In this episode of Navigating H.O.P.E., Dr. Jaime Hope sits down with Dr. Hooman Melamed, a renowned orthopedic spine surgeon specializing in minimally invasive treatments. Together, they explore the alarming impact of insurance denials on patient care, sharing real-life stories and practical strategies for patients and doctors alike. Dr. Melamed draws from his extensive experience to discuss the frustrating barriers created by insurance companies, the emotional and financial toll on patients, and what can be done to fight back. This episode is a must-listen for anyone navigating the healthcare system, providing critical insights into advocating for the care you deserve.

 

Transcript

00:00:00 [Music] welcome to navigating hope your compass to health empowerment I'm Dr Jamie hope steering you through Health Care overcoming overwhelm personal goals and emergencies we'll navigate the healthc care maze with actionable insights and real world advice unlocking the secrets to a healthier more vibrant life join us to take control of your well-being and make informed decisions for your health and your future stay with us as we unravel the mysteries of medicine wellness and life's unforeseen challenges helping you bypass

00:00:39 the ER with a dose of knowledge stay tuned till the end of the episode with a recap of your actionable insights and a free gift let's chart a course to your well-being together all right hello navigating help audience I am excited to be back here with a very important repeat guide Dr Hooman Melamed who as you know from a previous episode is a renowned spine surgeon but here today we're not going to talk about the pain control and the surgical aspects of back pain but we're going to talk about something that can

00:01:12 be significantly more painful and that's dealing with insurance companies and all of the frustrations that come along with it now with the murder of United Healthcare CEO Brian Thompson this has certainly really brought this to the public eye and all of the things and you know the suspect Mr Manion has said you have had significant spinal problems surgical reinforced spine he's he had this complex treatment and it seems that he may have been very frustrated with insurance denying his access to care and

00:01:42 while we certainly do not condone violence there it underscores how significant this problem really is and how many people are denied care based on that so Dr melan thank you so much for coming back to be with us today good morning thank you very much for having me thank you it's a pleasure to be here again thank you so this is a topic we're we both get a little fired up and spicy about so so let's start so you are your job is to help people you've dedicated your life your career to help get people

00:02:11 out of pain and get people functional and what is your biggest barrier interference by insurance companies in delivering quality care to patients nice so tell us some examples of how this looks for patients patients care is all the time getting significantly delayed and it could be I'm talking a patient that needs let's say an urgent treatment done needs to get an MRI right away I mean we're talking or surgery can be delays up to few days few weeks few months even imagine you're in unbearable pain and

00:02:49 you have seen surgeons and you choose your surgeon and basically you're told surgery is not medically necessary or experimental surgery and you have to go through appeal after appeal and it could take months basically months and months so this is unfortunately a repeated too often of a pattern that something has to happen like this is unacceptable like it just can't continue going forward like this yeah it's very frustrating because and you in your previous episode you said you are not somebody who just

00:03:25 rushes people straight to surgery you're not someone who says everybody should get this you do a very individualized patient approach try to go with the most minimally invasive thing that's appropriate in that situation and still despite you being such a judicious Steward of resources you're watching patients suffer yes so I pride myself in surgery last resort and listen this is the thing but I want to make it very clear is I get it there are in every profession doesn't matter your plumber your uh

00:03:59 engineer your electrician dentist doesn't matter who you are there's always some bad apples we know that same with medicine you know we both know there are bad Physicians unfortunately it's just the nature of that's just how it is so I get it you want to protect patients against bad you know doctors bad surgeons who do unnecessary but I've been in practice 20 years and I would go on the record and say I want insurance company to come and tell me that in 20 years have I ever done an unindicated surgery have I ever done a surgery where

00:04:32 the patient basically called and says you know what I didn't need this surgery done you did unnecessary surgery on me it wasn't necess it was too much surgery I have never ever had that allegation never ever and still after 20 years I'm getting Deni 60 70 80% of the time for what I want to get done wait what you're deny getting denials of up to 80% despite your Inc impeccable track record that's what's very frustrating yes it is I feel like you know the problem is I don't go based on insurance company

00:05:07 guidelines I don't even you know I don't even look it up I because to me I practice what is right for the patient you know you can't do a cookie cutter approach every patient deserves an individual so I go through it okay this is the problem this is what we're doing right now for example right now I've got a young lady who's a graduate student and this lady has a basically actually same problem as Luigi same problem as Luigi this lady has been suffering for 5 years on and off she has done physical

