The Berman Method
The Berman Method
Episode #172: New Year's Excitement!
Are health insurance companies giving you the runaround, despite having all your paperwork in order? Join us on the Berman Method podcast as we share our personal battles with denied claims and the vital lessons of persistence and self-advocacy. Dr. Jake Berman and physician assistant Jenni Berman bring you an eye-opening discussion on navigating the often frustrating world of health insurance, drawing from our experiences and those of others who’ve fought for their rightful reimbursements. As the New Year rolls around, we tackle the common pitfalls of resolutions, emphasizing the necessity of personalized, root-cause approaches to health. From understanding the real issues behind inflammation and sleep problems to creating tailored plans that keep you accountable, we’re here to help you transform those fleeting January ambitions into lasting lifestyle changes.
Ever wondered why a minor ache suddenly turns into severe pain? We unravel the mysteries behind pain and inflammation thresholds, using a simple scale to demonstrate how these issues can sneak up on you if left unchecked. Our conversation doesn’t just stop at identifying the problem; we guide you through the maze of generic advice versus specialized expertise. With our backgrounds in pain management and nutrition, Jake and Jenny reveal why investing in quality health services is akin to choosing a luxury car over a budget model. Tune in to discover how expert guidance can pave the way for a more effective and personalized health journey, setting you on the path to sustained wellness.
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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 rolling with the New Year's Eve-ish. New Year's Eve Eve podcast episode Berman Method Treat problems and not symptoms. How was that for a smooth intro, probably the smoothest one I've ever done.
Speaker 1:Great way to end the year.
Speaker 2:Yeah, we should redo it, but I'm not going to.
Speaker 1:It's progress, not perfection.
Speaker 2:Yeah, one take, jake. We're rolling with this thing the Berman Method podcast, treating problems and not symptoms. David going against Goliath. We do not believe that the pharmaceutical companies or the health insurance companies have your best interests in mind. The health insurance companies are a joke when it comes to paying for what you actually need. Their job is to deny. Here is a black and white example of it.
Speaker 2:One of my clients from way back in the day when I first opened up was a retired employee from one of the major health insurance companies here in Florida. You can guess whichever one you want to guess. It was one of the major ones. She was retired, she had freshly retired and was one of my clients. She came in for out-of-network physical therapy services. We went through our treatment. She took my invoice to submit it for out-of-network reimbursement and they denied her. And she's going. I know what you're doing right now. You are denying me just because you were taught to deny me. They had every single piece of information. They needed every code, everything they needed to reimburse her for out-of-network services and they just kept denying her, because that's what they're taught to do Deny, deny, deny.
Speaker 2:You didn't put a period at the end of this sentence. So we're going to deny it and call it something else. It is a joke, an absolute joke. So two things Number one is pay out of pocket for as much as you possibly can for the things that you actually need and want, and number two is when it is appropriate for them to pay for something that they should be paying for. You've got to fight tooth and nail. Because here is my other example I had a procedure done two years ago, two years ago, and they billed me $4,500. The hospital here billed me $4,500 for this thing that should have been $500. Long story short two and a half years later I finally get my bill for $450. Originally $4,500. Finally $450 two and a half years later, because they just didn't code it right.
Speaker 1:Right, we just kept sending it back and fighting and sending it back and fighting and not giving up.
Speaker 2:Yeah, they build it through my insurance when I explicitly said I want to be self-pay, it was that simple, that simple Right Two and a half years later, it finally got resolved.
Speaker 2:That simple Two and a half years later it finally got resolved. So anyways, here we are. End of the year, new Year's Eve right around the corner, new Year's Day right around the corner. All the New Year's resolutions. I'm going to get a gym membership. I'm going to do something about my health. I'm going to lose 20 pounds. I'm going to fix my blood sugar. I'm going to get off these statins. I'm going to fix my back pain. I'm going to get back out to golf. I'm going to play tennis, I'm going to play pickleball. I'm going to play with my grandkids even more.
Speaker 1:You hit all of them.
Speaker 2:But then it doesn't happen.
Speaker 1:Well, it happens for a month. The first 28 days go great, january 2nd to January 30th, perfect.
Speaker 2:And for some reason, right around Valentine's Day, it's like what.
Speaker 1:New Year's resolution. Right, it starts to drop off because accountability yeah.
Speaker 2:Accountability is the biggest one.
