Transcript
[music]: [00:00:00] Knock, knock, hi,
Will: knock, knock, hi.
Hello, everybody. Welcome to knock, knock. Hi, with the Glaucomfleckens. I’m Will Flannery, also known as Dr. Glaucomflecken.
Kristin: I am Kristen Flannery, also known as Lady Glaucomflecken.
Will: You keep pointing out my enunciation, so I’m really trying hard to enunciate correctly. I don’t feel like. I slur my words.
Kristin: Only when you’re doing the fast talking at the end of the episode.
Will: Oh, okay. When
Kristin: you’re, when you’re doing your regular slow talking, you have plenty of time to enunciate.
Will: That’s true. Oh, are you telling me I cause I talk slow?
Kristin: Yeah, you’re a slow talker
Will: No, I feel bad for a listener sometimes because they have to like they should be an option You think podcasting technology would advance to the point?
Kristin: Yeah,
Will: where you can like specify how quickly each voice I like
Kristin: that, right? Cuz people might [00:01:00] want to slow me down or they might want to speed you up I
Will: think you talk at a normal rate.
Kristin: I don’t know. I’ve heard in the comments people There’s, it’s a mix.
Will: Really? Some people like the
Kristin: fast talking. Some people like this.
No, some people want me to be slower.
Will: Oh, really?
Kristin: And some people want you to be faster.
Will: Everybody wants me to be faster. Some people are
Kristin: just happy to listen. I grew up in
Will: Texas. We talk slow there. Yeah. But yeah, you don’t really count. I don’t know. I don’t know. You, you had, you had, you had too
Kristin: much, uh, outside influence.
That’s true. Cause I’m not a native.
Will: But despite the fact that you grew up in a much more Texas type environment than I did.
Kristin: Yes,
Will: like classic,
Kristin: very Rural small town, Texas.
Will: Yeah. Yeah. Cowboy country. Stray animals everywhere. Oh, yeah, Stephenville. Yes
Kristin: I sure do. That’s the big
Will: city.
Kristin: That’s where we had to go to buy our groceries
Will: and you’re that’s where the rodeo was
Kristin: Yes, they do have a rodeo.
How often did you
Will: go to the rodeo?
Kristin: I didn’t.
Will: [00:02:00] You weren’t a rodeo goer? Not a
Kristin: rodeo person. Can you see me at a rodeo? Did you?
Will: Were you like in 4 H or something?
Kristin: No, I’m an inside kid. I’m
Will: surprised your parents didn’t. I am a city kid
Kristin: at heart.
Will: Okay. Yes, you are.
Kristin: Yes. I like to I’ve seen your picture with
Will: you with a belt buckle.
Kristin: Yes, everyone mentions that. Do you know why?
Will: Why?
Kristin: That was, that was meant to be humor.
Will: Oh, I see, you were being ironic.
Kristin: Yes.
Will: Okay.
Kristin: It was a senior picture, so it was like, I’m getting out of here. And I thought, you know, it’d be funny.
Will: You’re done.
Kristin: Yeah.
Will: Your parents, did they ever try to, to make you Uh, raise livestock, like,
Kristin: they never tried to make me do anything.
Will: Yeah, sure. It was
Kristin: very popular and a lot of kids had a lot of success.
Will: What is it called? Federal?
Kristin: Did you just say FAA?
Will: FAA? Is it? That is
Kristin: uh, airplanes.
Will: Wait, what is it?
Kristin: FFA. Future Farmers of America. Not
Will: FAA. [00:03:00] Yeah. FFA. That was close. Look, I don’t, I
Kristin: don’t have anything bad to say about FAA. Well, of course not.
Any of that. It’s just, that’s not who I am as a person. I didn’t, I didn’t participate in, in that stuff. No, I was, I was a nerd. I
Will: feel like we’re arguing about who’s less or more
Kristin: Texas. I think that is what we have devolved to. You are more Texas. Like, there’s no argument.
Will: I think neither of us are very Texas.
That’s
Kristin: true.
Will: So anyway, I don’t know.
Kristin: I don’t know. Maybe we’re, maybe we’re an embarrassment to the state of Texas. Yeah.
Will: All right. Well,
Kristin: well then I’m not sure anyone’s still listening. Yes,
Will: they are. They love this stuff. Are you kidding me? No, we’re talking. We’re having a bit of a deep dive in some health policy, health care system topics.
Kristin: Yes,
Will: and which is actually good timing for for me because I just had to go through another Uh, renewal of my testosterone.
Kristin: Yeah. Explain to people why this is like, there’s a lot of people that are taking testosterone these days.
Will: That is
Kristin: not the situation for you. [00:04:00] It’s not like you’re just like getting a little
Will: boost.
Oh yeah. Cause I’m getting swole. I’m, I’m, I’m bulking up.
Kristin: Yeah. Can’t you tell just by, just by looking at it. I’m so
Will: strong now. Actually I need to get, I need a new suit. Cause my, my current suit is getting a little tight. Not just around the waist, all right, shoulders, I’m just, I’m like, kind of, I’m getting
Kristin: bigger.
Will: Yes, you’ve been
Kristin: doing physical training and perhaps it’s because you finally got the correct dose of your testosterone. I feel
Will: like I have the, the energy to do it. But it’s been a
Kristin: learning process, it’s like seven years before even we figured out. Why your insurance company like never wants to cover it?
So the
Will: reason I do is I don’t make any of my own testosterone because I had both testicles removed due to cancer and so I have to have replacement testosterone and It’s
Kristin: but not just like a little extra like all of it, which is exceedingly rare
Will: it’s very rare and also very difficult. I’ve learned from talking to all [00:05:00] my doctors over the years to titrate up to that amount As a young man,
[music]: right?
So
Will: I, I obviously I should have a higher level of than someone who’s like 60. Right. Uh, and so it’s been a challenge to convince the insurance company that I have to authorize. That’s an adequate dose for me.
Kristin: Which blows my mind because it’s also documented that you have no testicles.
Will: That is the funny part in all of this.
It seems
Kristin: like this should be very obvious.
Will: That I have to. That you need this. Like I got, I got a, I got an approval to have my testipel, so I have a little pellets that get shot up into my ass. Not like into my, like, into my ass cheek, I should say. Yeah,
Kristin: it needs to be specific. It is not a suppository. It’s
Will: a testosterone suppository.
Um, I wonder if that exists. Anyway, I, no, into my, into my [00:06:00] cheek, and it happens every three months. It’s like Swiss
Kristin: cheese back there.
Will: What the hell are you talking about? I find it very funny that every, like, year, year and a half, I go through this process with the insurance company where they’re like, does he really still need it?
Like I didn’t grow more testicles. Like I don’t, that doesn’t happen. I’m an ophthalmologist. Even I know that doesn’t happen. And so it’s um, it’s a process we got to go through and we just recently did it again. So it delayed my testosterone
Kristin: by a
Will: few weeks and I was feeling real bad for a while.
Kristin: Because that’s another thing I didn’t realize when you, when you make no testosterone of your own.
