biobalance healthcast episode 162 how
insurance companies metal in your
healthcare biobalance healthcast
features conversations about positive
agent your hosts are dr. Kathy Maupin
medical director of biobalance health
and a leading expert in treating the
symptoms of aging and Brett Newcomb a
licensed professional counselor
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hello and welcome to the biobalance
healthcast this morning kathy and i had
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prepared a conversation that we're going
to have about toxins and oxygenation in
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the aging process and when we were
discussing toxins we we discovered that
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we have a toxic event which is a
different thing that had happened and
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got us both startup so instead of the
conversation we originally intended to
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have we're going to have a different one
and it has to do with the way
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insurance companies operate there
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there is a general perception among the
consuming populace that their insurance
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companies are sort of caring
grandfatherly figures that are worried
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about making sure that they get the best
quality health care that they can and
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providing the services that they need to
make them healthy and prolong their life
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you can't be an hour of dependent that
that is not why insurance companies
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exist wore how they function
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it's a lot of screen so that you believe
that so you'll do what they say we
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believe the insurance companies are
about making profit and one of the ways
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that they make profit is they deny the
provision of services
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so when you have a condition or
situation when you send bills into your
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insurance companies then they evaluated
according to whatever protocols they use
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and fairly often they will say we don't
pay for that that's experimental that's
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outside the norm that's not in the broad
range that we use and find acceptable
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and an example of that is that for
probably the last year
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kathy has been prescribing armour
thyroid for me because I had a low
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thyroid which was causing my body
temperature not to get high and
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to make my hormones work the way they
were supposed to work on your
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cholesterol went up and my cholesterol
was going up as a result so I i was on a
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blood pressure medicine and I was on a
diuretic and I was on a couple of other
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things question that's all and high
blood pressure
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other doctors had prescribed to
counteract that symptomatology can he
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said if you go back to the beginning and
get your thyroid in the active range
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where it needs to be
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you won't need all these medicines and
so my insurance company and I were
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spending in excess of two hundred
dollars a month to pay for all of these
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various medicines that I am now no
longer on and haven't been on for a year
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and a half so there's there's a expense
savings that I think they're not
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recognizing but at any rate the reason
we got in this conversation is yesterday
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Kathy who has no official connection to
this insurance come to which is humana
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at all
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I'm sure I'm contract with them she's
not a provider for them shift she's a
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physician who's doing her business with
her patients but you're going to attack
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from them now you have to check your
night
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there's no monetary connection to them
or any kind of obligation but she gets a
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letter from my insurance company which
my insurance company has denied me this
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drug they will not pay for it
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it's not in there formulary it's not in
their protocol for people my age with my
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condition
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whatever that is but it's approved by
the FDA is really high right and that's
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part of standard of care and it's the
cheapest thyroid medicine on the market
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right now so for four dollars and makes
no sense
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yeah i can get this medicine that's why
pay for it myself so I figure that's the
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end of the conversation
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they we sent them the request they said
no we don't pay for that
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if you choose to do that you're on your
own so I'm out but now they're going
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around without speaking to me about it
and they sent a letter to Kathy that
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basically says justify and cease and
desist
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so tell me about the letter that you see
the letter was basically said that I was
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giving a drug that should not be given
to elderly pay so lonely men elderly
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women only
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and according to their their statistics
it's so sad it says that I mean when I i
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called him to tell him this and he's
like hunt from yeah I'm not want to go
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blocks can i get a wrong
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I was going to call first of all that
they called her our route written to her
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because again I'm paying for the
medicine and she has no connection of
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them we are not part of humana in
regards to this medicine in this
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treatment or mean that
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and your harvest they've inserted
themselves into this relationship in a
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way that I find offensive because they
not only asked her to justify why she's
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doing what she's doing
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they've instructed her to cease and
desist stop giving me the medicine
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they're not doctors first of all yeah
you have to understand the insurance
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company has multiple levels where they
may have one doctor on staff everybody
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else our salespeople accountants and and
people who don't have necessarily have
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any more education than high school
making phone calls to doctors office
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denying treatment
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I don't think anybody realizes that be
and they take out tons of money out of
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the health care system every year to
deny you coverage and denied care right
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the doctors who have gone through eight
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- lets see neurosurgeons 9 + 4 13 years
a true of care
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excuse me out training right hard
training they had to pay for or they
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were paid so little they could barely
live
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they they had to go through this tough
training and make it and succeed would
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be doctors and they're being told by
somebody who doesn't have any education
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they can't do it
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well this is by the higher-ups you
they've developed something they call
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their quality of care that I've never
heard of which is baloney called the
