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Speaker 1: From UFOs to psychic powers and government conspiracies. History is

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Speaker 1: riddled with unexplained events. You can turn back now or

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Speaker 1: learn this stuff they don't want you to know. A

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Speaker 1: production of iHeartRadio.

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Speaker 2: Hello, welcome back to the show. My name is Matt,

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Speaker 2: my name is Noel.

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Speaker 3: They call me Ben. We're joined as always with our

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Speaker 3: super producer Dylan the Tennessee pal Fagan. Most importantly, you

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Speaker 3: are you. You are here. That makes this the stuff they

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Speaker 3: don't want you to know. Hurtling headlong through April. We

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Speaker 3: wish you the best with your paperwork. I feel like

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Speaker 3: everybody has to deal with paperwork at this point, no

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Speaker 3: matter who you are.

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Speaker 4: Guys, would you believe I've already done my taxes? I

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Speaker 4: did them, like right away, the moment I got my

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Speaker 4: W two, I feel like such an adult.

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Speaker 3: Yeah, you were telling me that that's.

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Speaker 4: Awesome, you know. I mean, it's not bragging, it's just

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Speaker 4: for me. It's a big deal.

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Speaker 2: Did you get to write off any medical expenses?

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Speaker 4: No, I didn't. I wrote off a lot of modular

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Speaker 4: synthesizer equipment. Though don't tell Uncle Sam. Now I do

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Speaker 4: use that for business, but yeah, how does that even work? Guys? Like,

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Speaker 4: I don't think I even knew that you could do that.

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Speaker 3: Yeah, cand you just have to out receipt the other people.

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Speaker 3: It's a war of paperwork attrition, getting your documentation right

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Speaker 3: in the right place, always having the thing when it's

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Speaker 3: asked for in the format it is requested. This leads

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Speaker 3: us to a fascinating conversation we had back in October

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Speaker 3: twenty twenty four with our conspiracy realist K Dog. K Dog,

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Speaker 3: you said something that stood out to all of us,

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Speaker 3: and K Dog and I had a bit of a

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Speaker 3: correspondence over this. The US healthcare system is diplomatically put complicated.

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Speaker 3: Supporters are going to say it's imperfect, but you know,

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Speaker 3: it's better than nothing, and critics, by which we mean

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Speaker 3: the majority of the US population, will say it's worse

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Speaker 3: than not great. It can be predatory at times. It

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Speaker 3: is not near the level of other developed countries, like

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Speaker 3: right now, as we report, millions of people are attempting

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Speaker 3: to get possibly life saving medications, procedures and surgery.

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Speaker 2: Yeah, the rest of the world says, why can't you

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Speaker 2: provide that? Don't you guys make a lot of money?

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Speaker 4: Why is it a crapshoot that you might get like

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Speaker 4: acceptable healthcare. It just seems kind of like a lot

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Speaker 4: of people in the rest of the world look at

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Speaker 4: that as a human.

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Speaker 3: Right, yeah, because it is. So we're coming in here

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Speaker 3: with a bit of a bias. But this is the

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Speaker 3: quick skinny folks. Here in the United States, patients and

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Speaker 3: doctors can't immediately agree that a procedure life saving right

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Speaker 3: outside of maybe an emergency room. Doctors have to get

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Speaker 3: prior approval from private health insurers to cover part of

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Speaker 3: a medical.

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Speaker 2: Cost because they're the ones paying for it, right.

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Speaker 4: Sure, and who, by the way, are not themselves medical professionals,

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Speaker 4: and who are making assessments based on dollars and cents,

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Speaker 4: not necessarily you know, the well being of the patient.

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Speaker 2: We're going to talk about that because that's why one

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Speaker 2: of the value adds of one of the corporations we're

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Speaker 2: going to be talking about is we use doctors, and

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Speaker 2: we have doctors because doctors have to make those decisions.

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Speaker 4: Oh right.

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Speaker 3: This leads us to the story k Dog that you

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Speaker 3: suggested not too long ago, back in October of twenty

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Speaker 3: twenty four. This is the tale of evycore not evil.

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Speaker 4: Nobody not noticed or like let them know that this

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Speaker 4: is one letter away from being evil core, which sounds

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Speaker 4: like an incredible genre of that high parody.

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Speaker 3: Account on Twitter.

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Speaker 2: I think it's evicre e core.

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Speaker 3: Well, you know what will give them the measure of

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Speaker 3: respect they deserve. Here are the facts. Let's okay for

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Speaker 3: anybody unaware, guys, could we explain what prior approval is.

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Speaker 3: What does it mean.

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Speaker 2: It's authorization by a medical professional that says, hey, this procedure,

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Speaker 2: this medication, this, whatever it is, is medically necessary for

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Speaker 2: this patient. That's what a prior authorization is. Before the

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Speaker 2: surgery happens, before the MRI test, before the certain exam.

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Speaker 2: Name it that an oncologist would perform, before your heart

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Speaker 2: gets checked out, or you get a catheter in there

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Speaker 2: to make.

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Speaker 3: Sure you get medication.

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Speaker 2: Yes, any of that. It's a group of people saying, yes,

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Speaker 2: this is necessary before anybody takes on any further costs.

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Speaker 3: Yeah. And additionally to this important note, this is evaluated.

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Speaker 3: Part of this is not just whether it's medically necessary,

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Speaker 3: but whether it is specifically covered by whatever hierarchy of

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Speaker 3: plan you have. So even if you definitely need that

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Speaker 3: kidney and you don't have the right plan, you may

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Speaker 3: not get approved, meaning that you would be theoretically responsible

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Speaker 3: for the entirety of that bill.

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Speaker 4: It's another reason too that it's really really difficult to

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Speaker 4: get certain experimental treatments covered. And you always hear about,

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Speaker 4: you know, people that have cancer and that maybe there's

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Speaker 4: this you know, cutting edge treatment that's being used. That's

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Speaker 4: the kind of stuff or to get the top person,

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Speaker 4: that's the kind of stuff that almost always has to

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Speaker 4: be paid out of pocket and can bankrupt people at

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Speaker 4: the very least cause them to carry massive, massive debt.

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Speaker 2: I agree. I think one of the things we have

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Speaker 2: to address at the top here is that most medical plans,

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Speaker 2: no matter who's providing them, will state somewhere within the

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Speaker 2: massive documentation you have to sign that medically necessary things

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Speaker 2: will They won't be fully paid for, but depending on

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Speaker 2: your whatever your contract says, they will be paid for

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Speaker 2: with a certain percentage, right.

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Speaker 3: Sure, after a certain threshold of payments.

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Speaker 2: Well, yeah, there's like all these different things. Well it

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Speaker 2: just depends. There's all these different things that can go

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Speaker 2: into it. And but ultimately, almost every single one of

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Speaker 2: the healthcare plans that I have seen say within that

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Speaker 2: writing that they will cover medically necessary things, which is

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Speaker 2: why that term, that phrase becomes so important.

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Speaker 3: Yeah, yeah, and also such a such a foundational stone

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Speaker 3: in the controversy and indeed conspiracy we're discussing here. You know,

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Speaker 3: in theory, the idea of prior approval is used by

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Speaker 3: insurance companies and their health plans and physicians to make

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Speaker 3: sure things are cost effective, that the service is necessary,

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Speaker 3: it's covered. That makes sense. However, we could argue the

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Speaker 3: solution to the second part of covered by your plan

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Speaker 3: could be solved very easily by just getting everyone on

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Speaker 3: the same plan, like so many other developed countries. Story

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Speaker 3: for another day does need to be mentioned. But in theory,

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Speaker 3: prior approval does mean that drugs and services are going

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Speaker 3: to people who need them.

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Speaker 4: And which I guess you know, was sort of the

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Speaker 4: point of the Affordable Healthcare Act. But even that in

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Speaker 4: and of itself was like a little not great because

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Speaker 4: it still required, you know, connecting with these private insurance

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Speaker 4: companies that were just in this new network, right yeah,

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Speaker 4: the marketplace, that's the market the marketplace. So it's still

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Speaker 4: not even close to resembling what other countries have and

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Speaker 4: have had for many, many years. And it's also something

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Speaker 4: that is for whatever reason and very controversial and seems

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Speaker 4: to be in the process of being shut down, or

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Speaker 4: at least attempted to be.

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Speaker 3: Yeah, it goes back and forth just because there is

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Speaker 3: so much money here. We have it later in the episode.

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Speaker 3: But maybe one of the things you have to consider

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Speaker 3: now when you're playing along at home, folks, is that

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Speaker 3: as an industry in the United States, healthcare is by

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Speaker 3: far the number one employer, and that that is as

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Speaker 3: of March twenty twenty five. Went back and forth between

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Speaker 3: that and retail or even I guess the Pentagon is

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Speaker 3: technically the largest single entity employer, but not anymore well

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Speaker 3: healthcare industry, Yeah, it's all the other companies. Oh no, yeah, God,

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Speaker 3: I haven't even thought about all the stuff that's gonna

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Speaker 3: happen rip to the stock market. By the way, I

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Speaker 3: guess there's no prior approval on whatever surgery was needed

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Speaker 3: for that one.

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Speaker 4: Ah, the patient's just stuffering for a minute and then

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Speaker 4: it's going to heal. I mean to be fine, but

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Speaker 4: to be fair, y'all, we've seen corrections before. We've seen

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Speaker 4: you know, recessions before. I'm not trying to diminish what's

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Speaker 4: going on, but also I really trying not to be

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Speaker 4: utterly doom and doom about it.

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Speaker 2: Cool, that's good.

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Speaker 4: I stuck the mental health thing, guys, I'll go on

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Speaker 4: to call it, call it willful self decepsion if you must.

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Speaker 4: But this is where I land.

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Speaker 3: I had a I had one of those moments where

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Speaker 3: I said, you know what, I'm just not going to

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Speaker 3: look at anything like a four four A one K

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Speaker 3: until twenty twenty nine. Get yeah, exactly.

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Speaker 2: So let's let's also just state here most of what

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Speaker 2: we're talking about, if not everything we're talking about right now,

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Speaker 2: have to do with insurance companies. So all the patients

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Speaker 2: to the provider to the insurance company. The insurance company

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Speaker 2: is the most important thing. These are private entities that

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Speaker 2: are for profit entities. Right There are other medical plans

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Speaker 2: that you may find yourself getting if let's say you

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Speaker 2: were you were formerly a member of the military, if

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Speaker 2: you don't reach a certain level of income on a

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Speaker 2: yearly basis, you could be a part of a federal

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Speaker 2: or a state like medicare system, et cetera. That they

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Speaker 2: function very differently than the ways we're talking about this

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Speaker 2: whole system. They're still attempting to cost cut right and

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Speaker 2: sure and save get some savings wherever they can, but

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Speaker 2: those systems are much less likely to have this type

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Speaker 2: of system in play with the denials we're going to

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Speaker 2: be talking about today.

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Speaker 3: Right right, especially the rate of attrition here, which is

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Speaker 3: going to be key.

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Speaker 4: Now.

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Speaker 3: We gave the the theoretical defenses, right and god knows,

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Speaker 3: nobody wants an innocent person to die because somehow the

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Speaker 3: medicine that they should have gotten has been, you know,

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Speaker 3: funneled off to someone who doesn't need it. Everybody agrees

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Speaker 3: on that point, but it is is it not an

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Speaker 3: argument of convenience because practice prior approval gets super dicey.

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Speaker 3: We'll talk about the rules and criteria, and before we

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Speaker 3: do that, we have to establish this is a hodgepodge

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Speaker 3: of incongruous, sometimes conflicting bureaucratic regimes. States have their own

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Speaker 3: different laws regulating the process and what indeed should even

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Speaker 3: be reported about the process. And the most important thing.

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Speaker 3: I feel like we get lost in the banality of

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Speaker 3: evil here, But the most important thing to remember when

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Speaker 3: folks are navigating this arcane system is that there is

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Speaker 3: often a ticking clock involved not getting a medicine, not

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Speaker 3: getting a procedure or treatment can lead to disaster. It

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Speaker 3: is not as if your failing kidney is going to

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Speaker 3: wait on your insurance company's paperwork. You know what I mean.

