Episode 224: Short Rant You Won't Want To Miss...

In this episode of the Berman Method Podcast, Dr. Jake and Jenni Berman take aim at one of the most frustrating parts of modern healthcare: health insurance. From denied claims to outrageously expensive “covered” lab work, they share real-life experiences that highlight why the current system often fails patients—even when care is medically necessary.

They break down the growing shift away from traditional insurance-based care, explaining why more people (and even providers) are moving toward self-pay and functional medicine. Using a powerful analogy, they compare today’s healthcare system to choosing between a horse and a car—familiar and cheaper upfront vs. more efficient, effective, and future-focused.

If you’ve ever questioned whether insurance is actually working for you, this episode will challenge your perspective and help you understand why investing directly in your health may be the better long-term solution.

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Transcript

Speaker 1 0:01

And we're rolling, baby, with the Berman Method Podcast. Dr. Jake Berman here with my beautiful co-host.

Speaker 2 0:07

Jenni Berman, physician assistant.

Why Health Insurance Feels Like War

Speaker 1 0:09

We are all about treating problems, not symptoms. David going against Goliath, Goliath being the corporate medical system, big pharmaceutical companies, your freaking health insurance companies. Oh my gosh. It just feels like every time we have an episode, we've got something to rant about when it comes to health insurance. And I'm just this morning, I'm going, holy cow, we could almost justify hiring a full-time quote unquote house manager for our own home. For our own home, whose only job is to frickin' call the health insurance companies and battle them. Yeah.

Speaker 2 0:52

As we're still going through health insurance drama on our end.

Speaker 1 0:57

And this wasn't even intentional this time. We didn't like this one was one. Like, where did this even come from? We didn't even try to do this one.

Canceling Coverage And What Changed

Speaker 2 1:06

Yeah. I mean, I think we've already told everybody that we canceled our health insurance for our family, with the exception of Walker. Walker was on his own plan and we're we're going through some testing, so I was like, eh, we'll just leave it there. It's not helping us. It came back to bite us again this morning. And so, yeah, just done with it.

Speaker 1 1:31

It is just amazing. Holy cow. So I just finished writing the cover article for our May newsletter that we send out. And I was just on a I was on like a pedestal. I was so frustrated with this thing where I'm like, this whole entire freaking article is going to be about this problem. And here's the health insurance problem? Not so much health insurance as much as health care.

Speaker 2 2:04

Okay.

Speaker 1 2:04

Like m a much bigger picture, health care, where we're at a we're at a transition right now in history. We're gonna look back on this 20, 30, 40 years from now. We're gonna look back on this and we're gonna go, that is when it was happening. So back when it was back in the 50s and 60s when the doctors were smoking cigarettes in the clinic. Right? Right. I think one of the opening scenes right at the beginning of Forrest Gump, the doctor is smoking cigarettes looking at his legs. Right. And that was completely normal. Meaning that right now it's still completely normal for a lot of people to use health insurance and to think that their Medicare is gonna cover things. And come to find out 50 years later, it's not completely okay to smoke cigarettes, and it's really not okay to smoke them as a doctor, and it's really, really, really not okay to smoke them as a doctor in a clinic.

Home Health Checks And Layoffs

Speaker 2 3:04

Correct. Yes. And we think, well, we don't think we we almost know that this is the way health insurance is gonna be going, where people even 20 years from now are gonna be like, what? Health insurance is for catastrophic things only and nothing. I just had a friend who had um been working as a PA or MP for a health insurance company, kind of doing like the home checks and the insurance checks, right? Like if you've ever had insurance and you're over 50, they usually send somebody to your house to do a quote unquote health check to make sure you can still qualify for the plan that you're on for health insurance. Did you know that?

Speaker 1 3:45

I did not know that.

Speaker 2 3:47

So, and you know, there's other areas where like some um some health insurances won't do it until you're 60 plus. Some will, you know, there's also Medicare checks. But anyways, they come to your house, they do like this very basic health check and say, okay, yep, you're good to go. They draw like blood right there on the site to look at just some mark, you know, quick markers to say, okay, yep, you're healthy, you're good to go, you can stay on this plan, versus nope, you don't qualify. We need to change your plan, which and then of course cost more money, right? So I had a friend that was doing this, and she said she just suddenly was laid off because so many people in her territory didn't renew their health insurance this year. And because so many people didn't renew their health insurance, they had to lay off a bunch of employees because they can't afford them. And I was like, this is it.

Speaker 1 4:35

It's finally turning.

