Episode 139: "MRI Stands for Might Require Incision"
Apr 01, 2024
Jenni
Peel back the curtain on healthcare's persistent ailment: treating symptoms instead of the root problems. We're here to arm you with eye-opening insights on the industry's profit-driven mentality and how it overshadows the quest for genuine patient cures. Our latest episode takes you through the murky waters of corporate medicine and Big Pharma, sharing firsthand accounts of insurance battles and profit prioritization that leave patients in the lurch. We dissect the infuriating maze of insurance claims and the heart-wrenching consequences of time wasted in a system fraught with inefficiencies.
Encounter the gritty reality of healthcare's shortcomings as we share personal stories, including a family's struggle with diagnosis and treatment, that underscore the imperative to identify the true source of pain. We challenge the norm with a critical look at the overuse of MRIs in diagnosing non-traumatic pain and introduce you to the concept of "weak ass syndrome." With biting candor, we discuss how emotional connections can sometimes obscure the hard truths of professional judgment. This episode is not just a conversation; it's a call to action for a system that values swift, effective healthcare solutions, and places patient outcomes at the forefront of care.
Check Us Out On Social Media - Facebook: @bermanwellness , @physicaltherapynaples, @Berman Golf Instagram: @berman_wellness, @bermanphysicaltherapy , @Berman Golf Youtube: Berman Golf, Berman Physical Therapy TikTok: Bermangolf, Bermanwellness
Email us - drberman@bermanpt.com jenni@bermanwellness.com
Check out our website - https://www.bermanpt.com/ https://www.bermanpt.com/wellness/ https://bermangolf.com/
Peel back the curtain on healthcare's persistent ailment: treating symptoms instead of the root problems. We're here to arm you with eye-opening insights on the industry's profit-driven mentality and how it overshadows the quest for genuine patient cures. Our latest episode takes you through the murky waters of corporate medicine and Big Pharma, sharing firsthand accounts of insurance battles and profit prioritization that leave patients in the lurch. We dissect the infuriating maze of insurance claims and the heart-wrenching consequences of time wasted in a system fraught with inefficiencies.
Encounter the gritty reality of healthcare's shortcomings as we share personal stories, including a family's struggle with diagnosis and treatment, that underscore the imperative to identify the true source of pain. We challenge the norm with a critical look at the overuse of MRIs in diagnosing non-traumatic pain and introduce you to the concept of "weak ass syndrome." With biting candor, we discuss how emotional connections can sometimes obscure the hard truths of professional judgment. This episode is not just a conversation; it's a call to action for a system that values swift, effective healthcare solutions, and places patient outcomes at the forefront of care.
Check Us Out On Social Media - Facebook: @bermanwellness , @physicaltherapynaples, @Berman Golf Instagram: @berman_wellness, @bermanphysicaltherapy , @Berman Golf Youtube: Berman Golf, Berman Physical Therapy TikTok: Bermangolf, Bermanwellness
Email us - drberman@bermanpt.com jenni@bermanwellness.com
Check out our website - https://www.bermanpt.com/ https://www.bermanpt.com/wellness/ https://bermangolf.com/
Speaker 1:
This is the Berman Method Podcast, featuring Dr Jake Berman and physician assistant Jenny Berman. We are here to treat problems and not symptoms. Disclaimer this podcast is for entertainment purposes only and not to treat anyone or to give medical advice. If you are interested in any information that we are giving and would like to use this for yourself, we recommend that you contact your primary care physician or reach out to us and ask us questions about yourself specifically. Enjoy.
Speaker 2:
And we are back. Baby, for the Berman Method Podcast. Was that lovely?
Speaker 1:
Yes, I think that was one of your better ones. Yet Hitting the high pitches, I like it, or is that the low pitch? You've been practicing.
Speaker 2:
I think that's a low high pitch, a higher of a low pitch.
Speaker 1:
I do.
Speaker 2:
Here we are, dr Jake Berman here with my lovely co-host.
