Podcast 8 – Insurance: A Betting Man’s Game

Insurance: A Betting Man's Game


Dr. Chad Edwards: Podcast Number Eight of Against the Grain.


Speaker 1: Welcome to Against the Grain podcast with Dr. Chad Edwards where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients to help you on your way to a healthy lifestyle. Get ready because we are about to go, go Against the Grain. Tulsa Prolotherapy


Brian Wilkes: Welcome to Against the Grain. I’m Brian Wilkes here with the Dr. Chad Edwards.


Dr. Chad Edwards: Welcome Brian, how are you today?


Brian Wilkes: I’m fantastic, having a great day.  [chuckles]


Dr. Chad Edwards: That’s awesome. I am so excited to get going. Let’s rock and roll.


Brian Wilkes: Yes, well, they say you got to be positive on radio, you got to keep it positive. So I got a quote for you, I got a positive quote for you.


Dr. Chad Edwards: Let’s hear it.


Brian Wilkes: Not really, it’s a little slap in the face to the healthcare system, which I know you hate to be negative about healthcare these days.


Dr. Chad Edwards: Well, [chuckles] sometimes I’m an electron.


Brian Wilkes: [laughs] You remember Walter Cronkite?


Dr. Chad Edwards: I do, that dates me.


Brian Wilkes: Our counterpart. I mean, we’re basically in the same field as Walter. Yes, good buddy- [crosstalk]


Dr. Chad Edwards: With his much notoriety.


Brian Wilkes: Absolutely right. The problem is he’s dead so neither one of us know him. But he gave a quote which I think defines a topic today, “Is America’s healthcare system is neither healthy, caring nor system.”


Dr. Chad Edwards: Absolutely amazing. And I don’t think I could have said it any better myself.


Brian Wilkes: Nice. It leads us right into our topic today is Insurance is a Betting Man’s Game.


Dr. Chad Edwards: Hot topic.


Brian Wilkes: They bet you won’t need it, you are betting you do.


Dr. Chad Edwards: That’s right, “Hey, should we pay the bills first?”


Brian Wilkes: Oh our sponsors. They’re probably listening thinking, “You guys are horrible.”


Dr. Chad Edwards: I’m going to start. I want to start.


Brian Wilkes: Okay. Go for it.


Dr. Chad Edwards: Revolution Health & Wellness Clinic clinic. If you’re tired and fatigued and want bioidentical hormones and some alternative to traditional Western medicine views, where the clinic for you, give us a call at 918-935-3636. Especially, if you have musculoskeletal stuff, need prolotherapy stem cell, PRP, it’s awesome. You need that stuff or visit our website at revolutionhealth.org. Tulsa Prolotherapy


Brian Wilkes: If you’re a guy, you need to get fixed up, you can go there for that too, right?


Dr. Chad Edwards: Screen for one of those today, you got it.


Brian Wilkes: Right. Every guys, like it turned off the podcast immediately, but if you do need it, go to Revolution.


Dr. Chad Edwards: Yes. So for those of you don’t know, we’re talking about vasectomy.


Brian Wilkes: [laughs]


Dr. Chad Edwards: We do those too.


Brian Wilkes: There’s that. Okay. Upper Cervical Health Centers. Upper cervical health center is not your typical chiropractic office. They have an improvement rate for all of their patients of over 75%, which is pretty amazing. Tulsa Prolotherapy


Dr. Chad Edwards: And that’s not just musculoskeletal stuff, we’re talking about overall health.


Brian Wilkes: It’s nice.


Dr. Chad Edwards: It’s pretty. They’re great people.


Brian Wilkes: Yes. Call them at 918-742-2300 or you can visit their website at uppercervicaltulsa.com/newyou. Chad, let’s jump into it, again, Insurance is a Betting Man’s Game. They bet you won’t need it, you are betting, you do. Talk to me. Tulsa Prolotherapy


Dr. Chad Edwards: Yes. So first of all, that I put on my little sheet here. Insurance is a necessary evil and I would totally agree with that. The problem is, is that what we have today is not really insurance. I mean, it is, but I think when most people think about health insurance, they’re talking about prepaid medical care. I hear every day, my insurance doesn’t cover that, is this covered, is that covered and those kinds of things. And when you think about what is insurance, the first thing that comes to my mind is that indemnity type insurance. I just bought some insurance the other day on a structure that I’m working, building a structure and wanted some insurance, in case a tornado comes along and rips it off the face of the earth, I don’t want to have to pay cash for that thing again. So insurance covers to those- [crosstalk]


Brian Wilkes: Right. Catastrophic.