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Speaker 3: You can't tell a bodily function or an organ of

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Speaker 3: yours that you didn't fill out form XYZ correctly. The

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Speaker 3: heart's not going to go now. Yeah, okay, well I'll

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Speaker 3: keep taking along for ninety days.

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Speaker 2: That is a great point, Ben, because it is human

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Speaker 2: beings that are potentially on the brink of death or

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Speaker 2: you know, extreme extreme illness or pain. Yes, right, And

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Speaker 2: as we found out last year, sometimes that denied back

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Speaker 2: surgery could lead to a homicide.

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Speaker 3: So you know, we're learning, Luigi Mangio.

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Speaker 2: We're learning that this is the stakes couldn't be.

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Speaker 3: Higher here, And I really appreciate that because that foreshadowing

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Speaker 3: is one of the crucial mission critical larger contexts that

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Speaker 3: want us to get to at the end, because this

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Speaker 3: occurs in situ with this stuff in media arrests. What

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Speaker 3: is medically necessary quote unquote If you ask most insurance

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Speaker 3: companies or insurance company adjacent things, they will say medically

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Speaker 3: necessary means that when a doctor tells us or puts

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Speaker 3: in a request for insurance to cover this thing private insurance.

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Speaker 3: Then we have to know for sure that the recommended

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Speaker 3: treatment from the physician is proven to be the best

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Speaker 3: current approach based on the most current verified research.

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Speaker 2: Again, that's also that there's not a cheaper alternative that

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Speaker 2: will have quote the same outcome.

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Speaker 3: Right. They want to make sure something's not getting duplicated,

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Speaker 3: and that can happen if you're seeing multiple specialists, right,

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Speaker 3: One one specialist request an X ray, another one request

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Speaker 3: an X ray, So an insurance company will say, hey,

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Speaker 3: we've already got an X ray. The economical option, or

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Speaker 3: what we'll call lowballing, it occurs when just simply put,

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Speaker 3: there are two or there are a couple of drugs

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Speaker 3: that could treat a condition or a specific aspect of

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Speaker 3: a condition, your doctor, for one reason or another, recommends

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Speaker 3: one that is more expensive. The insurance company you will

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Speaker 3: then ask your physician, why can't you just go with

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Speaker 3: the less expensive version. That's not an automatic denial, but

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Speaker 3: that does mean your doctor, who's already very busy, has

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Speaker 3: to justify why the more expensive option is better. Right,

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Speaker 3: Is it because the pharmacy far is it because the

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Speaker 3: pharmaceutical reps bribe them?

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Speaker 2: Which which is a potential thing. But then you create

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Speaker 2: a situation where that physician has to spend hours on

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Speaker 2: the computer typing up the reasoning behind something right that

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Speaker 2: they just as the physician and as a care provider,

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Speaker 2: said hey, this is what needs to happen.

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Speaker 3: Right, and you can appeal these denials. You can resubmit paperwork.

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Speaker 3: A lot of times, it's the bureaucracy that gets people.

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Speaker 3: You might have some kind of other quite innocuous error.

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Speaker 3: So if you ever get denied for one of these

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Speaker 3: prior approval requests, the first move you and your physics

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Speaker 3: team are going to make is to try again. And

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Speaker 3: there are cases where someone got denied for something twice thrice,

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Speaker 3: only to get approved the third or the fourth time.

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Speaker 3: It for a long time, a huge issue with this

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Speaker 3: was that these just like how the laws go state

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Speaker 3: by state, each private insurance company in the United States

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Speaker 3: had their own different systems, their own kind of formatting

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Speaker 3: for things, their own kind of reasoning behind how we

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Speaker 3: evaluate medical necessity. So what flew with like your I'm

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Speaker 3: just making stuff up, but like what flew with you know,

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Speaker 3: casadea United might not fly with shoe feed incorporated.

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Speaker 4: Well, and it's just I don't know. It's just kind

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Speaker 4: of mind boggling that it's not more standardized, and it

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Speaker 4: just really points to the problem of how having all

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Speaker 4: of these separate entities kind of making their own rules

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Speaker 4: without much cohesion between them, really is tough when it

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Speaker 4: comes to like human health and human life and well

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Speaker 4: being and being treated humanely, because so much of it

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Speaker 4: feels like a crap shoot. The idea of getting approved

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Speaker 4: the third or fourth time.

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Speaker 2: Why well, we'll get into it. But I think the

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Speaker 2: real problem is that each of these entities is looking

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Speaker 2: at the bottom line, and each of these entities, especially

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Speaker 2: at the very top of the private insurers, are trying

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Speaker 2: to make sure the total revenues for that year or

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Speaker 2: that quarter are higher than the ones that they were before.

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Speaker 3: Yeah, you could also argue that their primary patients are

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Speaker 3: the shareholders. Is just wild.

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Speaker 4: I'm sorry. I mean, I don't understund naive. It's just

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Speaker 4: I know this is how capitalism works. But when you

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Speaker 4: have such a capitalist, you know, philosophy behind something as

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Speaker 4: important as like saving human lives, it's just yeah, it's wild.

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Speaker 2: It makes you wonder what the American Medical Association, it's

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Speaker 2: four Besides lobbying, I guess or the.

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Speaker 3: Many other related medical associations. I love what you were saying.

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Speaker 3: There no the idea of this massive discrepancy, these competing,

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Speaker 3: sometimes contradictory systems. There's a solution, Dylan, if we could

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Speaker 3: get some fanfare perfect set about large scale automation courtesy

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Speaker 3: of companies like Core.

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Speaker 4: Right right.

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Speaker 3: The idea is uniformizing the approval process. Supporters will say, look,

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Speaker 3: this saves cost, it cuts confusion overall. While imperfect, it

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Speaker 3: is a better system. However, critics will say this system

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Speaker 3: is purposely, brutally designed to deny as much coverage as possible,

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Speaker 3: accelerating profits while you know, endangering or even ending human lives.

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Speaker 4: And we'll get into more about how that happens after

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Speaker 4: a quick word from our sponsor.

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Speaker 3: Where it gets crazy. All right, evil Core, Evcore, Evycore.

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Speaker 2: However you they say, eviCore our corporate video.

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Speaker 3: All right, Well, we've given them the respect they're due.

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Speaker 3: So evil Core is founded in the early nineteen nineties.

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Speaker 3: It's a medical imaging company, you know the kind of

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Speaker 3: folks who work with cat scans and X rays and stuff.

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Speaker 3: This is nineteen ninety two, and it goes through several

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Speaker 3: different headquarters like back and forth from South Carolina and Florida,

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Speaker 3: et cetera. It goes through acquisitions. There's a merger in

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Speaker 3: twenty fourteen, and the product of the merger is ultimately

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Speaker 3: acquired by the gigantic company Signa in twenty eighteen. And

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Speaker 3: so now this is unnecessarily complicated, right, This company operates

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Speaker 3: through eviCore operates under Signa with relative autonomy because they

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Speaker 3: operate under a another subsidiary of Signa called ever North.

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Speaker 3: So yes, it's Petroshka Dolls, right, that's partially to help

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Speaker 3: out with accounting, to be quite honest with.

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Speaker 2: You, Yeah, it's really fun to go through those companies

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Speaker 2: and then just see what all the mission statements are

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Speaker 2: for the companies. As you imagine going down and parsing

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Speaker 2: the mission into a sharper thing. I guess as you get,

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Speaker 2: you know, through ever North, through Signa to ever North,

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Speaker 2: to to eviCore.

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Speaker 3: Which is dance of euphemisms.

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Speaker 2: Oh yeah, which is now in Franklin, Tennessee. Everybody head quartered.

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Speaker 3: Tell them we said hi. So Evicore's best known thing

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Speaker 3: the platform we're talking about tonight, along with thirty eight

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Speaker 3: other huge clients of theirs is something called in telepath.

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Speaker 3: In telepath, which sounds like a weirdly specific superhero power,

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Speaker 3: I'm not a telepath, I'm an intell past that's funny.

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Speaker 4: I only read smart people's minds.

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Speaker 3: We got there. But the idea is that this proprietary

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Speaker 3: platform can get things approved faster, can at least get

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Speaker 3: decisions made faster, reducing the burnout of doctors. Overall, their

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Speaker 3: argument is this makes things more efficient and less stressful

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Speaker 3: for everybody, including patients on the ground who already pay

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Speaker 3: these insurance companies a ton of money.

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Speaker 4: Well, you could certainly argue or see the merit in

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Speaker 4: something like this. It all just depends on the rubric

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Speaker 4: that it's using, you know, and then which sign it

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Speaker 4: favor and which ultimate outcome is prioritized for the folks

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Speaker 4: programming the platform or the very least nudging it in

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Speaker 4: whichever direction.

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Speaker 3: What's the dial?

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Speaker 2: Oh, we're going to learn about the day dial. But

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Speaker 2: if you want to put yourself in maybe you're not

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Speaker 2: a medical provider or a physician, but if you want

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Speaker 2: to put yourself in the shoes of somebody, let's say

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Speaker 2: you're a doctor that you go and see on a

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Speaker 2: regular basis, Evicre on their website has a nice little

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Speaker 2: author pre authorization or they call it prior authorization checklist

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Speaker 2: where you can see just all the things you need

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Speaker 2: to do as a provider to provide to this thing

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Speaker 2: that we're talking about, this automated service, and then all

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Speaker 2: of the different steps you need to take as that

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Speaker 2: physician just to get a single prior authorization done.

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Speaker 3: And it is.

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Speaker 2: From my eyes, it's infuriate, infuriating the amount of busy

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Speaker 2: work that somebody has to do to make one surgery happen.

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Speaker 3: Which is why there are entire small armies of support

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Speaker 3: staff who has who have to walk through this stuff.

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Speaker 3: You know, and keep in mind again we are make

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Speaker 3: no mistake, we are talking about potentially life saving services. Now.

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Speaker 3: Evicor can't get in too much, too much trouble for

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Speaker 3: this as an insurer because it is not itself a

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Speaker 3: direct insurer. It is a third party. Your insurance companies

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Speaker 3: are outsourcing these approval decisions to companies like Evicre or

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Speaker 3: evil Core, and these clients. It might sound small when

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Speaker 3: you hear these folks say, hey, we started with like

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Speaker 3: three clients and now we have thirty eight. But those

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Speaker 3: clients each one. They comprise some of the biggest insurance

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Speaker 3: companies in the United States. So as a result, the

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Speaker 3: partially automated approval decisions from this company, this outsourced third party,

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Speaker 3: they affect around one hundred million people in this country

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Speaker 3: as of last year. That is about one and three

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Speaker 3: Americans with insurance.

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Speaker 4: Yep.

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Speaker 2: So if you've got oh, I don't know, Blue Cross,

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Speaker 2: Blue Shield, Etna, United Healthcare, you were, or even some

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Speaker 2: Medicare or some Medicaid groups use this service.

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Speaker 3: Yeah, I mean, and this is Look, this did not

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Speaker 3: come out of someone's fever dream one night. This is

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Speaker 3: the culmination of a massive decade long, multi decades long

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Speaker 3: campaign by existing insurance companies because they looked around and

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Speaker 3: they saw some studies that are again sort of convenient,

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Speaker 3: and they said, all these healthcare costs are exploding, all

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Speaker 3: these people getting over treatment. That's the euphemism over treatment.

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Speaker 2: That's not healthcare costs for you and me and us

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Speaker 2: and the human beings. That's healthcare costs for healthcare corporations.

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Speaker 4: And again, though I mean, like this centralized platform that

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Speaker 4: we're talking about, it would if used kind of more humanly,

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Speaker 4: I guess be the thing we were saying maybe needed

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Speaker 4: to happen some sort of standardization between these companies. But

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Speaker 4: what it's trying to do is just not that's exactly

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Speaker 4: the opposite of what we want, right.

