Hey guys and welcome back to the Medical Entrepreneur podcast.
My name is Adam Sewell, and this is where we teach you how to break free from traditional medicine, to carve the career of your dreams and still do what you love.
So if you work in a hospital… you’ve probably seen just how frustrating it can be to deal with medical insurance companies.
But what you have seen so far is just the tip of the iceberg.
There’s a whole range of tricks and dirty ways that they can sneakily squeeze every dollar possible out of their customers.
And in today’s episode, I want to share the truth with you and expose these guys for what they really are.
So without further ado… let’s get into it!
How This All Started
So back years ago, there were corporations who would actually partner with insurance companies to provide care for their employees.
Essentially, you had companies that were so interested in providing for their staff they would actually hire physicians or offer contracts to hospitals to care for them.
And essentially it would look something like this: The physician would have a look at the patient, make a recommendation on what was best and then the care would get delivered and paid for by the corporation.
And this was how it was for a long time, until one day insurance companies came in and said that they had a better way of doing things. This meant that the insurance company would essentially act as a gatekeeper in healthcare.
They promised that by acting as a gatekeeper, they would be able to decrease the costs of healthcare for the company… but as we know, that hasn’t happened.
The actual cost of healthcare has gone up, and as we know now, 51 cents out of every dollar spent in healthcare goes towards administrative costs.
And the real issue here is that these corporations have grown so large that they have too much power and control over the entire industry.
They themselves are now the ones that set the standards in the medical profession – which is actually illegal for them to do.
But How Bad Are They?
Some people who are just starting out in the medical industry won’t realize just how bad the damage they are doing really is.
For example, most people don’t realize but these companies have massive budgets for lobbying, and are almost inseparable from our government. And most things like the Affordable Care Act, are designed to increase profits for medical companies, but not for physicians and not for patients either.
Another reason why these companies are so dangerous is that they are so good at finding ways to not pay for cover.
For example, it’s very common for medical companies to take 10% of the claims they receive and simply trash them.
These claims are just deleted electronically before they get processed, and it’s totally legal, too! It’s just a simple way for them to say that they didn’t receive the claim, which means that they don’t have to pay for it unless it gets sent back to them.
The Problem with Specializing
What these companies also do is they look for things that they can systematically deny.
So if you get really good at doing a procedure, like maybe you become the top knee surgeon in your area, and all you do is a partial arthroplasty, so you’re doing a partial knee surgery, it’s kind of a new procedure.
Maybe you just want to do that one procedure until you become the best in your area.
Eventually, these insurance companies will turn to you and say, “Hey, you did so many of this one procedure and other people with your same specialty didn’t, you’re now an outlier…
… So we want more investigation. So we’re going to pull more records from you, we’re going to put more people on you, we’re trying to find ways to deny more of your stuff, we’re going to look for any gap that you have in your documentation.” Whether it’s real or not, doesn’t matter – that’s what they do.
Because you’re gonna have to find it either way, and it’s going to cost you a fortune to fight it. And this is what they do. They basically intimidate and hurt you. And basically, anybody who becomes a very tight specialist is automatically flagged for analysis.
This is just one of the ways they try to save money anywhere they can.
The Real Truth About Medicare
One of the things that a lot of people don’t realize now is that we live in a socialized medical care system, thanks to Medicare.
People may point to the system that exists in Canada and talk about how well it works there, but what they don’t realize is that when you look deeper, those systems are actually failing miserably.
The way that Medicare works is that it runs on a set of codes, which are provided by the AMA – who make a lot of money from these codes.
And essentially,, Medicare went to them and said that if they didn’t support Medicare they weren’t going to renew their contracts and they would be hung out to dry.
So this went on to the point where basically every physician in the country was raving about Medicare.
But as we found out, it turned out to be a huge disaster.
Health care costs have actually skyrocketed. Since then, Health care insurance rates have skyrocketed, premiums have skyrocketed. Providers have made less than ever before. Now, the amount of paperwork and red tape has been worse than ever before, it was probably the single worst thing to ever happen to health care!
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Additional Resources:
– Join my challenge here!
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Medical Entrepreneur is a podcast dedicated to those who are trying to escape mainstream medicine and start building the healthcare business of their dreams.
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