00:05:39 therapy in the past to no avail and finally she made the decision to okay I want to do the surgery so first they said she hasn't done any physical therapy in the last six weeks five years really they've done therapy it didn't work on and off now they have to do six weeks so we got over that her then they said the X-ray we don't see any we don't see any instability I had to send the poor patient go get proper x-rays even though I knew it so x-ray shows it then they said well the Radiology report doesn't

00:06:13 say instability on it so I had to call the radiologist and have him look at it he said you know what you're right there is instability you know what I'm going to make an add Endo we gave it to them then they said they denied the surgery well you know what we're going to stand because of the fact the patient didn't have physical therapy in the last 6 weeks on somebody who has unstable spine like what we call a gr two is a unstable spine basically you have one vertebrae basically has shifted about almost 50%

00:06:45 over the other vertebrae is unstable so you have a patient if it's an unstable spine that indicates to me that there's risk for actual spinal cord and nerve damage that doesn't sound like something we should be waiting on I don't know if it's on stable but not to the point like people think like it's it hasn't gotten to that level yet you know because it's slowly progressing but it's like pain like quality of life you know yeah I had another patient I had this is another patient from out of state that I

00:07:14 was treating wasn't getting better and she was developing some weakness so we decided to do surgery I mean we're talking she's dealing with like 10 out of 10 pain basically Insurance denied the surgery saying there is no physical exam so we said so pain is not a reason to so pain is not a reason to do surgeries like if you have a knee arthritis your physical exam is going to be normal you have a knee arthritis if you have a you know arthritis in your back you know your physical exam if you have nerve

00:07:46 compression most of the time the physical exam is normal you know so that's not a reason so pain is not a reason to do surgery so that's really frustrating because it's not taking account the patients's quality of life what and what I fear is that leaves people utilizing other options for pain control which could include opioids which are substantially more dangerous we know that the risk of addiction and overdose and so insurance companies are are pushing people toward non-surgical non-curative options it sounds like you

00:08:16 know this is what's really sad because what happens is uring that much pain like this patient finally I literally actually did a surgery yesterday we had to what I had to do I had to get on another Zoom call because I told the patient no it's ridiculous you should not be flying out here so I got on a zoom call or a virtual video call we always did video call with her I said let's do another video call I'm going to demonstrate to you to your husband how to do the exam that's what I had to do be and guess what the exam I knew the

00:08:44 patient said the patient tells me I cannot walk this way or that way I didn't need to like do it formal and guess what when the husband was doing it it showed yeah the patient has a foot drop can't walk has this weakness basically so then the finally the case went went to a uh external review actually they still were denied they had to go to an external review and then they finally approved the surgery and still by the way no they were not still the insurance company was still denying the surgery finally we had to show him

00:09:13 like look this is what it is they're like oh it was a mistake yeah it was a mistake we're going to approve it now really a mistake so this took literally this process took about five months wow so and I know it varies depending on the insurance but so first you say you know as a surgeon you you feel with your expert P that this is medically appropriate for this patient so you submit the initial paperwork and right and then it gets denied and so then like walk us through what does this look like

00:09:39 for from your end so it gets Den so then you have to do you get on a phone we requested demand a peer review the peerreview with your own colleague of your own expertise you get on the phone and these peer reviews a lot of times it's supposed to mean I mean the whole purpose of a peerreview is to discuss evidence-based literature you're supposed to to talk what is the real deal now like what is the latest information that has the evidence to support what you're doing so when I sit when I tell them about this I mean it's

00:10:11 so obvious the person on the other side the doctor which is really what's very shameful is they're literally are sitting there I can't tell they're just reading the guideline they're literally I can tell they have a piece of well they say the uh the guideline is this patient doesn't fall in the guideline I said but I'm giving you literature let's look at the literature and tell me the guideline you're telling me tell me show me support latest support for it the guideline is from 25 years ago but I'm

00:10:40 giving you literature now well I can't do that I cannot do that I have to go with the guidelines I said so what's the purpose of this call if I if you're not interested in listening to other you know literature I said what's the and then here's a question that they all avoid answering every single one of them and that's really outrages the patients every patient as you know when you talk to them well if it was you doctor if it was your own family member what would you do right so then I asked him I said

00:11:09 if it was your you yourself what did you want done well I can answer the question this is not about me I said no no no no I said you are the doctor that is going to make the decision to deny the care I'm asking you what would you do if it was you or your family member if it was you what treatment do you want done they don't answer the question they they don't answer the question I'm not answering the question well these are the GU well I can't say anything I just have to go with the guideline I said so