Dr. Chad Edwards: Exactly. It covers those kinds of things. I don’t plan on going to the hospital or having to be admitted to the ICU this year, but I have insurance that protects me in the event that that happens. But I don’t have car insurance for rotating my tires, filling my air, changing my oil, all of those kinds of things.


Brian Wilkes: It’s so funny because I think most people don’t see it that way. They see insurance as a day to day thing, when in essence the whole very definition of is protecting against a catastrophic failure. Tulsa Prolotherapy


Dr. Chad Edwards: That’s exactly right. And that is a lot of what I want to talk about today because we talk about like the Affordable Care Act or most people would refer to as Obamacare. There were some issues prior to the implementation of Obamacare where some patients couldn’t get insurance. They couldn’t afford it, they didn’t have it- [crosstalk]


Brian Wilkes: Well, yes, in 2014, there were 32 million people without insurance.


Dr. Chad Edwards: In this country.


Brian Wilkes: In this country.


Dr. Chad Edwards: That’s amazing, 32 million.


Brian Wilkes: That’s what it says, at Kaiser Foundation. Ooh, that was sweet.


Dr. Chad Edwards: Oh, that’s awesome.


Brian Wilkes: They really backed up- you don’t even need to Google it, now you’ve got that little–


Dr. Chad Edwards: Exactly.


Brian Wilkes: Yes, that’s for real.


Dr. Chad Edwards: Absolutely. And when it comes to that insurance- I totally lost my point. I don’t remember what I was going to say on that whole thing.


Brian Wilkes: No, that’s okay. I think the topic today is, is I think most people fit into a mindset of, there’s really two categories for our healthcare system is, you’re either insured or you’re not. And what that means is, you’re either have a co-pay or you don’t in your below the property level and the government facilitating it all. But I guess there is a third option of, you have insurance for catastrophic, high deductibles, very high deductibles. But when I say very high, $5000 to say of a deductible for a catastrophic event that may cost a million dollars, cancer, some of the more deadly diseases out there, protecting against those. But people are paying higher premiums month to month for- as you said earlier, service related, I would think a physical checkup or whatever the case is. And what they don’t know is, they can have a direct doctor relationship where they pay that doctor a nominal fee, whether it be every month or every visit, without high premiums. Tulsa Prolotherapy


Dr. Chad Edwards: Right. And I think that that kind of model, what we call a Direct Care model, which is actually covered under the Affordable Care Act. There is legislation in there that provides for direct primary care and really encourages people to go that route. And I think it’s brilliant for a number of reasons. The first one is, when you look at- I remember, one time I got a car called for insurance and I mean really any time you get a insurance on a car, they’re going to ask you, “Okay, what deductible do you want?” And I’m going to say, “Well, how much does it cost?” Because I look at the cost- whatever that deductible is, I’m going to set it aside in my savings. So if it’s 500 bucks, I am going to make sure there’s $500 in there earmarked that if something happens to that car, I can pull that out and that way I’d maximum out, it’s $500 that’s already set aside. But if it costs me a $1000 over whatever period of time to have a $500 deductible, well, I would rather raise it and have a $1000 deductible, must have 500 because it’s cheaper on my monthly premium.


Brian Wilkes: Absolutely.


Dr. Chad Edwards: The lower you get the insurance, the more likely it is you’re going to dip into that policy and pull out. So your premiums have to go up to compensate. It makes sense. And they used to use regular insurance, not post-Obamacare insurance, uses actuarial tables, to determine how much you’re going to pay for your insurance. You’re a 32 year old guy that has no medical problems and they’re going to look at the tables and they’re going to say what is the likelihood- [crosstalk]


Brian Wilkes: The law of averages.


Dr. Chad Edwards: Yes, exactly.


Brian Wilkes: Our listeners know, that’s how all insurance works.


Dr. Chad Edwards: That’s right, that’s all insurance except for Obamacare Insurance. They used to do this. They used to use actuarial tables. And then if someone had some kind of cardiovascular disease and had a heart attack, their insurance is going to more expensive because based on those actuarial tables, your cost is going to go up. So with the Affordable Care Act, they basically said, the insurance company can no longer charge more for one person than for another person. They have to charge everybody the same. So they completely abandoned actuarial tables. Dave Ramsey did a fantastic job of just running the numbers, independent of politics.


