What to Do When Insurance Denies Your Claim (And Why They Count on You Giving Up) SB1880

It's easy to walk out of a rushed appointment, an unexplained bill, or a denied claim and quietly blame the person in the white coat. Doc G (Doctor Jordan Grumet), the hospice physician and longtime Stacking Benjamins favorite, argues that's exactly the wrong target, and that the confusion isn't an accident. Somewhere between the insurance company, the pharmaceutical company, the private equity firm, and the electronic records system, a lot of people are getting paid, and the two groups actually providing and receiving care are left holding the bag. Here's the good news: almost nobody appeals a denial, and appeals win far more often than you'd expect. This episode gives you the real playbook. What You'll Walk Away With The exact first move to make when a claim gets denied, and why documenting it matters more than people realizeWhy a procedure can get pre-approved and still get denied months later, and what to save to protect yourselfA simple "who do you call first" framework for untangling a prescription, billing, or coverage problemThe pharmaceutical industry trick of repackaging old drugs as "new" ones, and the one question that sidesteps it completelyHow to spot whether your doctor's office is privately owned or backed by private equity, and why it changes the care you getWhy so much unnecessary testing exists purely to protect doctors from lawsuits, not to protect youThe real math on insurance appeals, and why giving up is exactly what the system is counting onWhy This Matters Now Healthcare confusion isn't just an annoyance, it's a real financial risk hiding in plain sight. A denied claim, a surprise bill, or a medication that suddenly isn't covered can undo months of careful budgeting in a single afternoon. The difference between losing that fight and winning it usually isn't luck, it's knowing the specific, doable steps to push back before you give up. This isn't about becoming your own doctor or insurance expert. It's about not getting steamrolled by a system that's counting on you not knowing what to do next. From the Basement A story about FedEx's founder famously saving the company with a lucky night at a Vegas blackjack table becomes the day's trivia detour, and somehow ties neatly back into an episode all about refusing to give up when the system says no. Resources Mentioned The Healthcare Heist by Jordan Grumet, MD https://www.amazon.com/Healthcare-Heist-Physicians-Patients-Transform/dp/1960762532 — Doc G's new book on fixing the doctor-patient relationshipEarn & Invest podcast https://www.earnandinvest.com — Doc G's award-winning personal finance podcast See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

• 0:00Speaker 00

  Maybe it's time we talked. Kiplinger calls it the trillion dollar talk, a conversation about inheritance, estate planning, wills, and the questions families should be asking before those decisions become urgent, because knowing what your family wants and having a plan for it can be one of the most important financial conversations you will ever have. Ready to start yours? Visit kiplinger.com to learn more about the trillion dollar talk and what this historic wealth transfer could mean for your family.

• 0:32Speaker 01

  At Humana, our Medicare Advantage plans are easy to understand and easy on your wallet, like offering more benefits than you'd get from original Medicare alone, and including dental, vision, and hearing coverage in every plan. And the best part is, every plan has a $0 or low monthly plan premium, which makes it easier to save, too. So this Medicare planning season, plan well with Humana. Learn more at gethumana.com. Humana is a Medicare Advantage HMO and PPO organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal.

• 1:02Speaker 02

  Hey, kids. How many people you think are dead in that cemetery? All of them.

• 1:15Speaker 03

  Live from Joe's mom's basement, it's The Stacking Benjamin Show.

• 1:29Speaker 03

  I'm Joe's mom's neighbor Doug, and today we shine a light on your health care. How does the system work? How can you find better care? And what changes need to happen? Today, we tackle all of that with an expert we've come to know well, Dr. Jordan Grumet, AKA Doc G. And you know what makes a special day even more special? My trivia, of course. And today, I'll make your day halfway through this episode. And now here comes a guy who's learned the hard way that lifting weight is great for your health, but not as much when it's a box of donuts. Joe Saul Sehaj.

• 2:13Speaker 00

  Hey there stackers. Welcome to the happiest show in personal finance land, the Stacking Benjamin Show. We are super happy you're here. And you know what? We brought the donuts because there are ancillary benefits, Doug. You can say all day there's not, but carrying that box of donuts, that could, that thing begins heavy. And then it's like, you know, you know, those, those exercises OG where you do like 15 reps, then 10 reps, then like seven reps the third time. You have the full box of donuts you carry around, then the half box, and then the empty box.

• 2:43Speaker 03

  The difference is, Joe, you start carrying them with your arms and your biceps, and you're working out those muscles. And then they go straight to your abs. Oh, you're carrying them with those.

• 2:53Speaker 00

  Well, there you go. I'm working the abs. That's perfect. More, more weight there. OG, how come you didn't bring the donuts today? Why did I have to bring them again?

• 3:01Speaker 04

  Because all we eat here in the basement is protein, bruh.

• 3:08Speaker 03

  And speaking of that, OG, I am tired of like cleaning up that powder all over the basement. Can we, can we keep the scoops in the, in the glasses of your teen?

• 3:20Speaker 04

  Oh, that powder. I thought, nevermind, different.

• 3:26Speaker 04

  Wow. Cause I was like, I'm pretty sure I keep track of that.

• 3:29Speaker 00

  Well, the reason we're talking about donuts and protein and health is because one of our favorite people in medicine, Doc G, from the Earn and Invest Podcast, is here. He's upstairs talking to mom right now. And the state of healthcare, you've talked about this before, OG, it's all over the map. Like, how, how dysfunctional can this medical clinic be?

• 3:53Speaker 04

  Dude, I just went through this exact same thing again. And the person behind the counter was like, I can't answer this question for you because we don't even know how much this stuff costs until we type it in the computer.

• 4:04Speaker 00

  It is so crazy.

• 4:05Speaker 04

  Awesome. Why don't you type it in the computer right now as a, for instance, and give me a guestimation? Can't do that.

• 4:13Speaker 00

  Wouldn't that be a great place to start?

• 4:15Speaker 04

  Yeah. Could you imagine running a business that way? By the way, like I'm just going to run my business. Cool. How much do your widgets cost to make? Great question. You know, when we do know though, once we sell one of them, then we know how much it costs.

• 4:26Speaker 00

  Yeah.

• 4:27Speaker 04

  Like, great. Sure. Okay, fine. So after you sell one or two, you've got a pretty good idea of what it will cost to produce a third. Right? No, no, that's completely random every time.

• 4:35Speaker 00

  We'll install it, including the service. And then about a two weeks later, we'll let you know what it cost.

• 4:40Speaker 04

  Two weeks? I've heard stories of people getting invoices from hospitals like two years later. Oh, we forgot to bill you this. It'd be like, well, I paid it. Trust me.

• 4:48Speaker 00

  Yeah.

• 4:49Speaker 04

  No, no, no, I already paid that. You have to go, go research it on your end and get back to me.

• 4:56Speaker 04

  I can tell your research department's really locked on right now. So in about 24 months, you'll figure out I'm still owe you 80 bucks.

• 5:03Speaker 00

  So why is it such a mess? I mean, a lot of what we do here in Mom's Basement, we unravel your financial situation. Well, a big piece of your financial situation is your healthcare. And Doc G is going to walk through something he calls the healthcare heist, which lets you know what he thinks about the way that hospitals and medical clinics run. Before that though, we have a couple of sponsors who help us keep on keeping on. We're going to hear from them and then Dr. Jordan Grumet, AKA Doc G, coming down to Mom's Basement for today's special Thursday episode. Well, you may know that chaos is the name of the game here in Mom's Basement. What with guests coming in and out, Cooper the cat getting in the way, Doug being, well, being Doug.

• 5:46Speaker 00

  The holidays make it even worse because it's all about food and big meals. And the problem is prepping for those takes forever. But what about those between meals, right? The meals between those huge, huge bookends. Well, that's where Factor comes in. Factor is made with high quality ingredients that you recognize and trust with over 175 banned ingredients. You always know you're eating something that's good for you, even when you don't have time. It's ready in two minutes, whether it's lunch between meetings or dinner after holiday shopping. Factor requires zero. Prep cleanup or effort from you or mom so you can focus on everything else in your

• 6:29Speaker 00

  day. Factor even has heart smart options like the green goddess barramundi with tomato rice, peas, kale, and green beans, or the enchilada style chicken and sweet potatoes. Those are so good. They're crafted with lean proteins, fiber packed fruit and veggies, and healthy fats. Try those out. Your heart and your taste buds will thank you. For Cheryl and I, Factor has been a great way for us to stay busy and focus on family life and beating mom at card games. I use Factor and you should too. So let's eat real stackers. Head to factormeals.com/sb50off. Use code SB50OFF. And you know what? You're going to

• 7:13Speaker 00

  get 50% off and one free breakfast item per box for one year while supplies last until December 31st, 2026. That is code SB50OFF at factormeals.com. SB50OFF at factormeals.com. See website for more details.

• 7:30Speaker 02

  Hey, Drake May here. As a pro quarterback, I know I can't do it alone. I have to trust my team, and that goes for my money, too, which is why I use Betterment, the trusted investing and savings platform. Their automated investing tools always have my back, just like my O-line. Over a million people already trust Betterment to build their wealth. So I know I'm in good company. Start building yours at betterment.com or download the app.

• 7:53Speaker 05

  Investing involves risk. Performance not guaranteed. Paid client ad. Views may not be representative. See App Store and Google Play reviews. Learn more at betterment.com/ambassadors.

