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
And then even if you get the procedure approved and everything's hunky-dory and you go have the surgery, they're going to tell you who to go to, where to go, and then they're They're going to take 90 days to pay the hospital back or the surgery center back. And that surgery center holds the bill. But here's where it gets even more fucked up. They set the co-pays and deductibles.
Sorry, am I allowed to cuss? I didn't even ask you that. They set the co-pays and deductibles. And so oftentimes your employer offers you 10 different plans. Like I employ 300 plus people. And so... I let my employees choose the plan. They have an option between like 10 different plans. My young people will usually choose a plan that has a bigger out-of-pocket expense.
Maybe a $10,000 deductible on a surgery. The way they word the insurance contracts is they make you the hospital or me the lab. Like when I had a genetics lab, there were times I had to go after the patient for a $5,000 deductible, right? I don't want to. It's not what I... I don't want to play, you know, collection agent on a patient. But the way they word the contract is...
If I didn't collect the co-payer deductible, they have recourse. They can deny the claim and never pay me for the procedure, the surgery, or the lab screening that I did. And so I have to show a reasonable effort to collect. And if I don't, they can do an array of things. They can deny the claim. They could come back and say, we're going to do an audit. This is where we get into depose, right?
Deny, delay, depose. The depose of the situation is, Let's say I did that spine procedure and let's say this kid's out-of-pocket expense on it was $10,000 and he doesn't have the money. Well, I'm required by law to go after him and make a reasonable effort to collect.
But in the fine print of my contract with United Healthcare, they're going to say if they uncover that I didn't collect the copay or deductible, they can deny the claim and never pay me for the surgery. And so I have to chase it. So then now you get into a dispute with United or like I did with Blue Cross Blue Shield where they just don't pay me.
if i sue them they're going to depose they're going to dig into every time i didn't collect a copay or deductible and they're going to argue that they have a contractual ground to stand on that they don't owe me the money it's it's it's almost like a lie agreed upon they're not they they wait until the deficit gets big and then they put you out of business and then what happens
hey, it's tough out there for a small privately held pharmacy. We're actually buying pharmacies right now. Would you like to sell to us? So, Etna owns, or CVS, CVS Health owns Etna. CVS Health owns CVS Pharmacies. CVS Health owns the PBM. All of that's vertically integrated. They set the price point. They set the copay. They set the reimbursement. They set the deductible.
They also own mail pharmacies, like mail order pharmacies, and they will tell patients, oh, we can get you this drug cheaper if you'll go to our mail pharmacy in an effort to cannibalize and monopolize that patient life so nobody else has access to them. And so they can't see behind the curtain to find out that they're really getting screwed.
that they never should have been paying that price point on the drug in the first place. And so like one of the things we're doing at my pharmacy is we disclose pricing. Like we added, you could search and find out what the real wholesale price is on any drug and research that. And to show a real world example of how dirty this is, Tucker, and if any of it's too much, let me know.
I can tailor this to whatever.
Because it's a lot. Okay, the state of Ohio. launched an investigation, hired 32 forensic auditors, just the state of Ohio, just Medicare, just Medicaid, sorry. Guess what they found? $230 million in fraud from the insurance companies in one year through gap pricing, what they're calling gap pricing, the whole Ponzi scheme I just explained.
They are telling the state, this drug cost us $200, you owe us $200. But the state pays them the $200, they only paid $100. So they made $100 every time that script got written. The state realized that they could negotiate directly with the pharmaceutical companies and get better pricing. So the state of Ohio is saving hundreds of millions of dollars. Now multiply that times all 50 states,
Now multiply that times all the federal payers because Medicaid is just the state. The Medicare program covers the whole freaking country. 60% of the profits of these insurance companies is coming from the taxpayers. So we're getting killed paying taxes to give these guys all this money at the government level. But then we're getting killed on our company insurance plans.
And then as a business owner, I'm getting killed because at the end of the year, they renegotiate the rates and they charge me more, right? I'm paying half of the care of my employees, my 300 something employees, and everything that costs that insurance money, they've taken a 30% markup on. That's why we're facing this mega healthcare expenditure issue in America.
It's not just the pharmaceutical industries. It's the collusion and the capture of all of them working together to essentially screw all of us.
The doctors are making less and less to do more and more.
And we are facing a crisis with that. We have a booming aging population. We have a primary care shortage in America. That's why it takes three to six months to get in with primary cares. And... 80% of primary carers in an interview, I think it was done by Harvard, said they will not be in this profession within 36 months. They don't want to do it anymore. It is a beat down.
These poor people are working their asses off, but they're in a system that ties their hands up.
And then in certain states, clinicians have the right to earn into and make profit off of things. And so because the insurance companies have gotten so dirty and have cut the reimbursement rates for clinicians, clinicians are now looking for ways to make money. And so oftentimes when I say corporate capture again, it's the word of the day. But when I say it, either it's one of two things.
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