Speaker 1:
Jenny Berman, physician assistant.
Speaker 2:
Good morning, good afternoon, good evening. Whenever you're listening to this hopefully it's first thing Monday morning we are focused on treating problems and not symptoms. David against Goliath, going against the corporate medical system. We do not believe that the corporate medical system or Big Pharma has your best interests in mind. They are focused on client retention and not curation, and it's been proven time and time again and we just ain't about that.
Speaker 1:
That's right. Right Focused on treating problems and not symptoms.
Speaker 2:
Yes, insurance companies are no different from any other business. Well, I shouldn't say it that way. Insurance companies are very similar to a lot of very big businesses, where they are focused on profits versus patient outcomes. Right, it's very simple If you're not profitable, then it doesn't really matter about anything else. So anybody that has ever struggled with getting something reimbursed you understand that, or at least you should understand that. The insurance company's job is to deny. It doesn't matter how legitimate it is, they will deny.
Speaker 1:
Right, we've been through that many times.
Speaker 2:
Holy guacamole. Let's go way back. Let's go back to the early years when I first opened up. One of the first clients that I had back in the day she actually worked for one of the major major healthcare insurance carriers in the country for 20 years and she actually just retired within a year and she agreed to come to see me completely out of network for some physical therapy services and she knew that she could take my receipts and submit them for out of network reimbursement and she knew every single code and number and identifier that needed to be on that receipt because she had literally just got done doing this for 20 years, right, right. So she actually educated me when I first opened up. Actually, you need to format it this way, you need to highlight this line, to draw attention to it this way, and she was just giving me all of these tips where she's like these are the reasons why they will deny, and I was like, wow, this is amazing. Thank you so much. Right.
Speaker 2:
So after she was done with her plan of care, we created this itemized bill for her to submit. That was exactly, word from word, cosmetically appealing. Everything looked the way that it was supposed to look.
Speaker 1:
And she still got denied.
Speaker 2:
She still got denied. Stop it. I didn't even know about this story.
Speaker 1:
But I always wondered why our invoices have like certain highlights on them and certain boulds. But I never changed it, I just went along with it. Now I know, but I didn't know she still got denied.
Speaker 2:
She got denied. So she called them up and argued with them and she literally said the words listen, I know what you're doing. I worked there for 20 years. I just retired. You're not going to deny this because this is everything that you need. And they said well, no, the period is in the wrong place. Can you please resubmit? Or some bullshit answer.
Speaker 1:
Oh, my goodness.
Speaker 2:
Long story short, she went back and forth four different times on the phone, four different invoices that I created for her, before they finally agreed to pay her the amount that she was due to get back, because the first time they said no, we're not paying anything. Then the next time, after a 30 minute long conversation, they said, ok, we'll pay you $15 for every visit. And she said absolutely not. So then the third time, they said OK, we'll pay X amount. And then, finally, after the fourth time, they agreed to pay her back whatever it was that she was supposed to be paid, because that's what her plan signed up for or what she was paying for. So now, when people want to come see me and submit for out of network reimbursement, I say you're more than welcome to do it If you want to see how high your blood pressure can get.
Speaker 1:
Right. How many times do you have to fight with them and how angry they make you before they finally agree to do something?
Speaker 2:
Yes, how many times have we dealt with this over the past four years, going from being two young, healthy adults never going to doctors or hospitals, to having a kid, having a second kid, with all sorts of things that were supposed to be covered and weren't covered.
Speaker 1:
Yeah, I mean we've talked about it before on this podcast that we had. We lost a baby at 16 weeks and had to have a D&E. They had to go in and actually deliver the baby and insurance came back and said they were not going to cover the procedure of delivering this 16 week old dead fetus because it wasn't medically necessary to deliver the baby and so they just weren't going to cover anything. And we had to fight and fight and fight and say this was a life or death situation for mom. I mean, baby was already gone, but life or death situation for mom and it wasn't going to be covered because it wasn't medically necessary.