• 8:09Speaker 00

  You wait weeks for an appointment. Then you sit in the waiting room. When you finally see your doctor, he or she spends half the visit staring at a screen. The prescription gets delayed. The test gets denied. The bill arrives and looks like somebody generated it with a random number machine. And sitting in the middle of all this is your doctor. And it's easy to assume that your doctor is part of the problem. Dr. Jordan Grubbe, as you may know him, if you've listened to stacking Benjamins for any length of time, we call him Doc G, says that may be exactly what some very powerful people want us to believe because while patients and doctors blame each other, somebody else is collecting the money. And today we're following that money. We're going to talk about how

• 8:53Speaker 00

  to fight insurance denial, what to ask before an expensive procedure, how to recognize when business interests may be shaping your care, and how to get your doctor back on your side. Doc G, welcome back, man. How are you?

• 9:08Speaker 06

  I'm just glad that we're going to be able to solve all these problems in one short conversation. We're going to fix it.

• 9:14Speaker 00

  If you're going to solve a problem like this, you do it in mom's basement.

• 9:16Speaker 06

  Yes, that's the place.

• 9:18Speaker 00

  All right. Your medical career changed in an otherwise ordinary Wednesday evening. The doorbell rings. Who's standing there?

• 9:26Speaker 06

  So the kids were watching TV. I get up to answer the door. Mind you, this is when we used to answer the doors because there are people no longer answer the doors around here. This guy hands me his piece of paper. Basically, you've been served.

• 9:37Speaker 00

  Oh, he hands you, he hands you a legal document.

• 9:42Speaker 06

  Yeah, every doctor's worst nightmare. And we all know it, right? We've all heard the stories, people having process servers come into their office, getting you when you're walking out to your car. But a common thing is for them just to show up at your house at night because they know you'll, they'll be there. And yeah, and it's like, surprise. And the problem with this, and what I didn't know at the time was this was going to eat up about five years of my life.

• 10:06Speaker 00

  What did you believe you were being accused of?

• 10:08Speaker 06

  I had no clue. I didn't even remember the patient's name. Remember, we take care of thousands and thousands of people. And it's not the big cases where people normally get sued. It's something you had no clue. It was a patient I took care of for a few weeks in a nursing home. They died of something that no one could have fixed. And I had to go look up the patient. I looked at all the medical records. I felt pretty certain. Upon looking at the medical records that I had done nothing wrong. And in fact, data shows that about two thirds of cases are thrown out before they even make it to court are thrown out without a finding. So if you are sued for medical malpractice, two thirds of cases are thrown out, 67%. And once you get to court, eight out of 10 cases find for the physician and show that

• 10:53Speaker 06

  there was no malpractice. So your likelihood of winning a malpractice suit as a patient is far less than 10%. And even if you do win, over 40 to 45% of that money is going to go to the lawyer anyway.

• 11:04Speaker 00

  But I think there's a, I mean, I just think you and I have known each other for a while. Like, what is, you mentioned this four years. What does this four years do to you personally?

• 11:13Speaker 06

  Oh, it changes everything. I mean, there is a phenomena of post-traumatic stress disorder having to do with malpractice. So every physician fears it. And the minute you've been sued, that changes everything. We were talking about the fact that doctors of patients almost feel like combatants nowadays. There's all sorts of things standing in way, in the way of us, like electronic medical records are physically standing in our way. But the emotional divide of knowing that your patients could sue you changes the way we interact. For one, we order way too many tests and get way too many consults. And so defensive medicine, the most recent data I could find was from like 2011 showed that over $50 billion worth of spending in our healthcare system is due to defensive medicine.

• 11:56Speaker 00

  Well, you, you call it, you call it, Jordan, you call it defensive medicine. I call it CYA, right?

• 12:03Speaker 06

  Yeah. Oh, it's totally the same thing. And because what happens is every patient who walks in, you start being suspicious of, and you're like, well, how am I going to make sure that this horrible thing that happened to me that's taken up four or five years of my life? How am I going to make sure it doesn't happen again? And what people don't recognize is how much this actually costs the system. When we spend 40 or 50 billion dollars in a year on defensive medicine, Guess who pays for that? Either the government or insurance companies. And guess who pays for the government insurance companies? You either pay through taxes.

• 12:35Speaker 00

  Still comes from you.

• 12:36Speaker 06

  Or you pay through premiums. What we don't realize is this system, and remember, less than 10% of cases actually find against a physician, we are all paying for it. And if you look at premiums, look at premiums, healthcare insurance premiums over the last 20 years, they just go up and up and up. The average cost of healthcare outside of the United States is about $7,000 per person per year. In the United States, it's $13,000 per person per year. How much money are you paying on insurance and doctors and co-bays? I guarantee you're paying a lot more than $13,000 a year.

• 13:08Speaker 00

  There's a kicker to this story, though. The case, like you said, happens with a lot of these cases. The case gets thrown out. But what does the attorney say to you afterward?

• 13:18Speaker 06

  So you have to recognize, right? This changed me emotionally. I was already struggling with burnout in medicine. And this was a sentinel event that helped lead me to leaving medicine. In my previous books, I often talk about how I realized that medicine wasn't fulfilling my sense of purpose and identity. But the other side to that is the parts I did like about practice were overshadowed by this horrible event and what was happening, not just with medical malpractice, but with insurance companies, with private equity and venture capital, all these third parties kind of reaching their hand into the cookie bowl, pulling out all the money from the system and leaving patients and physicians bereft. So this was the beginning of the end.

• 14:00Speaker 06

  And after all these years, and I decided to leave my medical practice and I left medicine or was in the process of leaving medicine, doing hospice only, the attorney had the gall to say, oh, we were always going to drop you from the suit. We were just waiting to use your testimony as leverage against the nursing home. I was mere leverage in a system where everyone was getting paid except the patients and except the doctors.

• 14:23Speaker 00

  Wow. Have you talked to, because you and I have a mutual friend, another physician friend, Bill Yount, who's the host of Catching Up Defy. He's talked about this being a big moment of the beginning of end of his career, too. He's flying, he's going as fast as he can. He's an emergency room doctor. I mean, just imagine how many people he's taken care of. And he is very forward about saying the fact that he was super tired and he missed something. But it wasn't so much missing it as the drag afterwards that happened to him as a way to get at the hospital, the attorneys to get at the hospital and get at the system, the bigger system than him, that kind of changed the arc of his life.

• 15:03Speaker 06

  We have to remember that these systems have been put in place not to help patients and not to help physicians. They've been put in place by people who are trying to make money off the system. The hospital systems want to make money off the doctors, so they crowd those emergency rooms and they don't have enough physicians on staff. The medical malpractice attorneys want to make money on the physicians and on the patients, right? You go ahead and bring a malpractice suit, you're handing 40 to 50% of whatever you get awarded over to the lawyer. The insurance companies want to make money on you by selling you malpractice on one side, and then the health insurers want to make money basically

• 15:44Speaker 06

  selling health insurance to everybody. And then when there is things like medical malpractice and the cost of everything goes up, doctors charge more, hospitals charge more, and insurance premiums go up. It's all connected. It's all tied. Basically, we've taken a system, a complex system, and we've inserted all these other parties who aren't actually improving the system. And this is what I want to be really clear about. You have two main stakeholders in our healthcare system. We have the patients, most of us who need care, and then you have those who are giving care. I say doctors, but we're really talking about doctors and nurses and social workers and chaplains and physical therapists and occupational therapists and respiratory therapists. Think about all the people you interact with when you go to a hospital. That's it. The people who give care and the people who need care. Everything

• 16:27Speaker 06

  else is a little bit superfluous. And when you look at, for instance, pharmaceutical companies that are some of the most profitable companies in the S and P 500, they have some of the highest profit margins. When you look at the insurance companies and see that their CEOs are making $500, $700 million a year.

• 16:44Speaker 06

  When you look at electronic medical records companies where electronic medical records have not actually improved care, have not made it more safe and not have made it more efficient, and yet CEOs are retiring from places like Epic with billions and billions of dollars, you realize that that money once went to healthcare and now it's going to all these parties that are kind of just extracting it willy nilly, but it's not making for better healthcare. And that's what we're finding, right? Defensive medicine isn't better healthcare. We're not seeing less malpractice because we have these aggressive malpractice lawyers. We're seeing more cases, but yet less awards. And so all this is telling you is that their system is being taxed by these other people who are making money on it.

• 17:25Speaker 00

  And I'm glad you brought this up here because, you know, I want to make it clear what you and I are, the journey we're embarking on. We're embarking on the journey about how the system works. We're not embarking on protecting bad doctors. That's not, that's not our goal. There are some bad actors in every field. The goal here isn't to say, woe is a bad doctor who missed something or who, whatever, but it's a systematic way of lining the pockets of a bunch of people instead of providing that money toward care.

• 17:56Speaker 06

  Yeah. And, you know, simple solution. We always want there to be a mechanism for people who are wronged to deal with this. Get rid of contingencies. It would fix the whole problem. Lawyers work on contingency and so patients can basically come and without any money, say, I need your help. Let's go sue someone. And what happens then is there's a really easy road to entrance. In other countries where there's no contingency fees, basically you want a lawsuit, you're going to have to pay for it. You're going to have to pay for your lawyer. You're going to have to pay for court fees. A lot of countries also have, the loser pays all the court fees, right? So if you bring a lawsuit and it's frivolous, and in court they find that there was no malpractice, you're going to have

• 18:41Speaker 06

  to pay the court fees or maybe even the attorney fees for the physician who is defending themselves. So there's, there's ways around this where we can still make a system that allows you to sue a doctor who's wronged someone, but makes it much more reasonable, makes it less predatory.

