out at a radiology center. So they
have I mean negotiated, We have negotiated prices with them
for our patients for cash based prices. So since it
doesn't go through insurance, they don't have to have the
overhead to do the billing and coding stuff just like
we don't. And right GPC, So they can just give
you a price right up front, and we get the
(13:40):
imaging we need and then we can make that decision
for a joint injection. It's like the cost of the
meds plus I think it's a ten dollars fee that
we do, so that winds up being like twelve bucks.
Speaker 1 (13:48):
I think people think that you guys are charging the crazy,
outrageous prices, but the reality is you're charging wholesale prices
because you don't have to pay for the insurance.
Speaker 2 (13:57):
Midtalman, Right, Yeah, that's not a stream of revenue for it.
We're not trying to Yeah, oh no.
Speaker 1 (14:01):
Go ahead. I didn't realize what time and is I
got to take a break. When we get back, I
the patient am going to Smith Medical. We'll talk about
that next. Okay. I am joined here in the studio
with doctor John Dygert. He is one of the founders
of Pinnacle Advanced Primary Care. You've heard me talk about
them now for years. Then we have Lisa Pagan from
Smith Medical because they are now a cash pay critical
(14:23):
care office. They do surgery, they do your big stuff,
and every price is up front. You can do what
I do. You can go and look at their pricing
menu and map out your plastic surgery that you may
want to have, just in case you're thinking about that
in the future. All the pricing is there. And joining
us via Zoom is Preston Guthrie from Zion health Share.
And I just told Preston on the break, I'm like, boy, Preston,
(14:45):
I got a lot of questions for you, because I
think people are starting to understand the direct primary care
and we're coming to you, Lisa for my fake knee
surgery that I need. I think they understand what you
do because it's pretty straightforward. The health Share part is
the part that we're going to ask a bunch of
quiesquestions about in just a moment, I do want to
answer this question. Hey, Mandy, wouldn't it be better if
(15:06):
doctors went into private practice again? Seems to me like
it wouldn't be a bad idea. And I got to
tell you, this took me back to my childhood when
we saw doctor Ozaki, the best pediatrician that finally kicked
me out of his office when I was twenty one
years old. They made me get a new doctor. But
when I was a kid, you went to the doctor
and you walked in and they said, okay, this business
is going to be twenty five dollars or forty dollars
(15:26):
or whatever it is, and you pay the money, and
then you saw the doctor, and the doctor took care
of you, and if you needed anything else like a
strip test or whatever, you paid for that that was
just the thing that you paid for. That is what
this is. So in a way, it is a return
to private practice, but without the massive, cumbersome infrastructure that
(15:48):
is required to take health insurance. Do you guys know,
either of you, how much health insurance adds to the
cost of running a practice. I'm sure you have some.
Speaker 2 (15:56):
Idea upwards of forty percent the overhead, or for having
a billing office where you fight with the insurance companies
NonStop in order just to get the payment.
Speaker 1 (16:08):
I want to come to you, Lisa, because now doctor
Diegert has examined me. We've tried some stuff, and he's like, nope,
you need a knee replacement. I'm going to Sandy to
Smith Medical. What does that look like when I hobble
into your place?
Speaker 2 (16:20):
Yeah?
Speaker 1 (16:20):
Absolutely.
Speaker 3 (16:21):
So the process from there is he sends over the
medical records, which is great, so we know what's going on.
So we immediately call the patient within twenty four hours
or less right when we get the referral, so it's
a fast process. We ask them like what their priorities
are and like surgeons, so we give them options on
like we have multiple surgeons that can do a total
(16:41):
knee since that's what you're getting done, and then we
refer them over to the physician, and the physician gives
them a call and sets up a consultation. We make
sure that they have all the right imaging that they'll
need so that it's fast and they don't have to
go back and forth from there. Once I see the
patient and they want to move for with surgery. Then
we give them an upfront price prior to the day
(17:03):
of surgery, which is very rare in healthcare as you know.
And if they have a group share plan like Zion,
we reach out to Zion, let them know that this
patient would like this, and we work with their group
share process.
Speaker 1 (17:18):
Does that help? And I'm going to come to Preston
for this, Preston because a lot of people have questions
about what health shares cover what they don't cover, and
there's a lot of concerns about that. So the current
example of the full knee replacement, you get a call
from Smith Medical that says, hey, Mandy is going to
get a full knee replacement. What happens on your end
at that point?
Speaker 4 (17:39):
That's a great question. Now I'm going to correct one
thing really fast. We look at the word covered as
a bad word. So they are an eligible sharing request
is what we call it. So that was a hard
transition for me coming from the insurance world. But what
we want to do is we want to be involved
in this whole process. Right when this patient goes to
(18:00):
see their provider and they say, man, my knee is
hurting really bad, Like that's where we want to start
looking at opening a sharing request process because now we
look at this from a point of view of we
want to help you through this whole journey. Because if
the doctor just says, hey, let's just do some physical therapy. Okay,
let's figure out how much it's gonna cost, we have
(18:20):
something that's called an EYUA, or an initial unsharable amount.
People at home are probably thinking in terms of insurance
and that would be like they're deductible, But we look
at these eyuas on a per event basis. So this
whole knee situation is going to be one eyua. So
they're gonna go see their doctor. The doctor is gonna
prescribe them. Hey, let's either get you into an orthopedic surgeon.
(18:43):
Let's get you into surgery, Let's do all this stuff.
And now when we are working with Lisa's team, now
let's say, hey, we're going to make sure that we're
trying to get the very best rates, the very best costs,
and then we're going to take care of the payment.
Whether the patient wants us to just send them a
we can do like a virtual card, so that way
(19:03):
they can walk in and say, hey, here's the card.
They'll pay for it, or we can send the payment
directly to the surgical center. We can reimburse the member.
We don't love doing that just because then it gets sticky.
We want to just remove the hassle. Getting a surgery
is always a scary situation, and we want to be
able to help them. The other great thing is when
(19:25):
Lisa's team reaches out to us or when the member
reaches out to us. You're assigned a member needs person
and you're gonna work with them through the entire time, right,
so you're not trying to call in, find somebody new,
work with somebody different. Try to explain yourself every single time.
You're gonna work with the same person, and the process
is gonna be familiar to them, Like they're gonna know
the situation, they're gonna help them, and they want these
(19:47):
people to feel like man, like all this health insurance
and paying for healthcare is scary. Let's try to remove
some of that burden and lower that cost, hopefully magnificantly.
Speaker 1 (20:00):
A lot of people on the text line are asking
questions about who is the final decider. Is there a committee,
Is there a group of people, Is it like we
put it on the Internet for a vote. I mean,
how does that work on what gets approved, what gets
shared for yeah, and what gets shared and what doesn't.