Speaker 2:
And this is no exaggeration, that's not sugar coated, that's as explicit and as blunt as you can get. This was a surgical procedure that had to be done and it was not cheap at all. It gives us surgery, right? We had to go under anesthesia and everything and they come back and said this was not medically necessary. We're not paying for anything and we are ripping our hair out trying to talk to people over the phone, because you can't talk to anybody in person. You can never go face to face with these people and try to reason with somebody and rationalize. This is always over the phone. Do you understand? There was a dead baby in my body that wasn't going to pass naturally, right? So what do you mean? This wasn't medically necessary.
Speaker 1:
Right, right. So not only now did we just lose our first child, but then we're arguing with the insurance company about wanting to cover something. So it's just. I mean, it gets to the extremes Like, yes, getting reimbursement for physical therapy is really important to a lot of people and you can fight and fight and fight and maybe get reimbursed for it, but it goes to the extremes of something like our situations. It's crazy.
Speaker 2:
I don't know if I would use the word extreme. I would use the word clear, sure, right. Okay, so our situation was clear, cut and dry, black and white. You should pay for this Right. Then you can go down this rabbit hole and try to say maybe it's not clear that they should pay for X, y, z, and that's why you have to argue, but it's really not. At the end of the day, their job is to deny, because they are about profits, not patient outcomes. The more money they have to pay for your medical services, the less profit they make. It's that simple.
Speaker 1:
Right and that's the same thing that we've talked about a few times on this podcast on why our practices are out of network, specifically my health and wellness and your physical therapy practices not accepting insurance Because, as a provider, we cannot do what is medically necessary for our patients, because we are being dictated by what insurance says they will pay us to be able to do.
Speaker 2:
What they deem as medically necessary.
Speaker 1:
Right, right. So the insurance company is deciding what the doctor or the PA or the doctor of physical therapy should actually be doing for treatment, even though they haven't even seen the patient, or not once or spoke to the patient or understood what's going on with the patient, but they want to tell us what they will consider necessary for treatment.
Speaker 2:
Right.
Speaker 1:
Or for diagnostic testing in my case.
Speaker 2:
I'm so glad you said diagnostic testing, because that's actually what I wanted to talk about in the first place today, before I got off on this rant.
Speaker 1:
We're always on rants.
Speaker 2:
So over the weekend I was talking to a guy down on the beach where he's the father of a dear friend and we're just talking about. He found out I was a physical therapist and he's like yeah, my knee popped and I just finished physical therapy and now I'm waiting to get an MRI. And I said, okay, tell me more. I was like how's your knee feel now? He goes oh, my knee feels great now. I said, okay, why do you want an MRI? He goes well, I just want to know.
Speaker 2:
I mean, I don't know if it's my ACL or I just don't know what it was, and I always try to tread lightly when I'm talking to people that don't really know me or what I stand for and how aggressively I stand for it, or bluntly, or whatever you want to call it. I said, okay, so you just want to get there, even though your knee is feeling great now, you just finished physical therapy. You just want to get the MRI. He's like, yeah, I mean, I just felt a pop and I just want to make sure that it wasn't my ACL and I just I didn't really push it in, I went on to something else, but I wanted to talk about it today, because it's so common that people want to get an MRI. Right.
Speaker 2:
I felt a pop. I felt a click. I heard a pop. I heard a click. I want to get an MRI to make sure that nothing broke. Right.
Speaker 2:
And it's so funny that I wanted to talk about this today because on my time hop this thing just popped up on my time hop. That those of you that don't know what time hop is. It's an app on your phone that brings up pictures from the past that were whatever happened on this day a year ago, or five years ago, or seven years ago, whatever it was back in time on today. And today what popped up was eight years ago. I took a screenshot of this thing that I saw on the physical APTA American Physical Therapy Association website that says patients who get imaging before physical therapy spend $4,793 more than those who get physical therapy first.
Speaker 1:
And you showed that to me this morning. You're like, oh, coincidentally, what we're going to already talk about on the podcast today, and he showed that to me and I was like, and that was eight years ago, now it's probably triple that amount.