Brian Wilkes: Right. I have done it. They don’t run.


Dr. Chad Edwards: Right. Exactly. Independent of politics, it doesn’t matter which side of the aisle you sit on, it doesn’t really matter if you’re for or against- [crosstalk]


Brian Wilkes: It’s called math.


Dr. Chad Edwards: Exactly, it is a scientific fact.


Brian Wilkes: That’s right.


Speaker 2: That is a scientific fact.


Brian Wilkes: Love it. We’re trying to use that button more.


Dr. Chad Edwards: Yes, we’re going to wear it out. He did a fantastic job of running the numbers. And the idea was that the Affordable Care Act was going to be more affordable insurance across the board.


Brian Wilkes: Hence the name.


Dr. Chad Edwards: Exactly. But what has happened and I have seen this on a daily basis, is that insurance has become more and more unaffordable and people are looking for alternative solutions more and more because their insurance premiums have gone up and up. So when you have that person that’s 32 and has some kind of either genetic condition they’ve got- one of my patients has- he had what’s called an IGA nephropathy, that resulted in his kidneys failing and he’s on dialysis. Well, that is a horrifically expensive disease. And it consumes a lot of resources and it takes a lot of money. So that guy, his health care is going to be much more expensive than an otherwise healthy 32 year old guy.

Normally insurance would charge more for one than for the other. Well, they said that you can’t charge more anymore. And also you can’t not cover someone, you have to accept them in. Now you’re deluding out the healthy pool, there’s not as many in the – that’s just how insurance works and you know that better than I do.


Brian Wilkes: Yes.


Dr. Chad Edwards: So what has to happen is, if they can’t charge one person more than the other, then they just have to charge more for everybody. And that’s what I see everyday.


Brian Wilkes: Well, I don’t think you and I- I mean, you fought for your country, you’re a veteran, I think you love your country, we’re not out to bash government or our country, as they say it’s the worst system in the world besides all the other ones.




Brian Wilkes: Right. I don’t think that’s what it’s about. But here’s what I will say, let’s do a HIPAA compliant story.


Speaker 1: HIPAA. Health Insurance Portability and Accountability Act.


Brian Wilkes: So here’s what I’ll say, I know we’ve got a case here, Chad, that you want to cover but let’s take my case for a second, because I’m a business owner. For me, it’s about numbers. It’s not about being Republican or Democrat- [crosstalk]


Dr. Chad Edwards: I get it.


Brian Wilkes: -when you’re running a business. So and this relate this to the average person, so the average income in the US, the dual family income is $51,000 a year, 51,939, again, according to Google.




Brian Wilkes: Somebody’s going to check the facts.


Dr. Chad Edwards: So, it must be right.


Brian Wilkes: Like somebody who is in at the Census Bureau is going, “That’s not right.” Like 10,000, forget it, call in, the number is 1800-We don’t care.


Dr. Chad Edwards: [laughs]


Brian Wilkes: So here, it’s probably right to some degree. If you have an average income of $51,000 and we could talk about the really wealthy, we could talk about the really poor, but for that group, okay, let’s just talk, let’s just run the numbers here for a second. And I’ll use myself.

So middle class folks. If you’re middle class, you have a couple options, let’s talk a little bit about the health savings account that I think you’re touching on that I have. What I do with my health savings account and this is affordable for a person in this category, the middle income person is, is I view, first off, and we talked about it earlier, insurance as catastrophic.


Dr. Chad Edwards: Correct.


Brian Wilkes: Okay. So when we say catastrophic, I want to be covered for myself, my children and my wife for an event like cancer.


Dr. Chad Edwards: I’ll take it a step further and say for an unforeseen unbudgetable issue. So fall down, go, boom, break a leg. That would count- because you can’t budget for that, unless, you just set some extra money aside to cover. So it can go a little bit further, but go ahead.


Brian Wilkes: So for that person prior to Obamacare which I think changes the game in how we view insurance because you’ll have to educate me here, but as I understand, Obamacare, you cannot have insurance right now, have a catastrophic event and theoretically, I suppose that you could get insurance because they can’t deny preexisting conditions.


Dr. Chad Edwards: My understanding of law is that’s correct.