You get sick. Like it’s not just I
Will: feel bad I feel tired and cranky and I don’t know so it sucks a lot of people have to go through that But my situation is just a tiny bit unique because it just doesn’t happen very often But you know eventually work through it
Kristin: again though once you’ve explained it once It should [00:07:00] be obvious that yes, you need this forever,
Will: but this leads into our discussion today with our guests.
So we are talking to, uh, Warris Bakari, MD. He’s a former practicing physician, ex, ex insurance executive. He talks about that, why he started working there, um, uh, some of the nefarious practices unbeknownst to him, uh, and then why he stopped working there and now is running a company called, uh, claimable.
Uh, that’s trying to fight health insurance denials. We also talked to Julie Bach, who is the Chief Patient Advocate and Practice Manager of the Arthritis Center in St. Louis. Uh, so, uh, we had an interesting conversation. We talked about denials, appeals, uh, and where the
Kristin: insurance companies shenanigans of
Will: insurance company stuff.
And so if you don’t, if you’re not a fan of insurance companies, this is probably the episode for you.
[music]: Yes.
Will: So let’s get to it. All right. Here is Warris Bokhari and Julie Bach.[00:08:00]
Today’s episode is brought to you by DaxCopilot from Microsoft. To learn about how DaxCopilot can help you reduce burnout and restore the joy of practicing medicine. Visit aka. ms slash knock, knock high. That’s aka. ms slash knock, knock high.
All right. We are here with Dr. Warris Bokhari and Julie Bach. Thank you so much for joining us.
Warris Bokhari: Thanks for having us. You know,
Will: I was, I was just, um, uh, reading about, uh, the recent lawsuit that express scripts or Cigna has, has, has filed against the federal government and just really enjoying myself. I don’t know if you’ve been keeping up with, uh, what’s going on in the, in the pharmacy benefit manager world, but
Kristin: I have not.
So why don’t you tell us?
Will: Okay. Well, why don’t you guys, I mean, what do you, you know, what [00:09:00] do you think about what’s been going on there?
Warris Bokhari: I mean, in case you hadn’t noticed, I am Jimothy. Yeah, so we got Horace
Will: here, he’s wearing a red, uh, puffy vest. Yes, just like Jimothy does.
Warris Bokhari: With a, with a slightly handicraft Patagonia logo.
Oh, oh, this,
Julie Baak: I never even,
Will: I never even, uh, uh, noticed that at first. So you wrote, you drew your own Patagonia logo. You did it so well that we
Kristin: were convinced. That was, I didn’t even notice.
Will: That’s, that’s true. That’s very well done. I’m impressed by that.
Warris Bokhari: Uh, credit goes to my wife who wanted to make sure that Jimothy looked authentic enough.
Um, but yeah, look, I mean, the Cigna lawsuit is hilarious and tragic because it’s a complete Streisand effect. So they don’t want anybody to talk about factually about their business model. So they put out a lawsuit that everybody can then share on social media, which You know, [00:10:00] effectively what they’re saying is like, dear federal government, please stop saying mean things about us, which also AKA happened to be the truth.
Will: Right. So, so what happened back in, I think it was over the summer, um, maybe a few months ago, the, the FTC put out a report, basically it was wild. It basically blamed the, the pharmacy benefit man, the, the big three, which are like Express Scripts, Optum.
Julie Baak: Caremark.
Will: What’s the other one? Caremark, yeah. Uh, so, which are respectively, uh, Cigna, United, and CVS, uh, and so, Edna, Edna, CVS, yeah.
And so, um, they put out this report and, uh. Express Scripts, CVS, was so upset that they said, oh, this is defamation by the federal government against us because we are not to blame for rising drug costs. Like, they were very upset by this.
Kristin: And that this [00:11:00] wasn’t satire.
Will: No, no, this is, this is true. This is really happened.
And so they decided to sue the federal government for defamation. This is
Kristin: an Onion headline. Like this is ridiculous.
Will: Exactly. Right. And what I’ve, I’ve, uh, my understanding is that, um, it’s, it’s almost impossible to successfully sue the federal government. So, uh, I don’t know how this is going to turn out for them.
Well, what are the
Kristin: grounds? Like if, if it was just like, the truth about their business model, then.
Will: Yeah. The
Julie Baak: grounds are boohoo and we call CVS and Express Scripts and OptumRx, the trifecta of hell. If you want to go ahead and jot that down for some new merchandise.
Will: Well, what I’m, what I’m excited about is that, is that it’s, it’s really, all this stuff is.
Is creating more transparency for the general public about what a PBM is because there’s such, there’s such a mysterious thing, this middleman of healthcare that is, is causing so much [00:12:00] destruction in our healthcare system.
Warris Bokhari: Yeah, I mean, they, they obscure the relationship between a doctor and their patient, right?
Because they interlope into that relationship and say, no, you can’t have this medication. You can have another medication, which, you know, P. S. our specialty pharmacy, also us. Uh, well, you know, it has in formulary and, uh, you know, we, we may or may not have a, uh, relationship with the manufacturer. P. S. It’s us.
And we, we’ve literally seen this happen where, uh, patients on, you know, Humira forced onto, uh, Haimeroz by CVS, um, which CVS manufactures. And, you know, you can argue one way or another about switching patients on to biosimilars or not. Um, which is, you know, effectively generic biologics, that’s fine. But when you look at the vertical integration, that’s at play here.
And the fact that all of this is just getting around the affordable care act, 15 percent cap on profits, because they can, they can [00:13:00] effectively create as much revenue as they want through the PBM and pharmacy channel, which they can’t do. You know, they can’t do 3d insurance side. So it makes perfect sense for them to do that.
And, and they’ve been very effective at it.
Will: And it’s, it’s what I think is, is. A, a great thing about this lawsuit that they’re bringing against the government for just telling the truth is, is that typically like there’s discovery in a lawsuit, so they’re going to have to do like the one thing that they probably don’t want to do, which is just tell people about their business practices and so, you know, the truth is going to come out about, about these companies one way or the
Kristin: this is the same thing Uh, people that had an internal meeting about your videos and wanted them, quote, taken off the internet.
Oh, yeah.
Will: Yeah. I’ll be telling you guys. Do you
Kristin: know how the world works?
Will: Exactly. Yeah. I got, I had, I did a video about, you know, Aetna doing a prior authorizations for cataract surgery [00:14:00] requiring prior authorizations for cataract surgery and made a video making fun of them. And, um, I was told. Uh, by a source who knows somebody and we
Kristin: don’t know for sure that it was at Aetna,
Will: but circumstances aligned.
Kristin: Yeah.
Will: And, uh, that, that they were, the chief marketing officer was very upset by my video and wanted it taken down from the internet, which is not how the internet works, unfortunately. And then, you know, if you want to keep your
Kristin: business model a secret, then a lawsuit is not the way to go. Yeah,
Warris Bokhari: exactly.
Julie knows all about this. She gets calls from Aetna.
Julie Baak: Well, and I actually have two cease and desist letters, so I must be doing something right because multi international billion dollar company Cigna is worried about what I’m doing in Bridgeton, Missouri. Give me a break.
Will: So, so, so Julie, tell us about your role in healthcare.
What is it? What do you do?