00:11:37 this conversation was a waste basically well they're like sir well they're like doctor you can appeal it if you want so then I have to go write another appeal go to you know this thing stuff can take weeks or months and then I end up sometimes because the pain is unbearable I send the patient to the emergency room because you know patient has they ask me what can I do I cannot be I said you have the right to go to the emergency room and get care and I'll be there for you to do it to take care of you yeah that and that's so

00:12:10 frustrating because that's not the ideal way and that's not how you're trying to utilize the system but it when the straightforward treatments when the appropriate treatments are denied that is how people end up on pay medication getting therapies that don't work coming to emergency department when this is something that could have been handled yes and what's even worse is that when is you know pain when you're in a pain for a long time and you're not getting the care as you said you know you start taking not only Ms but

00:12:38 sometimes the pain becomes hardwired in so after you do the surgery their recovery is rough you know they don't have a good recovery they're in more pain than they should be you know there's this like Phantom Pain a little bit that's the component of it that's there oh yeah gosh pain there's so many components to it it is physical and it is psychological and to be clear I'm not saying it's in people's heads by any means oh but but as you said it rewires those brain and nerve Pathways so what would normally be a four out of 10 just

00:13:09 becomes a 10 out of 10 all the time that is cor that's exactly right that's exactly right and sometimes the PE reviews have told me on the phone pain is not a reason to do surgery I said really pain is not a the C well the patient doesn't have any ner any weakness or numbness I said listen you know and I know 90% of patients don't always present with nerve you know neurologic issues pain is the driving factor for them and when you examine them the exam is normal usually and so the insurance company

00:13:41 wants you to wait until they have damage before you can help them well I tell him I said what is the patient supposed to do well you know that's between you and the patient interesting so then I said you know what it's it's really not I I said you know what I call I'm sorry I call him out I said you know what you should be ashamed that you are working for the insurance and you are supposed to be helping your doctor you're supposed to be helping the patient not the pocket boot of the insurance I didn't tell them

00:14:07 that on the peer review recording and then I send the recording to the patient is obviously very outraged and then I they ask options I said listen we can do this and if it doesn't we can go to the ER and you know half the time we end up doing this we go to the ER yeah and especially given the state of emergency medic Medical Care in the country right now you're talking 6 hours in a waiting room before they're even seeing correct and I tell him I said I'm sorry you get there you have to wait for a few

00:14:34 hours yeah sometimes it depends because you know ER is not first come first shve they go based on priority you know life-threatening you're having pain from nerve pain that's not life-threatening compared to you know as other people's stroke you know abdominal like they need emergency appendectomies or heart attack you know things like that obviously take priorities sometimes listen it depends how busy the ER is and I tell them I always tell them like let's say if you have to do surgery I tell them please go

00:15:02 the night before because a lot of patients think well I'll just show up there you can do my surgery two I said it doesn't work like that I said I recommend you going the night before to get there so they can do work up because you may it may take time you know there depends how busy they are so then the next day we can do your surgery yeah nothing happens very well certain things happen very fast in an emergency department if you're not breathing everything happens very fast but otherwise a lot of things can happen

00:15:28 slow just because the system is full yes and it's not fair you know I feel very bad about overwhelming our colleagues our colleagues the ER Physicians you know but I I don't have a choice I mean there's a there's at least we have some recourse I have to do something about it it's not fair for patients to be suffering and waiting yeah so and this takes a significant amount of time where you could be doing patient consults you could be doing surgeries but you're getting on peerto peers where they had

00:15:58 no int of changing their mind it sounds like um and then drafting an appeal and how many more layers are there after that there's still more aren't there so the aggravation I mean just to put it to you honestly this is one of the reasons I tell people around me one of the main reasons like I want to quit medicine dealing with this like this is one of the reasons I want to quit medicine because I'm so it just gets so sick and tired of like you know it's the Cs are so aggravating so you you get so

00:16:25 agitated and then I have to go drop everything or or finish my day whatever I have to sit down and dictate this long appeal why they're wrong and I'm and you know I'm visibly angry as I'm doing it like it's just like you know a really emotional toll that it takes on you to do it and then you send it to them and then you're sitting there waiting and waiting and waiting and then they usually tell you no we're going to stick by our decision and then you have to send it to Department of managed healthcare or an external review Source