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beers quality of care and they say dear
dr. Maupin
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our records indicate that the patients
and Brett was one of them listed on the
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enclosed report received a medication
considered high risk when used in
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patients 65 years of age or older
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according to the beers criteria which
I've never heard of
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please review the enclosed patient
reports so underneath that it says
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discontinue the medication
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if appropriate or consider an
alternative the appropriate
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parenthetical right
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just continue the medication if
appropriate so they've they say they've
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implemented a quality program
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well armour thyroid was out there and
has been used successfully and without
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problems as many problems as synthroid
since the forties and it is the drug
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that split the community between do and
md's do said and i'm not a DM an MD but
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my daughter is a do do said natural is
better
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armour thyroid is natural natural and it
works
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so why do we need a synthetic well and
the md set up we have a synthetic we're
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throwing away all the natural stuff
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this was in the forties and fifties they
divided they fought over this issue that
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to two types of doctors split do is
became holistic and became more natural
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doctors not nature path they are just
like md's and training and and the test
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they take they just have a more holistic
view and then the md's went up we're
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going synthetic so they go synthetic so
synthetic is synthroid and levoxyl they
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want me to change him to a synthetic
that is more expensive but they'll pay
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for it and it won't work as well
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armour thyroid works much better in most
people now i have to say i do you sense
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right in some people after I figured out
that armour thyroid doesn't work or
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sometimes in young men since right seems
to work a little better but that's my
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own choice
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and because I'm a doctor I get to make
that choice
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that's what i get for all of this hell
I've gone through training and these
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kind of letters I get to make the choice
of how I treat my patient well and I
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segue this conversation before we
started to talk today I was telling
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Kathy about my previous physician who
used to give me a prescription for blood
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pressure medicine and she gave me the
prescription and I got to the pharmacy
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to get filled and the insurance company
refused to pay for it and they said we
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we don't have that particular drug in
what's called our formulary they create
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a
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basket of drugs that they buy in bulk
quantity from the production systems
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manufacturing pharmacology and if it's
not in their list
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they don't provide or pay for it so they
sent me back to my physician with
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instructions to get a different blood
pressure medicine one that was in their
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list that they had bought pricing for so
it would be cheaper for them and then
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they relevant to whether that was the
best drug for me
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my doctor was upset she's like I chose
this drug for you because of your unique
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individual circumstances and now the
insurance company says we have a
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one-size-fits-all response the blood
pressure medicines and you need to
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choose from among these three or four
and that's and that's what's going to
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happen more and more
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what was her response to me with we can
change to one of these that they're
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saying you can use we'll see how that
works for you or you can choose the one
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that I know is best for you but it's
going to cost you three and fifty
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dollars a month
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ok that's it which will people can't do
it that's exactly what I couldn't do it
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i took well drug another drug that's
that's common there's a blood-pressure
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drug called lisinopril lisinopril is an
excellent blood pressure drug
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it's cheap it works but in men it causes
ed so it cause erectile dysfunction
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so I have men come to me all the time
for testosterone the other testosterone
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slow but they have erectile dysfunction
because erudition there on life simple
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pro it decreases the blood pressure in
your pelvis not just all over bit more
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in your pelvis than in other places so
many blood pressure medications can
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cause ED
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so you're taking viagra and the blood
pressure medicine which are working
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against each other what
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well they're working with with each
other once
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yeah was decreasing your blood pressure
in a there's different methods are in
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different different mechanisms but one
drops your blood pressure but viagra
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also drops your blood pressure and
that's why they say you shouldn't you
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should probably do both
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or they might get too low everybody does
it in a different way but viagra dilates
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the pelvis and brings the blood to the
pelvis which helps with erections
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so what I have men that come to me and
they need to foster own and that will
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help their erections
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but they're not going to be happy if
they come back . yeah it's half better
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yeah it's kind of better for about two
minutes that's not going to work so i
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have to change their blood pressure
medicine
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the best blood part of blood pressure
medicine for erectile dysfunction is
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been a car
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well we went we have gone through that
with other people including my husband
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and I put them I change them to been a
car while Ben of cars and expensive drug
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and so but that works and it doesn't
drop his blood pressure
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so that's really one of the best but the
insurance companies resist that they
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would pay for it we paid for and it's
expensive but it was worth it i mean
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what do you you're going to pay for
viagra if your blood pressure medicine
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is causing your ed you're going to add a
pocket have to pay for viagra birthday
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the insurance company doesn't care about
that they don't care that you have to do
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that
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no that's not their problem because
they're not sure much standing there .