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Speaker 3: It's so weird because the idea is that this company, like, okay,

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Speaker 3: you're an insurance company, you outsource, you sign one of

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Speaker 3: two types of contracts with this company, and as a result,

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Speaker 3: they will somewhat automate the decisions or they'll they'll offload

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Speaker 3: the decision making process from your company. They specialize, ever

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Speaker 3: Acorse specializes in expensive or niche procedures and recommendations, so oncology,

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Speaker 3: gastro entrology, sleep problems, a Baker's dozen of other specialized

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Speaker 3: fields like cardiology, course, and the idea is kind of

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Speaker 3: what you were describing there. Know that this proprietary platform

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Speaker 3: in Telepath streamlines everything in a single application. It manages requests,

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Speaker 3: clinical surveys, and it gives you real time decisions. That

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Speaker 3: real time decision aspect is a game changer, especially when

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Speaker 3: we're talking about time sensitive stuff, especially if those requests

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Speaker 3: get approved. And that's the problem we can't thank again,

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Speaker 3: k Dog and our pals at pro Publica and Capital Forum,

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Speaker 3: we can't thank them enough for the fantastic work they

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Speaker 3: published in October of last year. It's a long breed,

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Speaker 3: but everyone should check it out.

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Speaker 2: It's huge, Yes, but dang is it intense. You can Yeah,

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Speaker 2: you can find it everywhere. I think CNN even reposted

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Speaker 2: it when it's like word for word, Yeah, exactly, a

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Speaker 2: couple other places that our big publications put it out

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Speaker 2: because it is that important.

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Speaker 3: Yeah, and they're saying they're saying what we've been sort

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Speaker 3: of saying here at the top. Their investigation indicates that

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Speaker 3: this company and companies like it's there are more than

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Speaker 3: one in the game. They may be incentivized by more

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Speaker 3: than just efficiency. They may be pursuing profits for clients

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Speaker 3: by increasing rates of denial and doing so knowingly. And

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Speaker 3: they don't even call it denials. They call it inappropriate

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Speaker 3: care intermentrop say.

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Speaker 2: Guys, we talked about overtreatment, but ben, I think we

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Speaker 2: skipped over the actual stats there of what is stated

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Speaker 2: by the health insurers in like why they're looking for

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Speaker 2: this service. Can we just hit those real quick?

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Speaker 3: Yeah, they said something the overtreatment rationalization right from the

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Speaker 3: insurance companies are a handful of studies that if you

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Speaker 3: read them are a little bit dodgy. We're not experts,

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Speaker 3: but they're a little dodgy. They're claiming that twenty to

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Speaker 3: forty five percent of certain medical treatments are ineffective, wasteful,

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Speaker 3: or unnecessary. Forty five percent is a really high number,

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Speaker 3: especially considering that the people making these requests have gone

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Speaker 3: to medical school forever.

437
00:26:58,440 --> 00:27:02,840
Speaker 2: Dude, Yeah, well, and just this concept that, oh, well,

438
00:27:03,400 --> 00:27:07,320
Speaker 2: we checked out patient a's heart because patient A was

439
00:27:07,320 --> 00:27:11,080
Speaker 2: complaining of you know, heart issues. These are symptoms that

440
00:27:11,160 --> 00:27:13,840
Speaker 2: someone who might have a heart attack soon would have,

441
00:27:14,240 --> 00:27:18,800
Speaker 2: so we checked out his heart. Is that wasteful? Is

442
00:27:18,880 --> 00:27:23,440
Speaker 2: that unnecessary? Because he wasn't actively having a heart attack? Right.

443
00:27:23,520 --> 00:27:25,960
Speaker 3: We talked about that too, you know, like, how do

444
00:27:26,000 --> 00:27:30,160
Speaker 3: you That's such a devilish thing how one defines necessity? Right,

445
00:27:30,200 --> 00:27:35,119
Speaker 3: someone's blood work comes back right, indicative of a possibly

446
00:27:35,240 --> 00:27:38,840
Speaker 3: serious symptom. It's the sort of thing that as a

447
00:27:38,920 --> 00:27:42,960
Speaker 3: physician you are ethically required to look into. It is

448
00:27:43,000 --> 00:27:46,680
Speaker 3: your job to do that, and instead they're insured comes

449
00:27:46,720 --> 00:27:50,240
Speaker 3: to you and says, well, this is going to be unnecessary.

450
00:27:50,320 --> 00:27:53,520
Speaker 3: Or a few years ago, people did these blood tests,

451
00:27:53,560 --> 00:27:56,320
Speaker 3: and this percentage of people did not in fact have

452
00:27:56,400 --> 00:28:01,080
Speaker 3: that dangerous condition. So roll the dice, you know, pick

453
00:28:01,119 --> 00:28:03,919
Speaker 3: a card. Yeah, because it's probably not going to be

454
00:28:03,920 --> 00:28:08,719
Speaker 3: the dangerous one. Request denied stamp, like denied stamp.

455
00:28:08,960 --> 00:28:14,000
Speaker 2: Sound already you can see how it feels like betting

456
00:28:14,240 --> 00:28:17,560
Speaker 2: on human lives already. And we haven't even gotten to

457
00:28:17,600 --> 00:28:18,480
Speaker 2: the details yet.

458
00:28:19,359 --> 00:28:21,879
Speaker 3: No, we've got to. We've got to talk about the dial,

459
00:28:22,280 --> 00:28:26,879
Speaker 3: all right. This is the partially AI powered algorithm that

460
00:28:26,960 --> 00:28:30,680
Speaker 3: makes the initial call your doctor. You know, someone comes

461
00:28:30,680 --> 00:28:35,200
Speaker 3: in and they say, I'm having shortness of breath. I'm

462
00:28:35,240 --> 00:28:38,320
Speaker 3: having you know, maybe like fugue states something like that,

463
00:28:38,400 --> 00:28:41,920
Speaker 3: or heart palpitations, and you put in a request for

464
00:28:41,960 --> 00:28:46,160
Speaker 3: some stuff. This AI powered algorithm is not a set

465
00:28:46,160 --> 00:28:49,560
Speaker 3: in stone system the thing that replies. It's referred to

466
00:28:49,600 --> 00:28:53,120
Speaker 3: the dial because it can be adjusted. I want to

467
00:28:53,160 --> 00:28:55,560
Speaker 3: be careful how we say this. It can be adjusted

468
00:28:55,680 --> 00:29:00,440
Speaker 3: in a way that in practice raises rates of denial.

469
00:29:01,520 --> 00:29:06,160
Speaker 2: Yeah, yes, yes, and and and specifically that has to

470
00:29:06,160 --> 00:29:08,640
Speaker 2: do with the type of contract EVI Core ends up

471
00:29:08,680 --> 00:29:12,920
Speaker 2: signing with whatever insure other entity, right, because Ben, you

472
00:29:12,920 --> 00:29:15,960
Speaker 2: mentioned there's at least two types of contracts. One of

473
00:29:16,000 --> 00:29:19,560
Speaker 2: them is like the general we're gonna we are going

474
00:29:19,640 --> 00:29:24,280
Speaker 2: to handle your prior authorizations through our system. Then we'll

475
00:29:24,320 --> 00:29:25,840
Speaker 2: just do the whole thing of back and forth if

476
00:29:25,880 --> 00:29:28,320
Speaker 2: we need to appeal the other one that you talked about.

477
00:29:28,720 --> 00:29:33,880
Speaker 2: There's a great example within that Pro Publica article of Uh, well,

478
00:29:33,920 --> 00:29:36,520
Speaker 2: I'll just I'll read directly from the article. Uh, you

479
00:29:36,520 --> 00:29:38,719
Speaker 2: can check it out if you want. The title of

480
00:29:38,800 --> 00:29:43,760
Speaker 2: it is not medically necessary. You can just look that

481
00:29:43,880 --> 00:29:46,080
Speaker 2: up probably and find it Pro Publica.

482
00:29:46,520 --> 00:29:47,080
Speaker 4: You'll find it.

483
00:29:47,560 --> 00:29:49,400
Speaker 3: Oh and is it? Is it okay if I shout

484
00:29:49,400 --> 00:29:50,520
Speaker 3: out the authors there?

485
00:29:50,600 --> 00:29:50,719
Speaker 2: Oh?

486
00:29:50,800 --> 00:29:54,160
Speaker 3: Yeah, this is several Yeah, because they're there. This is

487
00:29:54,200 --> 00:29:57,080
Speaker 3: like a posse track. So we're talking about t Christian

488
00:29:57,240 --> 00:30:01,239
Speaker 3: Miller from Pro Publica, Patrick Rucker from Capital Forum, and

489
00:30:01,360 --> 00:30:04,880
Speaker 3: David Armstrong also of Pro public journitists exactly.

490
00:30:05,480 --> 00:30:08,720
Speaker 2: So this is a direct quote from that. They're talking

491
00:30:08,760 --> 00:30:12,600
Speaker 2: about these known risk contracts, which is a separate type

492
00:30:12,640 --> 00:30:16,200
Speaker 2: of contract. They say, as an example, say an insure

493
00:30:16,560 --> 00:30:21,280
Speaker 2: spends around ten million dollars a year on MRIs if

494
00:30:21,720 --> 00:30:27,440
Speaker 2: eviCore keeps costs below ten million dollars per year on MRIs.

495
00:30:28,880 --> 00:30:32,720
Speaker 2: eviCore as a corporation, as an entity, pockets the difference

496
00:30:33,640 --> 00:30:36,520
Speaker 2: in how like basically how much money that insurance company

497
00:30:37,040 --> 00:30:41,600
Speaker 2: saved on MRIs that year according to that contract, or

498
00:30:41,680 --> 00:30:44,880
Speaker 2: it might split those profits like fifty to fifty sixty

499
00:30:44,920 --> 00:30:47,400
Speaker 2: forty something like that, depending on the contract with the

500
00:30:47,440 --> 00:30:48,520
Speaker 2: health insurance company.

501
00:30:48,920 --> 00:30:50,720
Speaker 4: So isn't that like a kickback?

502
00:30:51,680 --> 00:30:54,880
Speaker 3: Yes, it's it's loosely called a risk contract.

503
00:30:55,280 --> 00:30:55,520
Speaker 4: Yes.

504
00:30:55,560 --> 00:30:58,960
Speaker 3: Former employees speaking under anonymity, called it.

505
00:30:58,920 --> 00:31:00,840
Speaker 4: Betting on future or something.

506
00:31:01,040 --> 00:31:04,520
Speaker 3: It's very much so, I mean that's the that's the

507
00:31:04,560 --> 00:31:05,000
Speaker 3: other thing.

508
00:31:05,160 --> 00:31:05,400
Speaker 4: Right.

509
00:31:05,440 --> 00:31:11,000
Speaker 3: So the argument that there may be incentivization that moves

510
00:31:11,040 --> 00:31:16,920
Speaker 3: you beyond just efficiency. It goes to look the contracts

511
00:31:17,240 --> 00:31:21,000
Speaker 3: that have been verified by the investigation. They do indicate

512
00:31:21,080 --> 00:31:24,280
Speaker 3: company profits can be tied, like you were saying, Matt,

513
00:31:24,360 --> 00:31:28,200
Speaker 3: directly to the amount of cuts made and expenditures. Now,

514
00:31:28,360 --> 00:31:32,880
Speaker 3: the insurance companies have agency in this. The contracts that

515
00:31:32,920 --> 00:31:37,000
Speaker 3: they sign can direct can direct this company and others

516
00:31:37,120 --> 00:31:41,720
Speaker 3: like it toward focusing on certain not just outcomes, but

517
00:31:41,800 --> 00:31:45,080
Speaker 3: certain conditions, certain medical conditions like now you're going to

518
00:31:45,080 --> 00:31:51,120
Speaker 3: be our oncology approval gang. Right, And so some folks

519
00:31:51,160 --> 00:31:54,280
Speaker 3: may argue, hey, this is just a matter of perception,

520
00:31:54,440 --> 00:31:59,400
Speaker 3: because companies that are baking in this relationship between denials

521
00:31:59,720 --> 00:32:04,280
Speaker 3: and profits. They might just be trying to get stuff

522
00:32:04,360 --> 00:32:08,640
Speaker 3: up and running that's better than their own older approval methods.

523
00:32:08,760 --> 00:32:10,840
Speaker 3: Those may have had a lot of room for error,

524
00:32:11,200 --> 00:32:13,040
Speaker 3: you know, and a lot of people were working with

525
00:32:13,120 --> 00:32:15,520
Speaker 3: antiquated paper based systems.