• 18:59Speaker 00

  You know how much mom likes games? I want to play a game called, who do you blame? We're going to test my instincts. I'm going to describe what happened. You tell me who probably deserves the first phone call, not necessarily the final blame. All right, so we might not get to who is truly to blame, but who's the first phone call? Who's the first person you think of? Sound good?

• 19:17Speaker 06

  Good.

• 19:18Speaker 00

  The pharmacy says, your doctor never sent the prescription.

• 19:23Speaker 06

  We have electronic medical records nowadays, and most times the prescription goes immediately. Often what happens, unfortunately, is there are multiple steps in between. So the doctor writes for your prescription. It goes to the pharmacy and it gets basically blocked because the insurance company requires a preauthorization. They've found actually in recent years that most doctors need a full-time staff member to work at least 13 to 15 hours a week just on preauthorizations for tests and for pharmaceutical companies. So a lot of time what happens, you go to the pharmacy, they say, prescription was never sent. You go back to the doctor, the doctor said they sent it. You go back to the pharmacy, pharmacist says, oh, they need a preauthorization. Your doctor never called the insurance company. Remember, it's always the doctor's fault, right? Your doctor never called the insurance company.

• 20:07Speaker 06

  You eventually get in touch with the insurance company. Insurance company's like, oh yeah, there was a preauthorization form. We just got it. They then have to call the pharmaceutical company, the pharmacy and okay the medicine. And so there's just, again, and you have to think about the fact that preauthorizations are running rampant because pharmaceutical companies have found, as well as, so this is pharmaceutical, this is insurance companies, but they found that when you order a test or a medication, if they make doctors' offices get preauthorization, there's a good chance that no one will ever do it. Right? Because just the extra work and the possibility of denial slows people down. And then on top of that, their denial. So just saying that to get this medicine or to get this study, you need a preauthorization. And the number of preauthorizations has gone up hugely.

• 20:51Speaker 06

  And nowadays they use AIs. It's not even a person who's deciding. It's basically an AI that's looking at this form and deciding whether you need it or not.

• 20:59Speaker 00

  So your answer is, it's probably an insurance company to blame?

• 21:02Speaker 06

  Most likely.

• 21:03Speaker 00

  How about this one? A medication that worked for years suddenly isn't covered anymore.

• 21:09Speaker 06

  Again, that's going to be one of two things. It's going to be insurance company has changed their formulary, or the pharmacy benefits manager basically made a better deal with another insurance company. And then all of a sudden went back to the insurance and said, sorry, we don't cover that one anymore. You're going to have to order this one. So there's a lot of backroom business dealings. So you have the drug companies who make deals with the pharmacy benefit managers, and the pharmacy benefit managers then negotiate with the insurance companies. And so everyone is trying to get the best deal. The question is between the pharmacy benefit managers, the pharmaceutical companies, and the insurer, who's winning out will depend on which drug

• 21:49Speaker 06

  happens to be formula that month or that year, and it can change often. The problem you have is the likelihood your med coverage will change in any given year, you know, is quite high, actually.

• 22:03Speaker 00

  We went into this slightly, but doctor spends most of the visit typing.

• 22:12Speaker 00

  Who to blame?

• 22:12Speaker 06

  Back in the early 2000s, the government actually was the one who forced the mandate to electronic medical records, and eventually told doctors, if you don't get electronic medical record and don't use it the way we think you should use it, it was called meaningful use, we're going to start paying you less for your Medicare and Medicaid patients. So believe it or not, it was the government who pushed electronic medical records, but they didn't want to do it themselves. So believe it or not, in the 1970s, the VA, right, government-run healthcare, the VA started an electronic medical record called Vist A. Vist A, I used it during residency when I worked in a VA. It's extremely inexpensive, extremely effective. It's shared by every VA

• 22:53Speaker 06

  across the country, and they've used it constantly since the 1970s. They recently tried to decide to go with a commercial product, and so many more people died, they had to go back to Vist A.

• 23:05Speaker 00

  More people died?

• 23:07Speaker 06

  More people died.

• 23:08Speaker 00

  Just going to a different type of record system?

• 23:10Speaker 06

  They did. They ended up having a number of new mistakes, and people died from them. And so they went back to Vist A after spending millions of dollars trying to convert to a commercial product. But in the United States, because we are very pro-capitalism, we didn't just roll out VistA to everyone in 2000. We basically opened it up and allowed these third parties to create the electronic medical record systems. Now, the electronic medical record systems, the third parties weren't selling to the government. They were selling to the hospitals and the medical practices. So they had to say, well, we're going to help you code your visits better so you can upcharge insurance. The rigmarole that followed is the systems weren't particularly easy to use. They were mostly based on charging as

• 23:54Speaker 06

  much as possible. And because it was a commercial electronic medical record company, and it was commercial hospitals and doctors' offices, those doctors' offices and hospitals decided they didn't want to share any information with another hospital, another doctor, because then they could steal your patients. So all of these electronic medical records became siloed. What basically happened because of this is it didn't improve care whatsoever. I mean, the studies show care is not more efficient, and they don't make any less errors. We make different errors, but they end up causing problems either way. So if you look at all the money that's been poured into electronic medical records, and we're talking billions and billions and billions of dollars, I mean, it can cost a medical practice $20, $30,000 to just implement electronic medical record for their doctor the first time, and

• 24:38Speaker 06

  then it's a few thousand dollars every year for maintenance. They actually found this didn't help anyone. All it did was enrich the companies like Epic that make electronic medical records. It's a complete waste of time. We wasted all these billions of dollars. We all could have used VistA starting in 2000. It would have cost you nothing, and we would have been better off.

• 24:56Speaker 00

  My daughter used to work for Cerner, who's an electronic medical record

• 25:00Speaker 06

  Don't get me wrong, they're great companies. They actually, their products are decent, but the system wasn't made to make medicine better.

• 25:06Speaker 00

  Well, and the fact that I can't take a Cerner record and easily port it over to Epic if my new doctor's on a different system is just...

• 25:12Speaker 06

  Here's the thing, Joe. You can, but they won't let you. You can. They've actually have the means of connecting different record systems. It's just if I work in one hospital and you're at another hospital, that hospital doesn't want to help you port over the information because then you're going to leave their hospital and come to my hospital and they don't want to lose the business. Why? They're, they're competition.

• 25:37Speaker 00

  How about this one? The hospital says a procedure was approved, right? So good to go. But then the insurer, after you get it done goes, yeah, we're not paying.

• 25:46Speaker 06

  Yeah. You want to hear something really dirty? Insurers have gotten the habit of pre approving operations and things. And then three months or six months later, they come back and revise the preapproval and say, I'm sorry, we've decided after all, it's not covered.

• 26:02Speaker 00

  After you already did it.

• 26:04Speaker 06

  After they pre authorized it, said they would cover it and you did it. I actually know someone this happened to and they had a surgery. What their doctors told them was a life saving surgery. And then the insurance company said, well, this has been basically a post authorization audit and we have, if you read all the, the writing in all of your documents, you would have seen that on page 356 in, you know, the smallest font size possible, we said that we can decide to deny payment after we've pre authorized. And they do it all the time.

• 26:38Speaker 00

  Let's follow the money. Thanks for playing my little game, by the way. But you know what? I actually do. I got one more that I want to get your take on because these are so interesting. Your primary care doctor refers you someplace else instead of treating the problem.

• 26:51Speaker 06

  So again, with any of these, honestly, doctors do play some role. Of course, when we allow venture capital, private equity to buy us, we've made that decision. When we decide to take insurances, right? When we decide to take insurances, that's on us. When we decide that we are going to get an electronic medical record because we don't want to lose out in Medicare and Medicaid payments, that's our decision. Now you can argue that we have no choice on some of the stuff, but it is what it is. Basically, that is everything put together, right? It's the doctor's fault because they should really be upholding their Hippocratic oath and manage what they can. It's the electronic medical records fault because the electronic medical records slow us down so much that people are rushing through their visits.

• 27:36Speaker 06

  It's private equity and venture capital because they buy out primary care and tell the doctors they have to see four patients an hour instead of three. It's the pharmaceutical companies because basically they are creating a system in which they patent common drugs to such a level that you have to spend a half an hour trying to figure out what drug is covered and what drug your actual patient can afford. It's everyone, basically. Your question, I think, in a capsule is why aren't you getting the good old time primary care that people used to get before these third parties were so aggressive? And it's because your doctor and you have become a pawn and the point of the system isn't good medical care anymore. The point of the system is to bolster the profits of corporate America.

• 28:21Speaker 00

  So, two things. Number one is, we used to have two hospitals in Texarkana, we now have one. One of our hospitals went under and the government was after the, is still after, I think, the private equity guy left the company, or left the country, rather, is gone, on the run. CBS, a long time ago, did a, 60 Minutes did a huge expose about all these little regional hospitals that were being gutted by private equity. They come in and they just gutted it. And I see the effect, Doc, I see the effect on our town. The number of nurses that had to go find jobs, the number of orderlies, the number of janitors, the number, you know what I mean? This isn't, this wasn't a little game in our little town of 60,000 people, our little city of 60,000 people.

• 29:06Speaker 00

  A significant number of them lost their job because of the private equity raid on one of our two hospitals. And guess what happened, by the way, when the one went under? The other one had the ability, and is supposedly a nonprofit hospital, but you wouldn't know it because the second that hospital went under, all of a sudden a new facility fee began on the second hospital because your choice was gone and they jacked up the cost on everybody because there was no competition anymore.