Speaker 4 (20:18):
Okay, So we have, like I said, we have our
member guidelines. They are on there. You can go through
and read them, right. So, like, for example, while we
were on the break, I went through and I looked
at knee or joint replacement surgery, and it says in
there that these are generally eligible for sharing, right as
long is there not falling in that pre membership situation, right, Like, hey,
(20:40):
you sign up resign health Share after you hurt your knee,
and you're like, man, I want to get this cheaper
than my twenty thousand dollars deductible with my health insurance. Right,
But if it's not considered a pre membership situation, then yeah,
that that most likely is going to be considered a
sharable event. Now. The one thing that I want to
make people comfortable with is if something is within our guidelines,
(21:02):
we've never not paid it, right, That's something that we
want people to feel comfortable with on like, hey, we
are here to help the community pay for their you know,
their health events that get scary, that get expensive. That's
what this whole thing is for we're trying to avoid
going into the profit route and we can focus more
(21:25):
of that money into this now. We do have an
appeals committee as well. If something comes back is like hey,
we felt like that this didn't really fit into our guidelines.
We actually have an appeals committee that meets every Thursday,
and you can come back and say, hey, I feel
like this should have been shared into and I feel
like this should have been paid for, And we take
each one of those very very seriously, and we're constantly
(21:47):
looking for opportunities to pay for those sharable events.
Speaker 1 (21:52):
It sounds like if someone is going to sign up
with Zien HealthShare, they need to go through and read
all of the information before they sign up so they
have a very clear so is it sounds like transparency
here is where you're coming from, and if people just
take the time to educate themselves, they'll have a very
clearer picture on what is covered and what is not.
And again I'm now getting people saying, well do they
(22:14):
cover reach out rich of medicine? Those are questions that
I'd rather you guys direct towards Zion specifically or go
look at their website. Okay, now, oh my god, here
we go. You guys, here we get Preston. We're gonna
be here all day. How do you deal with er situations?
Emergency room situations? When your kid falls up a great question,
(22:36):
breaks his arm? What does that look like?
Speaker 4 (22:39):
That's a great question, and that's such a normal thing
for people to deal with, right, And that's what people
I would say that the things that I get asked
the most are like, man, what if my kid breaks
their arm? Or like what if I'm diagnosed with cancer?
Like those are the things that people always want to
know about. And what you do is when you go
to the er, you present yourself as a cash pay patient.
(23:00):
Right that at the er is going to unlock all
of these discounts that they legally cannot offer. If you
walk in with an insurance card and say, hey, I've
got insurance, I think I get a discount.
Speaker 1 (23:11):
Wait wait what so there? I just found out a
fascinating thing about Medicaid and direct primary care here in Colorado,
and now I'm finding out that they legally cannot tell
you how much cheaper it would be if you just
walked in and said, I'm going to write a check,
so let's bring this under control.
Speaker 4 (23:26):
Yeah, so if you walk in, you present yourself as
cash pay. Now we are coaching these members through it, right,
So walk in, take care of your kid, say hey,
you know, get me the bill, give me the give
me the invoice for this, give me an itemized invoice.
Now you're going to reach out to us, and then
we're going to walk them through how to negotiate potentially
(23:50):
a better discount and then help them pay for that situation. Right.
So they've got their their EYUA. Let's say it's a
twelve hundred and fifty dollars EUA. They cover that part
and then no matter what happens with that broken arm,
that sharable event is going to be paid for by us. Right,
And it's not just that situation. What happens in six
(24:11):
months If they say, oh man, there's complications from that
arm and we find out they need surgery, we look
at that is still the same event, and they don't
have to pay for that surgery. That's still part of
that same IUA initial sharable event, unsharable event.
Speaker 1 (24:25):
I think the complicated part or for some people, and
I know that there's a lot of people that are
going to get this and be able to grasp it
very very quickly. But it sounds like this is a
more active form of engaging on your healthcare, meaning that
we're all sort of trained like little trained monkeys. We
go to the doctor, they tell us what our cope is,
we pay our copay, we do whatever they tell us
(24:46):
to do, no matter how much it costs, and then
we get all these bills at the end and go,
holy crap, that's ridiculous, and we end up paying twenty percent. Right,
So that's what we're used to. That's the standard. So
here's a question, So are you paying the bill when
you leave the door at the er because somebody, I mean,
cash is tight for people right now, so that would
be a big concern.
Speaker 4 (25:08):
So it's gonna depend on the situation if you if
you want to, you can and have the means you
can pay for it, right But a lot of times
you can get out of there with an invoice, or
you can get out of there with paying a certain amount. Hey,
I can put a few hundred dollars down bill me
for the rest, and then that's going to allow our
team to like really coach them through. Hey, here's how
(25:29):
to get more discounts. Here's how you negotiate this, here's
how we can get a better rate for you. So
it's interesting, manny, because I come from the insurance world.
I was in the insurance world for over a decade.
And all of these big insurance companies will come and
they'll sit down in a business owner's office and say, hey,
we're creating consumerism here. But then when you got a
(25:52):
mom that's taking their kid to the doctor or to
the er, she doesn't know how to be a consumer.
She's terrified and the only thing she's caring about is
how to get her kid taken care of. Right, there's
no consumers in there. They get slapped with a bill
and now they're just like, oh, man, I guess this
is just it. This is this is just what I
pay for now. And with Zion Health Share, we want
(26:14):
her to feel like, hey, I know this is scary,
and I know that you just want to take care
of your child. Let's try to make sure that the
financial burden is as low as humanly possible.
Speaker 1 (26:26):
Right, remind us what an IUA is. People are asking
that as well. People it didn't hear that.
Speaker 4 (26:33):
So that is an initial unshareable amount that's like a deductible, right,
So think of it as like a deductible, except a
deductible is like you have a big deductible for the
entire year that you have to pay for everything until
you hit the deductible. With Zion and with health Shares,
when you have an IUA, you only have to do
(26:54):
that per event, and for households you only have to
do three of those in a year. So if you
you've got one thousand dollars EUA, you may only end
up being a three thousand dollars out of pocket if
you have three of those big events in one year. Okay,
and then on the fourth, fifth, sixth, we're going to
cover it all.
Speaker 1 (27:12):
So I want to ask And by the way, if
you have more questions, please call Zion if you have
more questions. I know this is it's so different than
what we're used to, right, It's so different than what
we've sort of been lulled into a false sense of.
But let me ask you this one last question for you, Preston,
and then we're going to talk a little pricing with
you guys too, because really this is the thing that's
going to make people try it is the price They're
(27:34):
going to stay because of the quality of care. I
truly believe that. I truly truly believe that, especially when
we're talking about direct primary care and direct critical care.