Brian Wilkes: Which is really a bad thing for society as a whole, because if that happens, I don’t know how hospitals can stay in the business and all that stuff- [crosstalk]


Dr. Chad Edwards: Well, either it goes into this- I don’t know how else to say, other than the bleeding heart mentality. And I don’t mean that in a negative way. And I think we all feel this way, if one of my friends had an issue like that, I would want them to be able to be covered. From an emotional perspective, of course we want everyone covered. Of course, we want them to be able to get their medical care taken care, if they want to be taken care of and without question that is not really the issue of debate. The issue of debate is, how are you going to do it? And that’s where it gets sticky, because if they were just sprinkling Pixie Dust around and everybody’s covered then, “Hey, let’s all do it.”


Brian Wilkes: Let’s be realistic about it. And here’s what I’ll say is, back to the example is, so the option is, let’s say, if you’re a middle income person, you don’t get insurance, you have a catastrophic event, I think how it works currently is, you are penalized on your tax return. So for example, if you don’t qualify for- if you have not enrolled in Obamacare and you don’t have health insurance, that will be- if you’re a person that gets money back on your taxes to put it simply, if you’re a person gets money back on their taxes or if you’re a person that has to pay, you either pay more [chuckles] to cover those premium rates or you don’t get as much money back. But they make you pay, you pay for it.


Dr. Chad Edwards: Now my understanding- yes. First of all, you can have health insurance that does not meet Obamacare criteria. So you can have health insurance that covers catastrophic events and if it doesn’t meet the criteria, then you’re still paying the fee.


Brian Wilkes: Still paying the tax burden.


Dr. Chad Edwards: Correct. So you have to find a plan-


Brian Wilkes: Standardize plan.


Dr. Chad Edwards: -that and they got, whatever the copper, platinum, whatever, I don’t remember what they are.


Brian Wilkes: We got options folks. And the government is like, it’s a circus. [chuckles] Circus of options but I don’t even- it’s like the tax code, you can’t follow, who knows.


Dr. Chad Edwards: Right, exactly. So then- [crosstalk]


Brian Wilkes: You’ve got a problem when you can’t even put up a website for it, that should be the first indicator, that’s too complex.


Dr. Chad Edwards: Right. But the other piece of that is the tax component or the fee, now how they implement the fee I don’t really know. But yes, there is an annual fee based on your income and those kinds of things. Anywhere I think it’s from $97 to 3000?


Brian Wilkes: Yes, something like that. And that is somewhat beside the point, where the next level here in my case, right. But you have to consider it now that Obamacare is in place, so you need a policy that’s compliant so you’re not doubling up on tax problems for a catastrophic event.


Dr. Chad Edwards: But let’s run that, just for one second let me interrupt. So $3000, that’s the high end because I think that’s the upper limit of the fee.


Brian Wilkes: I could Google it. [laughs]


Dr. Chad Edwards: And I’m sure that will be right.


Brian Wilkes: And we’re sure about that.


Dr. Chad Edwards: Let’s say it is $3000. The average family $3000 for the year, that’s less than $300 a month. Now how much is that person paying for their insurance? This isn’t an issue of them saying, “I don’t want health insurance, screw them.” This is an issue of, I’m barely making budget and now I’m spending five, seven, $800, not uncommon dollars a month on insurance for that family versus taking a $3000 hit. So that’s a net difference of $3000 a month. If you’re barely making your bills as it is, it’s cheaper to pay the fine and roll the dice.


Brian Wilkes: Yes. Again, the main reason why most people don’t have health insurance and most people don’t in our country, a good number- well, you could argue now, they have Obamacare but the chief reason prior to Obamacare was 48% of adults said, “I just can’t afford it.” It’s not affordable. It’s not that they don’t want it, it’s not affordable.


Dr. Chad Edwards: And then what I have seen is patients coming in and their plan, their insurance plan used to cover- [crosstalk]


Brian Wilkes: A consortium, a large group of problems and tests.


Dr. Chad Edwards: And now, we get letters all the time that this is not- [crosstalk]


Brian Wilkes: Deny, deny, deny. Because it’s the only way they can make money, they can’t cover it anymore because the way it’s set up.


Dr. Chad Edwards: Exactly.


Brian Wilkes: So let’s go back to this. So you’re going to have to get covered, now you’re mandated to pay money for insurance. So what I do?


Dr. Chad Edwards: And again, I think everyone should have health insurance. That’s part of a sound financial plan.


Brian Wilkes: But now you’re forced to have it. Not forced or pay.