526
00:32:16,000 --> 00:32:21,280
Speaker 2: Oh yeah, absolutely, But to really dial down on it,

527
00:32:21,320 --> 00:32:25,600
Speaker 2: Oh god, sorry, I'm so sorry that this dial thing

528
00:32:25,760 --> 00:32:30,400
Speaker 2: that is referenced a ton throughout that investigation, which is direct,

529
00:32:30,440 --> 00:32:33,480
Speaker 2: which is essentially the algorithm that we're talking about here,

530
00:32:34,040 --> 00:32:36,520
Speaker 2: it can be, according to a lot of those insiders,

531
00:32:36,560 --> 00:32:40,480
Speaker 2: really turned right. So you could say the insurance company

532
00:32:40,480 --> 00:32:44,840
Speaker 2: actually needs to save x more percentage on those MRIs

533
00:32:44,960 --> 00:32:47,880
Speaker 2: or something, and you could adjust how it looks at

534
00:32:47,880 --> 00:32:53,360
Speaker 2: these prior approval documentation, the documentation for each individual one.

535
00:32:53,920 --> 00:32:58,520
Speaker 2: And it's talking about how it can deny claims that

536
00:32:58,600 --> 00:33:04,120
Speaker 2: have like a ninety five percent necessary rating or something.

537
00:33:03,920 --> 00:33:09,520
Speaker 3: Ninety five percent or less likelihood of approval. Yeah, yeah, yeah,

538
00:33:09,640 --> 00:33:11,520
Speaker 3: And this is before we get to that. I got

539
00:33:11,640 --> 00:33:15,160
Speaker 3: to I gotta say, I want us to put the

540
00:33:15,280 --> 00:33:20,240
Speaker 3: claims of evicre in in context with the claims of

541
00:33:20,360 --> 00:33:24,680
Speaker 3: critics and the claims of investigators. So you've got it, folks.

542
00:33:24,720 --> 00:33:29,160
Speaker 3: While you're on the internet. There is a webinar from

543
00:33:29,240 --> 00:33:32,480
Speaker 3: eviCore because yes they have a YouTube channel. Check out

544
00:33:32,520 --> 00:33:36,440
Speaker 3: ours as well, Conspiracy Stuff show. So in this video

545
00:33:36,520 --> 00:33:42,280
Speaker 3: there's a spokesperson for evicre who says, yeah who who

546
00:33:42,800 --> 00:33:48,560
Speaker 3: portrays client profits as not the primary goal, but as

547
00:33:48,680 --> 00:33:52,400
Speaker 3: kind of a Bob Ros Style happy accident. And we

548
00:33:52,560 --> 00:33:55,680
Speaker 3: love to love to play a clip here, Dilan if

549
00:33:55,680 --> 00:33:56,360
Speaker 3: we could.

550
00:33:56,160 --> 00:33:58,120
Speaker 5: Not being exposed to things that they don't need to

551
00:33:58,160 --> 00:34:03,080
Speaker 5: be exposed to unnecessarily. So we are improving the quality

552
00:34:03,280 --> 00:34:07,480
Speaker 5: of health care, the safety of health care, and by

553
00:34:07,480 --> 00:34:11,600
Speaker 5: a very happy coincidence, we're also decreasing a significant amount

554
00:34:11,640 --> 00:34:12,920
Speaker 5: of unnecessary cost.

555
00:34:13,800 --> 00:34:16,640
Speaker 3: The line he says, I think is really important is,

556
00:34:17,520 --> 00:34:21,920
Speaker 3: by very happy coincidence, we're also decreasing a significant amount

557
00:34:22,040 --> 00:34:26,920
Speaker 3: of unnecessary cost. Woops, says the guy flying the plane.

558
00:34:27,160 --> 00:34:29,359
Speaker 3: As a side effect of this plane, it turns out

559
00:34:29,400 --> 00:34:33,560
Speaker 3: it flies, and of course, if you want to if

560
00:34:33,600 --> 00:34:35,960
Speaker 3: you want to see that. Specifically, we're big fans of

561
00:34:36,000 --> 00:34:39,839
Speaker 3: the titles and the Evicore's or Evcore or evil Core,

562
00:34:39,840 --> 00:34:41,480
Speaker 3: because I'm not going to give them too much respect.

563
00:34:42,040 --> 00:34:44,160
Speaker 3: We're a big fan of the titles and their webinars

564
00:34:44,200 --> 00:34:47,200
Speaker 3: that comes to us from retain and grow your self

565
00:34:47,239 --> 00:34:52,399
Speaker 3: funded business with effective utilization management three years ago.

566
00:34:52,840 --> 00:34:56,680
Speaker 2: Yeah. You can also find an update too that they

567
00:34:56,680 --> 00:34:58,960
Speaker 2: put out pretty recently on their YouTube that has the

568
00:34:59,000 --> 00:35:01,640
Speaker 2: same kind of language, not quite exactly the same, but

569
00:35:02,120 --> 00:35:06,279
Speaker 2: search understanding Evicore's approach to patient centered care.

570
00:35:07,040 --> 00:35:10,640
Speaker 3: So is this really a happy accident? If you go

571
00:35:10,680 --> 00:35:15,640
Speaker 3: to back to pro Publicans and related investigations, you'll say,

572
00:35:15,680 --> 00:35:21,040
Speaker 3: you'll see that what representatives of this company are saying

573
00:35:21,160 --> 00:35:25,440
Speaker 3: internally does not match what they're saying externally. I'd love

574
00:35:25,480 --> 00:35:28,920
Speaker 3: for us to go to a quote from pro Publica directly.

575
00:35:29,840 --> 00:35:32,919
Speaker 4: eviCore markets itself to insurance companies by promising a three

576
00:35:32,960 --> 00:35:35,759
Speaker 4: to one return on investment that is, for every one

577
00:35:35,840 --> 00:35:39,799
Speaker 4: dollar spent on eviCore the system, the insurer would pay

578
00:35:39,800 --> 00:35:42,800
Speaker 4: out three dollars less on medical care and other costs.

579
00:35:43,120 --> 00:35:46,800
Speaker 4: Of of course, salespeople have boasted of a fifteen percent increase

580
00:35:46,840 --> 00:35:50,359
Speaker 4: in denials, according to the investigation, which is based on

581
00:35:50,400 --> 00:35:54,880
Speaker 4: internal documents, corporate data, and dozens of interviews with former employees, doctors,

582
00:35:54,920 --> 00:36:01,480
Speaker 4: industry experts, healthcare regulators, and insurance executives. I mean, y'all

583
00:36:01,480 --> 00:36:04,120
Speaker 4: if you took the first part of this lift from

584
00:36:04,440 --> 00:36:06,759
Speaker 4: this quote from the article eviCore market it self to

585
00:36:06,840 --> 00:36:09,280
Speaker 4: insurance companies by promising a three to one return investment.

586
00:36:09,520 --> 00:36:11,439
Speaker 4: It sounds like the kind of thing that they would

587
00:36:11,480 --> 00:36:13,600
Speaker 4: do as a sales pitch, you know what I mean, Like.

588
00:36:14,080 --> 00:36:17,680
Speaker 3: Yeah, it is yeah, one hundred so one hundred percent

589
00:36:17,719 --> 00:36:22,040
Speaker 3: that yeah, And we know that because former salespeople, I

590
00:36:22,040 --> 00:36:26,240
Speaker 3: guess legally I can't say they're former salespeople. Former employees

591
00:36:27,320 --> 00:36:31,000
Speaker 3: confirmed this in some very high level ones. We also

592
00:36:31,160 --> 00:36:35,040
Speaker 3: know some disturbing stats because again, remember how we're saying earlier,

593
00:36:35,160 --> 00:36:39,800
Speaker 3: state by state laws change. Some states require denial rates

594
00:36:39,840 --> 00:36:42,400
Speaker 3: to be a matter of public record. It is crazy

595
00:36:42,440 --> 00:36:45,840
Speaker 3: that not every state requires that. But with that, armed

596
00:36:45,840 --> 00:36:49,080
Speaker 3: with that information, we can give you another stat here,

597
00:36:50,200 --> 00:36:54,799
Speaker 3: pulling from evicuor's own self produced data, they fully or

598
00:36:54,880 --> 00:36:59,080
Speaker 3: partially turned down around twenty percent of all request for

599
00:36:59,400 --> 00:37:03,200
Speaker 3: medical care in Arkansas, So twenty percent, so one out

600
00:37:03,200 --> 00:37:07,440
Speaker 3: of five of every request. And for comparison, people in

601
00:37:07,480 --> 00:37:11,840
Speaker 3: that same state who were in Medicare advantage, about seven

602
00:37:11,960 --> 00:37:16,200
Speaker 3: percent of their claims would be rejected. So this shows

603
00:37:16,320 --> 00:37:22,160
Speaker 3: us a big discrepancy between the business as usual and

604
00:37:22,239 --> 00:37:26,600
Speaker 3: whatever innovations we could call them evicres bringing to the table.

605
00:37:27,360 --> 00:37:31,759
Speaker 3: So to understand what's going on, we have to go

606
00:37:31,840 --> 00:37:34,280
Speaker 3: back to the dial. Dial it back to the dial

607
00:37:34,400 --> 00:37:36,440
Speaker 3: and maybe take a break for a word from our

608
00:37:36,480 --> 00:37:39,680
Speaker 3: sponsors and walk through this claim process step by step.

609
00:37:39,719 --> 00:37:40,319
Speaker 3: What do you guys say?

610
00:37:41,400 --> 00:37:44,200
Speaker 2: Oh, but yes, we should do it.

611
00:37:44,280 --> 00:37:46,080
Speaker 4: Sorry I sounded too excited. Let's do it.

612
00:37:54,280 --> 00:37:58,920
Speaker 3: And we returned the dial of denial. Not proud of it,

613
00:37:59,160 --> 00:37:59,759
Speaker 3: but it's there.

614
00:38:01,280 --> 00:38:06,480
Speaker 4: That's worse than the dial of destiny, imaginarently, but it

615
00:38:06,560 --> 00:38:08,239
Speaker 4: is a dial of it's true.

616
00:38:08,440 --> 00:38:12,000
Speaker 3: Really good point, Yeah, it really is. So Okay, you're

617
00:38:12,040 --> 00:38:15,280
Speaker 3: a doctor. What's a good name for a doctor?

618
00:38:15,360 --> 00:38:15,520
Speaker 4: Oh?

619
00:38:15,560 --> 00:38:23,479
Speaker 3: Doctor? Spashuman doctor? Oh yeah, yes, yes, uh all right,

620
00:38:23,520 --> 00:38:27,800
Speaker 3: so submit some paperwork, right, and this goes to the system.

621
00:38:27,880 --> 00:38:31,080
Speaker 3: This goes to the dial, and the dial which is

622
00:38:31,360 --> 00:38:32,919
Speaker 3: it's an informal name. By the way.

623
00:38:33,160 --> 00:38:33,319
Speaker 2: Uh.

624
00:38:33,400 --> 00:38:37,399
Speaker 3: The dial can automatically approve a request or it can

625
00:38:37,440 --> 00:38:40,640
Speaker 3: flag it for further review. I think one thing a

626
00:38:40,680 --> 00:38:43,399
Speaker 3: lot of people need to keep front of mind. Here

627
00:38:43,600 --> 00:38:48,319
Speaker 3: is the dial, the AI power powered algorithm itself. It

628
00:38:48,400 --> 00:38:52,239
Speaker 3: cannot as of yet, automatically deny a claim. It can

629
00:38:52,280 --> 00:38:54,760
Speaker 3: only pop a flag and send it to a human.

630
00:38:55,239 --> 00:38:55,439
Speaker 4: Yep.

631
00:38:55,560 --> 00:38:58,440
Speaker 2: You will hear that as like rhetoric coming out from

632
00:38:58,480 --> 00:39:01,640
Speaker 2: people that you know rightly see major issues with this

633
00:39:01,800 --> 00:39:05,239
Speaker 2: and talk about how things are getting automatically denied by

634
00:39:05,280 --> 00:39:07,640
Speaker 2: this algorithm. But you're absolutely one hundred percent right. It

635
00:39:07,680 --> 00:39:09,719
Speaker 2: says that over and over in the investigation.