I really do believe that once the experienced the level
of service are getting outside the system, they will want
to stay. But preston, how do your rates for policies
for the initial I don't know if you call a
(27:55):
membership fee, I guess how do those compare it to
what people are seeing now with with insurance quotes for
thousands of dollars per month with a ten thousand dollars deductible.
Speaker 4 (28:07):
I'll use my mom as an example. She just signed
up for Zion health Share. Her and her husband just retired.
Her husband's already over sixty five, she's still in the
insurance bearing years, right, And she came to me and
she's like, pressing, I don't know what to do my
or my premium went up to over one thousand dollars
a month just for her. She's got a high deductible
(28:27):
health plan HSA, all that stuff. And I was like, well, mom,
just go to our website and sign up there. And
she saved over seven hundred dollars. So her premium for
insurance was over thousand dollars a month and her monthly
contribution is just over three hundred dollars right now. It's
just her right. If you're a family, if you're a couple,
like we rate those things out based on your demographics
(28:49):
and age and all that. But it is a massive,
massive discount as to what people are used to paying
for and with how much higher things have gotten this year.
I mean, we've had more people signing up, I mean
this week than any.
Speaker 1 (29:04):
Other week we have in the last Oh, I'm sure. Ever,
I'm sure. So let's get to direct primary care. And
I'm wondering, you guys have been doing this for a while,
have you had the chance to either ask, patience or analyze.
And I know, Travis, you're CFO over there, you'r CXO
over there is a numbers guy. I'm wondering how much
people are paying out of pocket realistically annually, compared to
(29:29):
what they would be paying if they were paying a
high premium, high deductible plan. I'm curious what those numbers
look like.
Speaker 2 (29:37):
Well, it's hard to say exactly because it does kind
of depend on age and risk, and also it keeps
going up every year.
Speaker 1 (29:43):
So that's the thing.
Speaker 2 (29:44):
I think our memberships really have not gone up for
ten dollars in the last five years or whatever it's been.
But yeah, I mean our membership start at seventy nine
dollars a month and you go to our website, it's
all listed. They're just like Smith Medical has their surgery
prices listed. We have family pricing, we have business pricing,
(30:05):
and there's some modifications just based on age and complexity
and those kind of things.
Speaker 1 (30:10):
But you're cheaper than direct primary care in Florida. I
looked it up today. Well, yeah, you're a bargain at
twice the price. But here we are they are the best. Yeah,
and as Smith medigal, How has the response been. Are
people starting to get it here? Because in Oklahoma City,
the Oklahoma City Surgical Center has not only provided a
cash pay option for people who self insure or maybe
(30:30):
don't have great insurance or have a high deductible, but
they've also kind of suppressed pricing at the surrounding hospitals,
showing that competition really does work. So are people starting
to get it when they need surgery?
Speaker 3 (30:43):
Yeah, patients are really enjoying it because especially if they're
the uninsured. This is a bundled, transparent price, so it's
just one price and it's laid out to them before surgery,
so they're really enjoying it. We get lots of calls
and we're like, so we got this one up for
total joint. We're up in the mountains and they said,
just for the facility is seventy five thousand totally and
(31:05):
I'm like, oh, ours is all in and they were like, no, no, no, no,
that can't be right.
Speaker 1 (31:09):
I'll no, but for real, they too. Do you guys
have financing options available for people?
Speaker 3 (31:14):
Yeah, we do work with a couple of financing Enough, okay.
Speaker 1 (31:16):
Preston, I want to ask you one more question about
Health Shares before we have to wrap up, and that
is is your plan not right for some people? And
if so, who are those people?
Speaker 4 (31:28):
I would say, yes, it is not right for some people. Right,
people with chronic existing conditions, we're not a good fit.
I typically tell people, hey, if you're relatively healthy and
you don't have any chronic longstanding issues, design is going
to be fantastic fit.
Speaker 3 (31:46):
Right.
Speaker 4 (31:47):
The whole point of what we do is having it
be a community shared program. And so if you are
relatively unhealthy, you have a chronic condition. It's not a
great fit for the better of the entire community's financial concern.
Speaker 1 (32:03):
So, and also your plan is not a do you
have a religious component? And I do, like there's other
med shares that are a Christian based or there's a
religious component design have that. That's a great question.
Speaker 4 (32:16):
We don't have any requirements that anybody is necessarily faith
based or part of any specific denomination.
Speaker 3 (32:23):
Right.
Speaker 4 (32:23):
We are mostly faith based within our company. We believe
in a higher power, but we don't have any requirements
that say, hey, you must be X y Z religion
for you to be part of our community.
Speaker 1 (32:36):
All right, that is perfect, Okay, Doctor Diagert, you want
to have any last words for the audience on our
healthcare round table here?
Speaker 2 (32:42):
Yeah, I'm just happy today I meant to talk to
these partners that we've worked with for several years now.
I just want everybody think about a year ago, just
over a year now, when the dude, Luigi Man, you
actually shot the guy on the back, Brian Thompson, and
then people I feel like he was Robinhood or something
like he was saving everybody from the terrible healthcare industry
(33:04):
and all this kind of stuff. But you look at
a stupid manifesto. He had no solutions to offer, and
he just wrote that out. These people actually do have solutions,
and these are the people I like to work with.
And that's a much better solution than shooting a you know,
married father two in the back.
Speaker 1 (33:20):
I agree, Lisa Fagan. Any final words from Smith Medical.
Speaker 3 (33:24):
Yeah, I think that it's really important for the consumer
to look at their choices, see what's out there. Even
if you have health insurance or high deductible plan, there
are more affordable options that can save you money right away.
Speaker 1 (33:35):
And I'm just going to say this, I would urge
all of you and I put links to all of
these places on the website today on mandy'sblog dot com.
Do what I did. Go look at their price list.
And I'm not saying that I've been thinking about a
boob job and I'm like, well, that's all it costs.
I mean, come on, I'm just kidding. I'm not right,
But I love to look at the prices and it
gives you some perspective about when you get those fifty
(33:57):
pages of bills with your insurance. My daughter or I
won't even tell that story. I can't even you just
get the bills and the pages and the pages and
the pages. Any final words for our audience, Preston, before
we have to go.
Speaker 4 (34:12):
I would just say that there are solutions out there
right especially with what's going on in the government. People
don't know, Hey, what's going to happen with my subsidy?
Is it just going to be completely unaffordable? There are
solutions out there. Yeah, we would love for everybody to
join Zion Healthcare, but it's something that we want you
to do your research, reach out.
Speaker 1 (34:33):
To us, call us.
Speaker 4 (34:34):
We've got fantastic partnerships and you can see with these
three companies together, we're putting solutions in place that make
a big difference or everybody involved.
Speaker 1 (34:45):
I got one last comment for you, Preston. I'm a
member of Zion Health Share, says this Texter and had
to take my child to the er. They paid it
one hundred percent. After I met my IUA, they held
my hand and let me take care of my child
instead of stressing out about what I I had to pay.