• 29:34Speaker 06

  Private equity venture capital, they are corporate raiders. There is a playbook. They buy these medical systems and you know what the first thing they do? They sell all of the land, sell all of the buildings and sell all of the equipment and then rent them back. Why do they do that? Well, because they spent millions or billions buying the healthcare system. The first thing they want to do is get as much money out of it as they can to pay back their shareholders.

• 30:03Speaker 06

  And then they run them into the ground and then they leave them bankrupt after they've paid everyone off.

• 30:07Speaker 00

  Same thing we've seen with chain restaurants around the nation.

• 30:10Speaker 06

  Yeah.

• 30:11Speaker 00

  Yeah, same thing. But it's sad when it gets to your healthcare. I mean, this is a whole different level. The fact that it's, you know, harder to get Red Lobster today is one thing. The fact that my medical care is being compromised is a whole nother one. By the way, I also gave a talk last year to a group of veterinarians and seeing the same thing happen with vet clinics is, is amazing. It's happening to us, it's happening to our pets. Let's follow the money, by the way, because you make a provocative argument, Jordan, that there's really only two essential groups in healthcare. Who are these two groups that are truly the essential people?

• 30:44Speaker 06

  Yeah, I often talk about the stakeholders in our healthcare system. And the reason why is because I think the solution lies with the stakeholders. So the main stakeholders really are those who receive care, which is all of us, and those who are giving care, which is the doctors, nurses, social workers, et cetera.

• 31:01Speaker 06

  We've allowed these third parties to intrude and don't get me wrong. There are good reasons to have pharmaceutical companies. They create drugs that save lives. And so I'm not saying that these third parties shouldn't be around, but let's put this in perspective. Basically, if you go back from like 1930 to today, over $900 billion of research came from the National Institutes of Health. That was government and people funded research. And if there was a study done where they looked at every major drug that went to market between 2010 and 2016. Every single drug was made possible by that NIH research.

• 31:42Speaker 06

  When you realize that a lot of what the pharmaceutical companies are making profits on has been publicly funded already. It starts to make you question how they can patent drugs for up to 38 years so that generics can't be made so that they can jack up the prices without competition.

• 32:00Speaker 00

  It would seem to me that insurance companies want the cost of care to be lower, but you're shaking your head. Why would that assumption be wrong?

• 32:11Speaker 06

  It's a perfect example of good ideas gone bad. So back in the Obamacare era, they rightfully said, look, insurance companies should take the premiums and put them towards patient care. It makes a huge amount of sense, right? Actually, part of Obamacare, I think it's 90-10 was the split. It was like 90% of all premiums that come into the insurance company have to go to patient care and only 10% can be used as profits to build the company to pay everyone, et cetera. Sounds great, right? This sounds good.

• 32:40Speaker 00

  Sure.

• 32:41Speaker 06

  But then the insurers realized, you see, the insurers are always fighting battles with hospitals, with pharmaceutical companies. They're fighting battles with everyone to get the cheapest price. In the old world, the cheaper the price for the insurance company, the more money they made. But now with the Obamacare 90-10 split, they realize something. If we pay out a million dollars, or let's say a billion, because it's a big company, if we pay out a billion dollars, we get to keep 10% of it. But what if we pay out $2 billion? Then we get to keep 10% of $2 billion, which is doubly as much.

• 33:15Speaker 00

  Oh, I'm laughing because it's so not funny.

• 33:16Speaker 06

  What they realized is they stopped fighting, like, say, a hospital. If you go for a hip replacement, they used to basically argue with the hospital till they got it down to a price that made sense. Now they basically pay off whatever the hospital wants, and then they just go and increase premiums because they can increase premiums as long as they pay out 90% of what they bring in. And so it's perverse incentives. It actually, there is no incentive anymore for them to try to negotiate prices. All they have to do is keep increasing premiums. And if you look every year since 2000, our premiums have gone up and because of the big, beautiful bill, they're going up even more and people are losing care. So that's Medicare, Medicaid, that's one side. But then the other side

• 33:59Speaker 06

  is that insurance premiums are just going up higher and higher and people who had subsidies aren't going to be able to use them anymore.

• 34:05Speaker 00

  So percentage pricing makes it worse. Let's talk about the actual bill. I've heard the story, I think everybody, all of our stackers have heard the story about the $200 charge for two Tylenol, right? Is that, is that number even real?

• 34:19Speaker 06

  Basically, everything tends to be inflated. And here's why. Usually, the hospital, as well as the doctors, contract with many insurance companies. And they usually hire staff, or if you work in a medical group, that spend time negotiating with each and every insurance company. Some insurance companies are going to pay a little bit for some procedure, some medicine, or something, and some are going to pay a lot more. And so what happens is, you can't charge one insurance company one amount, and one insurance company another amount. What you do is, you charge every insurance company the same, but then you have side deals with each one of them to say what discount they get. And this includes the government with Medicare and Medicaid. And so what happens is-

• 35:02Speaker 00

  Wait a minute, so you're just, what you're saying is-

• 35:04Speaker 06

  You have to charge as much as possible to make sure you capture every, what every insurance company is willing to pay. Because one insurance company might pay 50 bucks for that Tylenol, one insurance company may pay five bucks, and if you only charge 10, you don't get the 50 bucks.

• 35:18Speaker 00

  Hold on, so the letter of the law is, I'm going to charge everybody the same? So this is just a convoluted workaround-

• 35:23Speaker 06

  Correct.

• 35:24Speaker 00

  -to get around the letter of the law, going, "I'm not going to charge everybody the same."

• 35:28Speaker 06

  Here's the even funnier part. So what if you don't have insurance? Well, everyone gets charged 200, and one insurer will pay five for that Tylenol, another pay 10, but you, you don't have insurance, so you get this bill for 200. Well, here's the thing. If you, as the hospital, negotiate and say, "Well, all of our uninsured people are going to only pay 10," the government can get you for fraud, because now you charge the government a higher amount with Medicare and Medicaid than you've charged your Joe public person. And that's basically fraud. And they can, they can, you can get in big trouble for that. It's called inducement. You're inducing people to become your patients by giving them cheaper costs than you give the government, and that's a no-no.

• 36:10Speaker 00

  A lot of people want to be a doctor or a lawyer, not because of the fact that they are particularly interested in medicine or interested in law, it's because they've heard that they make a lot of money, right? Doctors make a ton of money. Where do doctor salaries fit into the healthcare spend pie?

• 36:26Speaker 06

  On average, doctors take up about 20% of the healthcare pie, but about 10% of that's overhead, like to run their facilities and to order the things they need, et cetera. So doctors' take home is about 10% of all medical spending. And so the big argument is, you know, a lot of people say, "Wow, we pay doctors too much." And that's been a big argument from some sides about how to reduce healthcare. There are a few problems with that. One is if you decide to pay doctors half. So let's say we cut every doctor in the US, we cut their salary in half. You would go down from spending 10% of our healthcare dollar to 5%. It just wouldn't move the needle that much. But you would lose more than 50% of the doctors. When we look at the population of doctors today, there's been a flight away.

• 37:09Speaker 06

  Doctors are opting out. They're doing what I did, which is becoming financially independent. They're going into corporate America and not practicing anymore. Or they're opening concierge or direct primary care practices that severely limit their number of patients.

• 37:22Speaker 00

  Look at what, God bless teachers, but look at what's happened to the teaching profession from the 1980s to today. It used to be the teacher was a well-paid position in the 1980s and could afford a really nice house. And teachers have to marry each other just to get two salaries that equal. I mean, teacher pay has not kept up with that. And I know many people that wanted to go into teaching, me included, who decided not to because the pay was so low.

• 37:49Speaker 06

  Yeah. And let's talk a little bit about doctor pay because this is one I hear all the time. Like, how much do average doctors make? A lot of doctors make $350,000, $400,000 a year. And people are like, well, you know, you can't complain about that. Doctors are well-paid. What people don't realize is the cost of medical school in the US is higher than almost any other country. Doctors often come out with $300,000 to $500,000 in debt. What people don't realize is

• 38:11Speaker 00

  And they start much later.

• 38:13Speaker 06

  Well, I was about to say, you start much later. So by the time you finish four years of medical school, at least three years of residency, if there's any fellowship, you're well into your late twenties, early thirties by the time you practice. They look at other countries and say, yeah, but in England, they only make 150 and in Spain, they only make 75. But you don't realize, A, medical school often is free or much less in those countries. You spend a lot less time going to medical school in those countries. People in Europe and other places tend to work, on average, many less hours. In the US, we tend to work way more hours and take less vacation. And then last but not least, they don't realize, you know, everything in the US, we make more. Our engineers make more, our accountants make more, our CEOs and founders make more. So yes, doctors make a lot in the US.

• 38:59Speaker 06

  But when you look at it on its face and the amount of decision making and stress that your average doctor deals with, depending of course in which specialty, it's not as oversized as people think. I won't argue the fact that doctors don't make good money. Hey, I make great money. But I don't think the amount of overpayment is nearly as much as people really think.

• 39:20Speaker 00

  And I'm sure, Doc, that a lot of our stackers worry that pharmaceutical companies, and everything you've said so far does not give us a lot of confidence that this is not the case, that pharmaceutical companies are influencing what doctors are prescribing. How real is that concern?