636
00:39:10,840 --> 00:39:15,120
Speaker 3: Yeah, it look where it is an important note because

637
00:39:15,120 --> 00:39:19,480
Speaker 3: we do have to be fair. Anything it flags as

638
00:39:20,000 --> 00:39:23,960
Speaker 3: not entirely kosher gets sent to an internal team of

639
00:39:24,120 --> 00:39:28,680
Speaker 3: evicre nurses and doctors, some full time, some consultants. Only

640
00:39:28,800 --> 00:39:34,520
Speaker 3: the doctors can issue that actual final denial, but all

641
00:39:34,600 --> 00:39:37,400
Speaker 3: along the way, depending on the nature of the contract,

642
00:39:37,960 --> 00:39:42,839
Speaker 3: the conversations with execs and shareholders, people in EVICORPS can

643
00:39:42,840 --> 00:39:46,960
Speaker 3: adjust the settings on the system. They can dial up

644
00:39:47,120 --> 00:39:51,400
Speaker 3: or down what rates as an automatic approval.

645
00:39:52,280 --> 00:39:52,600
Speaker 4: Yep.

646
00:39:53,160 --> 00:39:55,880
Speaker 2: Oh, and just to have Evicor's back a little bit here, guys,

647
00:39:56,080 --> 00:39:59,279
Speaker 2: according to their videos that they put out, they let

648
00:39:59,280 --> 00:40:03,279
Speaker 2: everybody know they only hire doctors for these purposes who

649
00:40:03,320 --> 00:40:06,040
Speaker 2: are going to be doing the denials or approvals, who

650
00:40:06,040 --> 00:40:10,480
Speaker 2: have had medical experience, like actually worked in a hospital

651
00:40:10,560 --> 00:40:12,040
Speaker 2: or some similar practice.

652
00:40:12,560 --> 00:40:15,400
Speaker 3: Oh no, somebody like ethics degree. Isn't going to let

653
00:40:15,440 --> 00:40:21,120
Speaker 3: me get in there, you know, underwater basket underwater basket

654
00:40:21,200 --> 00:40:22,120
Speaker 3: weaving PhD.

655
00:40:22,400 --> 00:40:25,120
Speaker 4: Is it going to work for this ethics degree? All right?

656
00:40:25,560 --> 00:40:27,200
Speaker 4: That sounds I wish more people had one of.

657
00:40:27,120 --> 00:40:32,600
Speaker 2: Those philosophy major doctor exactly.

658
00:40:33,280 --> 00:40:35,560
Speaker 3: Oh god, there's so many airplay jokes that could make.

659
00:40:35,640 --> 00:40:38,839
Speaker 3: But anyway, okay, just one.

660
00:40:39,040 --> 00:40:39,399
Speaker 5: All right.

661
00:40:39,440 --> 00:40:41,520
Speaker 3: So somebody's having a heart attack there on the plane

662
00:40:41,520 --> 00:40:44,040
Speaker 3: and the you know, the flight attendant says, is there

663
00:40:44,080 --> 00:40:45,200
Speaker 3: a doctor in the house?

664
00:40:45,600 --> 00:40:47,799
Speaker 4: Anyway? It goes, no, I'm not a doctor. I just

665
00:40:47,880 --> 00:40:50,200
Speaker 4: play one on TV. There it is.

666
00:40:50,719 --> 00:40:54,440
Speaker 3: Uh So, this algorithm gets that paperwork, it analyzes it,

667
00:40:54,440 --> 00:40:57,719
Speaker 3: it assigns it what we could loosely call a likelihood

668
00:40:57,800 --> 00:41:01,440
Speaker 3: of approval, knowing what we know in the past, based

669
00:41:01,440 --> 00:41:05,439
Speaker 3: on the guidelines that we have generated internally, how likely

670
00:41:05,560 --> 00:41:08,879
Speaker 3: is this thing to be a yes? One request could

671
00:41:08,920 --> 00:41:12,680
Speaker 3: get rated at sixty or seventy percent, and depending upon

672
00:41:12,800 --> 00:41:16,440
Speaker 3: where the algorithm is set, maybe if it meets seventy percent,

673
00:41:16,680 --> 00:41:20,319
Speaker 3: it gets automatically approved. Because now there's the argument would

674
00:41:20,320 --> 00:41:25,960
Speaker 3: be fighting for that thirty thirty percent possibility of being denied.

675
00:41:26,080 --> 00:41:29,600
Speaker 3: It's not worth our time it's not cost effective. But

676
00:41:30,280 --> 00:41:35,440
Speaker 3: if the company wants more denials for a certain contractual relationship,

677
00:41:35,840 --> 00:41:38,520
Speaker 3: they can dial that threshold up, like you were saying, Matt,

678
00:41:38,520 --> 00:41:42,560
Speaker 3: to something around ninety to ninety five percent. So when

679
00:41:42,600 --> 00:41:47,440
Speaker 3: you think under that likelihood gets flagged for review and

680
00:41:47,480 --> 00:41:51,200
Speaker 3: it goes to those internal employees, and the more reviews,

681
00:41:51,560 --> 00:41:54,480
Speaker 3: the higher the chance of denial due to the nature

682
00:41:54,520 --> 00:41:55,919
Speaker 3: of the internal guidelines.

683
00:41:56,640 --> 00:42:01,279
Speaker 2: This is just it's so infuriating, and you have you know,

684
00:42:01,520 --> 00:42:05,759
Speaker 2: if you look at the outward statements for anyone who

685
00:42:06,160 --> 00:42:08,160
Speaker 2: you know is going to be talking about this that

686
00:42:08,200 --> 00:42:10,120
Speaker 2: has their job on the line, let's say it works

687
00:42:10,160 --> 00:42:13,560
Speaker 2: for eviCore in any capacity or is is in that

688
00:42:13,680 --> 00:42:17,360
Speaker 2: chain anywhere from the healthcare company down to the physician.

689
00:42:18,160 --> 00:42:21,040
Speaker 2: You you can imagine that nobody is going to come

690
00:42:21,080 --> 00:42:26,080
Speaker 2: out and say, well, I'm incentivized to deny the things

691
00:42:26,120 --> 00:42:29,200
Speaker 2: that are even at ninety percent ninety five percent approval,

692
00:42:30,400 --> 00:42:34,280
Speaker 2: I am incentivized as a physician working for Evicre to

693
00:42:34,280 --> 00:42:38,320
Speaker 2: stop that from happening, because if I stop that from happening,

694
00:42:38,840 --> 00:42:41,359
Speaker 2: I'm you know, I'm going to keep my job. The

695
00:42:41,400 --> 00:42:45,000
Speaker 2: company's going to make more profit. The healthcare insurance insurance

696
00:42:45,000 --> 00:42:47,440
Speaker 2: company is going to make more profit, and then somebody

697
00:42:47,680 --> 00:42:50,759
Speaker 2: might have a big, big problem, you know, with their health.

698
00:42:50,840 --> 00:42:53,080
Speaker 4: It's one of those things too, where it's just they

699
00:42:53,320 --> 00:42:55,839
Speaker 4: kind of tweak it just enough, it would seem where

700
00:42:55,880 --> 00:42:59,520
Speaker 4: it's not like you could trace doctors getting paid off

701
00:42:59,640 --> 00:43:02,160
Speaker 4: or like an incentive of you know, a bonus of

702
00:43:02,200 --> 00:43:05,840
Speaker 4: some kind of four denials. But in a roundabout way,

703
00:43:06,440 --> 00:43:09,040
Speaker 4: what it amounts to is more or less that in

704
00:43:09,120 --> 00:43:13,120
Speaker 4: terms of like systematically the way this organization operates.

705
00:43:13,600 --> 00:43:17,000
Speaker 3: Yeah, because you can always say it's just for review, right,

706
00:43:17,040 --> 00:43:20,680
Speaker 3: We're not immediately saying no, And then well we should

707
00:43:20,719 --> 00:43:26,719
Speaker 3: get into the controversy about the guidelines. But yeah, that's

708
00:43:26,800 --> 00:43:31,720
Speaker 3: the thing. When this stuff goes to review, the chances

709
00:43:31,760 --> 00:43:34,840
Speaker 3: of it being denied are much higher. And then also

710
00:43:35,360 --> 00:43:40,640
Speaker 3: you could argue they're foisting a bureaucratic burden upon the

711
00:43:41,040 --> 00:43:44,880
Speaker 3: actual on the ground physician, upon the patient, anybody involved.

712
00:43:45,480 --> 00:43:49,120
Speaker 3: They've et acre evil Core has always said the system

713
00:43:49,160 --> 00:43:54,240
Speaker 3: is built on continually updated guidelines, always based on the latest,

714
00:43:54,600 --> 00:43:57,600
Speaker 3: most accurate research. And then they also say they go

715
00:43:57,640 --> 00:44:00,000
Speaker 3: a step further, they say, look, these guidelines are sacked

716
00:44:00,120 --> 00:44:02,439
Speaker 3: or sank to us, they're part of the system. They're

717
00:44:02,560 --> 00:44:06,680
Speaker 3: state agnostic. The same stuff gets applied for all states,

718
00:44:07,040 --> 00:44:11,960
Speaker 3: all clients. Someone requesting an MRI in Vermont gets treated

719
00:44:12,000 --> 00:44:15,040
Speaker 3: the way someone the same way someone requesting an MRI

720
00:44:15,480 --> 00:44:19,400
Speaker 3: in Georgia would be treated. In short, they deny any

721
00:44:19,560 --> 00:44:23,000
Speaker 3: and all claims. Get it of willful misconduct.

722
00:44:23,360 --> 00:44:29,960
Speaker 2: Hey, they deny all the claims, deny the Yeah, yeah, yeah.

723
00:44:30,160 --> 00:44:33,880
Speaker 2: Just another quick quote from that investigation about those guidelines.

724
00:44:34,239 --> 00:44:36,280
Speaker 2: And this comes from as you as we were saying,

725
00:44:36,719 --> 00:44:41,000
Speaker 2: there are people inside the system speaking out talking about

726
00:44:41,000 --> 00:44:44,200
Speaker 2: what they've experienced. This comes from they had to kind

727
00:44:44,200 --> 00:44:46,239
Speaker 2: of mask it a little bit.

728
00:44:46,719 --> 00:44:47,080
Speaker 4: Uh.

729
00:44:47,160 --> 00:44:50,520
Speaker 2: This comes from an eviCore employee involved in the radiation

730
00:44:50,680 --> 00:44:56,560
Speaker 2: oncology program. And the quote says company executives quote would say,

731
00:44:56,960 --> 00:44:59,640
Speaker 2: keep a closer eye on the guidelines for reviews for

732
00:44:59,680 --> 00:45:04,799
Speaker 2: aarticular company because we're not showing savings unquote for that

733
00:45:04,920 --> 00:45:07,400
Speaker 2: particular company that they have a contract with.

734
00:45:08,680 --> 00:45:11,440
Speaker 3: And again, you know, the argument from that perspective is

735
00:45:12,440 --> 00:45:15,600
Speaker 3: due diligence, right, But that's a big umbrella, and you

736
00:45:15,640 --> 00:45:18,960
Speaker 3: can put a lot of villainy under that umbrella. And

737
00:45:19,120 --> 00:45:22,319
Speaker 3: if we I've also want to point out the other

738
00:45:23,760 --> 00:45:27,120
Speaker 3: the another issue that does not to be fair does

739
00:45:27,160 --> 00:45:30,880
Speaker 3: not come from Evicors. But you know, we said evicre

740
00:45:30,960 --> 00:45:33,480
Speaker 3: is kind of the Coca Cola. There are other brands

741
00:45:33,480 --> 00:45:36,759
Speaker 3: in the game. One we could call the PEPSI would

742
00:45:36,800 --> 00:45:44,120
Speaker 3: be under Elevance Health, a subsidiary called Caroline Medical Benefits Management.