The er didn't require any payment upfront, So I don't
know if that's your mom, but well done, guys. I
(35:07):
so appreciate everyone making time today. Doctor John Dygert and
Lisa Fagan and Preston Haney from Zion Health Shairs, thank
you so much for making time. I hope this, I
hope this at least spurs people into looking into it
a little bit more and finding out with their own
personal situation and questions. Get those personal questions answered. Guys,
(35:28):
thank you so much for coming in.
This last hour, we are going to talk about something
that I am so excited about on a daily basis
that I should work as the spokesperson for the freaking
industry at this point. Direct primary care, medical health share plans.
These are two things that you can use to change
your healthcare delivery life. Honestly, the current insurance system sucks.
(00:24):
We all know this. We know that the Affordable Care
Act is nothing like affordable. We know that it has
distorted the market even more. We know that everything is
too expensive. We know we have crappy plans that don't
get us access to our doctors and don't even kick
in until we spent ten grand a year. We already
know this. So what we're talking about today is an alternative.
And it's not like a pie in the sky alternative
like we should try this. This is working for so
(00:47):
many people already. So it is a healthcare roundtable about alternatives.
And joining me in the studio right now is the
founder of Pinnacle Advanced primary Care, doctor John Diger.
Speaker 2 (00:58):
Thank you very much for having How did you draw
the short.
Speaker 1 (01:00):
Straw to come here and talk about this today?
Speaker 2 (01:04):
I think I don't know. I think April just gave
it to me actually this time.
Speaker 1 (01:08):
Well, you guys both can talk about it quite eloquently.
Speaker 2 (01:11):
Thank you.
Speaker 1 (01:12):
I appreciate that.
Speaker 2 (01:13):
But I guess I got the long strike actually because
I'm the one who gets to talk about it.
Speaker 1 (01:17):
Oh, there you go. And also with us Lisa Fagan,
you've heard her on the show before. She is with
Smith Medical. They are a cash pay surgical center with
a delightful pricing menu. I went and looked at it today,
so I could, you know, plan my little touches and
nips and talks as I moved forward, a real idea
what things cost. And you know, I kind of want
(01:38):
to start with how you both ended up going in
a completely different direction. I'm gonna start with you, doctor Dager.
You're an MD, You're a medical doctor. You went to
medical school for all those years, then you get out
and you start practicing.
Speaker 2 (01:51):
Tell me about that experience. Well, I think part of
it just came out of necessity for me. I mean,
I was starting to get burnt out, and it was
because of the patients or the people I worked with.
It was because of the system. It seemed like you
would do two hours of clerical work for every one
hour of patient care and that wasn't what I envisioned
(02:11):
when I got into the industry. So about twenty fourteen,
so it's been more than a decade ago. I started
listening for alternative options and I listened to doctor Josh
Umber with Atlas MD out of Wichitak, Kansas. And actually,
in the same podcast that I learned about direct primary care,
I also learned about Surgery Center of Oklahoma, which is
(02:34):
a direct specialty care. And you know, it's the same
folks they do Smith Medicals. So I was like, man,
I want to be part of that. So I had
to finish out my contract at the little town I
was working at Kansas and Colby, and then I left
that and went right into direct primary care and haven't
looked back.
Speaker 1 (02:54):
What are the differences in how you get to practice medicine?
Speaker 2 (02:57):
Well, like I said, you had to do so much
paperwork and you had to do so much billing and
coding stuff that didn't really provide any value to the patient.
And you could tell that like no patient ever goes
to the doctor and leaves and says, Wow, they're so
good at coding.
Speaker 1 (03:15):
That's not what happened. Is it's magical, But.
Speaker 2 (03:20):
That's honestly that's what was in the forefront of your
mind when you were in the fee for service insurance
based system, as you had to make sure you connected
all the dots. You had to have certain points in
the history, you had to have certain points in the
review of systems and the physical exam in order to
meet a criteria for a level that you could charge
(03:41):
and then build the insurance company for the care of
the patient. And when you have that in the forefront
of your mind, you're not thinking about the patient, which
was disturbing to me. And that's the first thing I
noticed when I got into direct primary care is oh,
that was gone, Like you could just focus on what
the patient was telling you, listen very carefully. It was
like a carpentry term that I heard but back when
(04:03):
I was younger, which is measured twice cut once. It
was like that, so you could do a better job
when you're there with the patient, so you didn't have
to go back and you know, collect all the loose
ends later.
Speaker 1 (04:15):
At least I want to come to you because you
work with Smith Medical and Smith Medical is actually named
in part after doctor Kevin Smith, who I interviewed in
like two thousand and seven on my radio show in
Florida about the Oklahoma City Surgical Center, and that is
what you're named after. But how did Smith Medical Specialty
Care come to being here in Denver.
Speaker 3 (04:35):
Yeah, So two of our founders met doctor Keith Smith
through another company called HPA, which helps physicians stay private
instead of going into the healthcare systems. And they met
doctor Smith and they were like, this is incredible. Why
are you not doing this all over the United States?
And He's like, I'm just going to focus on this one,
but I'm welcome to give you the blueprint and help
(04:57):
you open it. So these guys were like, oh, let's
open one in Colorado. And doctor Smith sat on our
board for a little while and we asked him if
we could name our company after him.
Speaker 1 (05:09):
I love that. Yeah, he is so great. He's wonderful.
I mean, think about that for a second. Though. He
gave you like the keys of the kingdom by saying
I'll help you and tell you what you need to do.
That indicates to me that his motivation is far different
than some of the other motivations in medicine today, right.
I mean, his motivation is truly helping people and getting
them the healthcare that they need and truly deserve, absolutely
(05:32):
and we all work together, which is great. Now, I've
also got with us today from Zion health Share, and
this is the part Preston, We're going to get to
you in pretty good depth here in the second part
of the hour because a lot of people, I've gotten
so many questions in the last month about how direct
primary care works and how Zion health Share works with
(05:52):
all of this, so I kind of want to if
you could just give us a quick overview. We got
to take a break in about two minutes. Can you
give me like a thumbnail sketch of how health share
works to lay the foundation.
Speaker 4 (06:04):
Yeah, so, really, a health share is a community based
alternative to traditional health insurance.
Speaker 2 (06:10):
Right.
Speaker 4 (06:11):
It's a place that members can come together to share
one another's eligible medical expenses and needs. And unlike insurance,
it's built around transparency, right, simplicity, shared responsibility, rather than
focusing on profits and growth of the overall company.
Speaker 1 (06:29):
What are the big questions that I get? There's two
big big questions that people have. One they're like, tell
me about pre existing conditions, that's one of their concerns.