Dr. Chad Edwards: Well, you’re forced to have health insurance that meet certain criteria and therein is my problem that that’s going to– I don’t even remember all the criteria for but it meets all of these criteria. And the problem is that what I’ve seen is, you end up paying so much for it, it’s no longer affordable for the people that I see on a daily basis. And I see average middle income, middle class people-


Brian Wilkes: Folks, that fit the category that we’re talking about.


Dr. Chad Edwards: Right. I don’t see patients that are- the poverty patients, because my patients have to pay cash when they come in.


Brian Wilkes: Yes, I want to get to that. I like using an example because I am a patient of yours. So this is how I do it. And you can look up my credentials online if you want to evaluate whether I’m trustworthy or not.


Dr. Chad Edwards: [laughs]


Brian Wilkes: So this is how I do it. I have a health savings account. And in that health savings account, I have rather than a PPO and that’s important. So the difference between the health savings account and a PPO would be- in a PPO, you pay- [crosstalk]


Dr. Chad Edwards: Fee for service.


Brian Wilkes: -fee for service. Meaning, that you are probably covered in a provider network and your premiums are fairly high.


Dr. Chad Edwards: So let me interrupt you for one second. Provider network means that, there is a contract between the medical person, the doctor or the clinic, the lab, X-ray or whatever and the insurance company. They are in a contract with them that says that they’re going to agree to basically being controlled by the insurance company and accept payment accordingly. And in exchange for that the insurance company will sent them money, then you also have out of network, meaning, we can take your insurance but we’re not going to sign a contract with any of the insurance- with that particular insurance company, which is what I usually recommend. But that’s we’ll talk about that in our podcast for sure.


Brian Wilkes: Gotcha. So you have this PPO plan that I would say, I don’t have the statistics but most people that work for a company probably have a PPO. I would say with a higher premium payment, okay, that means month to month, how much your health insurance cost you. And then you probably have a low deductible, lower deductible and you can balance those two, you can choose. But I would say that most Americans probably have a lower- I’m sorry, a high- it depends on what you want to do. If you want your premiums to go down to get a higher deductible, you want your deductible to go down. It depends on what you want to do, but that’s one option, the PPO option.

I would say a good vast majority of your patient visits, this is the catch on the PPO aren’t covered. Covered is a little clever word that the insurance companies use. Because think about it in your own plan, if I’m paying $800 a month for a family and if you have your own business, that’s what you’re paying or more, that’s for healthy people, middle class people. Now let’s say, you went to the doctor and you paid $800 a month for as much as you go to the doctor, I can almost assure you and I don’t have the statistics, at least in my family, there’s no way that we spend $800 [chuckles] a month on medical stuff. No way.


Dr. Chad Edwards: That’s exactly right. But you’re paying for the person that has high risk for the other stuff.


Brian Wilkes: But I’m paying for them.


Dr. Chad Edwards: That’s correct.


Brian Wilkes: So I saw that and I say, “Hey, I’m going to go on a different way.” So I have a health savings account, which basically says– I basically say, “Hey, look I am going to pay a lower premium but my health savings account is not going to cover every doctor’s appointment. My whole savings account and my option within my whole savings account is a high deductible.” So, it might be like ten grand per person in my family and then everything after that is covered, 100% but I got to pay the first ten grand. And that first ten grand means, even a visit to your office, but my premium might go to $200, does that makes sense?


Dr. Chad Edwards: It doesn’t go down that much though. [laughs]


Brian Wilkes: Yes. In a health savings account, I can take money that I make and put it in a non-taxed fund, in the name health savings account. So if I make $10, I can put $2 a month and I’m not taxed 30% on that or whatever the tax rate is, that’s what the whole savings account is. So the equation is, non-taxed health savings account, to which I can pay. Now follow me here, this is tough for most people, follow me. I can pay pre-taxed money directly to you, $200, whatever my employment is, which I’m automatically getting a benefit from because it’s not taxed, because $200 from that health savings account, non-taxed money. And so I pay that to you, let’s say, I pay $200 every month to Chad in Revolution Health. And I go to the doctor once a month, I pay $200, think about this, pretax money, $200, health savings account that you set up. Instead of $800 a month premium, my premium is $400 a month. And we don’t have something catastrophic happened to us. Now I’m going to talk about catastrophic here in a second.