Julie Baak: So I am the practice manager and the bathroom monitor for the arthritis center in Bridgeton, Missouri. Bridgeton, Missouri is a, [00:15:00] um, a small little, um, underserved population. I take care of poor people. Um, but what I deliver is a concierge level. experience. I have 24 people to support one physician.
Therefore, they take amazing care of my patients. Um, if we have an acute new rheumatology referral and a physician or someone from the physician’s office calls my office, that patient’s in my office in one to three days. It’s unheard of in the industry. Um, but we just work five days a week and we Answer the phone, and we do all the stuff you’re supposed to do, and we do it just for the E& M codes.
Will: And, and then, Warris, tell us about, uh, so you, you’re no longer a practicing physician. When did, when did you give it up?
Warris Bokhari: I, so I gave it up in 2012. Thereabouts is like a long time ago. I, so I was a resident in anesthesiology ICU in England. Um, we call them [00:16:00] junior doctors, but I think they’re actually adopting the term resident, but,
Will: um, I’ve learned, I’ve learned the difference.
So, and so there’s the difference in terminology, but yeah,
Warris Bokhari: yeah. Kind of same thing. And you were very recently I saw. Um, but yeah, I mean, I was an NHS doc. Um, I got kind of burned out by some of it. I think just being in a, being in a, an environment where I didn’t have like a lot of support for like some of the very, very complicated cases.
And like practicing medicine either gets easier for you in critical care, or it gets harder because you, you kind of internalize some of, Some of the things you see. And for me, it definitely got harder. And then I ended up, um, meeting this guy called Kerry Mullis who invented the PCR test, um, and ended up working with him on an oncology program and a gram negative sepsis program.
And I remember thinking, I lost a lot of patients to gram negative sepsis. Which was really like, it doesn’t matter how quick I was on any given day in the [00:17:00] ICU, I couldn’t be, you know, faster than meningococcal meningitis. Like, it just was an unwinnable war. So like, doing something at scale made sense.
Then I ended up in corporate America, uh, you know, worked in a variety of roles. I was at ge, uh, I was at Apple, uh, you know, and then I went to the dark side and became Timothy in an insurance company, and
Will: yeah.
Warris Bokhari: Yeah, I’ll take questions on that.
Will: Well, yeah, actually, well, I mean, you’re, cause you’re coming from a different system entirely, right?
You’re, you’re, you grew up, you started, you know, your introduction to medicine was in the NHS, which is very different than how, um, our system works in the U S. And so did you know what you were getting into whenever you started working, uh, for, uh, one of the main big insurers?
Warris Bokhari: Um, I don’t think I understood it very well.
I don’t think I understood this idea of like, oh, the patient, the patient episode is really just a claim and claims can have various fates within [00:18:00] an insurer. I don’t think I had any idea of what that would mean. to a patient, uh, and I had no idea, like, how many of these claims get denied or pushed back to the provider for, like, clarification.
I’d never heard of prior authorization before, and my only real exposure to it had been reading Elizabeth Rosenthal’s work. Um,
[music]: and,
Warris Bokhari: you know, she, she wrote extensively on, on, you know, the pains, uh, inflicted on Americans, either through unaffordable healthcare and then latterly through denials. And I got really fascinated at wanting to unpick that problem.
So even when I was on the insurance side, I was working on programs to give Medicaid patients access to better care and using digital health to like really do that. And we were successful. Like we actually kept a lot of Medicaid patients out of hospital, not through denial, but like getting ahead of their symptoms and asthma.
Um, and, and that was good. But when I realized that Insurance didn’t really care about scaling these solutions and the work I was being put on [00:19:00] was just super not inspiring.
Will: I
Warris Bokhari: wanted to get back closer to patient care.
Will: Right. And so, was there, I guess, how long were you working there? How long were you in that
Warris Bokhari: environment?
About two, about two and a half years. And, you know, when I started it, no one knew what remote patient monitoring was or digital health. And they just, they’re like build a team. So I brought in all of these amazing people that I worked with at Apple. I brought in, um, you know, great humans who understood like, you know, health economics and health policy.
And we took a real kind of patient centric approach, like, okay, how do we build a program, you know, in Stanford, Connecticut for, you know, patients. You know, black Medicaid members to ensure that I get to appointments or, you know, how do we focus on, you know, um, re removing copays for specialty meds, et cetera, et cetera.
And what, and what a good solutions for women’s health. Uh, if we expand what’s considered women’s health from just beyond fertility, which is like an overly narrow definition into all of the other aspects. So like that was kind of a thesis of a team of being really [00:20:00] Socratic and like taking like a scientific approach to solving problems.
Um, and then COVID hit. And then it just became like an unbridled, like, disaster of like, trying to like, You know, um, keep patients out of the ER that didn’t need to be in the ER. And I remember just dialing for dollars for about six months of like everyone I knew putting together like a coalition to get masks to hospitals and whatever else.
And then suddenly everyone became a digital health expert within the company. And none of these people had any idea about patient care. And at that point I was like, no mass, like none of these solutions are going to help people.
Will: I see. So that was my next question is how, because it sounds like you were, you were being set up in this company to do some actual good work, right?
To help people. And so there must have been a tipping point, right? Something that just was. You know, tip the scales, uh, towards the opposite of that. And you realize that this is not a place for you to [00:21:00] do what you want.
Warris Bokhari: I mean, I would, the horizon was very short to like really do real patient, real patient centric things because insurance companies are governed by the quarter.
And so maybe you’ve got two or three quarters to like show results. But like, if you think about a diabetic patient, you want to show like an improvement in outcomes. That’s going to take you. You know what, it’s gonna take you more than a quarter because what’s the life of a red blood cell. Right. So how do you prove it?
And then they would never do studies that, that big, but no one’s going to fund that. Um, so it gets hard. And then, you know, some of the women’s health studies were just kind of not fit for purpose. And, uh, and I kind of hit a point where there wasn’t a lot of intellectual truth in the work we were doing and it just wasn’t worth my time because I didn’t think it was really going to help patients.
Julie Baak: And you also realized they were just kidding.
Warris Bokhari: Yeah, of course. Like, there was that kind of unseriousness to it. And I think the last thing I saw was the appeals, like the grievance and appeals process. And I was like, Oh, this is a catastrophic mess. [00:22:00] Someone should do something about this.
Will: And so, so you left and decided to really dive into the patient.
Advocate, health advocate type of, type of work and tell me, tell me about the, you both of you went recently to a health advocate summit, right? That was in Las Vegas. Tell us, tell, I would love to hear about that being on the, the, the, the light side as opposed to the dark side and, um, some of the pushback you might’ve received from.
From the dark side.
Julie Baak: CVS got all butthurt and filed a complaint against us. We both were called separately by the organizers of the summit to get our side of the story.
Will: Well, tell us about this. Like what is the summit? What was the
Warris Bokhari: summit? The summit is like a three day thing in Las Vegas, which convenes like people trying to solve healthcare problems for patients.
Right. So it’s a lot of people like Julie. And Julie’s colleagues in other states who are all, you know, trying to keep these independent practices alive and get care to patients. Right.
Julie Baak: [00:23:00] And I was actually asked to speak with my colleague, Nilsa Cruz, who does what I do in Wisconsin. And, uh, the title of our talk was social media is the new prior authorization.