Speaker 4 (06:40):
Yeah, so there's one benefit and also it's kind of
a downside for some people is that, hey, we're not ACA.
We're not ACA compliance, so we are able to put
into our guidelines. There are some things that hey, you know,
we don't want you to come into our commun if
there are certain restrictions that don't make sense for a
(07:03):
community to take care of, right, and so there is
a look back period of twenty four months of Hey,
I is there something that you're actively you know, treating
or taking medication for. Then hey, that's not something that
we feel like this is part of the community's responsibility.
But we do have a waiting period, right, So if
you do come on and you've got something going on,
(07:24):
after the first year, there's a there's a twenty five
thousand dollars limit, and then that tears up after about
four years, and then that thing is no longer considered
pre existing we call them pre membership, but it's no
longer a pre existing condition, and now it's fully sharable
and it's something that hey, this is part of the community.
Speaker 3 (07:40):
Now.
Speaker 1 (07:41):
If somebody has a question specifically to that when they
call Zion, could you answer those specific questions about specific
health gift people are sending me their medical history and
I'm like, I am the wrong person to answer the
questions about whether or not that and I'm so sorry
you have that if that is going to be a thing.
But can they get those specific answers for you.
Speaker 4 (08:01):
Absolutely, So there's actually a couple of things you can do.
We have a fantastic sales team. We've got a member
education team that they're just literally sitting in the office
right now waiting for the phone to ring, so that
way they can answer those questions. But we also post
our guidelines, our member guidelines on our website. Anybody can
go and read through those guidelines. We actually require that
you read them before you join our health share so
(08:24):
that you don't feel like there's any sort of you know,
blind side situation for them, right, But absolutely if you've
got a situation that you want to understand a little
bit more, Hey, I've got this situation going on. You know,
when when I joined Zion, it was very much a like, okay,
well I've got this, and can I be part of
the kemp, you know, and it's it's it's a very
(08:46):
sympathetic conversation of like, hey, yeah, absolutely, let's chat about
this these situations. Hey, this may not be a good
fit for you, right, And in those situations that's where
it's like, you know what, I'm not a huge fan
of insurance, but insurance is there for the purpose.
Speaker 1 (09:01):
Exactly, and that's the thing, it's part of it. Oh,
I got to take a quick break. When we come back,
I want to talk about how this works, how all
three of these work together to create like a net,
a safety net, and I want to get into specific examples.
After we do this, we'll be right back. Keep it on, KOA.
We're going to give you a real life example of
what this actually looks like when you are a direct
(09:21):
primary care patient who needs a certain level of care
and how that works with the medshare because I think
an example maybe the easiest way for people to wrap
their heads around it, because the hardest part about this
is that it is nothing like what we've been doing, right.
That is why it's so hard for people to sort
of wrap their heads around, because we've all been brainwashed
(09:42):
into thinking that the way we're doing it is the
only way to do it, when in reality, it's a
much different situation. Manby are these folks paid advertisers? I
hope you just heard their commercial A moment ago, but
they are not in here. They did not pay for this.
I am not being paid for this. We are not
paying each other for this. I think this is so
critically important, and I'm hearing from so many people that
(10:02):
are being priced out of the insurance market that we've
got to do something different. And if you're thinking about
dropping coverage, don't do that until you go and talk
to Travis at chat or at Pinnacle APC dot com
about these various plans. He can connect you with all
of these things and really help you out. So I
want to start, doctor Dagert, We're gonna I'm coming to
you my Regen revolution where generative medicine has failed, even
(10:26):
though it hasn't in real life because I feel amazing.
But anyway, I come to you and I need your Like, dude,
your knees jacked? What do we do there? First of all,
do I need an MRI? I do I want to
get X rays? What's included? What am I doing here? Okay?
Speaker 2 (10:40):
Well, so you come to me with knee pain.
Speaker 1 (10:42):
I'm a member. I pay my membership fee every single month,
exactly right.
Speaker 2 (10:46):
Yeah, you come in, you say, doctor Daggert, I got
some knee pain. I say, well, I'm sorry to hear that,
mandy bunch of hop up on my table. We'll do
some history, We'll ask some questions about when it her, it's,
how it hurts, does it swell, that kind of thing,
and then a physical examination where we can get a
(11:06):
lot of information about what might be going wrong with
your knee. Sometimes imaging like you mentioned X ray MRI
would be appropriate, not always, but we can usually decide
that based on the history and physical exam.
Speaker 1 (11:21):
Let's say that you.
Speaker 2 (11:22):
Had arthritis, for example, which is a very very common
condition that causes pain in the knee. We could get
an X ray. We have radiology partners that we can
usually get an X ray for seventy to eighty five
bucks something like that, and then that would help us
in the diagnosis. We say, okay, we know for sure
(11:42):
now the pain you have is from arthritis. Well, there's
all kinds of different things you can do, and I
wouldn't just kneed your extend them to Smith Medical to
get a knee replaced exactly exactly you picked up them,
and so we could do oral medicareations, physical therapy. We
have great physical therapy partners who are also cash based
(12:04):
that we can send our patients to and they do really,
really well. We can do joint injections right there in
the office, so there's all kinds of treatment modalities that
we can offer. However, if those are not working and
we say, hey, listen, you're getting to the point where
this is really a quality of life issue. This is
limiting your mobility, this is, you know, limiting your happiness.
(12:28):
We've done everything else, why don't we go ahead and
consider thinking about knee replacement. And that's when we would
refer to Smith Medical.
Speaker 1 (12:36):
Now from the I want to talk about the financial
side of this transaction, because you've got a membership fee
that gets great access to your doctors, gets you plenty
of time with doctor Diegert. But if we're talking about okay,
we're going to do physical therapy, that would be a
cash pay physical therapy office, and I'm not asking you
for their price list. But the thing people need to
understand is everything is upfront. You know exactly how much
(12:57):
something costs before you commit to it, agree to it,
or go to it. So this is not like where
you're waiting to find out what your copay is going
to be when you get the bill later after you
go to physical therapy. This is all up front, which
for me is very very appealing. Now when you're talking
about imaging and injections and things of all that that
stuff costs extra. Correct.
Speaker 2 (13:19):
Yeah, imaging is out at a radiology center. So they
have I mean negotiated, We have negotiated prices with them
for our patients for cash based prices. So since it
doesn't go through insurance, they don't have to have the
overhead to do the billing and coding stuff just like
we don't. And right GPC, So they can just give
you a price right up front, and we get the
(13:40):
imaging we need and then we can make that decision
for a joint injection. It's like the cost of the
meds plus I think it's a ten dollars fee that
we do, so that winds up being like twelve bucks.
Speaker 1 (13:48):
I think people think that you guys are charging the crazy,
outrageous prices, but the reality is you're charging wholesale prices
because you don't have to pay for the insurance.