00:16:56 like a um Maximus or something and then that could take another few weeks I mean it's just and then this is on your mind you know this thing is because you're worried about the patient patient is calling any update what's going on and you know and by the way have you ever tried as a patient to call your own insurance company to talk to them about it that's even worse that's even worse so this whole process is it it's I mean the amount of hours and the aggravation is psychological tool that it takes you

00:17:23 know it it wears you out eventually I mean that's I think that's their goal they want to wear you out basically yeah yeah so now we have patients who are frustrated and not getting care we have doctors who are frustrated and burn out and want to quit which means there's going to be less doctors taking care of patients in general I mean not that I'm glad that this murder happened again I don't condone violence but it's really bringing this to the Forefront I think that a lot of people did not realize how

00:17:50 bad this problem is it's rampant it is beyond like you know there was a I think few months ago I can't remember where it came out but for example this is public so Sig I believe it was siga they found out that they're using literally less than 30 seconds per claim and they're denying it it was some AI they're just going denying it was on a paper basically so Signa I believe was denying it but you know it's you know this thing really sting very badly stung to the high heaven you know they were doing and I

00:18:20 know a lot of them are doing it and I heard the United Healthcare CEO apparently came up with an AI some kind of an AI that basically was denied was looking at the claims and denying them most of them and here's another thing is a lot of times when you call is you're not even talking to somebody in the United States what I found out which is not right these people are taking massive premiums and money from us most of their employees are from overseas and they're getting paid less than like $8 an

00:18:53 hour yeah so where's all that money going to the CEOs and the people at the top with private jets cuz hospitals for the last few years and particularly during and postco era are actually in the red they're have losing money and working hard to stay afloat but not one single insurance company has not only been in the red but they've profited billions of dollars so the hospital is suffering financially and the insurance companies are profiting billions yes yes there if you look at the curve since 2010 Obama curve came

00:19:28 out they're profit it slowly like it's literally going up like that yeah oh my gosh it's so frustrating so what makes the difference in those that fight back and win and get to do their procedure versus not have you is there a specific thing that they can do a a pattern or do you I you know this is the unfortunately it's been my story for the past many years um dealing with this and it's as I said it's a huge sticking point for me that I want to like quit medicine like this is really has I tell sometimes I'm

00:20:00 frustrated I can't do this anymore like you know but the satisfaction when I get to do take care of the patient and I get him out of pain you know it's what keeps me motivated and going because I feel like I still can go try to help patients you know fight for the patients and unfortunately the problem is too much of our colleagues they are they just give up they don't continue to fight and that's why they get away with it now one of the things I just recently started doing is now I'm any of these doctors on

00:20:29 peer review that are denying it I'm actually starting to file complaints with the with our Academy the orthopedic Academy or neurosurgery or even the medical board here start filing complaints against them about this because I think something because I feel like these doctors are getting away with it they gave their decision and they go about their merry way they get their money and there's absolutely no accountability so we can't do anything you can't do anything about the insurance companies because our Congress

00:20:57 is not listening to us they're not doing anything about it so I said you know what we got to do something about our own colleagues like our colleagues cannot be working against us and against the patients you know we I mean we're GNA do that and um I don't know I just started doing it we'll see what happens with that so yeah you're looking at fighting back in a bigger way so you're doing the individual fight for every single patient which as you said is timec consuming it's frustrating but in a bigger way holding Physicians

00:21:24 accountable for decisions that prevent patients from getting care and you talked about even so really if each individual one of us as Physicians are fighting alone that it's harder to make a difference but we can work together and with patients and with other people to make our voice heard what would that look like what do you think I think we need to spread the word and enough listen it's timec consuming when I sit down it took about 20 minutes to file the complaint and get it out but you know it is timec consuming but the if

00:21:57 more Physicians like us start doing it trust me this no listen no physician wants to get a call from the medical board or from their own Academy um yeah we we have these complaints we would like to investigate I mean that's the last thing you want to hear basically once that happens you know they're going to think twice about doing this they're the ones that are enabling the insurance companies you know insurance companies unfortunately they're doing what they doing but our own colleagues are enabling them more yeah and particularly

00:22:27 what you were talking about the guy guidelines so if you submit you know a patient has this and they have guidelines that say if the patient has to meet such and such and such criteria such as recent physical therapy or blah blah blah but if those guidelines are old we know medicine changes the literature changes because yes when we get new evidence we're supposed to change our practice otherwise we'd still be bloodletting people and doing lobotomies right yes yes and so another thing it sounds like we need to hold