Right. And like, We’re writing stuff like, come here, these two spill the tea, which is completely out of the box for what, you know, most of the time it’s like these big, long, boring things. And so wars came down to, and, you know, we are just constantly getting in trouble constantly. Yeah. I don’t know what to say.
I mean, CVS was the sponsor of this and they’re the fricking problem. Okay.
Will: Yeah, how does that happen?
Warris Bokhari: I mean, it’s kind of like, it’s kind of like an arsonist sponsoring like a firefighters convention. It doesn’t make sense, right? Like it, and we were told that this particular team at CVS were really brilliant in solving, you know, patient problems and provider problems.
So like, we were just really curious. And now I happen to be wandering around with my Sony camera, you know, videoing people and talking to people. And so I wanted to talk to [00:24:00] CVS and just get an honest perspective of like, how is it that you guys are like the heroes here? But like, you’re also the reason why this summit exists because people have to unpick the madness you unleash on the healthcare system.
They got very unhappy. Were
Julie Baak: you, were you wearing
Will: your vest? I should have done it. You know
Julie Baak: what? That was a mistake.
Warris Bokhari: Should I, should I get invited? I don’t get invited back to a lot of places. I don’t think you’re going
Julie Baak: to get invited back there.
Warris Bokhari: No,
Julie Baak: probably not. No, people were running around going, whoever’s following Julie Bach around is filming people.
And we’re like, everyone’s on film all the time. What are you guys talking about? Like, and then also CVS had this special Stupid booth. And they had, I don’t know, six or eight people there. And then they all sort of, it was like a flock of geese. They were going around him to keep him away from us. And we were charming and lovely.
We weren’t, you know, actually Like zero percent rude at all. No, I can be, [00:25:00] I can be rude, very rude. But I was not in that moment.
Warris Bokhari: We were just at another conference where we got into trouble. We were in
Julie Baak: Nashville. Every place we go, we have a problem. Um, where, what were we doing? We were at the CSRO, the Coalition of State Rheumatology Organization.
Um, there was another problem involving you and a camera. Somebody asked him if he was the venue photographer, despite the fact that he has a name tag that says Morris Bakari, M. D. And I’m like, yeah, he’s the venue photographer. I could be like,
Warris Bokhari: I’m reasonably good. People are often in focus, not always.
Julie Baak: What did we get into trouble there?
It was
Warris Bokhari: you and, you and the guy.
Julie Baak: Never seen,
Will: never received any death threats, have you? Hopefully not just cease
Julie Baak: and desist letters, but cease good. I have to tell you, cease and desist letters make for great Twitters, you know, tweets and I also have incorporated them into my slideshow. Oh, there you go. Good content.
Will: Yeah, it is. I probably do the same. Great
Julie Baak: content. Yeah. I’m surprised you haven’t gotten one.
Will: Um,
Julie Baak: satire is [00:26:00] useful.
Will: Yeah. I, I, I get a, I get a little bit more leeway because it’s a lot of, uh, comedy protected by law. Does this protect
Warris Bokhari: me?
Will: I have some, I think so. You’re wearing that it’s, it’s clearly a parody of Patagonia.
And, and so while you’re, you can say anything you want while wearing that. Yes, absolutely. I can’t, I can’t protect you from the hordes on social media, but, uh, you know, uh, the insurance company, sure. You’re fine. Let’s take a, let’s take a short break. We’ll be right back. All right. We are back with, uh, Warris Bakari and Julie Bach.
Uh, and so let’s, I want to dive into how you really started to do the work on like denials and prior authorizations. Can you, do you have a couple of examples or an example of maybe a difficult. Denial that you had to deal with or work through and that really [00:27:00] encapsulates the problem that you’re trying to solve here.
Warris Bokhari: Uh, I’ll, I mean, I’ll, I’m happy to start. So I, I spent a lot of time wondering if this problem really existed. Right. So Elizabeth Rosenthal wrote this like brilliant article in the Washington post about denials getting stranger and weirder. And then I dug into some of her KFF data and I was like, wait, 17 percent of claims are denied, which means that there’s.
You know, 850 million denials out there and there’s only about, you know, one to two million appeals ever filed in a single year. So if you think about it and you, you, you think 800, they’re not 850 million insured Americans are like 300 million. So if you, if you do the math and you think that, you know, and the average person sees a doctor three times a year, how many.
patients. How many people are really getting affected? And the number I came up with was about 80, 80 and 90 million Americans are getting denied. And then there’s so few appeals. So what happens to these people? So I got curious inside looking on Twitter [00:28:00] and I found Julie taking a flame, a flamethrower to the insurer.
So I, so I called up, I called up the practice. I’m like, I’m a doctor. Please don’t hang up on me. And she’s like, I didn’t hang up on physicians and you need to come here and see what’s really going on. So like the following week, I think I would like showed up at the office, um, and we started working on patient cases.
So like, I don’t know, maybe you want to talk about, I mean, listen,
Julie Baak: I had to chuckle when he said, I just wanted to get closer to the patient care. So where does he go from there? So at this point in the program, I’d like to thank Cigna again, because had I not terminated my contract and trashed them on Twitter, all 900 of my followers, um, I wouldn’t have met Warris.
So yeah, so he, he calls me up and he’s like, Hey, what, what are you doing over there? And I’m like, listen, I’m the bathroom monitor in Bridgeton, Missouri. I’m dealing with about 50 denials a week and I work every one of them myself. I mean, obviously I have a huge team of people, but anything that they can’t get [00:29:00] approved comes to my desk.
Sometimes it would take me a hundred hours to get one patient approved, but I am here for it. I have a skillset that, um, you can’t win with someone who never gives up. That would be me. Um, and. You know, in rheumatology, there’s a giant target on our back because of the price of the drugs we prescribe.
Right. And it doesn’t matter if it’s infusion, oral meds, or sub Q. When these patients need, are on the right medicine, we do not do a non medical switch. We were talking about that earlier. We made two non medical switches in 2020, and both of the patients had such severe reactions that they were, you know, Transported to the emergency room and I filed two med watches with the FDA because those became my prior authorizations for any other non medical switches.
I don’t care what company it is, that’s just how it is.
Will: Right. And part of the problem, just for context, is that PBMs will change their formularies. [00:30:00] Based on how much money they call them rebates, how much money they can get kicked back to them by the pharmaceutical companies. And so they’ll change what’s covered on their formulary based on that, which causes havoc for, for physicians and for patients, because all of a sudden.
A medication a patient has been on for years and stable and healthy, all of a sudden insurance won’t cover that. And it covers an alternative that maybe doesn’t work as well or doesn’t work at all for that patient. And so you’re stuck between a rock and a hard place of, okay, well, do you make the patient pay out of pocket or do you?
Roll the dice and switch them onto a medication that might not work.
Warris Bokhari: I heard a case at the, at the conference we were at, um, last week where the doc was telling me that the patient got switched off originator biologic onto like a biosimilar slash generic biologic, if you [00:31:00] will, uh, and the patient was getting, uh, pulmonary issues from, from their rheumatoid disease.