Okay. Which one would you take? Better care at $600, because you get the $200 and then I say, a premium, still our $400 a premium, $200 directly to you and cash it from the health savings account, directly to the doctor. I don’t expect any co-pay because in a health savings account, I can hit that deductible in a year of 10,000, if I go to the doctor enough and they pay 100% after that. So the question is, health savings account $600 a month. That’s one example and that’s being very nice to insurance- [crosstalk]


Dr. Chad Edwards: The numbers.


Brian Wilkes: The numbers, very nice to the numbers. I feel like Donald Trump, very nice, I am very nice. I’m a very good guy. These numbers are very good. Trump makes you believe everything he says is true. So we got $600 in the health savings account, we got $800 on the PPO, tell me what I’m missing, I’m netting $200 right there.


Dr. Chad Edwards: When it’s done properly, you’re not missing anything.


Brian Wilkes: Nothing.


Dr. Chad Edwards: That is absolutely the way to go. The problem is that we’ve been so conditioned to think that, “Oh, you don’t take my insurance, that’s not covered.” I can’t do it, at the end its black and white deal. And that’s not the case. One, you have most insurance plans have out of network benefits. Meaning, if you’re in network, it’s a PPO, then you either have a co-pay or a co-insurance. If you go to the doctor and it’s a $100 allowable charge, in other words the doctor may charge 200 but the insurance says that we will only allow 100, so but in network they would pay for 100, on most of them, what I’ve seen is a co-insurance. So usually 20% and the insurance pays 80. So they will doctor $80 for that $100 bill. And then you would pay $20 out of your pocket.

If you’ve got an out of network, usually, it’s double that, in other words 80-20 versus 60-40. If you’re out of network, then you pay 40%, insurance pay 60, some are 50-50, there’s 70-30, there’s all different kinds of insurance plans and different- [crosstalk]


Brian Wilkes: And you can massage it and play with it and see what’s best for you and your family, depending on where your health is, your age is, all that stuff.


Dr. Chad Edwards: Yes. So you can still get cover, you can still get some reimbursement for that once your deductible is met.


Brian Wilkes: Yes. Let’s just unpack this whole thing because I think we’ve talked about a lot. It’s fairly technical, right?


Dr. Chad Edwards: Yes. It is difficult, extremely nuanced.


Brian Wilkes: And on purpose. It’s like stock market.


Dr. Chad Edwards: It’s crazy.


Brian Wilkes: They do “sophisticated things” so you don’t really know how their stock and they’re not [crosstalk] you surely know, “Oh, we’re so smart, don’t worry about it.” But really they’re not that smart, they’re just confused as anyone else, maybe even more so. It’s how the medical system is. In fact, if they were concerned about consumers acquiring information, studies have been done, there was a study it was done many years ago that I read about, its mutual funds and 401K plans, mutual funds within 401K plans in businesses. I guess, it was in the late 80s, they were trying to get more people on the mutual fund and companies. There was a problem, people weren’t investing, weren’t doing those things. So they added more options, they had two or three options of the mutual funds, so they added ten. And instead of the numbers going up and investing in 401K plans, they went down and then they tinkered with it. And the more simple that they made it, the more people that enrolled. So they went back to well thought out, easily unpacked options in 401K plan subscriptions went way up.

So the medical system knows what to do, they’re not idiots. They just don’t want you to know.


They know what it takes to make you know.


Dr. Chad Edwards: Well, part of the problem is that, I used to work at a large clinic here in Tulsa- [crosstalk]


Brian Wilkes: Nameless.


Dr. Chad Edwards: It’s a good clinic but it’s traditional, inside the box, thinking traditionally, all in network insurance blah, blah, blah, blah. And if a patient had called and said, “Hey, I want to come see Dr. Edwards and I want this lab, this lab, this lab, how much is that visit and that those labs going to cost me?” It would be impossible for them to tell them.


Brian Wilkes: Isn’t that crazy?


Dr. Chad Edwards: Part of it is because you don’t know what quote level of office visit it is, until the doctor’s done.


Brian Wilkes: My dad used to say, “Boy, you don’t know your butt from a hole in the ground,” and that’s probably going to get edited.



Dr. Chad Edwards: No, that’s good.


Brian Wilkes: That’s a great thing to say about medical. We’ve got Marshall where he’s eyes like, “Oh my God.”


Dr. Chad Edwards: But if you go to get your oil changed in your car and so you called Jiffy Lube or whomever. So you call these guys and you say, “I want to get my oil changed, how much is it going to cost?”


Brian Wilkes: We don’t know.