00:22:56 insurance companies accountable for their guidelines and Ure for the guidelines yes up to date yes that is correct you know the other problem is I know like some Physicians like they lie in their clinical notes about the patients like exaggerate the patients's clinical symptoms and objective exam to get the surgery approved basically and the other problem I know listen I see it like I don't want it to say like insurance company should just authorize everything because the problem is that who's going to protect the patients

00:23:27 against the bad doctors you know I think there has to be some kind of a medium I think if a physician has proven their track record they can say you know what 10 years you're doing this and you have no complaints you've done everything by the book you know what we going to basically uh approve like 90% you know 10% of the time May audit this and that but we're going to approve your surgeries because you have proven yourself that's I think should be quality you know if a physician has demonstrated their outcomes and their

00:23:56 qualities there should be now you can't just do a blanket approach and if you especially if you challenge them I feel like since I've challenged them by doing what I'm doing they have gotten more aggressive with denying my cares basically because you know they don't like it they don't like people ruffling the feathers and stuff yeah so the path of least resistance is either do nothing or lie and it seems like that's a completely ridiculous way to set up the system yes yes but I want to make sure

00:24:23 at the same time we want to protect patients against bad you know surgeons out there Physicians who are doing unne Neary test unethical procedures unnecessary spine surgery we have to do that too so this is my way is like if you demonstrate quality like let's say you know if you're a surgeon that is usually one andone surgery you have very little patients come back repeat surgery and you've demonstrated over and over quality and the patients like they have their outcome you should be approved for

00:24:50 the surgeries you're trying to do most of the time now let's say you want to do something very big I get it review it fine but you know you should not be questioned every single time basically if you've demonstrated it's like your own kids you know if your own kids are like you have good kids they good good grades they're doing everything you're not going to question him all the time about what they're doing you know this is the same thing in medicine like policing us like that just police the bad

00:25:14 ones yeah because it doesn't sound like there's any differentiation at all between who's doing quality care and who's not it's just this faceless criteria yeah I mean you could be the best doctor 30 years practicing versus a guy who just started you're treated the same which we know that's which we know you know no other profession is like that no other profession you can say a pilot that just started yesterday is the same quality of a pilot who's been doing it 30 years no with excellent track record like you you can't say they're

00:25:48 the same you know yeah oh my gosh that's not even close now so for p because you you do a lot of the ground work on this you're spending the time you're doing the notes for patients you're fighting the good fight which is incredibly admirable because the you know the alternative being laid down and do nothing as a patient what can a patient do to help you to help their Physicians to help with this process oh the patients have all the power the patients have all of the Power and I wish patients knew how

00:26:19 much power they have because I feel they are the ones that can actually really drive the change I mean if you think about it you know with the United Healthcare CEO it was a patient that committed the that heinous act you know but the P he was the one that brought it to the Forefront of what's going on it wasn't us Physicians yelling and screaming about this the physi the patients can file complaint with the medical board and it's very easy process they can go on there because think about it a Doctor Who's never seen you examine

00:26:53 you is basically going and I'm the're recording you know they're going by some ridiculous criteria area and they're basically are the board considers that unprofessional conduct they're acting below standard of the Care in the way they're treated and the patient can file a complaint if enough patients start filing complaints about these peerreview doctors oh God believe me it will this process will stop right away and because remember there are so many patients and if these patients flood the medical

00:27:20 board are you kidding me we it's more than me you know it's me by myself am I all these patients across they can do that because most Physicians I'm telling you they're not but if the patient does that you know for their own individual care you can imagine and write a letter to your Congress person your local House member start writing and believe me if patients do this I absolutely believe in less than a year we're going to get some concrete results something is going to happen like it's going to

00:27:47 shake so a lot of what I'm hearing is that we do we need to speak up not just as individuals because one person fighting the fight's not going to win the fight but really start telling not just Physicians but also patients the people who are affected the most to start speaking up and you give specific ways you can reach out I mean they can reach out to their insurance company as we know that's not always terribly effective the medical board it is I do get why they have Physicians working at insurance companies but you're right the

00:28:17 physician ultimately making the decision is someone who has never seen you the patient they have never talked to you never examined you and they're making the decision on what you qualify for I don't know how many patients are really aware of that that's actually part of the process that's the problem I don't think patients are aware they think it's the insurance company but they don't know it's a doctor that's sitting there they don't know they don't know any better and that's I'm hoping anybody