• 39:37Speaker 06

  It's a real concern, and a lot of it has to do with the R and D myth, right? Research and development. Pharmaceutical companies say the reason they should be able to charge so much for their drugs is that they spend so much money in research and development. And it actually isn't true. They found that basically for a typical drug, it's about $1.8 billion in research and development, but they make about $18 billion on the drug. So it's about 10 times. But what's really happened over the last bunch of years is the big pharmaceutical companies don't even do the R and D anymore. The smaller pharmaceutical companies do it. They spend a lot less. And then the bigger companies buy the drug from them. And the big part, and this is how it's affecting your healthcare, is what they've really been working on, the big pharmaceutical companies are either modifying

• 40:21Speaker 06

  the patent on a drug that already exists. So getting a new indication, they'll say, wow, that drug was for gastritis of the stomach, but now we're going to get the indication for peptic ulcer disease, which is a slightly different thing, but pretty much the same, and try to extend the patent time. Or what they try to do is they take a drug that is very beneficial, but is coming towards the end of their patent, and they slightly modify that drug, give it a new name, repackage it. It does all the same things. But now they get a new patent on that medicine. So how does it affect things? The pharmaceutical companies are constantly, instead of making new drugs, repackaging their old drugs and trying to convince you that that drug that you were using for 20 years that works great, that's now going generic, no longer suffices because you need this newer version of the

• 41:06Speaker 06

  same drug with a slightly different name and a slightly different structure, which is going to do all the same things for you. But now it's on patent for another 18 years.

• 41:15Speaker 00

  What do I, what do I ask my doctor then?

• 41:17Speaker 06

  Generic. Is a generic available and can I stay on it? Like, the best thing you can do is, if you're on high blood pressure medicine, cholesterol medicine, you don't need the newest and greatest. You actually can be on a generic medicine and it shortcuts the pharmaceutical industry immediately. The other thing the pharmaceutical companies do is they've created their own diseases. They call it disease mongering. So what they do is they take a pre-disease state, they define it, and then they suggest a drug to treat it. There was no such thing as prediabetes for most of human evolution. Only in the recent, whatever, 20, 30 years, there's a big deal about prediabetes and getting on medicine for it faster. That all came from pharmaceutical companies. Hypercholesterolemia, you know, it used to be they didn't treat cholesterol until you had a heart attack or a stroke.

• 42:01Speaker 06

  But now there's all sorts of assessments and they start treating you for it before it becomes an issue. And you say, aha, that's wonderful, except the data actually isn't particularly strong for treating people for a lot of these diseases in the pre-disease state. And so pharmaceutical companies are continuously trying to invent new medical problems, trying to modify pre-disease states, and then they're trying to change the medicine so they get longer patent lives on them. And that's why we've actually seen a decrease in the number of new drugs over the last few decades. A lot of these major pharmaceutical companies are creating less and less and less new drugs every year, especially when you start realizing that the ones they do create are what I call me too drugs. They're basically a new way of giving a drug, like giving it in a pen instead of an injection, or a slight modification on the drug to extend the patent.

• 42:47Speaker 00

  Let's stick with pharmaceutical companies and pharmacies. Stacker goes to their pharmacy, they learn that this medication isn't covered, or it costs hundreds more than what they expected when they got there. What should they do before they simply pay or walk away? Are there some things that they should do first?

• 43:07Speaker 06

  I mean, there are a number of things you could do. One is to get back with your doctor and be like, this is not covered. You could even look up your own formulary online and say, these are the covered meds. Are any of these just as good? This is the funny thing. A lot of pharmaceutical companies have rebates or free samples. So if you really need a medicine, especially if it's like an antibiotic or something short term, you might be able to ask your doctor for a sample or even get in touch with the pharmaceutical company for a rebate or a coupon. Those things are very, very common. I guess the other question is, if it's something like high blood pressure and cholesterol and you've never been diagnosed before, and this is the first time you're being diagnosed, you can also go back to your doctor and say, hey, are there some lifestyle modifications I could try before I get on a medicine? Sometimes for high cholesterol, high blood pressure, the first three to six months should actually be diet modification and

• 43:50Speaker 06

  exercise. And so I think those are all like really simple things you can do. But sometimes you have no choice. You have to be on a medicine and it might not be available. It might be patented. It might be one of a kind. You might have a rare disease. And then you have to really try to work with that pharmaceutical company. You can call the pharmaceutical company directly and say, hey, I need this drug and I can't afford it. How can you help me? And sometimes they will.

• 44:14Speaker 00

  Let's go similar question, but away from pharmaceutical companies into the insurance companies. You know, you mentioned a lot of times the insurance companies are inserting themselves. If I find out that my insurance company is inserting themselves, I know a lot of our stackers that go, well, hell, forget the doctor's office calling. I'm going to call the insurance company. Should I call the insurance company? Or should the physician's office call the insurance company? Should we both call the insurance company if we find that something isn't covered correctly the way that we want it to be covered?

• 44:44Speaker 06

  I think if you can convince your doctor to call and you call at the same time, I think you need to appeal as much and aggressively as possible. And it's sad, right? You're already feeling sick. You're already dealing with things. The last thing you want to do is keep records and make sure you have everything documented. But the more information you have, the more likely you're able to fight the denial or file an appeal or even ask the insurance company to intervene with the pharmaceutical company or what have you. Your insurer can also help you when it's not the insurance doing you wrong, because remember, they want to retain clients and patients too. But when it comes to something they're doing, you've got to appeal aggressively and keep as good records as you can. And if you can, get your doctors on your side, because when the doctors are saying, look, this patient really needs-

• 45:27Speaker 06

  This it gives you a leg up now. I've seen plenty of times when the insurance like we don't care what that doctor says because our doctor says they don't need it. Never mind the fact that their doctor is often not a practicing physician anymore and is their paycheck comes from basically denying a certain amount of care. So you have to be wary of these things.

• 45:44Speaker 00

  Foully incentives. Yeah.

• 45:45Speaker 06

  I want to be very clear here. We're talking about all these things you can do. But my book also makes the argument, you shouldn't have to do any of this. This system is fundamentally broken and we can work around the corners as much as we want. But the truth of the matter is this is a broken system that needs fixing. And the real answer is revolution. We need to significantly fix the system. And the only way we're going to do it is to topple the interests, the entrenched interests that are there now and actually have some say in how healthcare is practiced in the United States.

• 46:18Speaker 00

  I 100% agree with you, Doc, but you know me and I'm always looking for what can we do today to on a micro level, you know? So I'm going to stick with micro level for one more minute. You know, let's go back to this idea that, hey, you're pre-approved to have this surgery or this exam or whatever it might be, and then they don't pay. Is there a way today with the system the way it is that I can minimize the chance that that would occur?

• 46:45Speaker 06

  Even though they can deny you after giving you pre-authorization, whenever you're going for anything, you want to make sure that you talk to your insurance company and document your conversation with them. They should look at whatever procedure you're having and give you an idea right then and there. They should say, yes, we think this will be covered. No, we don't think this will be covered. So first thing to do is to get their pre-approval and document it. After the case, all you can do is gather all the information from your doctors on why it was necessary and try to appeal. If you feel like insurance still is not giving you a fair shake, I mean, you can report to the government. I don't know the name of the agency, but there

• 47:27Speaker 06

  are agencies that monitor the insurance industry. And that would be your next step if you can't get any kind of relief from the insurance company itself. But you have to, you have to keep pushing those appeals because almost no one actually appeals. And a number of decisions are overturned. Not everything, but a number of decisions are overturned if you push and push and push.

• 47:48Speaker 00

  It's amazing that Doug has stayed quiet this long, but he's finally tapping me on the shoulder. So we're going to Doug here, but coming up, Jordan's going to help us fight back. What do you do when the denial arrives? When should you appeal? What record should you save? And how can you tell whether the medical practice caring for use being run by people who see patients or by people who see spreadsheets? We're going to tackle all that right after Doug helps you stackers acquire a completely different kind of, it says useless knowledge here, Jordan, but I think it's useful knowledge of it, since Doug, it's gotta be useful. Doug, what do we got today?

• 48:27Speaker 03

  Hey there, stackers. I'm Joe's mom's neighbor Doug. And today we're talking healthcare, which includes making sure the important procedures, including deliveries, happen when you need them. But one of America's biggest delivery companies almost stopped making deliveries altogether. So here's today's trivia question. What popular delivery company stayed in business after founder Fred Smith famously flew to Las Vegas and won enough money at a blackjack table to keep the company operating for a few more days? I'll be back with the answer right after I see if mom accepts overnight delivery of apologies.

• 49:07Speaker 00

  Well, you may know that chaos is the name of the game here in mom's basement. What with guests coming in and out, Cooper the cat getting in the way, Doug being, well, being Doug, the holidays make it even worse because it's all about food and big meals. And the problem is prepping for those takes forever. But what about those between meals, right? The meals between those huge, huge, huge bookends. Well, that's where factor comes in. Factor is made with high quality ingredients that you recognize and trust with over 175 banned ingredients. You always know you're eating something that's good for you, even when you don't have time. It's ready in two minutes, whether it's lunch

• 49:48Speaker 00

  between meetings or dinner after holiday shopping. Factor requires zero prep cleanup or effort from you or So you can focus on everything else in your day. Factor even has heart smart options like the Green Goddess Bara Monday with tomato rice, peas, kale, and green beans, or the enchilada style chicken and sweet potatoes. Those are so good. They're crafted with lean proteins, fiber packed fruit and veggies and healthy fats. Try those out. Your heart and your taste buds will thank you. For Cheryl and I, Factor has been a great way for us to stay busy and focus on family

• 50:29Speaker 00

  life and beating mom at card games. I use Factor and you should too. So let's eat real stackers. Head to factormeals.com/sb50off. Use code SB50OFF. And you know what? You're going to get 50% off and one free breakfast item per box for one year while supplies last until December 31st, 2026. That is code SB50OFF at factormeals.com SB50OFF at factormeals.com. See website for more details. There is a financial conversation that's coming to millions of American families and there's a pretty good chance nobody wants to be the person who starts it. Inheritance.