Speaker 2 4:37

Yeah, where people are recognizing that the health insurance is doing them no good. So why renew it? Just self-pay.

Speaker 1 4:44

Wow, did not know that. I guess that's it's good. It's not good that they lost their job, but it is good that people are getting smarter.

Speaker 2 4:55

Yes, right. Yeah, I feel bad for her that she lost her job. She got a new job, so it's okay. But yeah, people are just getting they're they're recognizing it.

The Out Of Network Lab Bill

Speaker 1 5:04

And you know what's interesting about what you just said, just coincidentally, or maybe it's not a coincidence, we've gotten so many applications lately from PAs and NPs that are applying to Berman Health Club.

Speaker 2 5:21

Because they want to get out of the network.

Speaker 1 5:23

Yeah, they want to get out of the mill, the daily mill. So I don't think it's coincidence at all. Like people are getting smarter. We're sitting here beating the drum, screaming from the top of my lungs.

Speaker 2 5:38

Yeah, it's it's crazy. And just to kind of give some insight on the bill that we received this time, is I Walker's going through some blood testing and we're seeing an out-of-network doctor for him. Um now his their pediatrician is also out of network. We're not going through the in in network world anymore, even for our kids, as far as a pediatrician goes. But she ordered his labs to go to Quest through insurance, knowing that he had health insurance. And if I would have ordered the labs out of network, because all labs that we do in our office, we have out of network pricing, it would have been at least $500 cheaper than the bill that we got from insurance. So we did labs, we did them in our office, actually. I didn't even take them to Quest. I used our private phlebotomist to draw his labs, but the lab the lab order got sent to Quest. So the labs got run through his insurance, just the way they were ordered from his pediatrician. So they ran them through insurance. Insurance came back covering nothing. Zero dollars is what they covered for his blood test. And yeah, if I would it probably would have been even six or seven hundred dollars cheaper for me just to order them with the out-of-network pricing than the bill that we got.

Speaker 1 6:56

Yeah, let's just be conservative because this was a thousand dollar bill that we just got to draw a baby's blood.

Speaker 2 7:03

Yeah, like medically necessary, yeah.

Functional Medicine Meets Diagnosis Codes

Speaker 1 7:06

To put it into context, this was medically necessary, but because this is through a concierge doc, an out-of-network doctor who's looking at what we're dealing with. We'll disclose all this later once we have more information, but it's too soon to say anything. Everything's okay right now, by the way. But because we're going through this from a functional medicine standpoint, there's no Western medicine diagnosis.

Speaker 2 7:34

Quote unquote diagnosis codes. Or she couldn't, yeah, she couldn't put diagnosis codes on testing that is being used to evaluate him. Yeah.

Speaker 1 7:42

But there's a very legitimate marker that we did find that it's like, oh, this is an interesting marker. This requires more testing to see if it means anything or not. So from a functional medicine world, a functional medicine standpoint, we found a marker that says we need to dig deeper. It wasn't anything crazy. It was just like, oh, this is interesting. We need more information, but it wasn't um black and white enough for Western medicine to say you can get an actual diagnosis and cover it from insurance. And again, we didn't try, we didn't do this intentionally saying, I want insurance to cover this blood work. This was just a complete accident.

The Horse And Car Health Care Shift

Speaker 2 8:25

Yeah, it actually was. If I I mean, I guess if I had been a little more clear-minded about my own child go, you know, getting blood work done, I would have just ordered them myself out of network and gone self-pay. And I just, yeah. Anyway, so there we go. There we go again. Another insurance problem where I'm just like, I here I am paying a monthly premium. Now you're gonna cover zero dollars, and I owe this many thousand dollars for labs that we could have gotten for 300 bucks. Yeah.

Speaker 1 8:57

So coming back to my my May newsletter, the thing that I used in this, the the analogy that I used was back in the late 1800s, the automobile was invented. And prior to this, the only way that you could really get around was to walk or ride a horse. Yes, a bicycle came out around the same time, but it wasn't really um it didn't really work. There wasn't really terrain that you could do it. So it was either walk or ride a horse. Okay, then the automobile gets invented, and the automobile was very expensive at the time. At the time, once it becomes commercially available in the early 1900s, it was around $800 to $900 to buy an automobile. At that same time period, you could buy a very good, reliable horse for $100.

Speaker 2 9:50

Okay, yeah.

Speaker 1 9:51

So eight times more for an automobile.

Speaker 2 9:54

Right.