Speaker 1:Right, right, yeah, well, and in my opinion also besides, the accountability is it's not knowing the right way of how to get there. So you think I'm going to lose 20 pounds just by eating less and moving more, but then three weeks into it, your body is really sore from moving more and you're starving. Because you decided that you were just going to go down to intermittent fasting and eating two meals a day. You lost 10 pounds to start. Now you've hit a plateau and you're starving, and so you lose that motivation, that inclination that this is actually working, or you get the nicely said self-pity to say oh, this always happens, I always get to a plateau, nothing works and you give up because you didn't do the right thing for your body, you didn't get into exercise the right way, you didn't get the right meal plan for your body, you didn't evaluate what the actual problem is that is causing your inflammation, your weight gain, your poor sleep habits, the hunger, the cravings that you're having.
Speaker 1:It's oftentimes not just the calories in, calories out, it's oftentimes not just your mental capacity to say no to the sweets. There's something internal happening that's causing these things. So not just the accountability. After the first 30 days or 45 days. That goes away. It's the frustration that your progress hasn't continued or that you haven't seen progress because you're not doing it right, because you don't know. You don't know what you don't know. And the same thing happens on the physical therapy side. Right, they get into their exercise, they're doing great for three weeks and then they tweak their back.
Speaker 2:Yeah, it's one of the most common things that we see in our side is the pain's gone, don't need to come back anymore and it's like wait a second, the reason why the pain is gone is because you're coming here.
Speaker 2:I'm not saying you have to keep coming five days a week. However, you need to come at least once a month to make sure that you're doing it perfectly, your homework perfectly, because I've never in my entire career myself included, jenny included never seen anybody able to do their homework 100% correctly 35 days after being coached.
Speaker 1:I never do, nobody does. I don't know that I've ever done my homework 100% correct ever. You're always making tweaks on my homework, but it's making me better right. You get stronger and you have to activate something else differently, because a muscle that used to be weak is now strong. So then you're going to see a weakness in a different area because of the strengths that you're developing and as you lose weight and as you increase certain muscles and muscle activation, muscle tone, then you're going to see find weaknesses in other areas.
Speaker 2:It's so important to realize that if you're not doing your homework, your squats, let's say squats. If you're not doing a squat 100% correctly, you're doing it some percentage incorrectly. Let's use real numbers. Doing a squat, 97% correctly, most people would say, oh, that's pretty good. The way I see it is well, you're doing it 3% incorrectly and over the next couple of weeks that 3% is going to turn into 6%. Then over two to three months, that 6% is going to turn into 6%. Then over two to three months, that 6% is going to turn into 15 to 20%. Next thing, you know, six months down the road, you're doing a squat 70% correctly at best, which means you're doing 30% incorrectly, which means that inflammation is starting to build and you have to think of inflammation.
Speaker 2:You got to think of pain and inflammation as a threshold of inflammation. You got to think of pain and inflammation as a threshold. So, to be arbitrary, let's use zero to 10. Zero out of 10, there's no inflammation at all. 10 out of 10, the inflammation is so high, the pain is so high, you're going to the hospital.
Speaker 2:Don't hold me to these numbers. This is just for arbitrary purposes. If you have zero, one, two, three or four levels of inflammation, you're not going to feel pain because it's not being triggered. The pain response is not being triggered yet.
Speaker 2:But as soon as that inflammation reaches a level five out of 10, now all of a sudden that triggers the pain response in your brain and you're like, ooh, my knee is starting to hurt, ooh, my back is starting to get tight and stiff. And then, as the inflammation goes up higher six out of 10, okay, now it's going from stiffness to pain. Now it goes from seven, the inflammation is seven out of 10. Now that pain is getting even higher, more noticeable. So if you're doing your homework 20% incorrectly, 80% correctly, but 20% incorrectly you are slowly, gradually, consistently building inflammation until ultimately that inflammation is going to reach a threshold to trigger the pain response and now you have pain again. Now you're back in my office again. Versus just show up once a month every year and get corrected. So that's going to minimize the chances of the inflammation getting to that threshold, to where the pain comes back Right To where you've now regressed because of the pain.
Speaker 1:And the same thing happens with internal inflammation on our side too, with the gut, is that you get to a threshold that you start seeing symptoms with the inflammation. So, yes, the whole point is don't start this new year new. You jump right into everything without having the guidance, the knowledge, the accountability, someone to help you. I think another one of our favorites is oh, I joined a gym and I can do this on my own at the gym, or there's trainers at the gym.
Speaker 1:They'll watch me and it's like okay, but what are they trained to see? Are they trained to see that you're actually moving your body Great job or are they trained to actually see what we're seeing? Same thing with the meal plan, with the trainers at the gym and there you're like, oh they'll, they're going to work with me on the nutrition. That's great that they can count calories and they can count macros, but are they actually adjusting your nutrition based on your blood testing and your body composition?