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and i right
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so the others the other thing I mean to
me that's huge
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blood pressure medicine and is should be
that should be discussed with men if men
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knew that they would say well what about
what best blood pressure medicine for me
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they would be put on it and they would
have so much need to go on to this so
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there's two drugs i think that is called
CD which because it's not treated by or
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paid for by insurance companies they
don't really care right one is
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cholesterol medication because it drops
your testosterone
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so you go on cholesterol medicine and
immediately you start getting ed that's
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why so many people have it because so
many people are on cholesterol medicine
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so it decreases your testosterone but
rather than go off your cholesterol
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medicine and bring testosterone up which
eventually still going to go down with
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age
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they you know they put you on viagra or
I mean a lot of people don't think this
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through a lot of doctors don't think it
through there let's see the drug company
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on just enters well everybody would be a
nice gesture all medicine they do you
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think everybody should be on it yeah I
probably should have been on it in the
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past but once once i got my testosterone
back
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it made my cholesterol go down ok so i
don't need to be on it
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right so replacing my testosterone
helped but taking that would have made
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it worse so I don't know how it could
have been worse
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however for men it's much worse and most
men are on cholesterol medicine so
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that's another thing they say that they
don't have the cholesterol medicine on
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this list they gave me a list of things
that should not be given to the elderly
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which which day by definition 65 and
over over which i think is hilarious
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one is methyldopa it's a beta blocker
and that's something that I take and I
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have to take the rest of my life because
I have a tachycardia a fast heart rate
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so it's it is absolutely necessary
there's no replacement for it but they
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say what they say it causes low blood
pressure
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what yeah that's a problem but you have
to figure out the dose but it decreases
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my heart rate that's the only thing that
will do it
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so what happens when I'm 65
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I go off this this is that this is
elderly not men
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elderly so they don't and the other
things they don't want to take methyl
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testosterone either and they don't pay
for bio identical testosterone
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we've never even you've never been sent
in a request for that
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no but that the testosterone that we
give in general the insurance companies
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say they'll pay may not format they
never pay for women
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hardly ever for one so even though they
say their answer is different for every
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population what they say
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I don't pay for it for women because
it's not FDA approved and we don't
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approve bioidentical in any form right
but I give the men bioidentical and half
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of that we usually pay half back to the
big patient
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mhm so why is that same stuff
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yeah just a different sex is just a
sexual discrimination thing and a way
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for them to save money right
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so these are the things that are in play
when you're in your doctor's office and
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they're trying to think of something to
give you to make you better and to
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actually make you functional and healthy
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these are the things that are happening
in in your case it's saved you three
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00:15:13,320 --> 00:15:17,310
drugs right and and cost of those two
years now
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yes you look two hundred dollars a month
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work x 2 years and i'm sure it costs
them more than two hundred dollars a
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month thing but that was your savings
right and the insurance company pays up
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or a greater portion usually than the
patient so they saved a bunch of money
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and in that way they don't even
acknowledge that by putting them on 14
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dollar-a-month drive right and and you
know it's it's a broader range issue
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than the example that we are using in my
business which in mental health
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counseling years ago in eighties when
the HMOs were really taken off and
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trying to regulate cost control factors
in medicine and the provision of
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services you have to send in treatment
plans for my my patients are saying here
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is the diagnosis here
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the symptomology here's the strategy
this is what I'm trying to do
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will you approve payment for the
services and then the insurance
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companies would say well i will give you
ten visits in a two and a half months .
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and at the end of that time
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write us back and let us know if you
need more and so every two months you
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have to reapply for the provision of
services for the insurance company to
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cover so that that's kind of what you
just learned to do but I had an
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adolescent boy was in the seventh grade
his parents have gone through a divorce
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shortly after they've gone through
divorces father died so it is blaming
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his mother but he had to live with his
mother and he was in adolescence at a
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very difficult time he was very suicidal
and depressed
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so I saw him for about a year on a
weekly basis for his suicidal depression
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and his mother changed jobs and we
should change jobs or insurance company
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change the new insurance company said
this man is not on our it's an HMO
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00:17:05,900 --> 00:17:09,559
I'm not on their service provider list i
don't have a contract with them to
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provide for their patients
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00:17:11,539 --> 00:17:16,760
they said he cannot see your son so we
wrote letters saying this kid is
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00:17:16,760 --> 00:17:19,520
suicidal he's lost his male figure
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00:17:19,520 --> 00:17:24,230
I have been seeing him I am helping him
both as a male figure who supports and
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00:17:24,230 --> 00:17:27,319
cares about him in a in that adolescent
break
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13-14 were boys really mean men and I
dealing with the
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00:17:31,800 --> 00:17:36,240
the suicidality and your relationship
with them as well and they wrote back
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and said we have mail service providers
on our contract list her license and
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just as good as this man is so no you
can't see him he has to switch over
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00:17:47,970 --> 00:17:50,970
nobody asked the boy what is your choice
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00:17:51,480 --> 00:17:55,440
our credentials the provider list versus
the non providers for exactly the same
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00:17:55,440 --> 00:17:58,830
the treatment plans out of there would
have been the same or not but I had the
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00:17:58,830 --> 00:18:00,689
relationship in the history of the
credential
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00:18:00,690 --> 00:18:07,440
they said now and so we said if you rock
this boy's boat and he's already
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00:18:07,440 --> 00:18:09,930
demonstrable suicidal he may kill
himself
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you know let us have six months to
transition let us have three months to
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00:18:13,740 --> 00:18:19,320
transition and move him towards a new
clinician and I certainly don't think i
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am the end-all be-all but not exist the
Italian adjustment we also need to
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consider they said no she doesn't she's
got change right now so they took him
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00:18:29,100 --> 00:18:33,959
and that really distressed both of us
but it was an insurance company
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00:18:34,650 --> 00:18:38,910
it was it was a cost-saving quality
saving contrail them south
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he could have and and they said i said
so you realize with all this
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00:18:42,990 --> 00:18:45,840
communication exchange that we've had
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00:18:45,840 --> 00:18:50,310
if this boy harms himself attempts to
himself his mother's gonna sue you and
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they said that's okay we have lawyers -
so they don't care they literally
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the boy they don't care about that when
they're concerned with the neck and
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their concern was the purity their
contract arrangement with their
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providers so it and that was in the air
and it was a different insurance company
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want to make clear about that
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00:19:07,620 --> 00:19:13,800
I had another insurance company and its
they call me i was seeing a woman for
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00:19:13,800 --> 00:19:18,419
again depression and I'd seen her for a
period of time and I was writing a
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00:19:18,420 --> 00:19:22,530
justification and the manager of the
interest company which was a local ppl
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00:19:22,530 --> 00:19:29,190
call me and said do you not understand
that this woman has a lifetime cap and
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00:19:29,190 --> 00:19:34,80
that you are using up her lifetime
payouts for these mental health services
289
00:19:34,740 --> 00:19:38,400
so you need to stop seeing her so that
she can save some in her bank for later
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00:19:38,400 --> 00:19:41,40
in case she has other problems she
changes insurance will have a different
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00:19:41,40 --> 00:19:42,210
lifetime cap
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00:19:42,210 --> 00:19:44,770
well my response was I don't work for
you
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I work for her she is my patient i have
a responsibility to you and I don't care
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about what I'm not asking your
permission to treat her
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00:19:52,30 --> 00:19:55,780
I am giving you information that you can
use to make your determination whether
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00:19:55,780 --> 00:20:00,250
you'll pay her for the services or not
but I don't have a relationship with
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00:20:00,250 --> 00:20:03,610
your responsibility you have
responsibilities to the to the patient
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00:20:03,610 --> 00:20:07,449
so you do whatever you're going to do
I'm going to see her as long as she
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00:20:07,450 --> 00:20:08,380
wants to see me
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00:20:08,380 --> 00:20:12,220
so that the reason tell the story is
couple weeks later a friend of mine who
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00:20:12,220 --> 00:20:15,220
socially was a friend of this woman I
was talking to on the phone
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00:20:15,220 --> 00:20:19,660
I my name came up in the conversation
and and the woman that ran the PPO said
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00:20:19,660 --> 00:20:22,810
who is that sob he is really arrogant
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00:20:22,810 --> 00:20:26,139
who's he is well he thinks he's the
doctor and you're not
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00:20:26,140 --> 00:20:33,280
yeah i mean the deal it was like there
there is there's a i guess i'm going to
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00:20:33,280 --> 00:20:33,910
call it
307
00:20:33,910 --> 00:20:42,940
I'm magic there should be a magic or a a
non-physical contract between a patient
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00:20:42,940 --> 00:20:47,830
and doctor and it is part of the healing
your relationship it's a relationship
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00:20:48,640 --> 00:20:52,330
it's part of the healing yes we use its
nurse extenders yes but you know your
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00:20:52,330 --> 00:20:56,230
doctors in charge of this but you know
that and you have a relationship with
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00:20:56,230 --> 00:20:57,880
the extenders as well
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00:20:57,880 --> 00:21:04,30
however the touch not like that but the
touch the touch that
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00:21:04,30 --> 00:21:09,580
I mean the fact that you know you can
hug your patient that I can
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00:21:09,580 --> 00:21:17,139
yeah I can have my patients that I can
you know I have a understanding with
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00:21:17,140 --> 00:21:20,410
them that I am going to look for the
best treatment
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00:21:20,410 --> 00:21:27,70
I'm going to look for the most and most
healthy way to proceed
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00:21:27,850 --> 00:21:30,490
I am they know i'm not going to just go
oh yeah i'm going to do with the
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00:21:30,490 --> 00:21:34,90
insurance company says here take this it
doesn't work but you know i'm not going
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00:21:34,90 --> 00:21:39,429
to do that and we should be and your
doctor should be fighting for you in a
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00:21:39,430 --> 00:21:45,520
way but his his or her relationship is
only responsible to you and then you
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00:21:45,520 --> 00:21:48,520
have to understand that the insurance
companies put us through hell
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00:21:49,150 --> 00:21:54,100
that's why I don't take insurance but
they put us through hell because they
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00:21:54,100 --> 00:21:54,520
have
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00:21:54,520 --> 00:21:58,360
all they do is figure were were a
bottomless pit of spending money and
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00:21:58,360 --> 00:22:01,929
they don't really care about who that we
were spending money of four but the deal
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00:22:01,930 --> 00:22:05,980
is we have to do tests we have to take
care of you and it takes a lot of
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00:22:05,980 --> 00:22:09,160
technology to do that nowadays to do it
appropriately
328
00:22:09,160 --> 00:22:14,380
that's expensive but in general doctors
have been paid less and insurance
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00:22:14,380 --> 00:22:17,710
companies have made more money where we
took them out which is what I'm really
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00:22:17,710 --> 00:22:23,110
an advocate of we don't need that we
would take out 50 cents on the dollar
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00:22:23,110 --> 00:22:29,320
name three schools money and that would
be off the plate and patients we get
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00:22:29,320 --> 00:22:32,770
more and they would just have to find
doctors a trust
333
00:22:32,770 --> 00:22:38,260
but that's that would take one visit you
can you should be able to tell somebody
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00:22:38,260 --> 00:22:40,180
that you want to have to take care of
you
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00:22:40,180 --> 00:22:44,380
so I guess at the end of the day and
thank you for allowing us to vent and
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00:22:44,380 --> 00:22:48,340
share some of our experiences with
insurance companies but the message is
337
00:22:48,340 --> 00:22:54,550
in this period of flux for questions
about insurance providers and medical
338
00:22:54,550 --> 00:22:59,649
coverage and how the system is evolving
weather should it go
339
00:23:00,220 --> 00:23:06,220
please get involved please be aware
contact your representatives in in the
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00:23:06,220 --> 00:23:06,970
government
341
00:23:06,970 --> 00:23:11,320
contact your insurance companies support
your physicians contacted and now doing
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00:23:11,320 --> 00:23:15,159
you know what this needs to stop because
i would like to think medicine without a
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00:23:15,160 --> 00:23:21,940
license there and they're interfering
and in this particular example I am NOT
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00:23:21,940 --> 00:23:23,650
asking them to pay for this service
345
00:23:23,650 --> 00:23:29,80
cathy is not in any way involved with
them as a and the insurance company and
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00:23:29,80 --> 00:23:32,320
they are sending her letters telling her
that she's to stop doing what she's
347
00:23:32,320 --> 00:23:37,990
doing because somebody somewhere in
their system has a standard that says oh
348
00:23:37,990 --> 00:23:39,340
that's not appropriate
349
00:23:39,340 --> 00:23:43,870
what is their business getting involved
so we are protesting and one way we're
350
00:23:43,870 --> 00:23:47,770
doing it is to share our story with you
will certainly be writing letters to
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00:23:47,770 --> 00:23:48,639
them as well
352
00:23:48,640 --> 00:23:52,570
and if you have similar experiences
write your letters write letters to your
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00:23:52,570 --> 00:23:55,689
insurance company and tell them how
unhappy you are the problem is is that
354
00:23:55,690 --> 00:23:57,820
that your employers in the middle
355
00:23:57,820 --> 00:24:00,850
well I'm if there are over like one or
two major suppliers
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00:24:00,850 --> 00:24:01,320
you know the
357
00:24:01,320 --> 00:24:05,399
the insurance companies of choice are
becoming progressively more limited
358
00:24:05,399 --> 00:24:08,789
right they're becoming the tunnels
359
00:24:08,789 --> 00:24:12,330
yeah so anyway thank you for listening
as always
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00:24:12,330 --> 00:24:19,379
and please defend yourself and hopefully
your doctor will help and I think that
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00:24:19,380 --> 00:24:22,559
there is some hope in this situation if
we all actually understand what the
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00:24:22,559 --> 00:24:23,340
problem is
363
00:24:23,340 --> 00:24:26,509
thank you
364
00:24:26,509 --> 00:24:31,369
e-mail your questions or comments to
podcast at biobalancehealth.com you can
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00:24:31,369 --> 00:24:36,168
find the biobalance healthcast on iTunes
and on YouTube for more information
366
00:24:36,169 --> 00:24:40,129
about bioidentical hormone kallik
therapy and other reverse aging
367
00:24:40,129 --> 00:24:50,658
solutions visit biobalancehealth.com or
call 3 1 4 9 930 963 you can find dr.
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00:24:50,659 --> 00:24:56,809
Martin on twitter at dr. Kathy Maupin
and on facebook at facebook.com slash
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00:24:56,809 --> 00:25:01,279
biobalance health find Brett Newcomb at
Brett Newcomb . cop
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