743
00:45:45,000 --> 00:45:48,239
Speaker 3: They had to settle a lawsuit in twenty twenty two

744
00:45:48,840 --> 00:45:53,000
Speaker 3: to the tune of thirteen million dollars because the courts

745
00:45:53,000 --> 00:45:58,719
Speaker 3: investigated claims about claims concerning tactics they would use to

746
00:45:58,880 --> 00:46:04,879
Speaker 3: deny approval requests. And one of the most villainous and

747
00:46:05,000 --> 00:46:09,120
Speaker 3: petty like supervillain level of petty we found was this

748
00:46:09,200 --> 00:46:14,480
Speaker 3: company has provably in the past set its fax machines

749
00:46:14,560 --> 00:46:18,719
Speaker 3: to only receive five to ten pages at once, and

750
00:46:18,800 --> 00:46:21,560
Speaker 3: it did not tell the customers. It did not tell

751
00:46:21,600 --> 00:46:25,120
Speaker 3: the physicians. What it would do is deny requests that

752
00:46:25,160 --> 00:46:27,560
Speaker 3: were longer than the page count and say you didn't

753
00:46:27,600 --> 00:46:30,880
Speaker 3: give us all the information, and someone at the doctor's

754
00:46:30,880 --> 00:46:34,800
Speaker 3: office refaxes the thing, and then they get the same

755
00:46:34,840 --> 00:46:37,279
Speaker 3: message back and get back on the phone and maybe

756
00:46:37,320 --> 00:46:40,640
Speaker 3: eventually with some digging, they say, why is your fax

757
00:46:40,680 --> 00:46:41,319
Speaker 3: machine like this?

758
00:46:41,920 --> 00:46:42,600
Speaker 4: Yeah.

759
00:46:43,040 --> 00:46:46,520
Speaker 2: In a quick note on that little company, from the

760
00:46:46,560 --> 00:46:50,719
Speaker 2: investigation and just from general knowledge that we've learned on

761
00:46:50,760 --> 00:46:54,239
Speaker 2: this show over the years. Elevant's Health used to have

762
00:46:54,320 --> 00:46:57,640
Speaker 2: a different name. What do we know about companies that

763
00:46:58,080 --> 00:47:02,280
Speaker 2: have to change their name of times? Once, twice, three times.

764
00:47:04,400 --> 00:47:06,399
Speaker 4: Come up with a joke about that earlier and I could.

765
00:47:06,440 --> 00:47:07,960
Speaker 4: That's good, Matt, you did it. You got there.

766
00:47:08,920 --> 00:47:10,360
Speaker 2: They were anthem back.

767
00:47:10,160 --> 00:47:13,400
Speaker 3: And they were anthem. Yeah. Yeah, companies who look on

768
00:47:13,440 --> 00:47:19,000
Speaker 3: this show. We always respect the preferred names and pronouns

769
00:47:19,000 --> 00:47:22,600
Speaker 3: of individual people. But if you're a sketchy company, sorry, man,

770
00:47:22,960 --> 00:47:25,480
Speaker 3: that first name is the scarlet letter. You earned it.

771
00:47:25,680 --> 00:47:29,200
Speaker 4: Pomecast guys, hey, it's been a weird channel.

772
00:47:30,000 --> 00:47:35,239
Speaker 3: Yeah, every all of them, you know, I know, I

773
00:47:35,239 --> 00:47:36,120
Speaker 3: hope we should keep it on.

774
00:47:36,360 --> 00:47:37,319
Speaker 4: I think you're probably right.

775
00:47:37,440 --> 00:47:40,880
Speaker 2: Yah yeah, no, I mean for real, because the biggest

776
00:47:40,880 --> 00:47:43,000
Speaker 2: one we talked about was back in the day, remember

777
00:47:43,040 --> 00:47:47,880
Speaker 2: that contractor business, Yeah, changed your name at least three times,

778
00:47:48,120 --> 00:47:53,520
Speaker 2: Xie academic. H Why did they change their name? Is

779
00:47:53,600 --> 00:47:54,680
Speaker 2: just a rebrand right? Oh?

780
00:47:54,680 --> 00:47:54,919
Speaker 4: Wait?

781
00:47:55,040 --> 00:47:59,320
Speaker 2: No? Oh wait, no, there is think called WikiLeaks showed

782
00:48:00,000 --> 00:48:04,720
Speaker 2: horrific videos of their contractors doing things.

783
00:48:05,000 --> 00:48:07,440
Speaker 3: So I need to continue today, yep, So just.

784
00:48:07,800 --> 00:48:11,440
Speaker 2: Remind yourself every time you see that rebranding thing, just

785
00:48:11,440 --> 00:48:12,480
Speaker 2: what does it really mean?

786
00:48:13,000 --> 00:48:17,560
Speaker 3: Yeah, you don't have to automatically deny the potential goodness

787
00:48:17,560 --> 00:48:20,000
Speaker 3: of that corporation, but you should flag it for personal

788
00:48:20,080 --> 00:48:23,160
Speaker 3: review and see what their likelihood of approval is.

789
00:48:23,239 --> 00:48:26,040
Speaker 2: On your end, I'm seeing the seventy percent chance.

790
00:48:26,320 --> 00:48:31,879
Speaker 3: Sits for chicanery. There are Look, there are a ton

791
00:48:32,000 --> 00:48:34,480
Speaker 3: of critics for this. It's pretty clear. You know, you

792
00:48:34,560 --> 00:48:38,359
Speaker 3: mentioned multiple medical organizations they say the guidelines are kind

793
00:48:38,360 --> 00:48:43,440
Speaker 3: of malarchy. And that's not just lobbying groups are all

794
00:48:43,480 --> 00:48:46,800
Speaker 3: familiar with, but it's things like the American College of Cardiology,

795
00:48:47,160 --> 00:48:51,319
Speaker 3: the Society for Vascular Surgery, the one I didn't know,

796
00:48:51,400 --> 00:48:53,520
Speaker 3: but I think we'll all love this. When the American

797
00:48:53,560 --> 00:48:59,280
Speaker 3: Society for Radiation Oncology or ASTRO. I think ASTRO is cool,

798
00:48:59,480 --> 00:49:03,160
Speaker 3: pretty cool. But the one thing these organizations all have

799
00:49:03,280 --> 00:49:08,040
Speaker 3: in common is that they are experts in the in

800
00:49:08,080 --> 00:49:12,719
Speaker 3: the conditions that this company approves or disapproves treatment for.

801
00:49:13,880 --> 00:49:18,000
Speaker 3: These are the boffins. These are the eggheads and the experts,

802
00:49:18,239 --> 00:49:24,279
Speaker 3: and they're the ones saying that the guidelines are crap. Yeah,

803
00:49:24,360 --> 00:49:26,000
Speaker 3: I just want to point that out. You know, it's like,

804
00:49:26,080 --> 00:49:30,319
Speaker 3: it's different from it's like if if the three of

805
00:49:30,400 --> 00:49:34,880
Speaker 3: us actually built cyber trucks, are actually built pickup trucks

806
00:49:34,880 --> 00:49:37,600
Speaker 3: and said we didn't like cyber trucks. That's way different

807
00:49:37,640 --> 00:49:40,200
Speaker 3: from us seeing one on the street in Austin and

808
00:49:40,239 --> 00:49:42,640
Speaker 3: going uh huh, that's goofy.

809
00:49:42,880 --> 00:49:45,480
Speaker 2: That is it's very different. These are the people that

810
00:49:45,600 --> 00:49:47,280
Speaker 2: actually know what they're talking about.

811
00:49:48,120 --> 00:49:50,240
Speaker 4: Have you guys seen a video of people using cyber

812
00:49:50,280 --> 00:49:54,200
Speaker 4: trucks as skateboard ramps. It's kind of the perfect perfectly sometime.

813
00:49:55,280 --> 00:49:58,319
Speaker 4: And also have we talked about the fact that they've

814
00:49:58,320 --> 00:50:00,360
Speaker 4: recalled literally I think all of them beca because of

815
00:50:00,400 --> 00:50:03,799
Speaker 4: this really dangerous metal strip that's just got glued on

816
00:50:04,000 --> 00:50:05,759
Speaker 4: and that will just fly off randomly. Yes.

817
00:50:06,640 --> 00:50:12,240
Speaker 3: Yeah, if you're trying to save cost and per unit manufacturing,

818
00:50:12,360 --> 00:50:15,160
Speaker 3: you can use the wrong adhesive and just have a

819
00:50:15,239 --> 00:50:18,760
Speaker 3: no refunds policy. But luckily the US still has something

820
00:50:18,920 --> 00:50:20,120
Speaker 3: like recall wawls.

821
00:50:20,320 --> 00:50:24,080
Speaker 4: Hopefully Healthcare doesn't deny your claim when that metal shrapnel

822
00:50:24,120 --> 00:50:27,200
Speaker 4: flies off in traffic and slices your arm off or something.

823
00:50:27,400 --> 00:50:31,759
Speaker 3: Oh man, yeah, no kidding. Uh, there's another let's talk

824
00:50:31,760 --> 00:50:34,239
Speaker 3: about the contracts too. There's another thing we have to mention.

825
00:50:34,840 --> 00:50:39,920
Speaker 3: So in some of these deals there will be an

826
00:50:39,960 --> 00:50:45,080
Speaker 3: agreement where we said evicor will guarantee a certain threshold

827
00:50:45,239 --> 00:50:50,560
Speaker 3: of rise and denials right or rise and deficient or

828
00:50:50,600 --> 00:50:53,920
Speaker 3: efficiency or whatever they call it. They'll also do a

829
00:50:53,920 --> 00:50:57,839
Speaker 3: little bit of glad handing and they'll say, hey, if

830
00:50:57,880 --> 00:51:01,440
Speaker 3: there are claims that are not denied, then we will

831
00:51:01,480 --> 00:51:05,200
Speaker 3: pay them. We the company, will pay the cost of

832
00:51:05,239 --> 00:51:10,600
Speaker 3: those in exchange forgetting to keep any savings that we

833
00:51:10,680 --> 00:51:14,920
Speaker 3: get beyond your standard expenses. This is part of the

834
00:51:15,840 --> 00:51:18,200
Speaker 3: This is part of the tricky and ethically fraught thing,

835
00:51:18,280 --> 00:51:20,960
Speaker 3: the risk contract. They have a flat rate contract, they

836
00:51:20,960 --> 00:51:24,319
Speaker 3: have a risk contract. It looks like it makes the

837
00:51:24,360 --> 00:51:27,439
Speaker 3: system not as objective as it would appear to be.

838
00:51:27,760 --> 00:51:29,920
Speaker 3: And that's not us saying it. That's folks like the

839
00:51:30,000 --> 00:51:33,879
Speaker 3: former California Insurance Commissioner Dave Jones, who has spoken about

840
00:51:33,880 --> 00:51:37,120
Speaker 3: this multiple times. Not just a pro public that's right.

841
00:51:37,200 --> 00:51:39,799
Speaker 4: Apparently doctors will sometimes be a bit more hesitant to

842
00:51:39,840 --> 00:51:41,960
Speaker 4: send a request in the first place if they know

843
00:51:42,080 --> 00:51:45,640
Speaker 4: the system is involved, the ev core system or core

844
00:51:45,680 --> 00:51:48,720
Speaker 4: E of courses, the claim will get denied no matter

845
00:51:48,760 --> 00:51:52,160
Speaker 4: what in this case, and Evicre internally refers to this

846
00:51:52,360 --> 00:51:56,040
Speaker 4: as sentinel as facts or sentinel syndrome. Yeah, it sounds

847
00:51:56,239 --> 00:51:57,799
Speaker 4: like something of X men.

848
00:51:58,320 --> 00:52:00,360
Speaker 2: Well, because you don't want to as the phys position

849
00:52:00,680 --> 00:52:02,680
Speaker 2: or you know, that care provider. You don't want to

850
00:52:02,719 --> 00:52:06,360
Speaker 2: get singled out and say, this person keeps pushing through

851
00:52:06,719 --> 00:52:09,200
Speaker 2: all these things, we keep denying Where why are they

852
00:52:09,239 --> 00:52:10,120
Speaker 2: being a problem?