And the insurance company was like, we’ll only switch them back if you can provide documentation, but they’ve been in a medical emergency. You know, AKA a invoice for a ground ambulance, transporting them to the emergency room. Like they’re not even following their own policies in these cases. So, um, and that, that that’s nowhere in their protocol.
Like there’s nowhere in their criteria that that’s required. Like we, we find them making it up on the fly. Uh, I’ve seen cases where, uh, insurers will change like on the fly, the degree of step therapy they’re requiring a patient to go on. Let us say like, you need to have tried and failed this drug, this drug, this drug.
And then I say, just kidding. And this one, and this one, just kidding. And this one. And really, yeah, yeah. They make it up and they, and they expect people to just go away. I mean, we, we had a case with, um, uh, I guess we can kind of talk about it. It was already [00:32:00] out there, I guess. But the, the, we had a case with Express Scripts where, you know, the patient has.
Cancer is on the only medication that is FDA indicated to be, um, you know, to be given in that situation. It meets their criteria and they denied the patient. And then on the back of it, um, someone there used a fake name to call up, uh, the, uh, patient assistance line at the pharma company and fill out an application for foundation assistance.
Julie Baak: With my information. In fact, I sent it to my office for clinician signature so the patient could go on free drug despite the fact that she had been stable on this drug for two years. Um, it’s just, listen, here’s the deal. Formularies are really, should be called pay to play lists. Okay. Pharma pays, and that’s how it is.
People get confused about formularies, but there’s nothing more than a, the pay to play list. Second of all, it can change quarterly. Okay. So you add in nine biosimilars of Humira, I mean, this is like a [00:33:00] shell game. So. Okay. We draw the line in the sand and we don’t do any non medical switches and I will, I will fight them tooth and nail, but we kind of get our way
Warris Bokhari: a lot.
And then the other, the other problem that exists is that the reimbursement cost for the biosimilars, and this is really the reason that it’s like driving consolidation, the reimbursement cost is below the acquisition cost. So then these provider groups who are infusing these drugs are losing money and then they go out of business or they get bought by a large hospital system.
Which then means the care becomes unaffordable, right? So, uh, we had a patient where, you know, it went from, uh, clinic care to hospital care to copay went from 50 to 1, 600. And then they had an infusion reaction, um, from the care being given at the hospitals, it was either the wrong drug was given or was
Julie Baak: there running an oncology protocol instead of rheumatology protocol.
She
Warris Bokhari: was
Julie Baak: sick for two weeks. Um, how is any of
Will: this [00:34:00] legal? Well, they. You know, they have good lobbyists.
Julie Baak: And they’re writing the rules. They’re in charge of themselves. Optum is so heavily embedded in CMS and HHS, they get to be in charge of everything.
Warris Bokhari: Yeah, I’ve seen your video, they get to write the laws.
They
Will: get to write, when you’re powerful enough, you get to write the laws. Well, tell us, So tell us about, about, uh, get claimable, tell us about this and what you’re doing to try to fight this.
Warris Bokhari: I mean, everybody’s got obsessed with building AI to protect big companies and big health systems. I wanted to do something which was kind of like the ticket clinic, but for appeals.
So, you know, you as a patient can now have, you know, the latest clinical, the clinical evidence brought to bear clinical studies. Uh, we even have like Libraries of precedent where the insurer has been beaten on cases just like yours that we can cite back at them and we use the patient’s words. So the AI takes the patient’s words and crafts it into a very compelling story and then it sends [00:35:00] the appeal by fax and by mail to the insurance company, to state governors, attorney generals, CMS in some cases.
Xavier Becerra, HHS, Lina Khan, if appropriate, like whoever, uh, we’ve got a big Rolodex of who all of these people are. It’s taken a lot of time of like finding, finding humans on the internet, but it’s been rewarding. Right. And, um, you know, you can do all of that for like 39. 95. So the idea being that we wanted to create like a utility feeling AI.
Um, and, and have no interest in collecting success fees, which is, I’ve seen a lot of actors in this business who are like, Hey, we’re going to take 20 percent of your upside. Well, if it’s a 100, 000 drug and someone’s earning 30, 000 a year, how does that work? That patient is never going to have the money.
So we’ve, we’ve gotten patients. We’ve saved millions of lives back, probably in a very, very early scale, like more than 3 million of healthcare value back to them. Um, which has been, which [00:36:00] has been great. Like they’ve been, you know, not to overstate it, but lives that we’ve saved and certainly like very, very, very delayed care.
Um, that we’ve managed to get people, you know, back on schedule.
Julie Baak: He built an AI Julie Bach and, um, that’s what he did because I, um, I fight every one of them and, um, he did an appeals clinic and brought in like, you know, amazing people. I was fangirling over Wendell Potter. Wendell Potter was in my car. I don’t pick up people from the airport, but I picked up Wendell Potter.
Will: Well, so, so a lot of people are in a lot of cases, rightly. Um, skeptical of AI, uh, because there’s, uh, there’s a lot of people using AI sometimes for good purposes and sometimes for nefarious purposes. And, um, and so what would you say to people that are skeptical of either the accuracy or just the effectiveness of using AI for something as this is, this is obviously really, these are tense situations.
Patients are, are looking [00:37:00] at not being able to get their treatment that they need or paying massive amounts of money. So what do you say to them who are, who may be like, Oh, another AI thing. I mean, you know, I
Warris Bokhari: think it’s, look, I think it’s reasonable to be skeptical. Uh, the proof is in the numbers. Like we’re beating 80 percent of these appeals, uh, with appeals.
Right. So. That I think, you know, happy to, you know, continue to share numbers as things, as things evolve and be transparent. Pretty good success rate. How long have you
Will: been, uh, have you had this program going so far?
Warris Bokhari: Four or five months.
Julie Baak: Well, but he’s launching his company, um, this week, so like, we’ve just been working together.
I don’t know. He’s been to St. Louis, what, three times?
[music]: Um,
Julie Baak: so yeah, but I mean, it’s, it works. And what is the best thing about it is it’s not, it. Because it combines the patient story in their own words, you take a 19 an hour employee who has this beautiful written story, but it also looks, she’s like a hundred lawyers that wrote it for her with overturned case [00:38:00] study and law, and all of a sudden it’s like hot potato.
Does it go to legal? Does it go to customer service? Does it go to escalations? Get this off my desk and approve this. Call that crazy Julie Bach and get this overturned. That’s what happens. So
Will: the patients are, they submit that. Their story, I guess, to, to you through the, the website or the app or whatever.
And then, and then the AI is using not only that, but also the regulations in place around this medication, uh, policy that’s out there, like public policy to create this appeal package. Right. It’s
Warris Bokhari: done in real time. So, you know, it’s 20 minutes of air time of Q and a, asking them very specific questions about their health, which a patient like reasonably knows.
I mean, I think that we infantilize patients far too often. And we, and as a result, we haven’t developed good tools for patients, right? We haven’t developed things which are truly usable, but feel empathetic [00:39:00] that feel like an experience that they can tell their story to
[music]: and
Warris Bokhari: like helps them unpick some of that fine detail.