• 51:12Speaker 00

  And here's why that matters. An estimated $124 trillion to heirs in charity is expected to be transferred by Americans over the next 20 years. It's an extraordinary amount of money, but Kiplinger's research found that 51% of adults and their parents, get this, never talk about money. And there's a pretty big disconnect. 47% of parents expect to leave a meaningful inheritance while only 24% of adult children expect to actually receive one. Nearly 30% of parents don't even have a will in place. Maybe it's time we talked. Kiplinger calls it the trillion dollar talk, a conversation about inheritance, estate

• 51:54Speaker 00

  planning, wills, and the questions families should be asking before those decisions become urgent. Because knowing what your family wants and having a plan for it can be one of the most important financial conversations you will ever have. Ready to start yours? Visit kiplinger.com to learn more about the trillion dollar talk and what this historic wealth transfer could mean for your family.

• 52:20Speaker 00

  It's incredible at a small company like Stacking Benjamins, how one, one hire makes all the difference in the world. If you're a small business, the right hire can be make or break. Hoping the right people see your job posting isn't the best growth strategy. When the pressure's on, you need the right hire. This is a job for sponsored jobs. Indeed Sponsored Jobs is a boost whenever you need to find quality talent. When workplace chaos hits and you need the right hire, this is a job for sponsored jobs. Hiring Indeed is all you need. Stop struggling to get your job post even seen at other sites. Get matched with and hire quality candidates who can drive the results you need. Reach candidates that meet your specific criteria like skills,

• 53:04Speaker 00

  certifications, or locations. Sponsored jobs boost your job post on search results so you can reach the people that can help your business thrive. Plus, with Indeed Sponsored Jobs, you only pay for results. People are finding quality hires on Indeed right now. In the minute I've been talking to you, listen to this. Companies like yours have made 27 hires on Indeed, according to Indeed data worldwide. And sponsored jobs posted directly on Indeed are 95% more likely to report a hire than non-sponsored jobs. So spend less time searching and more time actually interviewing candidates who check all your boxes. Less stress, less time, more results. When you need the right person to cut through the chaos, that's a job for Indeed Sponsored Jobs. And guess what?

• 53:48Speaker 00

  Our stackers are going to get a $75 sponsored job credit. That's you to help get your job the premium status it deserves at indeed.com/podcast. Just go to indeed.com/podcast right now and support Stacking Benjamins by saying you heard about Indeed in mom's basement. Indeed.com/podcast. Terms and conditions apply. Need a hiring hero? This is a job for Indeed Sponsored Jobs.

• 54:23Speaker 03

  Hey there, stackers. I'm overnight delivery expert and guy who's still waiting for mom to sign my deliveries. It's not action figures this time, Mom. Joe's mom's neighbor Doug. Before the break, I asked what popular delivery company nearly went under before founder Fred Smith took one of the most famous trips to Las Vegas in business history. Well, back in 1973, the company reportedly had only about $5,000 left after paying its bills. Smith flew to Vegas, sat down at a blackjack table, and turned that into roughly $27,000. Now, despite that buddy of yours who always says he's due at the roulette company, the casino didn't save the company. It simply bought enough

• 55:08Speaker 03

  time for Smith to secure the financing that actually saved the business. The business? Oh, yeah. It's called FedEx. And speaking of making important deliveries, let's get back to Joe and Dr. Jordan Grumet about something even more valuable than overnight packages: making sure your healthcare keeps delivering results.

• 55:29Speaker 00

  We're back with Dr. Jordan Grumet, aka Doc G. Before the break, we talked about what to do when you're denied. And I want to parse this out just a little bit. Like, should I, before I begin fighting, should I try to find the precise reason for the denial first before I just go, no, no, no, this is unfair. What's going on?

• 55:48Speaker 06

  I think you should. And often, they will give a reason for the denial. And so that's the beginning. Like, was the not, right paperwork not submitted? Is this an uncovered service? Is this that the pre-approval wasn't issued? Like, where's the problem? Is it something fixable? Most of the time, when you're getting a denial like this, especially post-care, it's that the insurance company has decided you didn't need that care. So then your goal is to really collect all the information to try to say, look, you say I didn't need that care, but here are the records, here are the notes, here are my doctor's notes. Here is the information that shows that this was actually a very logical progression of care and that I would have been in trouble if we didn't get it. What does that look like?

• 56:31Speaker 06

  Well, nowadays, because of the electronic medical records, there are portals and most of the time, people are actually interacting electronically with their hospitals and doctors' offices. So you want to look at those after-visit summaries. Every time you see a clinician of any kind, they usually have an after-visit summary. You also want to keep track of any and keep documented any interactions you're having with the medical staff. If the nurses or the doctors are sending you messages over that portal, you want to just have copies of those. Any interactions with the insurance company? If the insurance company originally said you were approved and then decided to deny it post-procedure, you want that to be documented, who you talked

• 57:10Speaker 06

  to, what you talked about, et cetera. Again, no one should have to do this, but if you really are worried and want to protect yourself and want to be prepared if something happens, you want to have fairly decent records.

• 57:23Speaker 00

  Speaking of decent, our stackers are very decent people. I've met a bunch of them as I've gone around the country. They're a lot like my dad, Jordan. And my dad, it's funny, because Cheryl is in healthcare as well, my spouse. And when my dad was alive, Cheryl would fight with my dad because my dad would be reticent to get the doctor involved in some of these things, just because he thought, you know, the doctor's so busy, they have so much stuff to do. Is there somebody other than the doctor that we should be talking to instead? Because maybe I don't need to involve the doctor. Maybe there's somebody else in the office that can help me with this.

• 58:02Speaker 06

  Yeah, your average doctor's office deals with about 39 pre-authorizations a week, and it takes about 13 hours of staff time. Usually, there's a point person in the office who actually it's their job to deal with these kinds of things. If it's a very small office, they might just have a medical biller, and that might be the person who you spend most of your time talking to. But there is usually an administrative person or two who is not the physician or clinical staff who deals with these things. And because they've done this many, many times, A few things. One, they've dealt with this before, so they know the kind of information you might need or not need. And they're also the ones who often go and call the insurers from the doctor's office. So they're used to talking to the insurance agents and the insurance companies.

• 58:41Speaker 00

  You talk in your book about going up the chain. I mean, we can maybe talk to somebody at our employer's benefits department. I can talk to the state insurance department, Medicare and ombudsman, a patient advocate, an attorney, like I can, there's this whole chain of people. One of the statistics in your research is astonishing, and this is where we get to revolution. Many denials are never appealed, yet as you have said earlier, a significant number of appeal decisions are reversed. Why do people give up?

• 59:11Speaker 06

  I think there's a hopelessness when it comes to our healthcare system, that that's the expectation. I think people walk in thinking this isn't going to work. People walk in already. They've already paid so much in premiums. They've already had trouble getting an appointment. They've already had trouble finding a doctor. And then when you finally...

• 59:31Speaker 00

  I walk into my medical clinic here in Texarkana, and I immediately think it's going to be a hassle. Immediately.

• 59:37Speaker 06

  I think that's what we've been trained to think. I hate to say, you know, I am not one who says, boy, everything was better before. Like, I think we've evolved as a country, and there's so many things better today than 50 years ago. But I will say, your interaction with your healthcare providers 50, 100 years ago were just more personal. You kind of knew them. You knew the staff. You called up the person at the front desk, and you were neighbors with them. And you said, hey, I'm really hurting today. And they'd say, okay, let me, let me grab doctor so and so out of a room, and let's figure out what to do. It's become very cold, very impersonal. And there's so many more barriers to care than they're used to. As the corporatization of healthcare has become so complex, again, we've just pitted this huge divide between those giving care and those who receive care.

• 1:00:22Speaker 06

  And it just makes it feel like a very daunting place where people give up, as opposed to assume that they'll eventually get what they need.

• 1:00:32Speaker 00

  At one hospice where you worked, the medical team stopped using a particular end of life medication because the evidence suggested it didn't help. It might actually cause harm. Then the ownership changed. What happened?

• 1:00:46Speaker 06

  The ownership changed of the hospice. And the first, so who originally, this is a perfect example. This hospice was actually started by physicians, run by physicians. And over the years, business people end up taking the place of physicians. And eventually, private equity bought out the practice. And there were a lot of reasons, but a lot of it had to do with compliance and some missteps when it came to business. It was a corporate to corporate conversation. Basically, the nursing homes where these patients were being cared for, so hospice would come in and take care of dying patients in the nursing home. The nursing home decided that they really liked it when this medicine was given because the medicine was to treat a problem that was bothersome and caused patients and families

• 1:01:31Speaker 06

  to get anxious. The problem was the medicine had been shown not to be helpful and possibly harmful. And so the nursing home eventually said, well, you know, our nursing home group is like 20 nursing homes in the area. If you hospice stop using this medicine that we think is beneficial, then we can just find another hospice to go see our patients in these 20 nursing homes. The problem is the people making these decisions were customer service people and corporate entities. Again, these were businesses practicing medicine and their responsibility was a fiduciary responsibility to the shareholders. The nursing home wanted to make its patients happy, whether it was good for them or not, because that made them lots of money and they could pay out profits.