Speaker 2:No, they're not, Because look at the price you're paying to get that advice from them versus the price you pay to get advice from Jenny or Jake.
Speaker 1:Right, I had a client just a month ago say you know, I've learned so much from you guys. I'm going to continue it, but I found somebody that is a nutritionist and personal trainer that's far less expensive and they're going to help continue to guide me. Okay, see you in a month.
Speaker 2:Here's the reality of it. You're paying us for our expertise right, we've been down this road for our expertise. Right, we've been down this road. You're paying us to guide you on the quickest, simplest route to reach your goals and objectives as quickly as possible. That's what you're paying us to do. Now here's my rebuttal to anybody that wants to go to somebody else. That's not Jake or Jenny. What book did they write? Did they write a book? Because Jake literally wrote the book on back pain. Jake literally wrote the book on knee pain, foot pain, shoulder pain, neck pain literally wrote the book on it. Is there anybody else in this town that wrote the book on how to avoid surgery and pain pills while maintaining a high quality of life? Jenny literally wrote the book on blood sugar stability. Literally, she wrote the book. Is there any other nutritionist in this town that wrote the book on it other than your mentor, dr Cedarquist?
Speaker 1:Right right.
Speaker 2:Right, so your mentor, the one that directly trained you, wrote the book. You wrote the book.
Speaker 1:Right.
Speaker 2:Is there anybody else that wrote the book? So yeah, you can go nickel and dime it and go take the cheap way out. You're not going to get the Maserati, the Bentley, the Benz, the Beamers, the Maserati, right, you're going to get the Hyundai. You're going to get the Kia, you're going to get the Kia. There's nothing wrong with Hondas and Kias, they're really nice cars, but they're not a Bugatti, they're not a Maserati.
Speaker 1:I'm not a car guy right.
Speaker 2:I always throw out these car names and I'm like I don't even know what these are. You don't even know what they look like. I couldn't pick one out to save my life, but all of my clients drive them.
Speaker 2:Like they show up with these cars and I don't even know what they look like. I don't know what they are, but I know that they're a quarter million dollar car compared to my truck, which I bought out the door 35 grand. Right, so we're in different ballparks here. Right, so we're in different in different ballparks here. But the point of it is I don't go get in my truck and expect it to drive me home. I don't get my truck and expect the seats to heat up. I don't get in my truck and expect power seats, like I don't expect those things if I expect he's still manually rolling down his window y'all.
Speaker 2:That's what you guys are doing when you go to these other personal trainers and I'm doing air quotes right now these health coaches they're going to coach me on my macros. Okay, show me the book that they wrote on this.
Speaker 1:Right, right. They're counting your calories and making recommendations for what worked for them at 26 years old to be able to gain some lean muscle mass, which is equivalent to manually rolling down your windows in your Beamer.
Speaker 2:You hit the nail on the head what worked for them at 20 years old, 26 years old Are you freaking, kidding me? We wrote the book on the 45 to 65 year old, the 75 year old, the 80 year old, the 90 year old that wants to keep active, mobile and avoid surgery and pain pills. That's the book that we wrote. If you want to go get advice from this 20 year old that can still eat a whole pizza and not gain an ounce that used to be me. I would not take advice from 20-year-old Jake, like I would not do it.
Speaker 1:Yeah, me neither. I didn't even date you when you were 20 years old.
Speaker 2:Yeah, you made me wait till I was 30.
Speaker 1:All right, well, happy new year everybody. Just keep this in mind Don't jump in thinking it's going to be a new year, new you, without actually making a change. You have to seek out help. You have to spend a little bit money on your healthcare. You have to invest and get the expertise to be able to see the progress, continuous progress.
Speaker 2:Yes, accountability is key and you get what you pay for.
Speaker 1:We say that all the time, don't we?
Speaker 2:Yeah, you get what you pay for. It is that simple. There's not a single person that I've ever met that would explicitly, blatantly, say you know what and say you know what. I've got a emergency. I'm in the emergency room right now. I'm bleeding out. Can you send in the cheapest doctor on staff right now, the one that you're paying the least amount? I want him to save my life right now. Right, or her, yeah or her. Nobody says that. Send me in the expert, save my life.
Speaker 2:Right, I don't care how much you're paying them, or how much I have to pay them. Save my life, right, that's it, all right, happy New.
Speaker 1:Year. Ciao for now. 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.