Speaker 2 (13:57):
Midtalman, Right, Yeah, that's not a stream of revenue for it.
We're not trying to Yeah, oh no.
Speaker 1 (14:01):
Go ahead. I didn't realize what time and is I
got to take a break. When we get back, I
the patient am going to Smith Medical. We'll talk about
that next. Okay. I am joined here in the studio
with doctor John Dygert. He is one of the founders
of Pinnacle Advanced Primary Care. You've heard me talk about
them now for years. Then we have Lisa Pagan from
Smith Medical because they are now a cash pay critical
(14:23):
care office. They do surgery, they do your big stuff,
and every price is up front. You can do what
I do. You can go and look at their pricing
menu and map out your plastic surgery that you may
want to have, just in case you're thinking about that
in the future. All the pricing is there. And joining
us via Zoom is Preston Guthrie from Zion health Share.
And I just told Preston on the break, I'm like, boy, Preston,
(14:45):
I got a lot of questions for you, because I
think people are starting to understand the direct primary care
and we're coming to you, Lisa for my fake knee
surgery that I need. I think they understand what you
do because it's pretty straightforward. The health Share part is
the part that we're going to ask a bunch of
quiesquestions about in just a moment, I do want to
answer this question. Hey, Mandy, wouldn't it be better if
(15:06):
doctors went into private practice again? Seems to me like
it wouldn't be a bad idea. And I got to
tell you, this took me back to my childhood when
we saw doctor Ozaki, the best pediatrician that finally kicked
me out of his office when I was twenty one
years old. They made me get a new doctor. But
when I was a kid, you went to the doctor
and you walked in and they said, okay, this business
is going to be twenty five dollars or forty dollars
(15:26):
or whatever it is, and you pay the money, and
then you saw the doctor, and the doctor took care
of you, and if you needed anything else like a
strip test or whatever, you paid for that that was
just the thing that you paid for. That is what
this is. So in a way, it is a return
to private practice, but without the massive, cumbersome infrastructure that
(15:48):
is required to take health insurance. Do you guys know,
either of you, how much health insurance adds to the
cost of running a practice. I'm sure you have some.
Speaker 2 (15:56):
Idea upwards of forty percent the overhead, or for having
a billing office where you fight with the insurance companies
NonStop in order just to get the payment.
Speaker 1 (16:08):
I want to come to you, Lisa, because now doctor
Diegert has examined me. We've tried some stuff, and he's like, nope,
you need a knee replacement. I'm going to Sandy to
Smith Medical. What does that look like when I hobble
into your place?
Speaker 2 (16:20):
Yeah?
Speaker 1 (16:20):
Absolutely.
Speaker 3 (16:21):
So the process from there is he sends over the
medical records, which is great, so we know what's going on.
So we immediately call the patient within twenty four hours
or less right when we get the referral, so it's
a fast process. We ask them like what their priorities
are and like surgeons, so we give them options on
like we have multiple surgeons that can do a total
(16:41):
knee since that's what you're getting done, and then we
refer them over to the physician, and the physician gives
them a call and sets up a consultation. We make
sure that they have all the right imaging that they'll
need so that it's fast and they don't have to
go back and forth from there. Once I see the
patient and they want to move for with surgery. Then
we give them an upfront price prior to the day
(17:03):
of surgery, which is very rare in healthcare as you know.
And if they have a group share plan like Zion,
we reach out to Zion, let them know that this
patient would like this, and we work with their group
share process.
Speaker 1 (17:18):
Does that help? And I'm going to come to Preston
for this, Preston because a lot of people have questions
about what health shares cover what they don't cover, and
there's a lot of concerns about that. So the current
example of the full knee replacement, you get a call
from Smith Medical that says, hey, Mandy is going to
get a full knee replacement. What happens on your end
at that point?
Speaker 4 (17:39):
That's a great question. Now I'm going to correct one
thing really fast. We look at the word covered as
a bad word. So they are an eligible sharing request
is what we call it. So that was a hard
transition for me coming from the insurance world. But what
we want to do is we want to be involved
in this whole process. Right when this patient goes to
(18:00):
see their provider and they say, man, my knee is
hurting really bad, Like that's where we want to start
looking at opening a sharing request process because now we
look at this from a point of view of we
want to help you through this whole journey. Because if
the doctor just says, hey, let's just do some physical therapy. Okay,
let's figure out how much it's gonna cost, we have
(18:20):
something that's called an EYUA, or an initial unsharable amount.
People at home are probably thinking in terms of insurance
and that would be like they're deductible, But we look
at these eyuas on a per event basis. So this
whole knee situation is going to be one eyua. So
they're gonna go see their doctor. The doctor is gonna
prescribe them. Hey, let's either get you into an orthopedic surgeon.
(18:43):
Let's get you into surgery, Let's do all this stuff.
And now when we are working with Lisa's team, now
let's say, hey, we're going to make sure that we're
trying to get the very best rates, the very best costs,
and then we're going to take care of the payment.
Whether the patient wants us to just send them a
we can do like a virtual card, so that way
(19:03):
they can walk in and say, hey, here's the card.
They'll pay for it, or we can send the payment
directly to the surgical center. We can reimburse the member.
We don't love doing that just because then it gets sticky.
We want to just remove the hassle. Getting a surgery
is always a scary situation, and we want to be
able to help them. The other great thing is when
(19:25):
Lisa's team reaches out to us or when the member
reaches out to us. You're assigned a member needs person
and you're gonna work with them through the entire time, right,
so you're not trying to call in, find somebody new,
work with somebody different. Try to explain yourself every single time.
You're gonna work with the same person, and the process
is gonna be familiar to them, Like they're gonna know
the situation, they're gonna help them, and they want these
(19:47):
people to feel like man, like all this health insurance
and paying for healthcare is scary. Let's try to remove
some of that burden and lower that cost, hopefully magnificantly.
Speaker 1 (20:00):
A lot of people on the text line are asking
questions about who is the final decider. Is there a committee,
Is there a group of people, Is it like we
put it on the Internet for a vote. I mean,
how does that work on what gets approved, what gets
shared for yeah, and what gets shared and what doesn't.
Speaker 4 (20:18):
Okay, So we have, like I said, we have our
member guidelines. They are on there. You can go through
and read them, right. So, like, for example, while we
were on the break, I went through and I looked
at knee or joint replacement surgery, and it says in
there that these are generally eligible for sharing, right as
long is there not falling in that pre membership situation, right, Like, hey,
(20:40):
you sign up resign health Share after you hurt your knee,
and you're like, man, I want to get this cheaper
than my twenty thousand dollars deductible with my health insurance. Right,
But if it's not considered a pre membership situation, then yeah,
that that most likely is going to be considered a
sharable event. Now. The one thing that I want to
make people comfortable with is if something is within our guidelines,
(21:02):
we've never not paid it, right, That's something that we
want people to feel comfortable with on like, hey, we
are here to help the community pay for their you know,
their health events that get scary, that get expensive. That's
what this whole thing is for we're trying to avoid
going into the profit route and we can focus more
(21:25):
of that money into this now. We do have an
appeals committee as well. If something comes back is like hey,
we felt like that this didn't really fit into our guidelines.
