Brigham Buhler
speaker
1,533 appearances
6 recordings
5 series
first heard Oct 2024
last heard 27 Feb
Brigham Buhler’s voice in public audio — every appearance, attributed to the second.
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recordings per month · last 12 monthsRecordings per month over the last 12 months — 1 in all, peaking in Feb 2026 with 1.
Appearances
So when we talk about obstruction, right, there's money being made off the prescription drugs. So the insurance companies are okay with you being on prescription drugs. They intentionally put obstacles between you and surgery because they don't make money off surgery. There is no backroom arrangement. There's no kickback. There's no money being paid to them. So that's an out-of-pocket expense.
So insurance companies have structured their plans in a way to intimidate, bully, and stress people out of getting surgery. So like I said, if you're a 20-something-year-old kid and let's just say you said, I'm going to go with the highest out-of-pocket copay or deductible because I'm never going to need surgery. And then you get in a motorcycle wreck and you injure your spine.
Well, now you're on the hook, most likely for north of $10,000 worth of your copay or deductible to have that surgery. Where this gets even shadier is the insurance contract with a MRI center, a lab, a hospital, whatever it may be, screws those entities and leaves you holding almost what I would call a subprime mortgage. You don't have a financial record on this person.
You are required to accept them as a patient. Then you're required to make them pay you the $10,000 copay or deductible. Your contract with United says, I have to go after Alex for $10,000 of her spine surgery. I have to chase you down. I have to make a reasonable effort to collect. That's what the contract says.
So at the end of the year, if I haven't got the money from you, oftentimes I'll settle for a couple thousand bucks. Whatever I can get from you, the patient, just so I can put it in a folder so United can't sue me. And it ends up being a lie agreed upon because that's why hospitals and all these companies are so terrified of the insurance companies. Because let's say I did that a thousand times.
Now United says, Brigham, we don't think you collected your co-pays and deductibles. Well, I did. I did the best I could. The contract says a reasonable effort. They could argue that because I only collected 20% of the money, they don't owe me anything. And they may win in a court of law and never have to pay me. And that would bankrupt me as a hospital or bankrupt me as a surgery center.
And so hospitals, surgery centers, doctors, they're terrified of these insurance companies. They do not want to fight the insurance companies because the insurance companies have them bent over a barrel. They control the flow of patients. They can control the reimbursement rates. It takes 60 to 90 days to get paid on a surgery.
So you're arguing with United for literally three months after I've already done the surgery on you to try and get paid. And then if the dispute gets big enough, they go, show me where you collected Alex's copay or we'll sue you. And it's like, well, it says a reasonable effort. And you and I both know Alex didn't have the $10,000 to pay. I'm chasing her down. Like, it's just not good.
Does that make sense?
Well, I think we have to take away some of the incentives. And one of those would be break up the PBMs, get rid of the middlemen, do not allow them to profiteer off chronic disease and prescription medications.
Okay. And they're saying they're going to go after the pharmacy benefit managers.
Like, yeah. And I've had multiple congressmen and congresswomen and senators reach out that want to understand the insurance companies better. And if they were to just remove those incentives, then they're not at least making these billions of dollars in profit off of our prescription drugs.
Yes, yes. And I think that there's, there is a, it is known now, like the roof has been blown off this thing. It's not a little secret anymore. They know that these PBMs are profiteering big time off of chronic disease. And they say they're going to take it on. It's going to be an uphill battle and it'll be a bear battle.
I hope not. I hope not. There's, you know, part of politics is horse trading, right? And if they're going to implement things that hurt big pharma, which, you know, is what supposedly is being said, like some of these safety nets and protocols and vaccine protocols and, you know, taking off some of these protective covenants.
These are all things that would be bad for big pharma's pocketbook, candidly. But if we were to dissolve PBMs and shut down middlemen, Big Pharma wouldn't have to negotiate rebates and inflate their price. And so in a way, they could keep more profits. And so it is it would benefit Big Pharma.
It would hurt the insurance companies, but it would most likely benefit humanity because now they're not making money off of selling us prescription drugs, which is a huge conflict for the insurance companies.
I think you escape it through being educated through the consumer voice. Uh, I think it may have been you at the Senate that said like, we have the ability to fight back through our choices in our pocketbooks. You know, we know that mothers control most of a family's healthcare.
Most of the time it's the moms making the decision on what doctor they go to, what pediatrician you go to, you know, the best thing you could do for you and your family is is to find a cash pay clinic and try and go at least once a year. Get a second opinion. That's where I was going earlier. How quick do we... You take time if you're going to remodel your house. You interview contractors.
You look at their work. You understand them and their character. Why would you not do that with somebody who's controlling your health? Like this is your one time, your one shot at living a healthy life is right now the bodies we have. We never get another one.
So take the time to find a great clinician that cares, that's passionate, that wants to help you, that will do the deep dive, that will have the conversation. And if a clinician doesn't like that you're Googling and researching things yourself, to me, that's a red flag. Like there's clinicians out there that get offended if a patient's Googled. But you should. You have to be your own advocate.
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