• 1:02:13Speaker 06

  It was one business talking to another business, making a business decision. Now, somewhere in the middle of that, the patient's wellbeing totally disappeared.

• 1:02:22Speaker 00

  Just completely.

• 1:02:23Speaker 06

  It's what happens when you let businesses practice medicine, which used to be illegal in the United States.

• 1:02:30Speaker 00

  As patients, is there a way for us to tell whether a physician practice, an emergency department, a nursing home, dental chain, et cetera, is owned by private equity?

• 1:02:43Speaker 06

  So the easiest way is to ask, look at their website. Usually you will see some sign of who owns them. But most don't lie. So like if you ask and talk to the front desk person and say, is this practice owned by the doctor or is it owned by a company? Most of them will tell you.

• 1:03:01Speaker 00

  Are there other clues though? Like shorter visits, more tests, more add-on services, higher staff turnover, the billing more centralized?

• 1:03:12Speaker 06

  I think they're clues, but they're hard to tell. Right? So usually it's shorter patient visits, highly technological offices, lots and lots of paperwork, lots of nowadays AI. So you're seeing more and more AI, more and more automatic systems and automization, meaning you're talking less and less to people and more and more to machines. I think those are some good signs, but yes, if you're seeing a different doctor every time you come into the clinic, like if you're going to a primary care doctor and you can never see your primary care doctor and you're seeing a different doctor every time, I think that's a big sign. If you're going in and the staff looks different every time, right? The, the old version, when I practiced, I owned my own practice. And you know, the, my patients got to know the front desk staff

• 1:03:58Speaker 06

  and looked forward to seeing them. And let me tell you, when a patient came in sick, it was that front desk staff who would be sitting there, holding their hands or would say, oh, I see it's been a tough day. What can I do for you? Or would be getting the door for them or wheeling their wheelchair around. It was actually the staff who was doing all that. So if you're not seeing familiar faces, all of these can be signs that there's something more going on.

• 1:04:20Speaker 00

  We talked about revolution. You mentioned revolution. We've got all these things that we can do to kind of work around the system. And let's start with private equity because by and large, we've talked about private equity as, you know, this evil entity. The two words private equity are not in themselves inherently evil. It's kind of the intent of the people in private equity. Are there times when private equity can help your quality of care? Can actually make things better?

• 1:04:50Speaker 06

  So most of the data shows not. Most of the data shows that it tends to bankrupt medical institutions. Hospitals taken over by private equity tend to give less efficient care, tend to have more complications. Medical practices overtaken by private equity or venture capital tend to have less physician satisfaction, have more job turnover, et cetera. So the data would suggest that actually it's a pretty negative thing. Now, I could imagine a world where, yeah, private equity could come in, could cause basically improvements of scale, could become more efficient. A lot of the reason why doctors sell out to private equity, because they're having so much trouble with compliance and technology and electronic

• 1:05:32Speaker 06

  medical records. So it is true, big companies can come in and ease that suffering. The problem is what their intention is. It's just very rare you see private equity or venture capital where their intention is really to make life better. It just, most of their intention is to charge and collect more money. There are isolated cases where you have a wealthy founder who decides to come in with private equity or venture capital because they want to treat an underserved area, or they want to revolutionize healthcare and change the way it's practiced. Occasionally, you get that. But more times than not, it's third parties trying to make a profit.

• 1:06:15Speaker 00

  So where does the revolution start then?

• 1:06:17Speaker 06

  So it starts with us. So first and foremost, a lot of people say, what do you mean revolution? I always say, look, we're not talking about bayonets and guns here. We're talking about how main revolutions happen in the United States as well as around the world peacefully. And I would suggest we've had several revolutions within the United States. Civil rights is a big example of one, right? So 1965, you had a coalition of main stakeholders, the people who really this affected, who came together. To basically throw off the entrenched interests and get real change in Washington. How did this happen? Well, one of the ways it happened was with shared storytelling. So I always bring up the story about Rosa Parks, right? Rosa Parks and the story about how she couldn't sit on the bus became a story that where people

• 1:06:59Speaker 06

  coalesced, it brought shareholders together, they became allies and became an undeniable force for change. I think we need the same thing in medicine, but there is something holding us back. Why is revolution in medicine so hard? Because doctors and patients have been separated by these third parties who are separating them, I think on purpose. But there's also something else that separates doctors and patients, and it's intimacy. Remember, when we talk about the 1950s or the 1900s, there was a real intimacy between those who gave care and those who received care because we all lived in the same communities. We all knew each other's families and medicine was much more local. But nowadays, the studies show that people travel many, many miles now for their medical care. They often don't know their doctor or the doctor's family outside.

• 1:07:44Speaker 06

  The doctor doesn't come visit them at home anymore. So there used to be that intimacy so that even when the doctor came into your house or into your office or examining room and saw you, they had to be objective then, but the distance wasn't so great. Nowadays, we are very distant from our patients, which means our patients come and they disclose every intimacy to us. They tell us all their fears, their worries, their concerns, and then they literally shed their clothes in front of us. So it's very unilateral intimacy. The problem is the doctor of today doesn't give any intimacy back, which is, makes sense, right? When you're coming into the doctor's office for chest pain, you don't want your doctor to unload on you on how hard a day they've had. But because we have this unilateral intimacy, it's really hard to coalesce under a shared story.

• 1:08:28Speaker 06

  What really needs to happen, at least from our healthcare side, is those who give care need to do a better job in public of telling people our stories, of telling people our intentions. We do a great job of telling people what we know, like, how do you treat cholesterol? Or how do you not have a heart attack? But we do a horrible job of telling people who we are. Like, this is what it's like to be a doctor. Now, we're getting better. If you happen to watch the TV show The Pit, I don't watch it because it would give me PTSD, but I hear it's actually a great shared storytelling that opens up and gives us some sense of what it's like to be a doctor in medical school. And these are the steps we need to take to bring about allyship so that we

• 1:09:09Speaker 06

  understand each other so that we can then come together and force change. And let me just say one thing, a lot of people think this sounds a little crazy and pie in the sky, but we're actually about 90% of the way there. Obamacare was the first attempt at this. It fell short for sure. But this kind of change is already happening. We're already starting to coalesce and push change against a very entrenched Washington, a very gridlocked Washington. But that doesn't mean that we're not on our way there.

• 1:09:36Speaker 00

  It's interesting, the clinic that Cheryl works at, where Cheryl complains about, my spouse complains about is sometimes the lack of intimacy and sometimes how much the patient doesn't realize how important that is to the physician. When a patient tells her that the clinic was open and they decided to go to the local emergency room dock box that doesn't know who they are. When Cheryl and the people around her know everything about that person, she's like, what are you doing? Why are you doing that?

• 1:10:12Speaker 06

  But people don't even realize, I used to write a medical blog for years about what it was like to be a doctor. My patients would stumble upon it and they would come into the office the next time and they'd be blown away and they'd say things like, I never knew my doctor even thought about those things or went through those things. See, the thing is, your wife's patients don't even realize that that would be hurtful to her. They don't even realize maybe her intentions about caring for them.

• 1:10:38Speaker 00

  Yeah, and it isn't hurtful, by the way, on an emotional thing. She could take it emotionally. She's like, I can provide so much better care just because I know this stuff that this person who's never met you has no idea about. And yet they will go to the doc in the box and then they'll call Cheryl and go, hey, what do you think about the thing that this doctor that don't we thought? Guess what she says half the time? Jordan, you know what she says? She's like, that doesn't even fit.

• 1:11:02Speaker 06

  Yeah. Or they didn't know about this time you took that medicine and it gave you this bad reaction, or they didn't take into account your diabetes and how that would affect it. Or, yeah.

• 1:11:11Speaker 00

  They have none of the history because of the lack of shared medical records.

• 1:11:14Speaker 06

  Yeah.

• 1:11:15Speaker 00

  They don't know the person. They don't have any.

• 1:11:16Speaker 06

  Listen, we're a team and we've lost this. No one feels like a team anymore. And how are we supposed to fight off corporate America? How are we supposed to fight off the gridlock in Washington if we don't come together as a team and say, this is, we don't accept this anymore. This is not acceptable.

• 1:11:34Speaker 00

  I found this also in my own healthcare. The older I get, the more I want a doctor who wants to be on my team, by the way.

• 1:11:40Speaker 06

  Yeah.

• 1:11:40Speaker 00

  After seeing it from the inside, and I have gone away from doctors because they were treating it too much like a transaction. I was like, I don't just want a transaction. I want somebody who knows me a little bit.

• 1:11:52Speaker 06

  One of my favorite patient stories is I used to have a patient, an older guy I took care of, and he used to call me his colleague. He used to introduce me as his colleague.

• 1:12:01Speaker 00

  And it's fun.

• 1:12:01Speaker 06

  That's awesome. It's funny, but the more I thought about it, yeah, we're colleagues in the care of him. And that's, we are like, he has input, I have input. We sat down, we discuss it. I tell him what I know. He would tell me what he knew and we'd have this shared joint decision-making. We were on the same team and people just, we don't feel that way anymore.

• 1:12:23Speaker 00

  It is a fascinating read. I very much, and it's weird to say about a healthcare book, but I really enjoyed it. For me to say it about a healthcare book. Some people would be fascinated. I'm more of a, of a money nerd, but man, I was blown away by A, all the things we talked about today, a few of the things we talked about today. There's so many more that we can do today with the broken system, but also how we can begin to think about the system differently. Dive into this stackers. It's called the healthcare heist. How physicians and patients can unite to transform healthcare. And I'm assuming I'm looking at it right now on Amazon, but I bet it's available all over the place.