We actually have an appeals committee that meets every Thursday,
and you can come back and say, hey, I feel
like this should have been shared into and I feel
like this should have been paid for, And we take
each one of those very very seriously, and we're constantly
(21:47):
looking for opportunities to pay for those sharable events.
Speaker 1 (21:52):
It sounds like if someone is going to sign up
with Zien HealthShare, they need to go through and read
all of the information before they sign up so they
have a very clear so is it sounds like transparency
here is where you're coming from, and if people just
take the time to educate themselves, they'll have a very
clearer picture on what is covered and what is not.
And again I'm now getting people saying, well do they
(22:14):
cover reach out rich of medicine? Those are questions that
I'd rather you guys direct towards Zion specifically or go
look at their website. Okay, now, oh my god, here
we go. You guys, here we get Preston. We're gonna
be here all day. How do you deal with er situations?
Emergency room situations? When your kid falls up a great question,
(22:36):
breaks his arm? What does that look like?
Speaker 4 (22:39):
That's a great question, and that's such a normal thing
for people to deal with, right, And that's what people
I would say that the things that I get asked
the most are like, man, what if my kid breaks
their arm? Or like what if I'm diagnosed with cancer?
Like those are the things that people always want to
know about. And what you do is when you go
to the er, you present yourself as a cash pay patient.
(23:00):
Right that at the er is going to unlock all
of these discounts that they legally cannot offer. If you
walk in with an insurance card and say, hey, I've
got insurance, I think I get a discount.
Speaker 1 (23:11):
Wait wait what so there? I just found out a
fascinating thing about Medicaid and direct primary care here in Colorado,
and now I'm finding out that they legally cannot tell
you how much cheaper it would be if you just
walked in and said, I'm going to write a check,
so let's bring this under control.
Speaker 4 (23:26):
Yeah, so if you walk in, you present yourself as
cash pay. Now we are coaching these members through it, right,
So walk in, take care of your kid, say hey,
you know, get me the bill, give me the give
me the invoice for this, give me an itemized invoice.
Now you're going to reach out to us, and then
we're going to walk them through how to negotiate potentially
(23:50):
a better discount and then help them pay for that situation. Right.
So they've got their their EYUA. Let's say it's a
twelve hundred and fifty dollars EUA. They cover that part
and then no matter what happens with that broken arm,
that sharable event is going to be paid for by us. Right,
And it's not just that situation. What happens in six
(24:11):
months If they say, oh man, there's complications from that
arm and we find out they need surgery, we look
at that is still the same event, and they don't
have to pay for that surgery. That's still part of
that same IUA initial sharable event, unsharable event.
Speaker 1 (24:25):
I think the complicated part or for some people, and
I know that there's a lot of people that are
going to get this and be able to grasp it
very very quickly. But it sounds like this is a
more active form of engaging on your healthcare, meaning that
we're all sort of trained like little trained monkeys. We
go to the doctor, they tell us what our cope is,
we pay our copay, we do whatever they tell us
(24:46):
to do, no matter how much it costs, and then
we get all these bills at the end and go,
holy crap, that's ridiculous, and we end up paying twenty percent. Right,
So that's what we're used to. That's the standard. So
here's a question, So are you paying the bill when
you leave the door at the er because somebody, I mean,
cash is tight for people right now, so that would
be a big concern.
Speaker 4 (25:08):
So it's gonna depend on the situation if you if
you want to, you can and have the means you
can pay for it, right But a lot of times
you can get out of there with an invoice, or
you can get out of there with paying a certain amount. Hey,
I can put a few hundred dollars down bill me
for the rest, and then that's going to allow our
team to like really coach them through. Hey, here's how
(25:29):
to get more discounts. Here's how you negotiate this, here's
how we can get a better rate for you. So
it's interesting, manny, because I come from the insurance world.
I was in the insurance world for over a decade.
And all of these big insurance companies will come and
they'll sit down in a business owner's office and say, hey,
we're creating consumerism here. But then when you got a
(25:52):
mom that's taking their kid to the doctor or to
the er, she doesn't know how to be a consumer.
She's terrified and the only thing she's caring about is
how to get her kid taken care of. Right, there's
no consumers in there. They get slapped with a bill
and now they're just like, oh, man, I guess this
is just it. This is this is just what I
pay for now. And with Zion Health Share, we want
(26:14):
her to feel like, hey, I know this is scary,
and I know that you just want to take care
of your child. Let's try to make sure that the
financial burden is as low as humanly possible.
Speaker 1 (26:26):
Right, remind us what an IUA is. People are asking
that as well. People it didn't hear that.
Speaker 4 (26:33):
So that is an initial unshareable amount that's like a deductible, right,
So think of it as like a deductible, except a
deductible is like you have a big deductible for the
entire year that you have to pay for everything until
you hit the deductible. With Zion and with health Shares,
when you have an IUA, you only have to do
(26:54):
that per event, and for households you only have to
do three of those in a year. So if you
you've got one thousand dollars EUA, you may only end
up being a three thousand dollars out of pocket if
you have three of those big events in one year. Okay,
and then on the fourth, fifth, sixth, we're going to
cover it all.
Speaker 1 (27:12):
So I want to ask And by the way, if
you have more questions, please call Zion if you have
more questions. I know this is it's so different than
what we're used to, right, It's so different than what
we've sort of been lulled into a false sense of.
But let me ask you this one last question for you, Preston,
and then we're going to talk a little pricing with
you guys too, because really this is the thing that's
going to make people try it is the price They're
(27:34):
going to stay because of the quality of care. I
truly believe that. I truly truly believe that, especially when
we're talking about direct primary care and direct critical care.
I really do believe that once the experienced the level
of service are getting outside the system, they will want
to stay. But preston, how do your rates for policies
for the initial I don't know if you call a
(27:55):
membership fee, I guess how do those compare it to
what people are seeing now with with insurance quotes for
thousands of dollars per month with a ten thousand dollars deductible.
Speaker 4 (28:07):
I'll use my mom as an example. She just signed
up for Zion health Share. Her and her husband just retired.