00:28:43 listening to this if you're getting your care denied and you really believe in your doctor and you feel you need the surgery get the doctor's name that denied your surgery and file a complaint with your respective Medical Board about this patient it's a very easy online process that would take about 10 15 minutes to do as a patient and you are they cannot retaliate against you there are laws about that and you know believe me they will start listening they listen more to patients than to doctors for some reason I've been doing

00:29:12 this 20 years they always tend to be listen to us last but people public they listen to public yeah because I mean the public are the ones that purchase the insurance the public are the ones that vote for congress so that's why I always encourage really understand what you're doing can reach out to that Congress person if they're getting enough phone calls they're going to go talk about it because they know that their constituents are getting spicy and they want to keep them happy that's exactly

00:29:39 right we if patients do this believe me I know in my heart we're going to see we're going to see a change I mean remember one guy did a commit a horrific crime which that's not the way to go about it but imagine if there were you know hundreds of thousands of people like Luigi started flooding the medical board and talking to the Congress person about that believe me we would see results very quickly oh yeah when that many people cuz right now it's easy for them to ignore if they're not hearing a

00:30:06 lot of problems and chatter about it then they can just assume everything is fine and be focusing on other problems instead of recognizing how significant and prevalent this problem is yes yes I mean patients I'm telling you the patients always say they have all the power and they listen to them like for example I know patients for example who were denied and they sued so that's another option you can sue also their attorney to do contingency but that's the problem with the lawsuit is ultimately guess what the insurance

00:30:35 company set it takes it take can take months to couple years oh yeah then they settle with you and then guess what the settlement is confidential nobody's allowed to talk about it and nobody would know about it and guess what if another patient sues for the same reason for negligence of the insurance company they cannot use the other patients lawsuit because it's confidential it's settled so it never comes to the public wow this insurance company has done this countless times you know basically so

00:31:03 nobody would get that out so with a lawsuit I've seen I mean get the insurance going to be settles like that right away they right away with the patient and but the problem is that not to in all these years I've had I think I've only had less than 10 handful of patients who've actually taken the lawsuit because it's you know it's cumbersome and it it takes a long time to get results yeah and during that time you're still not getting your care exactly so well I mean gosh there are so many frustrations but you've outlined some

00:31:33 things that we can do and a lot of it's just understanding the scope of the problem speak up Advocate you know find those Avenues where you where patients all the listeners to this can be heard yes yes I mean I think if the honestly the patients go complain start filing these complaints flood their Congress offices with this you trust me I I really believe I I know listen they when enough people speak they listen M absolutely they listen and they're going to do something about it basically because you know who no agency like the

00:32:06 medical board doesn't want to be flooded with countless like complaints you know like that no not at all no listen it's not but it's an issue you know one complaint I but when this physician is denying care over and over again why should they get away with it you're hurting so many patients you I'm sorry you don't deserve to have a license to practice because you're not practicing medicine you are basically acting as a as the right-hand person for the corporation profit yeah wow It it's incredible I'm

00:32:40 really glad that we've had this opportunity to talk about this and really lay it out for people and let them know what's going on let's end on a positive do you so you I know that there's the frustration the fight and all of that can you share with us a success story somebody that you did fight the good fight and you went through it and they were able to get that care and quality of life that they needed oh absolutely there are I have you know just as many countless patients I said so many of those countless

00:33:07 patients ended up eventually getting the surgery done and as I said that's what keeps me going being able to like finally I know I won the fight I'm getting their surgery you know the satisfaction that I was able to help a human being get the care they deserved and seeing them get their life back like I have one patient you know last summer where I saw her initially and I told her I said listen you have a problem in one level on your neck the other level I see the problem but I don't think we should do anything about

00:33:41 it because I'm not sure if it's really contributing so I don't want to do un necessary surgery for this it would have required to go from the back so the initial problem you go in the front so I didn't want to subject the patient to two front and back operation and now this is all documented in an initial time I saw the patient so once we did the surgery after 6 weeks goes by the patient tells me that some of these pains resolved but I'm still having this other pain basically it turns out it was the the

00:34:08 secondary problem so three months go by she's not getting better so then basically we submitted and the insurance company denied it I said listen this is in my initial note this is what I talked about doing and stuff and they're like well the Radiology report doesn't really support what you're saying and this patient was literally in tears and crying she had called not getting anywhere I finally sent her to the emergency room we did the surgery long story short I mean about a month ago right after Christmas you know I come to