Like. Sometimes you’ll ask patients, like, you know, uh, do you have any, like, does, how does this affect your family? And they’ll say, oh, it doesn’t like, what about your grandkids? They’re like, well, actually I can’t play with my grandkids at all because I can’t get down on the floor. How’s this affect you getting to work?
Oh, it doesn’t. What about driving? Oh, I can’t turn my neck when I drive. And that’s, you know, caused a, caused a couple of, you know what it’s like when you’re trying to like, Unpick a medic, a medical history, it’s the indirect questions, sometimes are very revealing. So we’ve like, we’ve like really thought about experience in that way to like be able to like extract relevant detail from the patient story.
Um, and then the accuracy we’ve just been, we’ve been super careful. Uh, so the reason why we’re, we’re doing this. We’re not open to all conditions and all medications. It’s just the, the, the amount of testing that has to go into like making sure that these appeals are actually filed in good faith and are accurate.
Um, [00:40:00] you know, it’s non trivial to even get to here where, you know, it’s 20 minutes plus 45 seconds to generate the appeal. And then boom, it’s gone. That’s been a monumental amount of work. Sure.
Kristin: What, what are you, um, Covering what, what would be the right word? What treatments is this? What’s the scope of
Will: this program?
Warris Bokhari: Uh, so, so far rheumatology, gastro for UC and Crohn’s, uh, migraine, uh, we met some migraine patients who became like functionally disabled because they were having so many migraine episodes that they could no longer work. And so you start thinking about that and, and, and then you look at the number of migraine patients and all of these new drugs and you’re like, wow, this is an enormous.
Will: I see a lot of migraine patients. Yeah. I’m sure. I mean, I send most of them to a much more knowledgeable neurologist, um, but, uh, but definitely understand the difficulty of getting a hold of some of those medications.
Warris Bokhari: Yeah. And then MS is soon to be added. Um, because there are a lot of MS patients [00:41:00] who get, who get moved around.
It’s not, it’s not a big community, but it’s a, it’s a well coordinated, you know, well informed community who’s willing to stand up for their rights. Um, I’ve started working on cases in oncology, uh, which are. Hugely difficult. So I’ve been doing this very manually right now, but we had a patient with, uh, stage four melanoma, um, who had been denied care for, uh, checkpoint inhibitor induced rheumatoid arthritis, which like I’d never heard of.
So I had to go back to like, you know, reading PubMed and whatever. And I had to write to the guy at the NCCN and say like, Tell me about this. And then he wrote me back and sent me a bunch of literature that I then read, wrote an appeal patient had been delayed from further chemo for nine months. We got it overturned in one day because they folded up like a launcher.
They knew then it, this isn’t that we’re brilliant. I just want to make this really clear. Like there is nothing that we’re doing that is brilliant is that these denials are capricious and when [00:42:00] confronted with reality, they know it.
[music]: Right.
Warris Bokhari: Mm hmm.
Kristin: Yeah, so they’re really banking on people just not knowing these things are happening.
Not doing anything about it and feeling like, well, I got a bill, I gotta pay it.
Will: And we know that based on the percentage of, of appeal, of denials that are appealed, which is abysmal.
Julie Baak: Yeah, right. Well, and the thing is for me as a physician’s office, like I’m just an unimportant independent contractor. No one gives a rat’s behind from the insurance company.
If we write letters of medical necessity, how many, I mean, it’s just constantly, we didn’t get it. Well, yeah, you did, but now the patient has a contractual relationship with the insurance company. That’s a thing. And the patient sends in an appeal. Stuff starts happening because now it’s, it’s serious.
Warris Bokhari: It’s awesome when it goes to the governor and then the governor opens an investigation.
I’ve seen that a couple of times. Yeah. Which is really,
Julie Baak: oh, yeah,
Warris Bokhari: that’s kind of great.
Julie Baak: We had the department of pharmacy, open up an investigation into one of the trifecta of health PBMs. And they’ve been in my office multiple times. I’m like [00:43:00] receipts. It’s my specialty. Here you go. Um, and. That was on the Humira switch to one of the PBM owned and manufactured thing and it completely blew up.
We haven’t heard any problems with Humira getting denied anymore.
Will: I guess this is an important distinction that I think kind of just dawned on me. So this is, these are appeals Coming from the patient’s perspective versus the, the medical practice, which, I mean, you already mentioned how many appeals you process, you know, every day.
And so it carries more weight for the insurer to hear from their customer,
Julie Baak: their member,
Will: whatever they want to call them. Right. Um, uh, and by the way, That patient’s appeal is, is being sent to these very powerful organizations and people. And so that’s why you’re getting the attention of the insurer. [00:44:00] Okay.
Kristin: You know what I would like, you know, the, uh, going back a ways, I guess, but humans of New York, or there’s, you know, um, accounts like good news movement that are just sort of like aggregator. Well, they’re not entirely aggregator, but you know, they just like curate a bunch of. Stories and just publish that, right?
Like different, different things that are happening, right? I want an account like that, that’s just sharing stories. Of these denials, of like, this is what they did, right? This is, this is, this is what they were supposed to do, and then this is what they did. And just making that public, just
Warris Bokhari: That’s in, that’s in my plan.
Like, ultimately, like, I, look, I, I care very deeply about telling, like, human centric stories, and this, like, why, like, I’m continually roaming around with a camera, uh, because to capture the patient stories, like it matters. And like, I, when I was at medical school, the thing that as a budding photographer, and it was like almost, almost a career at one point, but like, uh, it [00:45:00] occurred to me that the medical, um, Uh, textbooks.
Like you’d see rheumatoid hands and the eyes were blacked out. Right? So you like, you’re literally learning medicine, but you’re stripping the humanity away from the patient. You’re just learning the signs and symptoms. Right? Uh, or it’s an eye in your case, but without a face. Right? Um, and, and therefore you never actually understand like the functional limitation that this brings to a person.
You never really understand like the things they can’t do. Um, and actually at school I wanted to do facial plastics and a lot of it was like oncological reconstruction. I did like quite a lot of research on that in my twenties. And like you would, and you would just see that like a lot of these patients with severe facial disfigurement became completely isolated.
Um, and that was kind of like part of it as well. It’s like this. This exploration. So we’ve been working with a photojournalist, um, who’s a really interesting guy, uh, to capture these stories. He actually was a Pulitzer finalist. Um, he was actually in the [00:46:00] Capitol on January 6th and then, uh, was briefly on the FBI’s most wanted until they realized he was press.
I
Will: was about to say, he’s on the good side of January 6th, right? Fascinating. Yeah,
Kristin: I think we need more, more of those public, you know, places that they can’t control like social media, making it public, what it is they’re doing, because they require so much, uh, you know, confusion and silence around it in order to get away with these things.
And there are
Will: some. News investigative journalism outlets that are doing some of that work like ProPublica But it’s not enough and I there needs to be something that’s a little bit more Digestible.
Kristin: Mm hmm a
Will: smaller scale right
Kristin: cuz even like I am an intelligent
Will: TikTok
Kristin: educated person with an advanced degree and I’m having trouble following all this right because it’s just so
Will: Complicated.
Kristin: It’s complicated, and it’s obfuscated, and it’s intentionally so. So we need things that make it very simple and illuminated. If
Will: only there [00:47:00] was like some kind of social media, maybe even like a comedian position. Like who, who could maybe like take some of these things and like, just like 90 seconds. I don’t know.