Speaker 1 9:55

There were no roads at the time, and they broke down. So most people were saying, why would I ever buy an automobile? It's way too expensive, and you can't ride it anywhere you want. Um and it breaks down. Why wouldn't I just buy why won't I just stay on the horse? That's where we're at right now. Right. Is the horse is traditional medicine, the horse is your Medicare, the horse is only getting medical treatment that's covered by health insurance.

Speaker 2 10:24

Right.

Speaker 1 10:25

The automobile is doing more research. The automobile is going out of network, the automobile is taking out your wallet, pulling out that plastic thing, and spending it on your flesh vessel, which is your body, not a TV, an iPhone, or a new car or a new house, but spending it on your actually your body.

Speaker 2 10:45

Right. Yes, the efficiency.

Speaker 1 10:47

But wait, it's so expensive. What do you mean it's gonna cost $3,000 to heal my gut? Why would I do that? I can just go to the hospital and get insurance to cover a monthly dietary visit.

Speaker 2 10:58

Right. Yeah, once a month where they're like, okay, see you next time. Wait, what did I learn from this? What's working? This isn't working. Okay, great. Go back to your GI and have them give you a medication.

Speaker 1 11:13

But that's where people are still at. Why would I spend thousands of dollars to come work with you when I can go over to uh physicians regional and have my insurance cover it?

Speaker 2 11:23

Right.

Speaker 1 11:24

Well, because you want it done the right way, you can still ride a horse today. You could still ride a horse to Gainesville to go watch a gator game. You could do that. You could. Yeah. Or we get in a car and we could be there in four hours. Right. You want to be there in four days or four hours.

Speaker 2 11:40

Right. Same thing with your gut. Do you want to be on ten medications and take more time to heal? Or do you want to actually get the right answers and be able to get it done more efficiently?

Speaker 1 11:52

Ten medications and not heal at all.

Easter Wishes And Next Week Tease

Speaker 2 11:54

Right. Yeah. Well, that's true. Yeah, it's not healing, it's just covering. But wait, we were supposed to be saying happy Easter today.

Speaker 1 12:01

Oh my gosh, I completely forgot.

Speaker 2 12:04

Yes.

Speaker 1 12:04

I think the reason why I forgot is because of that torturous workout.

Speaker 2 12:12

What workout? Like your high rox race.

Speaker 1 12:17

Oh my goodness. Wow. More to come on that on next week's episode. Humbled? Holy cow. Yes. Happy Easter.

Speaker 2 12:28

It's Easter Sunday, yes.

Speaker 1 12:30

I hope you enjoyed it. I hope the Easter bunny came. Wherever you are. Wherever you are. Yeah, we had a traveling Easter bunny.

Speaker 2 12:38

Which I had to really work some magic for. Yeah, it's like I didn't have a team here.

Speaker 1 12:45

How in the world did this bunny make it all the way over to Miami and do all of this work?

Speaker 2 12:52

Easter bunnies is just like Santa. The Easter bunny magic. What are you gonna say?

Recipes Email List And Egg Elimination

Speaker 13:02

Oh my gosh, nothing. Nothing. Okay, anything else?

Speaker 2 13:05

Well, we hope everybody has a great Easter being able to spend some time with their family. And if you missed it, it might be a little too late now. But I did send out some Easter recipes in our email. So if you didn't get it, you need to contact us immediately so that you can get on this email list to get the recipes. Jenni, J-E-N-N-I at Bermanwellness.com is my email. So email me personally and tell me that you need to get on the list to receive more recipes. We're we're trying to send recipes at least once a month, um, especially for big events like Easter where you get to or you want to have all the family friendly, fun things and you want to make it a little bit healthier. And that's what we did this time, send out some recipes. So you might have already made your meals for Easter Sunday today, uh, but if you want them in the future, you should definitely email us. I hope everybody has a great time with their family. Yay! And you got to find all the eggs, and then we gotta send some recipes actually to be able to use all the eggs. Except not for you.

Speaker 1 14:07

Yeah, I'm on a egg hiatus now for two more weeks or forever.

Speaker 2 14:13

We'll see.

Speaker 1 14:14

Yeah. Yeah, we're doing an elimination right now on me personally. So we have removed eggs from my diet and we're gonna see what effect it takes. We're four weeks into it now.

Speaker 2 14:26

Are you already?

Speaker 1 14:28

Every time I say this, you're like, You just had eggs last weekend. I'm like, no, I didn't.

Speaker 2 14:33

Okay, good job. Good job. Keep it going. Nice work, chapter now.

Speaker 1 14:38

Bye.