00:34:39 my office there's a huge bottle of Don perion as a thank you gift patient thanking me basically saying thank you for sticking with me and helping me navigate you know like your podcast navigate through this trous situation and helping me go to the emergency room and getting he said I don't know he said uh and I actually just talked to her the other day and she said without you I'd probably be bedridden right now still be bedridden laying there that's how bad it was so you know things like that is like

00:35:06 it honestly makes your day it's more it's worth more than any Lottery you can win so I have many cvas stories like that too um I have a patient from Texas same thing I have another patient from Riverside you know I mean I can go on and on about patients who we thought were able to and got their life back that's fantastic so just that's an inspiring way to end for people out there like is a light at the end of the tunnel there there are ways to get better and I'm sorry that everybody that many people have to go through all of

00:35:36 these steps but the good care is on the other side of it and it's worth it so speak up speak out and thank you yeah go on social media listen go on social media put the doctor's name that denied your care put their name on there um and speak up you know the patients I swear they have all the power people the are public in institutions are state and local I'm sorry state and federal agency they listen to patients as you know doctors they listen to us the least we that's just how it is you know but

00:36:08 patients they listen because there are for every doctor there's 20 more patients basically so the power in numbers yeah absolutely Dr Melman thank you for coming back to to speak to us again on this incredibly I would say timely but this isn't timely this has been going on for ages people are just now get becoming more aware of it so thank you for your time and your expertise and your advocacy keep fighting the good fight because I know it makes a difference thank you very much for having me I really appreciate

00:36:39 it it was a pleasure being here all right here are your key takeaways from this episode with Dr human malamet before we dive into those don't forget to download your free red flags green flags for finding a healthc care provider guide so it'll be right in the show to not make sure you grab that and anytime you're working with a healthcare provider your health decisions matter and we want to make sure that you have the right healthcare provider for you all right let's dive into those takeaways uh number one was the harsh

00:37:10 realities of insurance denials in healthcare patients sometimes suffer due to Insurance interference Dr Melman highlighted how delays in care can sometimes last week or even months leaving patients in prolonged pain and to remind you that even reputable ethical doctors face denials so Dr melin says despite his impeccable 20year track record he still gets denials for up to 60 to 80% of procedures and that sometimes the insurance guidelines might be outdated now number two the devastating consequences of delayed care patients

00:37:44 are often forced into different types of pain management uh if surgery is not an option being approved by the surgery and that emergency room visits really should be a last resort hospitals and emergency department are all already overwhelmed and this can delay treatment even further but it is important to get help because that chronic pain rewires the brain it becomes hardwired and it makes it hard for patients to recover even after they've received treatment Dr malid points out that the review the

00:38:17 peerreview process for insurance companies can be flawed so the the doctors denying care have not seen or examined the patient and they're making decisions based on their protocols so how can you fight back Dr melamid suggests uh and really holds the idea that patients have the real power insurance companies and lawmakers Listen to More to patients than the Physicians so a few steps you could take number one you could file a complaint about the physician who is denying your claim you can submit the complaints to State

00:38:45 Medical Board to help hold these doctors accountable number two you can contact Congress reaching out to lawmakers and like sharing with and even flooding their offices with concerns could lead to policy changes number three speak up publicly sharing those experiences that you've had on social media tagging insurance providers and calling out Bad actors can create some public pressure for improved action and number four consider legal action Al um although lwuit do take a lot of time and will likely not lead to any type of quick uh

00:39:15 treatment they can force insurances to uh have a paper trail of the systemic denials so a glimmer of hope Dr Melamed shares success stories of patients who fought back and eventually received life-changing surgery the key takeaway persistence and advocacy your voice matters if you or a loved one are struggling with insurance denials don't stay silent file complaints contact your lawmakers and get the care that you deserve this has been another episode of navigating hope thank you again for joining us and keep on navigating those

00:39:47 difficulties with hope thank you for tuning in to navigating hope with me Dr Jamie Hil it has been an honor to navigate the real of Health and Wellness with you today remember in the journey toward a healthier life knowledge is your compass if you enjoin our time together please share like And subscribe to navigating hope join us next week where we'll continue to empower your health Journey arming you with the wisdom to navigate life's challenges and keep the emergency room in your rear view mirror 49 faces look to him in triumph

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