You could dress up in characters. Maybe, maybe that guy should get
Kristin: to work. I don’t know. We’re,
Warris Bokhari: we’re happy to give you stories. We’re happy to give you material. We’ve talked about it. And
Will: it’s. So it needs to do needs to get to work.
Julie Baak: Yeah. Well, the other part of the forces of the, of the claimable appeals is the last two pages are, and by the way, if you uphold your denial, this is my request for the entire claims file from the past three years, which includes recorded calls.
So you get that little bomb on your desk and now you’re looking at that cost and the insurance company or more. And they’re like, get. This approved an audit here. But, but I think that the important thing here is every one of us is a patient. Every one of us has been delayed or denied care. So it’s a super relatable thing.
Warris Bokhari: The, I [00:48:00] would put it, I would not, you know, I was thinking about this, uh, Breaking Bad would never have happened if Walter White was just able to appeal for out of network coverage. For, uh, for his chemo, he would have had no need to ever become a meth cook. It would have been a very, very short and very different show.
Julie Baak: That’s true. 50 bucks. He would have been got, he would have gotten care. Yeah. He
Warris Bokhari: would have been like, okay, I’m done.
Kristin: Yeah.
Warris Bokhari: So
Kristin: what about the patients that maybe can’t afford the 39. 95 per appeal? Are there any plans in place to help those people?
Warris Bokhari: So great question. Couple of things to know. So when we were developing this, we did a bunch of research with a group called Savvy Patient Cooperative, who anyone building a digital health experience, like they will save you years of your life by, um, corralling like actual real Professional patients to come talk to you about your, about your business, your business model, they give you the lived experience.
And so we did like a lot of price sensitivity testing. And when we, when we showed people, what do you think this costs? The [00:49:00] average answer was around two to 300. So, and then when, and the question was very simply like, at what price would this be a bargain? At what price would this be a ripoff? And the median was around 80 would be like what people would think would be acceptable.
So we’re pricing under that, but if someone can’t afford it, We’ve had so much interest from pharma and from distributors who are kind of saying like, look, we’ll pay. Um, and then we’ve also got clinics who are saying we will pay for our patients. Like you have a character of it’s rural medicine. There’s a, uh, I met a clinic in Oklahoma who are like, look, we, we don’t want our patients to pay for this.
We will pay for this. It’s a time saving for us.
Will: Right. And.
Warris Bokhari: And
Will: so huge time saving. Like that’s, that’s what I was thinking. It was like, you know, hospitals, clinics, independent clinics who are, who are sometimes just fighting for every cent they can get, um, would probably greatly benefit from something like this.
Julie Baak: Well, and we’ve talked to pharma about, um, giving the patients a voucher because they’re [00:50:00] paying to put these patients on free drug anyway. So you might as well make this a step before you pay for free drug. They have to make a patient appeal and they’re getting a return like this.
Warris Bokhari: Yeah. Yeah. Because they know they should be doing it.
So, I mean, that’s, so that’s certainly, that’s certainly part of it. Um, but yeah, I mean, affordability is like on my mind, like I essentially grew up in a Medicaid family. I had two disabled parents. So like thinking about what that means. To people, but if it means that, uh, the patient gets access to a medication, that’s hundreds of thousands of dollars, um, then, you know, they might, well, they might, we’ll do it.
A manual case we did was a liver transplant, uh, a
Julie Baak: hundred hours of this time, like
Warris Bokhari: took me a hundred hours to write that appeal. I’m not sure we can really automate that, but the guy. Got a liver. He’s at home. It capitulated
Julie Baak: in five days. Yeah.
Warris Bokhari: They just rolled, I mean, and they were using criteria from 2002, just FYI, which is when I started medical school.
Will: Right. Well, I’m glad, glad to hear [00:51:00] that you’re really, you know, you have that in your mind in terms of affordability and trying to make this accessible to people.
Kristin: What can people do? Um, is there a place on, on their, your website where they can contact you if they need that financial assistance or
Warris Bokhari: there’s a support, there’s, there’s a support, um, but in, but in theory, um, it will leave, like they will be referred by the practice or they can do it themselves.
So, you know, we’ll look at it on a case by case basis, but we think the price is pretty reasonable given, you know, given, uh, where, uh, you know, given the research we did and, and kind of the acceptability overall.
Julie Baak: Well, and the other thing is that I’m really good at my job, but he’s better. The first three cases I gave him were cases that I couldn’t get overturned.
And I thought, let’s just go, baby, let’s do this. And most of them capitulate in five to 10 business days. But he and I worked on a case. That overturned in two hours. These people are so sick of me, so sick of me. I’m [00:52:00] sure it’s like an email from Julie Bach. So I want patients and practices to have a Julie Bach because he’s better than I am at this.
Will: Well, by the time, uh, this episode goes live, uh, people will be able to go to your website and sign up if you want it’s, uh, get claimable. com. Is that right?
Warris Bokhari: Yeah. That’s right.
Will: And, um, anything else you want people to know about this?
Warris Bokhari: We’re, we’re really in this to help the patients. Like this, this is really like, uh, you know, trying to give the patients a megaphone to allow the people who don’t have voices to be heard.
And we want the, you know, ultimately we want the insurers to do better. They may not go anywhere. I mean, I grew up in socialized medicine. That may not be a reality in the United States. And if it was, it might just be optum. But we would. But we want them to do better. Like we want them to engage with our members.
We want them to listen to like, you know, the things they build without ever seeing a member and make it work. [00:53:00] Um, a lot of these things would, would, if they followed our own policies, a lot of these things would never happen.
Will: I think it’s a fascinating program and, um, sounds like a great way to try to. You know, fight these, these denials.
And so, uh, get claimable. com and then Instagram. You have an Instagram account at get claimable as well. So, uh, Warris, Julie, I want to thank you so much for joining us. It’s been a pleasure to talk with you.
Warris Bokhari: Thanks for having us.
Will: Thanks guys.
Hey, Kristen. What? You know what mites do when they get excited? They dance. They dance. They dance all over your face. You got these on your eyelids. You know that, right? I do not. Well, some people do. Okay. They’re demodex mites.
Kristin: Yes.
Will: They cause blepharitis, which is like red, itchy, irritated eyelids, like flakiness.
You want to scratch your eyes and that. Don’t do that, by the way. But yeah, sometimes that’s from a disease. Demodex
Kristin: dance. [00:54:00]
Will: It’s the Demodex dance on the eyelids, except it’s not that fun because it gives you all those symptoms. All right, so, yeah, but they’re cute, right? They’re not, they’re not gross.
Kristin: These ones are, these, these stuffy
Will: versions.
Right, oh, the real ones, not so much.
Kristin: Are the real ones gross in the microscope?
Will: They’re, they’re still, I think they’re still cute, but again, I’m an ophthalmologist.
Kristin: Yeah.
Will: But don’t get freaked out by this. Okay. Get checked out. All right. All right, you can find out more, go to eyelidcheck. com. Again, that’s E Y E L I D check.
com to get more information about Demodex and Demodex Blepharitis.