Dr. Chad Edwards: We won’t know until after we do it. Are you kidding?


Brian Wilkes: [laughs] That’s a great example. Even then, you get your bill, you pay it there and they say, we’re probably going to send you some more bills. Why? We really don’t know. [laughs]


Dr. Chad Edwards: No, no. They’re not going to tell you that, you’re just going to get a bill three months later and you’re going to say, “What’s this for?”


Brian Wilkes: Yes, we use synthetic oil. Well, I didn’t ask for synthetic oil. It doesn’t matter, it’s the way we do things. What?


Dr. Chad Edwards: Yes. And your insurance plan didn’t cover that, it was refused because it was not- you didn’t have a prior authorization.


Brian Wilkes: Yes. At the end of the day, what are we saying here? What we’re saying is, your whole clinic operates on this mindset and operate successfully. So there’s a case study here for us to look at, that is, it’s healthy to have a one to one relationship with your doctor, your doctor is accountable to you, you’re accountable to them, etc. And you’re paying them non taxed preferably pretax dollars from HAS, dollars directly to the doctor. And you’re holding a doctor directly accountable for your care. But what we’re not advocating is just pure cash, meaning no catastrophic insurance, we will go back to that. You need catastrophic coverage. And if you suspect, obviously, the trick with insurance agencies is, if you do suspect that you might get sick at some point, if you say that out loud anywhere, they have microphones and they’ll deny you-


I am fairly sure we’re in the Truman Story with insurance companies are the people watching.


Dr. Chad Edwards: It could be.


Brian Wilkes: Yes, because you know from experience how surprising it can be at times for people that are healthy, you’re going along, they get sick, they paid insurance, maybe they’re 60 years old, they paid insurance, their whole lives. They have one condition, their entire lives and insurance says, “Oh, that’s not covered.”


Dr. Chad Edwards: Right. And when you go to the doctor and they say, “You have high blood pressure,” they put that code in now under ICD-10, it’s an I10, and that goes into your database out into the ether and it stays there. And so they will be able to look at a list of diagnoses and see, “Oh, that was on the chart that was on the chart that was on the chart, I’m not a conspiracy theorist but that stuff’s out there.


Brian Wilkes: I don’t think it’s a conspiracy, I think it’s reality.


Dr. Chad Edwards: Yes, true.


Brian Wilkes: I think if you look at it from a business standpoint, if I’m selling a product to one of my customers, I do a credit check on them and squat on the amount of information I can get on them. I don’t think insurance people see the same way, they want to know your background, they want to know where you’re going. And people that say- I’ve heard stories where people say, “I don’t smoke” and then they say, okay, and they give you a policy and then they get some random person and you’ve got a $10 million claim for some treatment that you have, they will get some person from college, like you and me and they will say, “I saw him smoke one time.” It gets really hairy with insurance companies when they have to start paying.

And so the point is educate yourself, make sure you have a tight policy, make sure you read over it, maybe even get your attorney to look over it and make sure it’s for catastrophic, lower your premium rates, high deductible at a rate you could sustain if you needed to $5000 out of pocket, $10,000 in the event that there’s a catastrophic, at that point, make sure it’s 100% past there, something like that in that 20% or whatever the case is, make sure you have a good network.

Also day to day, be smart about it, save money, find a doctor that does cash, one to one.


Dr. Chad Edwards: and you can save money across the board like MRIs, some insurances will allow $1500, which means that they’re charging $1500, but through my clinic, we’ve got an arrangement, an MRI little over $500, a third of the price. Labs across the board, we can save a lot of money and this is on just pure cash.


Brian Wilkes: I love it, it’s a good show, Chad. We could talk about this all day long.


Dr. Chad Edwards: We will definitely have more stuff on insurance, how people can save money, how does insurance work, because honestly, I don’t think half the insurance people know how the insurance works. I mean it’s just incredibly nuanced, you got to do this job, in order to understand how this stuff works. So we’ll have more.


Brian Wilkes: How could you not listen to this show? I mean people, come on, you’ve got to listen to this show.


Dr. Chad Edwards: You’ve got to listen.


Brian Wilkes: You’ve got to listen.


Dr. Chad Edwards: And tell your friends.


Brian Wilkes: Hey, see you guys in the next episode. Thanks Dr. Chad.


Dr. Chad Edwards: I’m here for you, Brian.


Brian Wilkes: See you.


Speaker 1: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week where we will be going Against the Grain.