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
Either your doctor is an employee of the hospital. and works for the hospital, which is directly controlled by the insurance company, okay? And so they're essentially an employee of the insurance company, or your clinician owns the hospital or surgery center, and then they dictate to the hospital and surgery center the protocols and procedures.
And in those instances, they're oftentimes having to bill out of network which is a whole nother racket because when you bill out of network, you get paid a third of billed charges. So that's why when people go, what the hell? My MRI was $6,000. It's because they know that they're only going to get paid a third of what they bill United or Cigna. And so they have to inflate their bill by threefold.
But the insurance company sets you up for failure by saying you have to go after the patient for any short pay. So this is where people get into these medical bankruptcy issues because if I go to United Healthcare when I owned a blood lab and I said, United, I want to be in network. Their answer is fuck off. We don't want you in network. We don't need you.
We've got blood labs that we have browbeat for 20 years and we've got them negotiated down to a dirt cheap price. We don't want another in network lab. So I either lay everybody off and go out of business
go to a cash model which is what i do now or you do what's called billing out of network and if i were to i'm going to use blood as an example if i were to bill the the panel we run at ways to well if you were to walk in to a quest and i've and it's happened because i've had us the biggest right yeah i've had ufc fighters that are our clients and stuff walk into quest and they give them an insurance card and they quote them three thousand dollars for our blood panel
And they'll call me and go, oh my God, dude, they're quoting me. I'm like, no, no, no, no. Give them our code. It's a $300 deal and they bill me, they don't bill you. Like, I got it. And they're like, how can it be $300 when they're charging $3,000? And so it's because once you've billed a panel at a rate by law in the contract, you have to bill the patient for that rate.
And so if I take insurance at a blood lab and I'm out of network and I bill the insurance $300, they're gonna pay me a hundred. I can't run, I'll lose money. I lose $200. So I have to bill them $900 to get paid $300. Does that make sense? And then in the instance that the insurance denies,
One of the denied to pose, you know, if they deny, I am in my contract required by law to go after you for the additional money. I have to chase. Yes. I have to chase you down, but I never wanted $900. All I wanted was the $300 you owed me in the first place. That was it. But I can't get that because you won't give me a contract.
And that's what's happening with surgery centers, MRI centers, hospitals. There's in-network and there's out-of-network. You, the patient, oftentimes pay for out-of-network benefits and coverage. And then the insurance company tries to deny it and make it impossible for you to get that. And oftentimes clinicians are out-of-network.
Like the biggest, baddest, best, brightest minds for orthopedic surgery in the state of Texas, arguably is University of Texas, UT Medical School. UT Medical School is kicked off. of Optum and United Healthcare's plan. So if you're, let's say you blow an ACL, you know, the Texans, Rockets, Astros, Team Doctors, all those guys, for the most part, are either at Methodist or UT.
Well, you can't get to those guys because they're out of network for you. If you have an out of network plan, you can use it and pay a bigger co-payer deductible to get to go see those guys. Does that make sense? Yes. But they have to bill them out of network and they'll get paid a percentage of the bill charges.
I think what I tell people is the same way these insurance companies are using AI algorithms to deny coverage, they are going to use large language models and AI to obstruct your ability to get care. The last person in the world you want digging through your underwear drawer is the federal government, but the second is the insurance companies. You don't want them to know your blood work.
You don't, unless you need a procedure or something that's coming up that's catastrophic because they're going to use it and use AI to screen you out of their system. Right. And if they think you're headed towards a catastrophic event, like a heart attack or surgery or cancer, they're going to want to get you out of there before that manifests.
And the average person is employed or is insurance comes from their employer. And so if I'm a CEO at United and I know you're headed towards, you know, something catastrophic. I can delay your ability to uncover that through putting these obstructions on things that don't make me money. Oh, come on. You think they would do that? Oh, absolutely. Like diabetes is a prime example.
That's why they don't allow you to get comprehensive blood work. That's why they delayed women's care. Like the OB-GYN initiatives were saying that we should be screening for certain genetic disorders in your 20s. And the insurance company said, no, we think that number should be 35. And all the clinicians go, okay, the number's 35.
And so now women don't get that screening to see if their child's gonna have a genetic issue unless they're over the age of 35. And there's hundreds of examples of this. So I think what happens is I'm an executive at United. The whole system's built for quarterly earnings, quarterly profits. I gotta hit that number for Wall Street. Let's just say I'm managing 100,000 patient lives.
Every day, month, week I can delay those individuals is another day, week, and month that I don't spend money on a surgery. And if I deny those surgeries and only 10% of them come back and fight me on it, step one is to deny.
They don't want to treat preventative. And so anything preventative is proactive.
Here's an example. They will say these things are expensive. So the screening tools we use in health care are dated. This is why we have moved to a cash pay. Our clinic weighs too well. We've become a big name because of Joe. We helped Joe. We helped Aaron Rodgers. We're in the Aaron Rodgers documentary. But everything we do pretty much is not covered by insurance.
Almost everything we do wouldn't be covered by insurance anyway. And it's not that it's crazy expensive. It's that it's just not part of their ecosystem. Our job is not to push drugs.
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