853
00:52:12,040 --> 00:52:15,160
Speaker 3: Yeah, exactly, real drip. And then there's the other side,

854
00:52:15,200 --> 00:52:17,480
Speaker 3: the way this company will portray it because they use

855
00:52:17,520 --> 00:52:20,759
Speaker 3: the phrase sentinel effect as well. They'll say, think of

856
00:52:20,800 --> 00:52:23,920
Speaker 3: it like how a sheriff comes to town, you know,

857
00:52:24,280 --> 00:52:26,120
Speaker 3: and now people are a little more on their p's

858
00:52:26,160 --> 00:52:31,600
Speaker 3: and ques. That's their argument. Again, your perspective may differ here,

859
00:52:31,640 --> 00:52:34,280
Speaker 3: but this is the quick skinning. The US healthcare industry

860
00:52:34,480 --> 00:52:38,720
Speaker 3: is a leviathan by any means, and it's we mentioned

861
00:52:38,719 --> 00:52:42,080
Speaker 3: as the biggest employer in the country statistically. That means,

862
00:52:42,200 --> 00:52:44,280
Speaker 3: you guys, that a lot of us in the audience

863
00:52:44,320 --> 00:52:48,359
Speaker 3: tonight tuning in are employed by this industry in one

864
00:52:48,400 --> 00:52:51,759
Speaker 3: way or another, And that means it touches everyone in

865
00:52:51,840 --> 00:52:54,280
Speaker 3: this country. Even if you have never filed a claim,

866
00:52:54,440 --> 00:52:59,440
Speaker 3: even if you are in perfect health, this will somehow

867
00:53:00,120 --> 00:53:02,719
Speaker 3: reach you and your loved ones. So it's important for

868
00:53:02,840 --> 00:53:06,040
Speaker 3: us all to ask, is this, knowing what we know now,

869
00:53:06,360 --> 00:53:10,160
Speaker 3: is this genuinely a matter of reducing waste and making

870
00:53:10,200 --> 00:53:14,680
Speaker 3: things more efficient or did these, perhaps once noble intentions,

871
00:53:14,800 --> 00:53:18,719
Speaker 3: lead to a vast conspiratorial industry that is built to

872
00:53:18,840 --> 00:53:22,520
Speaker 3: purposely prevent people from getting the care that, by the

873
00:53:22,520 --> 00:53:25,759
Speaker 3: way they pay for, they're paying for us.

874
00:53:25,760 --> 00:53:27,520
Speaker 4: It's the most vexing part of all of it when

875
00:53:27,560 --> 00:53:29,840
Speaker 4: you start like, even with these wildfires and things like

876
00:53:29,880 --> 00:53:32,239
Speaker 4: I think we all have friends and colleagues of course

877
00:53:32,280 --> 00:53:36,359
Speaker 4: that lost things in those and lost homes or were displaced,

878
00:53:36,600 --> 00:53:40,960
Speaker 4: and just the attitude it would seem of the insurance

879
00:53:40,960 --> 00:53:45,800
Speaker 4: company to do everything humanly possible to deny claims, especially

880
00:53:45,840 --> 00:53:48,000
Speaker 4: after you've paid in all of this money, you know,

881
00:53:48,160 --> 00:53:50,120
Speaker 4: for so so very long, and then you don't even

882
00:53:50,120 --> 00:53:52,720
Speaker 4: get the thing that you've been paying towards. It's really

883
00:53:52,760 --> 00:53:53,799
Speaker 4: really disappointing.

884
00:53:55,480 --> 00:54:00,080
Speaker 2: It's baffling to see from Evercore's own website, in their

885
00:54:00,080 --> 00:54:03,439
Speaker 2: own statements, from officials and board members and people who

886
00:54:03,800 --> 00:54:07,239
Speaker 2: say things they give you the value add right, anytime

887
00:54:07,320 --> 00:54:11,040
Speaker 2: anyone's going to pay for a product or service, what

888
00:54:11,160 --> 00:54:13,960
Speaker 2: is the value that this product or service has for me.

889
00:54:14,280 --> 00:54:16,960
Speaker 2: The person who's buying it right in this case is

890
00:54:16,960 --> 00:54:20,960
Speaker 2: the health insurance companies, and they're also you know, essentially

891
00:54:20,960 --> 00:54:25,319
Speaker 2: giving a value add to the physicians and the care providers, saying, hey,

892
00:54:27,000 --> 00:54:30,319
Speaker 2: we're gonna remove a lot of that junk you have

893
00:54:30,400 --> 00:54:32,440
Speaker 2: to do all your busy work when you're getting these

894
00:54:32,440 --> 00:54:39,120
Speaker 2: prior authorizations. But ultimately, to me, it's trying to fix

895
00:54:39,160 --> 00:54:42,840
Speaker 2: a problem that's created by this insane system that we've built.

896
00:54:42,880 --> 00:54:45,600
Speaker 2: And every time we make these little changes to the

897
00:54:45,640 --> 00:54:50,040
Speaker 2: American healthcare system, the private healthcare system, it is like

898
00:54:50,160 --> 00:54:53,440
Speaker 2: putting band aids on leaking pipes, right, or pipes that

899
00:54:54,000 --> 00:54:56,240
Speaker 2: have a gaping hole in them. We're trying so hard

900
00:54:56,280 --> 00:55:00,759
Speaker 2: to fix something, but it just seems like, I don't know, guys,

901
00:55:00,800 --> 00:55:03,920
Speaker 2: we've talked about before, it seems like the only way

902
00:55:03,960 --> 00:55:08,120
Speaker 2: forward really is to dismantle the thing. But if you

903
00:55:08,200 --> 00:55:10,560
Speaker 2: dismantle the thing, as we said at the top of this,

904
00:55:11,160 --> 00:55:17,719
Speaker 2: you're dismantling the largest like what employer base essentially that

905
00:55:17,800 --> 00:55:18,640
Speaker 2: exists out there.

906
00:55:19,400 --> 00:55:22,120
Speaker 3: Yeah, yeah, and it is. It is a pickle. I

907
00:55:22,120 --> 00:55:26,000
Speaker 3: always think it's best to think in terms of analogy

908
00:55:26,080 --> 00:55:28,799
Speaker 3: to the point about whether the system itself is inherently

909
00:55:29,680 --> 00:55:32,880
Speaker 3: beyond repair right as the car totaled. Think of it

910
00:55:32,920 --> 00:55:39,120
Speaker 3: this way, Private insurance companies in this situation, just objectively,

911
00:55:40,360 --> 00:55:44,960
Speaker 3: it is as though somebody owns a shoe store and

912
00:55:45,000 --> 00:55:48,719
Speaker 3: they go to another company and they say, guys, these

913
00:55:48,760 --> 00:55:51,880
Speaker 3: people who buy shoes too many of them are walking

914
00:55:51,920 --> 00:55:54,640
Speaker 3: out with the shoes they bought. Is there a way

915
00:55:54,719 --> 00:55:58,239
Speaker 3: that we could, you know, make sure like fifteen to

916
00:55:58,280 --> 00:56:01,120
Speaker 3: twenty percent of them don't leave with those shoes.

917
00:56:01,960 --> 00:56:07,239
Speaker 2: That's evil. That yeah, that's that's evil to the core.

918
00:56:09,719 --> 00:56:13,000
Speaker 2: And let's also, hey, let's quickly point out here SIGNA

919
00:56:13,040 --> 00:56:16,920
Speaker 2: Group on their website they boast about how they have

920
00:56:18,280 --> 00:56:22,400
Speaker 2: one hundred and eighty point five billion total revenues at

921
00:56:22,480 --> 00:56:23,480
Speaker 2: last time they checked.

922
00:56:24,080 --> 00:56:24,319
Speaker 4: Uh.

923
00:56:24,440 --> 00:56:27,840
Speaker 2: SIGNA Group. That's the people that own what's ever North

924
00:56:28,120 --> 00:56:31,200
Speaker 2: that then runs this holostism we've been talking about the

925
00:56:31,239 --> 00:56:31,880
Speaker 2: whole episode.

926
00:56:32,120 --> 00:56:36,280
Speaker 3: And SIGNA is using revenues in the plural correctly, because

927
00:56:36,320 --> 00:56:39,800
Speaker 3: they're adding up the revenue from every arm of their.

928
00:56:39,640 --> 00:56:43,360
Speaker 2: Octopus exactly because they are the SIGNA Group, not just

929
00:56:43,400 --> 00:56:49,759
Speaker 2: SIGNA Healthcare, which is a you know, international situation. But

930
00:56:49,920 --> 00:56:53,520
Speaker 2: just think about that money that exists there, that money involved,

931
00:56:53,719 --> 00:56:56,759
Speaker 2: and in the end, what is it for.

932
00:56:56,960 --> 00:56:58,560
Speaker 3: I thought you were going to go, Oh gosh, I

933
00:56:58,560 --> 00:56:59,920
Speaker 3: thought you were going to do the song.

934
00:57:00,239 --> 00:57:08,879
Speaker 2: I almost did. It's just oh, it's given. I don't

935
00:57:08,920 --> 00:57:13,440
Speaker 2: know I put it. It's given MANGIONI core to me,

936
00:57:13,640 --> 00:57:16,920
Speaker 2: It's given core vibes. And you can just see, you

937
00:57:16,960 --> 00:57:17,600
Speaker 2: can see.

938
00:57:17,680 --> 00:57:20,760
Speaker 4: Why have we mentioned that they're seeking the death penalty

939
00:57:20,800 --> 00:57:21,560
Speaker 4: with old Luig.

940
00:57:22,480 --> 00:57:25,080
Speaker 3: That's yeah, that's how we're gonna wrap up. So it's like, yes,

941
00:57:25,160 --> 00:57:28,160
Speaker 3: the these two companies we mentioned, they did get in

942
00:57:28,200 --> 00:57:31,160
Speaker 3: trouble recently, just about two weeks ago, well over two

943
00:57:31,160 --> 00:57:35,000
Speaker 3: weeks ago, as we record, on Friday, April fourth, and

944
00:57:35,520 --> 00:57:40,280
Speaker 3: Anthem and Signat got in trouble with the Virginia State

945
00:57:40,320 --> 00:57:44,120
Speaker 3: Corporations Commission. They had to pay back hundreds of people,

946
00:57:44,120 --> 00:57:46,680
Speaker 3: but they had to pay back peanut fees. And this

947
00:57:46,800 --> 00:57:50,160
Speaker 3: further brings us to the context of Mangionics. Like you

948
00:57:50,160 --> 00:57:53,960
Speaker 3: were saying, Noel, the Attorney General Pam Bondi, just a

949
00:57:54,040 --> 00:57:59,120
Speaker 3: few days ago, just like this Tuesday, ordered federal prosecutors

950
00:57:59,160 --> 00:58:02,880
Speaker 3: to seek the death penalty for Luigi Mangio, who, as

951
00:58:02,920 --> 00:58:06,320
Speaker 3: we know, is the man I currently not convicted of

952
00:58:06,360 --> 00:58:10,760
Speaker 3: gunning down United Healthcare CEO Brian Thompson in New York

953
00:58:10,800 --> 00:58:15,640
Speaker 3: City last year. He's twenty six, he's in jail. The

954
00:58:15,680 --> 00:58:19,800
Speaker 3: population of the US overall versus the power structure of

955
00:58:19,840 --> 00:58:23,360
Speaker 3: the US overall are deeply divided on this case.

956
00:58:23,560 --> 00:58:25,600
Speaker 4: I think we could the very least argue that he

957
00:58:25,760 --> 00:58:28,200
Speaker 4: is sure as hell being made an example of.

958
00:58:29,720 --> 00:58:32,880
Speaker 2: Yeah, and he's also got an insane amount of support

959
00:58:33,360 --> 00:58:35,960
Speaker 2: in the news. Also this, I think it was this

960
00:58:36,000 --> 00:58:38,600
Speaker 2: past week, maybe the week before you're hearing this. Two

961
00:58:38,640 --> 00:58:41,840
Speaker 2: weeks he put out a statement asking people to stop

962
00:58:41,880 --> 00:58:43,320
Speaker 2: sending in so many photographs.

963
00:58:43,560 --> 00:58:46,520
Speaker 3: Yes, yeah, because Snell even talked about it.