Well, Kristin, is your head a bit spinning from all of the health policy discussion?
Kristin: Yes. Why does it all have to be so complicated and confusing? Um, hopefully a lot of people listening to this, you know, are familiar with it, at least somewhat through, um, their jobs. We do have a large number of healthcare workers listening.
Uh, but for those of [00:55:00] you who are not, um, I don’t know, I hope, hope you hung in there. I think it’s important and I am interested in it. So
Will: this, um, this really, this is
Kristin: part of the problem
Will: that
Kristin: if an intelligent person can’t. Understand everything that’s happening, like we need to back up a few steps and make it clearer.
This is something that affects every single American.
Will: So, I think the, the most fascinating thing about what they’re doing is coming at this from the patient side of things.
Kristin: Mm hmm.
Will: The, the appeals process.
Kristin: Yeah.
Will: I, I didn’t put that together, the fact that we’re always so focused on, oh, the medical practice, the physicians, we have to like do these, we have to try to get things covered.
I do it with my testosterone replacement. It’s like, I don’t do the appeal.
Kristin: Right, the doctor does. Like, the doctor
Will: does the appeal because ultimately, like, they’re the ones that need to get paid for a lot of the work they do, right? I’m just trying not to have to pay too much.
[music]: Right.
Will: But [00:56:00] so the idea of having the appeal come, basically doing the work for the patient and submitting it, I could see that as being, having much more weight with the insurer.
Yeah. And so I think that’s, that’s, this is the first time I’m really hearing of somebody, cause a lot of people are doing work on trying to do this. Limit the amount of denials and things, but
Kristin: that’s like a reimbursement perspective
Will: from the patient side of things, where you do the work for the patient and that it’s coming from the patient.
Sure. Like AI is involved in that, but they’re still taking the patient story. And then, so,
Kristin: right. I would love though, to see that. I think it’s a wonderful first step. Um,
Will: but we need it in the first place. Well,
Kristin: that’s right. That is ridiculous. But also I want patients to. I want me and other regular people
[music]: to be
Kristin: able to understand what it is that’s happening, what work is being done on their behalf.
[music]: Yeah.
Kristin: [00:57:00] Like, can AI explain it like I’m five? Right? Like, what is going on with these things? People, if they are end users of this insurance policy, they need to be able to understand the policy. That, I think, is a huge part of the problem because insurers are relying on the fact that we don’t understand our policies and we don’t understand our rights and we don’t understand the process by which we can make appeals, uh, they’re relying on that.
And so I think something that, that first of all, draws attention to the fact that all this is happening. And secondly, educates patients in a simplified manner about all of this is also necessary. Not sufficient to solve the problem, but certainly necessary.
Will: Yeah.
Kristin: So somebody get on that. This is the idea of the day.
Will: Do it. Do that thing. Do that thing. Well, tell us what you guys thought of the episode. Love to hear your thoughts. Email us knock, knock high at human [00:58:00] content. com. Visit us on our social media platforms and our human content podcast family. They’re on Instagram and TikTok. They’re doing a lot of cool stuff lately.
Kristin: Yeah, they got a lot of cool podcasts.
Will: A lot of really good stuff at human content pods. Thanks to all the listeners leaving feedback and reviews, we love those. If you subscribe and comment, by the way, if you want to just comment, you can, but we really do appreciate the subscriptions as well. Uh, on your favorite podcasting app or on YouTube, give me a shout out, our YouTube channel at Glaucomflecken.
That’s right. That’s where we post all these. At Jessica Young 8530 on YouTube said, I look forward every week to your episodes.
Kristin: Oh, thank you.
Will: We appreciate that. And full video episodes are up every week on that YouTube channel at Glaucomfleckens. We’ll also have a Patreon, lots of cool perks, bonus episodes, react to medical shows and movies.
Hang out with all the people in our wonderful little Knock Knock High community. Early and free episode access, interactive Q& A, live stream events, much more. Patreon. com slash Glaucomflecken. Or go to Glaucomflecken. com. To find more [00:59:00] information about lots of stuff, we got lots of stuff on our website, don’t we?
We sure do. New member shout out, Patreon Community Perk, Scott W., Stephanie M., and Susan F. Thank you all for being patrons. Welcome,
Kristin: all S’s.
Will: Oh, yeah, that’s kind of sweet.
Kristin: Lots of S’s this week.
Will: Lots of S’s. Shout out to all the Jonathans, as usual. Patrick, the CCC, Sharon S, Edward K, Steven G, Jonathan F, Marion W, Mr.
Grandetti, Caitlin Cipriano, LK, L, Keith G, JJ H, Derek M, Mary H, Susanna F, Ginny G, A, Muhammad K, Aviga, Parker, Ryan, Muhammad L, David H, times two! Gabe, Gary M, Eric B, Marlene S, Scott M, Bubbly Salt, and Pink Macho. A virtual head nod to you all. Patreon roulette, shout out to, thanks for doing the head nod. Patreon roulette time, shout out to someone on the emergency medicine tier.
We have Sally, thank you Sally for being a patron, and thank you all for listening. We’re your hosts, Will and Christopher Laney, also known as the Glaucomflecken. See you next time. Special thanks to our guests today, Warris [01:00:00] Bakari and Julie Bach. Our executive producers are Will Fenner, Kirsten Fleming, Aaron Korney, Rob Goldman, Shahnti Brooke, Editor in Engineer Jason Portizo, our music is by Omer Ben Zvi.
Whew.
Kristin: My goodness.
Will: To learn about Knock Knock High’s programs to eliminate the smallest suspicion of everything is analyzed in terms of ever released terms, go to glaucomflecken. com or reach out to us at knockknockhigh com. With any questions, concerns, or fun medical puns, I could do like the fast talking at the end of like, uh, a pharmaceutical I don’t know that you
Kristin: can because you you often don’t enunciate while you’re doing it.
You just kind of Blur your words knock
Will: knock. Hi is a human content production
Hey Kristen What do you think about clinical documentation?
Kristin: Boo!
Will: You feel that strongly about it?
Kristin: I do.
Will: Why?
Kristin: Because your doctor ends up spending all their time typing little notes [01:01:00] on their little computer instead of like, listening to you or looking at you in the eyeballs.
Will: Well it sounds like your doctors could use DAX Copilot.
Kristin: I bet they could.
Will: Yeah, this is like a little Jonathan in your pocket. Yeah! It’s an AI assistant that helps decrease the administrative. Burden that leads to burnout and leads to like your doctors not being able to look at you while they’re talking to you. Yeah,
Kristin: it helps them do their little typing and take their little notes without having to do it themselves.
Will: 93 percent of patients say their physician is more personable and conversational with Dax Co Pilot. You love conversation.
Kristin: I do and I want them to be a person.
Will: And that, that’s, and that we need that because today’s physicians are overwhelmed and burdened and they feel like work life balance is unattainable.
Kristin: That’s right. And
Will: we know that work life balance Makes you a better physician.
Kristin: That’s right.
Will: To learn about how DAX Copilot can help you reduce burnout and restore the joy of practicing medicine, visit aka. ms slash knock knock hi. Again, that’s aka. [01:02:00] ms slash knock knock hi.