Speaker 2:
It has to be triple that, because this was eight years ago and people were spending $5,000 more. If you got an MRI before you got physical therapy, on average you were spending $5,000 more than people who got physical therapy first, and this was eight years ago. It has to be at least 10 grand, probably 15 grand.
Speaker 1:
We just went through a very similar situation to this with one of our clients who came to see us and committed to doing a program with us for her GI issues, and she said I thought about doing functional medicine three years ago but decided that I would go the route of getting the testing and seeing the doctors in the gastroenterology office first In network. In network she has now gone through three different gastroenterologists, had multiple scans done, two of which CT scans that she had to pay out of pocket for because insurance wouldn't cover it. We didn't get into the details of it, but she had already had multiple tests done endoscopy, colonoscopy and then ended up having two scans that she had to pay out of pocket for. And she's like I should have just done functional medicine three years ago. I've now spent tripled what I would have spent with a functional medicine provider three years ago, going through all of this testing and seeing all these GI doctors, and I'm not better. Nothing has changed. I'm not better. I'm actually probably a little worse than I was three years ago.
Speaker 2:
And you're just talking about monetarily. So she spent three times more monetarily, or three years. What is your time worth?
Speaker 1:
In her quality of life, just dealing with what she's been dealing with for that long.
Speaker 2:
What is your time worth? I mean, I get this so often, especially with my demographic. I primarily work with people over the age of 60. A lot of them are over the age of 70. And, to be as morbid as possible, if you're 70 years old you're really on average. If you want to go on average, how many more years do you have left? 15. Right, that's an average. This is morbid. This is very morbid. But if you're 70 years old on average, you've got 15 more years of life left.
Speaker 1:
Maybe actually, if we're talking about average, like United States average, probably less than that. What is the average death age?
Speaker 2:
I don't know. Let's just say 10. Okay, okay, so if you're 70, let's say, on average, you're going to live until you're 80. You've got 10 years and you're going to sit here and tell me that you're going to wait to go through the cookie cutters. Are us physical therapy so that your insurance will pay for your MRI, Just so you can be in line right to get surgery. Right, and I'm going. We're talking about six months minimum. Then, by the time it's all said and done, you do have surgery. We're talking about 18 months, right? We're talking about over 10% of your life that you have left you just wasted on waiting for an MRI and surgery, and you might not even be better after the surgery.
Speaker 1:
You might not be, so I just check. Well, this is actually from 2020. The average death age was 77. That was in 2020, so if you're 70.
Speaker 2:
you have seven years left potentially On average, and you know we all want to sit here and say, yeah, I live a very healthy lifestyle, I'm very healthy, I'm not average, I'm way healthier than the average person. However, you don't know when it's your time. It just popped up on the local news this morning that two 71 year olds died in a boating accident just up the road from us. Like you don't know, I mean, these two 71 year olds could have been the healthiest people on the planet, husband and wife and they came around a corner, lost control, they ended up in the woods and they're both dead. So you don't know that you're going to make it till 80.
Speaker 2:
Why in the world would you want to wait 18 months for an MRI and possibly surgery, right? So, anyways, I want to come back to this statement where it says people who get imaging first spend, on average, $5,000. More than people who get physical therapy first. The reason why that is is what Jenny just insinuated or not insinuated outlined with her wellness patient, which is you go down this rabbit hole of what insurance deems as medically necessary, and it's these tests and measures that may or may not be appropriate or relevant for what you're dealing with. And you're paying co-pays, you're paying deductibles, you're paying all these things that you don't expect to pay along the way and the next thing you know it all adds up because we're talking about over time. Everybody thinks that it's Amazon Prime, like it's going to be here tomorrow, I'm going to get an MRI and I'm going to have results the next day and the solution is going to be there the next day. It's not Right.
Speaker 1:
It's absolutely not, and especially outside of physical therapy. In our world, if you're going through a CT scan, then the radiologist has to read it, and then you go to a colonoscopy and endoscopy and they got a sin for biopsies and then you're waiting on blood tests to come back, like this is a whole process.
Speaker 2:
So let's start to get ready to land the plane here and bring all of these things full circle. In the first job I ever worked at as a physical therapist, I was up in the panhandle of Dustin and I actually had a patient who was an orthopedic surgeon and he'll I'll never forget the words that he told me. We're talking about MRIs for some reason, and this guy was very conservative, he was not scalpel happy by any means at all. He goes. You know, I tell everybody that comes in my office asking me for an MRI, I say why do you want an MRI? Do you want to have surgery? And 100% of the people say no. It's like, okay, you don't want to have surgery, but you want an MRI.
Speaker 2:
And this surgeon came up with this kind of sarcastic, caustic comment and said you know MRI stands for might require incision, and the patients would always look at him baffled and say what he goes. You should not get an MRI unless you are prepared to have surgery, because once you get an MRI, you now have a diagnosis. Before you have an MRI you don't have a diagnosis. You can use knee pain, for example. Knees are probably one of the easiest ones because they naturally degenerate over time. They just do.
Speaker 2:
So if you're 60 years old and your knee hurts, you don't know why it hurts. You just know that it hurts. I know why it hurts because 9 out of 10 times knee pain is caused by a weak ass syndrome. However, you don't know why it hurts. So if you skip coming to see me and you go straight to the orthopedic surgeon who orders an MRI for you, then your MRI is going to come back and it's going to say that you've got degeneration of your medial compartment, your lateral meniscus is torn three quarters of the way and it's just going to say all of these things that are a normal part of the aging process. But before you had that MRI you didn't have that diagnosis. After you have the MRI now, you have a diagnosis of medial compartment degeneration and lateral meniscus tear.
Speaker 2:
So now, every time your knee hurts, your brain fixates on your diagnosis. You're like, oh, can't go up that stair because my meniscus. Oh, can't go up that stair because my bone on bone. I'm not going to get down on the ground and play with my grandkids because I've got bone on bone Versus. If you come and see me and you don't know what it looks like in there, I'm going to say oh, the reason why your knee hurts is because it's not getting enough support from your ass. Let's work on your ass, get your butt stronger. And now, all of a sudden, your knee has the support that it needs, so the inflammation decreases and the pain response resolves. Now you can go up and down stairs without thinking about it. Now you can get down on the ground and play with your grandkids without thinking about it, because you don't have a diagnosis in your knee. You actually have a diagnosis of weak ass syndrome, and it's in your ass, not your knee. So when your knee hurts, you're like, oh, my glutes are not working, let's get the glutes firing again.
Speaker 1:
Tiger Woods. So in other words you're saying is that the MRI is telling you that you have a diagnosis that could require, or probably would require, surgery, but that really may not be where your pain is coming from. So if you are able to have a different type of evaluation and treat the problem and not the symptom of where the pain is resonating, then you may not need the surgery to fix whatever the MRI is showing.
Speaker 2:
That is correct. Here's another way to say exactly what you said, and I don't know that I've ever said it this explicitly, so hopefully I get a little backlash from this from people that are critiquing. Here's one thing that I can say If we're talking about orthopedic or, I'm sorry, musculoskeletal pain so muscle pain, joint pain if it is non-traumatic, which means you did not have an injury, there was no trauma, there was no car accident, no slip and fall, no bicycle accident you didn't get hit by something. There was no trauma and your knee just started hurting for no reason. One day, your shoulder just started hurting for no reason. Your back just started hurting for no reason, and no bending over to pick up a pencil and your back goes out.
Speaker 2:
That's not a trauma. Whenever that's the case, wherever your pain is ain't where the problem is. I don't know a single time in my whole entire career where that has not been true. Wherever it is, it ain't Wherever the pain is ain't where the problem is. The pain is a symptom because of a problem somewhere else, and I have never in my entire career seen the two be at the same place for non-traumatic pain.
Speaker 1:
Right, right. So, unless there's a specific event or injury, this kind of goes with the neck issue that I had over the last couple of months, which was a wild presentation of pain that I had in my neck, actually from I felt when it exactly happened, but it turns out that the pain was really not coming from my neck. I was feeling pain in my neck, I was having triple swallowing to the point that that was affecting my neck, but it was actually coming from lower down, from a musculoskeletal issue, right.
Speaker 2:
It was nuts, absolutely nuts, and if we were not family, I probably could have figured it out sooner, right?
Speaker 2:
But this was a perfect example that you can't treat family because it's too subjective, there's too many emotions, it clouds your objective thinking and for those reasons I intentionally say I'm not working on you or any of my family members, because we're just not gonna get the results that I would expect. But yes, I mean, it was a weird presentation. Where I'm going, I told you explicitly like this is outside of my scope of practice, call up Gerber, call the surgeon, get an MRI, do something else. Because like it was just weird and we chased that rabbit hole or we went down that rabbit hole for a few weeks before. Finally I said, okay, nothing's getting better, nothing's getting worse, let's do some objective testing. How would I treat you if you were just some random patient that walked in the door and we started doing that and come to find out it was scapular positioning and posture that was putting all this stress on the upper cervical area, mid to upper cervical area, and it's like geez, louise, this is so simple, not easy, so simple.
Speaker 1:
Right, right. So the point of that story was it was really coming from my scapula. Underneath the scapula, the way my shoulder blade is what the scapula is was positioned. That was the entire problem. But the symptom was at my neck and presenting very strangely. I mean it was affecting my ability to eat and to swallow from and causing pain actually at the cervical spine, but it wasn't my spine.
Speaker 2:
Yeah, and this is a perfect example where I'm not Superman, I'm not God, I can't fix everything. And if something is not making sense to me, I will be the first one to refer you out. I'll be the first one to say you gotta go get an X-ray, you gotta go get an MRI to make sure that I'm not missing something. And this was a perfect example with you where it was not making sense to me. So the MRI was relevant. It was necessary, because as soon as your MRI came back pristine I mean, there was nothing wrong on that MRI I was like okay, then this is in my wheelhouse, this is something I can figure out. It's just presenting differently than I had ever seen before. So that's when I'm like okay, we ruled out the scary stuff, let me get to work.
Speaker 1:
Right right, good, yes, perfect. So you might go out of network and pay a little. Put a little skin in the game, but it's gonna work out in the long run. It's gonna be way more beneficial in the long run if you put a little skin in the game early.
Speaker 2:
Yeah, it's way more upfront. However, it's significantly less long-term. You just have to put the money upfront, versus you'd go in network. You're putting way less money upfront, but it's gonna drag out forever and you're gonna keep getting nickled and dimed. And then next thing you know, five years down the road, you've quadrupled the amount of time and money that it would have cost you if you would have just did it the right way.
Speaker 1:
With potentially no improvement.
Speaker 2:
Kind of like fixing a boat right. Didn't we talk about that recently?
Speaker 1:
Yeah, go back and listen to it. All right, good Like. Subscribe comment. We want some more comments.
Speaker 2:
Yeah, this is a good one to comment on, especially all of my peers out there that are listening to me. All non-traumatic pain. The problem is never there. Let me hear your thoughts on that critics.
Speaker 1:
Ciao for now.
Speaker 2:
See you.
Speaker 1:
Thank you for subscribing on your social media and podcast platforms to the Berman Method Dr Jake Berman with Berman Physical Therapy and Jenny Berman, physician Assistant with Berman Health and Wellness. You can find more information on our website wwwbermanptcom for physical therapy. Wwwbermanptcom forward slash wellness for the health and wellness. You can also find us on social media, facebook, instagram, and on your podcast platform, so be sure to follow us, like us, subscribe to us and, if you would like any further information, definitely visit our website and reach out to us. You may also find our free reports on the websites as well, where you can download this free information for yourself. Have a great day.