964
00:58:46,800 --> 00:58:48,920
Speaker 4: Yes, And none of a support violence, none of a

965
00:58:49,000 --> 00:58:52,160
Speaker 4: support you know, this kind of thing. But it's interesting,

966
00:58:52,200 --> 00:58:55,920
Speaker 4: it's an interesting bellweather as to how so many people

967
00:58:56,000 --> 00:58:59,880
Speaker 4: feel about the healthcare system and how clearly broken it is.

968
00:59:01,200 --> 00:59:03,960
Speaker 4: It's just really kind of kickstarted again the whole conversation

969
00:59:04,120 --> 00:59:04,640
Speaker 4: around it.

970
00:59:06,840 --> 00:59:11,520
Speaker 3: Yeah, please check out our series on Luigi. We explore

971
00:59:11,600 --> 00:59:15,280
Speaker 3: the motivations for his actions, which are related to the

972
00:59:15,320 --> 00:59:19,880
Speaker 3: idea of denying healthcare. During the research for this episode here,

973
00:59:20,000 --> 00:59:23,520
Speaker 3: I think we were all unsurprised, but still moved to

974
00:59:23,640 --> 00:59:26,880
Speaker 3: find how deeply these stories tie together. We may be

975
00:59:26,960 --> 00:59:29,280
Speaker 3: looking at a sea change. You know, the Manngione case

976
00:59:29,760 --> 00:59:34,320
Speaker 3: has exposed this great divide that always existed between the

977
00:59:34,440 --> 00:59:38,720
Speaker 3: average American and those in power. And as we're recording now,

978
00:59:38,840 --> 00:59:41,840
Speaker 3: you know, we should also mention that he's got federal

979
00:59:41,960 --> 00:59:47,360
Speaker 3: and state charges. So if state prosecutors bring their case first,

980
00:59:47,400 --> 00:59:51,280
Speaker 3: he hasn't been federally indicted, then he could be imprisoned

981
00:59:51,280 --> 00:59:54,600
Speaker 3: for life without parole or something to that nature. So

982
00:59:54,640 --> 00:59:58,280
Speaker 3: that's still very much an evolving case, and in some case,

983
00:59:58,520 --> 01:00:02,880
Speaker 3: some points it does seem like people would rather it

984
01:00:02,920 --> 01:00:05,960
Speaker 3: be forgotten. I don't know, maybe that's where we end.

985
01:00:06,200 --> 01:00:08,000
Speaker 3: What do you guys think what's going to happen next?

986
01:00:10,640 --> 01:00:14,520
Speaker 2: I think this kind of thing only gets worse because

987
01:00:14,520 --> 01:00:18,880
Speaker 2: again we're talking about trying to fix leaky pipes, but

988
01:00:19,000 --> 01:00:21,160
Speaker 2: you've got whole sections of this thing that just don't

989
01:00:21,200 --> 01:00:23,480
Speaker 2: even have any pipes, and there's just water filling up

990
01:00:23,560 --> 01:00:26,920
Speaker 2: the submarine or whatever however you want to talk about it.

991
01:00:26,920 --> 01:00:27,920
Speaker 2: It's just it's messed up.

992
01:00:27,960 --> 01:00:30,680
Speaker 4: I think we should only talk about it in nautical metaphors.

993
01:00:31,240 --> 01:00:34,440
Speaker 4: I'm sorry, I'm joking. It's a really good one, Matt.

994
01:00:34,680 --> 01:00:36,600
Speaker 4: I'm visualizing it, and you're absolutely right.

995
01:00:37,080 --> 01:00:41,080
Speaker 2: It's a sinking ship that is only serving the people

996
01:00:41,080 --> 01:00:42,440
Speaker 2: who have life boats, you know.

997
01:00:42,640 --> 01:00:43,360
Speaker 4: See.

998
01:00:43,480 --> 01:00:46,640
Speaker 2: So continuing with I want to talk about something that

999
01:00:46,840 --> 01:00:49,320
Speaker 2: a friend of the show, Charlie, brought up to me,

1000
01:00:49,920 --> 01:00:54,320
Speaker 2: which was that in a lot of states, if you

1001
01:00:54,440 --> 01:00:57,280
Speaker 2: don't make enough money, you can get on that state

1002
01:00:57,360 --> 01:01:01,160
Speaker 2: run medicare program. But if you all of a sudden

1003
01:01:01,240 --> 01:01:03,520
Speaker 2: cross that threshold because you got a new job and

1004
01:01:03,520 --> 01:01:06,840
Speaker 2: now you're making a little more money, now you're required

1005
01:01:07,040 --> 01:01:10,480
Speaker 2: to get healthcare through you know the what is it

1006
01:01:10,520 --> 01:01:14,800
Speaker 2: whether the marketplace? You have to get healthcare there, which

1007
01:01:14,840 --> 01:01:17,959
Speaker 2: then those costs are in the hundreds of dollars. Before

1008
01:01:17,960 --> 01:01:20,400
Speaker 2: you weren't paying any money for your healthcare if you're

1009
01:01:20,440 --> 01:01:23,720
Speaker 2: on a state program or you know, the federal program,

1010
01:01:24,040 --> 01:01:26,240
Speaker 2: Now you have to pay, which means you're actually going

1011
01:01:26,320 --> 01:01:28,840
Speaker 2: to be making a lot less money on a month

1012
01:01:28,880 --> 01:01:31,400
Speaker 2: a month basis because you have to now pay into

1013
01:01:31,440 --> 01:01:35,520
Speaker 2: the private system. Like, how is that an okay thing?

1014
01:01:36,240 --> 01:01:40,480
Speaker 2: And how does that incentivize people to not get a

1015
01:01:40,520 --> 01:01:41,080
Speaker 2: better job?

1016
01:01:41,280 --> 01:01:41,520
Speaker 4: Right?

1017
01:01:42,640 --> 01:01:46,600
Speaker 2: And something we've talked about before, like this concept that's

1018
01:01:46,720 --> 01:01:51,840
Speaker 2: very popular in governmental speak, is a human being living

1019
01:01:51,840 --> 01:01:54,800
Speaker 2: off the system or something like that. Right, But we've

1020
01:01:54,800 --> 01:01:58,720
Speaker 2: designed a system that is going to punish people who

1021
01:01:59,000 --> 01:02:03,600
Speaker 2: aren't rich enough, right, or it's going to incentivize people

1022
01:02:03,600 --> 01:02:05,200
Speaker 2: to make sure they don't get too rich.

1023
01:02:05,960 --> 01:02:08,640
Speaker 4: I don't know. It's just weird. It is weird. That's yeah.

1024
01:02:09,480 --> 01:02:11,200
Speaker 4: It's an interesting way of looking at it. That I mean,

1025
01:02:11,480 --> 01:02:12,640
Speaker 4: is it's how it is.

1026
01:02:14,120 --> 01:02:19,000
Speaker 3: Yeah, something we had discussed previously, as as you mentioned.

1027
01:02:19,440 --> 01:02:21,160
Speaker 3: One thing that I think it's lost in a lot

1028
01:02:21,200 --> 01:02:25,560
Speaker 3: of the tribalization or politicization of things like that was

1029
01:02:25,920 --> 01:02:30,600
Speaker 3: calling the ACA Obamacare as a means of vilified it

1030
01:02:30,680 --> 01:02:33,400
Speaker 3: for people who didn't like that administration, when in fact

1031
01:02:33,520 --> 01:02:38,600
Speaker 3: it was generated by Mitt Romney very much as a

1032
01:02:38,720 --> 01:02:43,920
Speaker 3: conservative solution to the existing healthcare problems. Folks, this is

1033
01:02:43,920 --> 01:02:46,600
Speaker 3: where we're going to call it. Thank you so much,

1034
01:02:46,680 --> 01:02:49,880
Speaker 3: as always for tuning in. I think it's always important

1035
01:02:49,880 --> 01:02:54,000
Speaker 3: for us to note obviously we cannot thank journalists like

1036
01:02:54,040 --> 01:02:56,760
Speaker 3: the good folks at Pro Publica enough for this fantastic,

1037
01:02:56,840 --> 01:02:59,960
Speaker 3: truly disturbing work. We also know that a lot of

1038
01:03:00,120 --> 01:03:05,120
Speaker 3: us listening tonight work in the healthcare industry aren't villains.

1039
01:03:04,640 --> 01:03:08,919
Speaker 3: It's the system. It's like stick said, it's deeper than skin.

1040
01:03:09,000 --> 01:03:11,600
Speaker 3: It's the system that they're keeping us in. Stick Man

1041
01:03:11,640 --> 01:03:14,720
Speaker 3: from Dead Press of course. Anyway, that's our group. Whuitous

1042
01:03:14,760 --> 01:03:18,840
Speaker 3: hip hop reference. Gonna We're gonna call it an evening

1043
01:03:19,000 --> 01:03:21,720
Speaker 3: and we're off to noctivigate in the meantime. We can't

1044
01:03:21,720 --> 01:03:24,080
Speaker 3: wait for you to join the show. You can find

1045
01:03:24,160 --> 01:03:27,720
Speaker 3: us on an email. You can find us on a telephone.

1046
01:03:27,760 --> 01:03:30,880
Speaker 3: You can find us all over the internet, depending on

1047
01:03:30,920 --> 01:03:32,200
Speaker 3: how this episode goes.

1048
01:03:32,400 --> 01:03:34,080
Speaker 4: That's right, and all of those places. You can find

1049
01:03:34,120 --> 01:03:36,800
Speaker 4: us at the handle Conspiracy Stuff where we exist on Facebook.

1050
01:03:37,040 --> 01:03:39,360
Speaker 4: We have our Facebook group Here's where it gets crazy,

1051
01:03:39,400 --> 01:03:42,560
Speaker 4: on x FKA, Twitter, and on YouTube where we have

1052
01:03:42,680 --> 01:03:47,240
Speaker 4: video content for your perusing enjoyment. On Instagram and TikTok. However,

1053
01:03:47,480 --> 01:03:48,880
Speaker 4: we're Conspiracy Stuff Show.

1054
01:03:49,800 --> 01:03:52,320
Speaker 2: We have a phone number. It is one eight three

1055
01:03:52,440 --> 01:03:56,760
Speaker 2: three st d WYTK. When you call in, you've got

1056
01:03:56,800 --> 01:03:59,920
Speaker 2: three minutes, give yourself a cool nickname and let us know.

1057
01:04:00,080 --> 01:04:01,880
Speaker 2: We can use your name and message on the air.

1058
01:04:01,960 --> 01:04:03,400
Speaker 2: If you've got more to say than can fit in

1059
01:04:03,400 --> 01:04:05,120
Speaker 2: a three minute voicemail, why not instead send us a

1060
01:04:05,120 --> 01:04:06,040
Speaker 2: good old fashioned email.

1061
01:04:06,080 --> 01:04:09,720
Speaker 3: We are the entities that read every piece of correspondence

1062
01:04:09,760 --> 01:04:12,600
Speaker 3: we receive. It does not have to be longer than

1063
01:04:12,840 --> 01:04:14,680
Speaker 3: three minutes, does it could be used to it or

1064
01:04:14,720 --> 01:04:18,840
Speaker 3: as long as you wish, and be well aware of folks,

1065
01:04:18,880 --> 01:04:21,360
Speaker 3: yet unafraid. Sometimes the void writes back, you may end

1066
01:04:21,440 --> 01:04:24,360
Speaker 3: up in a correspondence with us, just the way k

1067
01:04:24,560 --> 01:04:28,200
Speaker 3: Dog was, which inspired this episode. So join us one

1068
01:04:28,240 --> 01:04:31,560
Speaker 3: step further out here in the dark conspiracy at iHeartRadio

1069
01:04:31,800 --> 01:04:51,200
Speaker 3: dot com.

1070
01:04:51,400 --> 01:04:53,440
Speaker 2: Stuff they Don't Want You to Know is a production

1071
01:04:53,560 --> 01:04:58,080
Speaker 2: of iHeartRadio. For more podcasts from iHeartRadio, visit the iHeartRadio app,

1072
01:04:58,160 --> 01:05:01,040
Speaker 2: Apple Podcasts, or wherever you listen into your favorite shows.