Her husband's already over sixty five, she's still in the
insurance bearing years, right, And she came to me and
she's like, pressing, I don't know what to do my
or my premium went up to over one thousand dollars
a month just for her. She's got a high deductible
(28:27):
health plan HSA, all that stuff. And I was like, well, mom,
just go to our website and sign up there. And
she saved over seven hundred dollars. So her premium for
insurance was over thousand dollars a month and her monthly
contribution is just over three hundred dollars right now. It's
just her right. If you're a family, if you're a couple,
like we rate those things out based on your demographics
(28:49):
and age and all that. But it is a massive,
massive discount as to what people are used to paying
for and with how much higher things have gotten this year.
I mean, we've had more people signing up, I mean
this week than any.
Speaker 1 (29:04):
Other week we have in the last Oh, I'm sure. Ever,
I'm sure. So let's get to direct primary care. And
I'm wondering, you guys have been doing this for a while,
have you had the chance to either ask, patience or analyze.
And I know, Travis, you're CFO over there, you'r CXO
over there is a numbers guy. I'm wondering how much
people are paying out of pocket realistically annually, compared to
(29:29):
what they would be paying if they were paying a
high premium, high deductible plan. I'm curious what those numbers
look like.
Speaker 2 (29:37):
Well, it's hard to say exactly because it does kind
of depend on age and risk, and also it keeps
going up every year.
Speaker 1 (29:43):
So that's the thing.
Speaker 2 (29:44):
I think our memberships really have not gone up for
ten dollars in the last five years or whatever it's been.
But yeah, I mean our membership start at seventy nine
dollars a month and you go to our website, it's
all listed. They're just like Smith Medical has their surgery
prices listed. We have family pricing, we have business pricing,
(30:05):
and there's some modifications just based on age and complexity
and those kind of things.
Speaker 1 (30:10):
But you're cheaper than direct primary care in Florida. I
looked it up today. Well, yeah, you're a bargain at
twice the price. But here we are they are the best. Yeah,
and as Smith medigal, How has the response been. Are
people starting to get it here? Because in Oklahoma City,
the Oklahoma City Surgical Center has not only provided a
cash pay option for people who self insure or maybe
(30:30):
don't have great insurance or have a high deductible, but
they've also kind of suppressed pricing at the surrounding hospitals,
showing that competition really does work. So are people starting
to get it when they need surgery?
Speaker 3 (30:43):
Yeah, patients are really enjoying it because especially if they're
the uninsured. This is a bundled, transparent price, so it's
just one price and it's laid out to them before surgery,
so they're really enjoying it. We get lots of calls
and we're like, so we got this one up for
total joint. We're up in the mountains and they said,
just for the facility is seventy five thousand totally and
(31:05):
I'm like, oh, ours is all in and they were like, no, no, no, no,
that can't be right.
Speaker 1 (31:09):
I'll no, but for real, they too. Do you guys
have financing options available for people?
Speaker 3 (31:14):
Yeah, we do work with a couple of financing Enough, okay.
Speaker 1 (31:16):
Preston, I want to ask you one more question about
Health Shares before we have to wrap up, and that
is is your plan not right for some people? And
if so, who are those people?
Speaker 4 (31:28):
I would say, yes, it is not right for some people. Right,
people with chronic existing conditions, we're not a good fit.
I typically tell people, hey, if you're relatively healthy and
you don't have any chronic longstanding issues, design is going
to be fantastic fit.
Speaker 3 (31:46):
Right.
Speaker 4 (31:47):
The whole point of what we do is having it
be a community shared program. And so if you are
relatively unhealthy, you have a chronic condition. It's not a
great fit for the better of the entire community's financial concern.
Speaker 1 (32:03):
So, and also your plan is not a do you
have a religious component? And I do, like there's other
med shares that are a Christian based or there's a
religious component design have that. That's a great question.
Speaker 4 (32:16):
We don't have any requirements that anybody is necessarily faith
based or part of any specific denomination.
Speaker 3 (32:23):
Right.
Speaker 4 (32:23):
We are mostly faith based within our company. We believe
in a higher power, but we don't have any requirements
that say, hey, you must be X y Z religion
for you to be part of our community.
Speaker 1 (32:36):
All right, that is perfect, Okay, Doctor Diagert, you want
to have any last words for the audience on our
healthcare round table here?
Speaker 2 (32:42):
Yeah, I'm just happy today I meant to talk to
these partners that we've worked with for several years now.
I just want everybody think about a year ago, just
over a year now, when the dude, Luigi Man, you
actually shot the guy on the back, Brian Thompson, and
then people I feel like he was Robinhood or something
like he was saving everybody from the terrible healthcare industry
(33:04):
and all this kind of stuff. But you look at
a stupid manifesto. He had no solutions to offer, and
he just wrote that out. These people actually do have solutions,
and these are the people I like to work with.
And that's a much better solution than shooting a you know,
married father two in the back.
Speaker 1 (33:20):
I agree, Lisa Fagan. Any final words from Smith Medical.
Speaker 3 (33:24):
Yeah, I think that it's really important for the consumer
to look at their choices, see what's out there. Even
if you have health insurance or high deductible plan, there
are more affordable options that can save you money right away.
Speaker 1 (33:35):
And I'm just going to say this, I would urge
all of you and I put links to all of
these places on the website today on mandy'sblog dot com.
Do what I did. Go look at their price list.
And I'm not saying that I've been thinking about a
boob job and I'm like, well, that's all it costs.
I mean, come on, I'm just kidding. I'm not right,
But I love to look at the prices and it
gives you some perspective about when you get those fifty
(33:57):
pages of bills with your insurance. My daughter or I
won't even tell that story. I can't even you just
get the bills and the pages and the pages and
the pages. Any final words for our audience, Preston, before
we have to go.
Speaker 4 (34:12):
I would just say that there are solutions out there
right especially with what's going on in the government. People
don't know, Hey, what's going to happen with my subsidy?
Is it just going to be completely unaffordable? There are
solutions out there. Yeah, we would love for everybody to
join Zion Healthcare, but it's something that we want you
to do your research, reach out.
Speaker 1 (34:33):
To us, call us.
Speaker 4 (34:34):
We've got fantastic partnerships and you can see with these
three companies together, we're putting solutions in place that make
a big difference or everybody involved.
Speaker 1 (34:45):
I got one last comment for you, Preston. I'm a
member of Zion Health Share, says this Texter and had
to take my child to the er. They paid it
one hundred percent. After I met my IUA, they held
my hand and let me take care of my child
instead of stressing out about what I I had to pay.
The er didn't require any payment upfront, So I don't
know if that's your mom, but well done, guys. I
(35:07):
so appreciate everyone making time today. Doctor John Dygert and
Lisa Fagan and Preston Haney from Zion Health Shairs, thank
you so much for making time. I hope this, I
hope this at least spurs people into looking into it
a little bit more and finding out with their own
personal situation and questions. Get those personal questions answered. Guys,
(35:28):
thank you so much for coming in.
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