• 1:13:05Speaker 06

  Where fine books are sold.

• 1:13:07Speaker 00

  Only the finest.

• 1:13:08Speaker 06

  Only the finest.

• 1:13:09Speaker 00

  And I would be reticent while you're here, if we also don't ask you what's going on over at the earn and invest podcast, because you don't just talk medicine, you also talk, you talk money.

• 1:13:22Speaker 06

  We talk money and I recently had Jesse Miekom on. His show is coming out very soon and we talked about whether budgeting is a bad word. Is the word budget a bad word, Joe? Cause Jesse has changed his tune over the years.

• 1:13:35Speaker 00

  I think he thinks it is.

• 1:13:37Speaker 06

  Actually, I wouldn't say he's changed his tune. I think over the years, he's realized that there's more effective ways about how we talk about money than to use the big B word. And so although his company is Y and A B, it used to be you need a budget. It's now just Y and A B. He has humbly said, I've really think about things different nowadays and I'd like to help you see things differently too.

• 1:14:00Speaker 00

  He's such an expert. He's been doing it for so long. He's a great guy to learn from. And I love how you curate these top minds at earn and invest as well. Doc, thank you so much for helping our stackers really see what the problem is in healthcare today. And who cares how much money you have if you don't have your health? Not only can we save money, but we can also make ourselves healthier so that we're able to spend the time, the other limited commodity that we have on earth, doing the things that we love to do. So thank you so much and I appreciate it so much.

• 1:14:30Speaker 06

  Thank you for having me on the show.

• 1:14:33Speaker 06

  Hey guys, this is Shane. And when I'm not chasing kids around, driving a tractor or scraping up poor [BLEEP]. I'm stacking Benjamins.

• 1:14:44Speaker 00

  Big thanks to Doc G for hanging out with us today. Too many, too many cooks in the kitchen, OG, between the insurance providers, the pharmaceutical companies, all kinds of people between you and your doc. Big mess.

• 1:14:58Speaker 04

  Lots of layers of the cake. Everybody wants a little piece.

• 1:15:01Speaker 03

  Benefit administrators.

• 1:15:03Speaker 00

  Yeah, too many. We will link to his new book in the show notes at stackyourbenjamins.com. I think there's a ton of lessons in that last 40 minutes about. What to question? And I think the biggest one for me is if it's denied by your insurance company, fight it. Fight it. Cause most of the time the insurance company ends up paying. Doug, you got a big smile on your face.

• 1:15:27Speaker 04

  He just poofed.

• 1:15:28Speaker 03

  I'm just a happy guy, Joe. I don't, I mean, does that seem unusual to you? Just enjoying the day.

• 1:15:36Speaker 00

  I thought, I thought you were going to opine about your healthcare coverage, but he's just randomly smiling.

• 1:15:40Speaker 03

  No, just a happy thought occurred to me. Just the happy thought just flittered across my mind as a bluebird would on a, on a nice spring day and it brought a smile to my face.

• 1:15:51Speaker 00

  Oh boy. Well, thanks for hanging out with us today, stackers. We're super happy you're here. If you know somebody who's very frustrated with the medical system, maybe send them today's episode. What we're going to do now is ask Doug, no idea why I'm going to ask him this, but Doug, what are the three things you took away from today's episode?

• 1:16:10Speaker 03

  You don't want to ask me what I took away from the episode, but I will tell everybody what they should have learned. First, take some advice from Doc G. Was your claim denied by an insurance company? Have your doctor's office help you find out why and fight it. There's a good chance you'll win. Second, want to make sure the insurance company follows through on covering your procedure? Get as much as possible in writing beforehand. That could save you some work later and save your pocketbook from doing all the heavy lifting. But the big lesson, don't tell Joe's mom you're going to Vegas because it worked for the Fed ex guy. She looked at me and said, Doug, Fred Smith built a company first. He built a collection of expired Sizzler coupons. Okay, mom, you win this round.

• 1:16:56Speaker 00

  Thanks to Dr. Jordan Grumet, AKA Doc G for joining us today. You'll find his book, The Healthcare Heist, wherever books are sold. We'll also include links in our show notes at stackingbenjamins.com.

• 1:17:10Speaker 03

  This show is the property of SB Podcast LLC, copyright 2026 and is created by Joe Saul Sehi. You'll find out about our awesome team at stackingbenjamins.com along with the show notes and how you can find us on YouTube and all the usual social media spots. Come say hello. And oh yeah, before I go, not only should you not take advice from these nerds, don't take advice from people you don't know. This show is for entertainment purposes only. Before making any financial decisions, speak with a real financial advisor. I'm Joe's mom's neighbor Doug, and we'll see you next time back here at the Stacking Benjamin Show.

• 1:18:44Speaker 03

  Joe, all of this talk about healthcare reminded me of a great stand-up bit. It's been showing up in my socials lately and I love this guy. He's actually, this is the only bit of his I've heard. I should go out and find more Aaron Weber stand-up. It's very clean. He's got a great delivery and he has this excellent piece on going to urgent care and how entertaining that can be. Like maybe even if you're not that sick, just go to urgent care just for the fun of it. Let's see what, what Aaron has to say here.

• 1:19:13Speaker 00

  Well, we, we will see what he says because when you tee something up as a great bit, we will be the judge. OG and I will be the judge on whether this is great or not. So.

• 1:19:21Speaker 03

  God, me and my adverbs and adjectives.

• 1:19:24Speaker 00

  I know. Let's have a listen.

• 1:19:28Speaker 02

  I'd been sick for a while. I came down with something. I was sick for like two weeks. I had to go to urgent care here in Nashville. I don't know if y'all been to an urgent care? Go check it out. It's fun. I like it in there. It's better than a real doctor. I think...

• 1:19:45Speaker 02

  There's no ego at an urgent care. That's what's fun, you know? Nobody in an urgent care is like, "This is where I thought my life would be." And I like that. That's actually a good feeling. You go to a doctor's office, they talk down to you, right? Diplomas on the wall. They're like, "I went to school. I know everything." Urgent care is like, "Do you have forty dollars? Let's figure this out together." "We don't know any more than you, you know? Let's put our heads in a room." "And let's tackle this sinus infection as a team." And that's fun. There's camaraderie at an urgent care, you know? I don't know if anybody's qualified, and that's a rush. That's a fun way to spend a day.

• 1:20:27Speaker 02

  You know how you fill out all your info in the lobby on like a clipboard? And then they take you to another room and act like you never did that?

• 1:20:36Speaker 02

  So the nurse comes in, or face to face, she's asking me questions. She goes, "What are you in for?" I said, "My nose is clogged." She said, "You been taking anything?" I said, "Just Sudafed." And she goes, "Oh, can you spell that for me?"

• 1:20:50Speaker 02

  I was like, "Sudafed? I maybe could.

• 1:20:57Speaker 02

  I would like you to take a stab at it, though, right? Feels like something you should know. I know y'all share a lease with a T-Mobile store, but this feels like day one stuff, honestly. Look, I've been taking ibuprofen as well, so maybe...

• 1:21:17Speaker 02

  I sounded that one out.

• 1:21:20Speaker 02

  You can write that down phonetically.

• 1:21:25Speaker 02

  I'm being mean, but they hooked me up. They gave me a steroid shot. I don't know if you've had a steroid shot. They are awesome. I don't know what's in them. It works so quick. I don't know why they've been hiding these. They should do a lot more steroid shots. That should be the first thing they throw at you when you walk in, you know? Just go around the waiting room, just give everybody a steroid shot and be like, "We'll see who needs to be here in five minutes." Most of y'all be feeling better than you've ever felt in your life.

• 1:21:56Speaker 02

  They got me. I felt good right away. I had some other medicine I had to get. I don't even know what. I had to go to the pharmacy to get it. They didn't have it at urgent care. I had to go to the pharmacy, another place, across town. I know that's how it works, but I don't know why we're all okay with it. You know, there's plenty of room. Just keep it there. Why do I gotta go off campus? To get the med- you know, no other industry in America works like that. Can you imagine you go to Jiffy Lube and they're like, "You need a oil change." "We don't have any oil here, but if you take this piece of paper to Walgreens, they'll get you oil in about an hour."

• 1:22:35Speaker 02

  You'll see it immediately, but it'll be an hour before they turn around and hand it to you. You ever see your bag over their shoulder? You're like, "Can I just reach out and grab that real quick?" It's gonna be an hour.

• 1:22:51Speaker 00

  Maybe it's time we talked. Kiplinger calls it "The Trillion Dollar Talk", a conversation about inheritance, estate planning, wills, and the questions families should be asking before those decisions become urgent. Because knowing what your family wants and having a plan for it can be one of the most important financial conversations you will ever have. Ready to start yours? Visit kiplinger.com to learn more about "The Trillion Dollar Talk" and what this historic wealth transfer could mean for your family.

• 1:23:23Speaker 01

  Network freedom and flexibility, that's what you want in a healthcare plan. With a Humana Medicare Advantage PPO plan, you can see any doctor in the country who accepts Medicare, including specialists. No referrals, no kidding. Learn more at gethumana.com. See any doctor who accepts Medicare and is willing to bill Humana. Humana PPOs may not be available in all areas. Benefits and costs share may vary. Humana is a Medicare Advantage PPO organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal.