Medical decisions should be made by doctors and patients, but increasingly, insurance approvals shape access to care. Spine surgeon Dr. Hooman Melamed shares his firsthand experience with the growing barriers to treatment, from delays in urgent procedures to financial pressures influencing medical choices. Why are some surgeries harder to approve? How do industry trends impact patient care? And what can be done to fix the system? Dr. Melamed offers insights into the challenges—and potential solutions—facing modern healthcare.

 

Transcript

00:00:00 we are hearing from California doctors that dealing with health insurance has become a big headache for them to the point that patients are suffering as a result of it because getting approvals are getting harder and harder my guest today is Dr Hooman Melamed who's a spine surgent who's in the middle of all of this and has been dealing with insurance and patient care he's here to tell us how money making has become a core part of Health Care and as a result of it patient care is suffering make sure to

00:00:28 share this episode with your doctor friend because a lot of them may face the same challenges but not many come public with it I'm Sam kurami Welcome to California Insider H man it's great to have you on welcome thank you very much for having it's a pleasure to be here you're a spine surgeon and you're here to tell us there's a lot of Trends in your industry and you're concerned about some of them as as a doctor as a surgeon insurance has become you know extremely extremely difficult I've been doing that almost 20

00:00:59 years now so I started in August of 2005 and I've seen the trend in the past you used to get an approval for surgery no problem they would approve the surgery right away or the treatment you want to go to MRI you want to you know anything doctors it was the relationship between the doctor and the patient so the insurance was there to help facilitate that now you cannot get any approval Hardy you get rejected a lot right off the bat you can't order MRI you can't order CT you can't get surgery approved

00:01:30 you actually I've had to hire an extra person literally in my office now to help with doing appeal calling the insurance phone calls it used to be very quick like 1015 now you could be on the phone 45 minutes to an hour on the phone holding transfer from this department that department they've created more roadblocks in order to get a treatment authorized for the patient now the more expensive the treatment the more Road Blocks spine surgery very expensive in general so they have more and more roadblocks that they have put up

00:02:05 basically to get this approved so then you have to get on a phone with a doctor I never hardly recall have to talk to a doctor to get my surgery approved I was never accused of oh you're doing the wrong surgery so they want you to talk to another doctor or they want to talk to you they basically we request I said I'm I'm I'm requesting like why are you not authorizing my surgery they're like okay you can talk to one of our doctors it's it's called peer review peer-to-peer review two doctors talking

00:02:33 about why I want to do the surgery and what is the medical justification for it so now they have come up with guidelines this is where it gets even bad doctors you're supposed to help for the patients not to help the insurance company these doctors that are on the phone I can totally tell they're not talking based on their experience or what they're talking the guideline of the insurance companies and a lot of times these guidelines some sometimes they're flawed they're based on very very old information or not correct there's a lot

00:03:09 of literature that supports a different view so I tell them look I have all this literature oh I can't oh I can't go based on that why not well I have to go insurance company guideline so then I say well what's the point of this doctor to doctor discussion if we can't discuss real evidence I said this evidence you're talking is from a decade ago I have new emerging literature one time a doctor said you know what I'll get it to you you know what okay you know what you're right I'm going to approve the

00:03:39 surgery I swear to God another one came up and the same doctor came for another thing I had to talk I said you know remember you approved that for me I swear to God he said you know I got in trouble for that wow so it's become like it's become so frustrating I'm not a volume guy I don't do so it's not like I have so many patients I see in my CL CL every patient for me counts and it becomes very frustrating that I I can't get my patients approved and they're calling me they're upset and sometimes I don't have

00:04:10 a choice I just have to go go to the emergency room I have one today right now I have a patient in the emergency room today right now I had to send because I know it's going to take weeks and weeks to get approval and this patient can't she's been already she saw me on Tuesday in tears young lady yoga teacher neglected for 3 months basically so the patient has pain they come to you with the back pain usually most patients listen what drives them to a doctor is pain uh for spine surgery it's usually

00:04:39 some kind of a pain back pain neck pain shooting pain down their arm shooting pain down their legs or something you know it's some kind of a problem that somehow the patient Googles it or the doctor whoever they see a primary care oh you have a spine problem you need to go see a spine special so that's how they end up coming most patients are now very educated they go online look at it they have neck pain that the pain shoots from the neck down the arm from the back shoots down they know they're educated

00:05:08 enough to go see a spine surgeon so that's how a lot of them come to me Word of Mouth basically so they come to me and it's very upsetting because I feel like you want to help them these people are literally I mean they're in tears crying they're not faking it and then you call them and they don't care at all like they take oh you have to go through appeal you have to do this you know and finally like this patient exactly to that I'm telling you I'm going to be operating on her tomorrow I said you

00:05:32 know what don't worry go to the I'll take care of you go to the ER that's how we have to do it so you have to do the surgery through the ER which is really bad because it's more expensive for the system overall so the patient has to say you know what I I there is an emergency I have to go to ER I can't can't do it and then that's right and then then they could get the surgery yeah I mean this patient today said what do I do when I went I said tell the truth I said tell them the truth how long you've been

00:05:58 suffering what is going on like for example their their leg or their arm starts stops like starts not working they start getting weaker num weaker like hey I can't use my hand my foot is like it's not coming up you know and you tell that to the insurance and they're like well the patient has to do six weeks of therapy first I said by the time they do it it's too late permanent nerve damage and what do the insurance companies require from you guys so you you have to justify right before did you have to do that or not trust you guys no

00:06:31 they they used to trust and stuff but I get it listen there are some doctors who do bad things I totally get it you got to protect but they have the data they have the data on every doctor you know they can look to see well is this doctor how is this doctor trending basically versus this other doctor how's the patient's outcome they know what happens after because they're the ones that are authorizing physical therapy after narcotics after so they know the data and I feel like they're applying a

00:07:02 blanket basically approach not helping rewarding good doctors but punishing everybody together under one umbrella for I feel for money basically and what's the impact on you as as a doctor and other doctors it's so frustrating I swear this is one of the reasons like I I like I talked to some of my good friends who are like this is one reason you want to quit medicine because you went in there to help people and you feel like there's so many roadblocks like it it really boils your blood I mean for me personally it's

00:07:36 agitates me so much because now I have to sit down I have to draft like in the middle of Clinic I have to drop everything go draft the letter of appeal letter this patient surgery was denied talk to the patient to calm him down basically get on a phone with the doctor and then you get more frustrated because this doctor doesn't care on the other side about what's going on with the patient and it just ruins your day I mean it's like the stress that gets created the emotional acing oh you know you know go like that how much you can

00:08:07 take in a sense when you mentioned that the these insurance companies should have the data and can you tell us what's that for us that may not know your space you know how how can somebody know what's a good good surgeon and what's a surgeon that maybe not as ethical or not doing as well that's very difficult I'll be honest I think I feel bad for the public because I do a third of my surgeries are revision I fix other people's bot stuff and it is very unfortunate because I I feel the public trusts Physicians you know we look at

00:08:41 Physicians you know at this high standard that they're going to do the right thing and I do think there are some amazing amazing Physicians who they don't care about anything other than patient care they just they don't care about money they don't care free surgery not get paid or not they want to do the right thing for the patient but unfortunately just like any industry there are bad Physicians too who are there I think patients should not just look at Google but start getting references call the hospital for example

00:09:09 where the doctor operates ask the hospital the nurses station that the patients get admitted that's a good play the nurses would tell you the truth how these patients doctors how many of the patients come back for repeat surgery that's the thing you know patients don't know how many patients come back repeat surgery with the same doctor with the same surgeon yeah listen no surgeon has perfect results I'll be the first one to tell you I absolutely don't have perfect result I've had patients where I had to

00:09:34 bring them back no problem but I'm talking about listen if you do everything by the book and quality is there right if the quality is there patient doesn't have the best outcome sometimes you know nobody can say ah you should have done it this way that way you know something something doesn't go perfect you know it's fine but I'm talking about where you look at the postop X-ray and you're like wow this this was not done well at all no wonder why the patient's coming back for repeat surgery or if you look at the schedule

00:10:03 and you see the doctor did eight surgeries in a day wow is that is that there are how you do it I've seen some of the doctors are doing concurrent overlapping surgeries patients don't know this and I tell the patient I said I've done this I've done this for a decade I've asked a lot of patients I said would you allow me to do two surgeries at the same time you're like what do you mean I'm ask I to ask you would you allow me if you knew that I'm going to have another surgery going on at the same time I'm

00:10:33 going to go from one room to another room and somebody else is going to be doing part of your surgery are you okay with that not a single patient that said yes would you be okay with that cic no of course not this is such a sensitive thing cuz you know especially spine surgery something goes wrong exactly to me this is not a volume surgery how many how many is usually can you do per day so it depends on the type of the surgery okay it depends on which type of surgery so let's say there's a like one big

00:11:01 scoliosis like a big major operation the real amazing spine surgeons I know in the country they would only do that one surgery for the day and that's it they will not try to because you know what it's a big sensitive operation big incision lot of moving Parts they want to just focus on that one patient do the perfect job but some of these guys they would schedule two or three they will do this room here another room another surgery and then another one after another one after they're doing like

00:11:26 four in a day and of course the results are not as good it's like a factor exactly it's becoming a big business right essentially of course the hospital is making a lot of money because they're allowing this overlapping surgery so imagine one surgeon is basically generating seven eight surgeries for them in a day versus me who in a day will do two who's making more money so the hospitals like that too in a sense they go I feel like they go along with it you know basically they don't they kind of look the other way I my

00:11:58 experience has been hospitals tend to fa for people who generate a lot of money for the hospital I've seen that our sponsor today is Shen Yun there has been some negative press on shenyun recently Shen yun's mission is to revive ancient and traditional Chinese culture shenyun performance started by a group of fallong gong practitioners in New York fallong gong is a spiritual and religious group which believes in living by truth compassion and tolerance putting others first the Chinese Communist Party CCP has been persecuting

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00:13:01 campaigns against shenon the show has managed to grow significantly across the world I highly recommend you go see it I've been going to it for the last 14 years as they change the performances every year they're coming back to California make sure you go see [Music] it so essentially what you're seeing from from what you're saying in your space money has become the major factor that's what I'm challenged I feel like money has become The Profit has become the most important thing and we we're losing sight of like individual quality

00:13:35 patient patient care and also more aggressive surgeries if you go look up Fusion operation which is where you're putting rods and screws in patients has gone up in the last decade significantly there was an article I don't remember where maybe Wall Street New York Times I don't remember but they talked about this how number of fusion operations implant has gone up significantly and that's where I have a problem with because I feel most patients don't need Fusion operation and I feel like it's they're

00:14:07 being pushed into that unknowing to the patient basically patients do not know like literally I saw two patients yesterday in my clinic both came to me and they had seen two other spine each had seen two other spine surgeon they're both were told their lower back they need Fusion or artificial disc doesn't matter it's some kind of implant-based surgery and when they Tomy I said you don't need that you just need a little red router and I would inject your own PRP your own bone marrow inside your own

00:14:39 disc and they just looked at the shock they're like wow that's not what I I never even heard of it I thought I'm going to come here you're going to tell me this one of these what the other guys told me they're like how come these guys didn't tell me I said I understand is there more money in that of course it is so for spine surgery in general if you divid it basically the the pay usually it's it's very simple you either are putting some kind of an implant in or no implants so basically you're either doing some kind of a bony

00:15:10 decompression some little opening what I call rotor rter or you're putting some kind of a device in some kind of screws rods or artificial disc implant in the implant-based surgeries in General on average they pay four to five times more facility fee and the for the surgeon on average so from what it looks like there's a push to to make money from from doctors and hospitals to jar and then the insurance companies on the other end don't want to pay correct so I I get what they're trying to do which I

00:15:44 think you know it's important to regulate like to stop like bad practice of medicine too but you you have to reward good Physicians basically you can't put everybody together and patients are poor patients are suffering who are being being seeing the good Physicians who want to do the right thing but they can't get it done because these other guys are like rooting it for all and these are patients that have insurance like normal insurance can you can you tell us more about just normal cases with individual insurance or

00:16:14 corporate Insurance the one thing I've seen which I don't think it's fair so it it's they're all tiers insurances so depending so if you're like the executive that has this very very highend corporate high level insurance or in Congress everything gets approved right away but lower tier ones usually middle like individual like you know lower tier ones if they're like not what we call self-funded or fully funded no they they put a lot of roadblocks so it's like it's like a VIP treatment think about it's like you know

00:16:46 it's like they say money talk so if you're a corporate you're paying that high dollar yeah your your stuff gets approved right away but other average common people no they they they don't get it B I don't think it's fair I think everybody should be treated the same no no matter whether you're Elon Musk or the guy that's barely making the minimum wage I think you're health insurance should apply equally to everybody the patient I just literally saw that came to my office on Tuesday neglected for

00:17:11 three months I feel bad she called my office we came in and my office knows I try to do proon surgery at least one or two proon surgeries per month you know help people I used to go up until 2007 I used to go outside United States and do free surgery then I was like wait a minute we have people here they're not getting good care I can help people here you know let me take care of our own people first you know here so I started doing more free surgeries here which actually I'm helping more people than I

00:17:39 would have gone if I would have gone abroad so I because you don't have to spend the time and travel and all that exactly so you go there for a week how many surgeries but here I said you know what at least if I do one at least minimum one if not two surgeries free a month I'm doing at least 12 to 24 people maybe more free surgeries a month basically a year I'm sorry so anyway this patient like medical is one thing which is I think is terrible because one of the things Obamacare did they open up

00:18:05 medical especially in California like a lot of people got medical which is for low income you know they're subsidized by the government now medical is not bad they cover your basic needs you know your basic OBGYN like pediatric your world checkups your like preventative preventive Stu but when it comes to Specialist Care my God these people are treated I hate to say it it's like a like a cattle like a factory they don't they don't and that's what really bothers me okay the doctor if you have the medical they pay very little which

00:18:39 is fine but you can't treat people based on you have to treat everybody equally that's where I get upset because I feel like the doctors who are medical they treat these people like a factor like this lady I told you because they have to do a lot more to make the same money right the same money yes so they're like they get paid very little back exactly so they spend very little time with them they they treat them just not good it's like a it's like a volume thing you know the volume thing and I I was very upset

00:19:06 when I heard like this shocking story this poor lady young lady if she had a regular Insurance she would have had her surgery like two months ago basically she would have had the surgery but she was neglected to run around she went to the ER at a hospital and she was like Oh no you're fine go follow up with your thing cuz she had medical get rid of it that's another thing I found is like a lot of the hospitals by law they're supposed to take these medical patients and take care of them because they're

00:19:33 nonprofit but they don't they're not being doing what they're supposed to do based on their nonprofit status they're supposed to you know I believe 25% of what they're supposed to take it's supposed to be Indigent lowincome Medical but they don't and nobody's looking into that anyway this poor lady bouncing around bouncing around somehow I don't remember how she came to me I saw her on Tuesday I felt so awful for her I told my office let's start getting authorization then it's cow like this is going to take week this poor lady

00:20:02 literally crying crying like her balls out in so much pain like nobody cares you know you feel bad it's like a human being I said you know what don't worry about it I'm going to do your surgery if we can't get anywhere I'm going to have you go to the emergency room I was supposed to do her surgery this morning there was a miscommunication with my office anyway I spoke to her late last night I said you know what come to the ER today I'm going to do your surgery tomorrow don't worry he like what about

00:20:25 you you you know I don't I said don't worry about money I'm not charging you anything don't worry about it I'm going to take care of you so I'm going to do a surgery tomorrow and when you do the ER you just donate your time is I just donate my time yeah so you just tell them to go to ER and then you just go there I just go there yeah I just she went in today and U I'm going to go you know do a surgery tomorrow basically I'm going to take care of it I said and I do that every so often you know help patients who have no

00:20:49 no means and that's what makes me very upset because I feel like people are being very treated not as a human being you know some dignity but they're looking at oh this one is a good good insurance you know or not I used to be somewhere I swear to God the place I used to be one of the doctors I some of them I know they look at Insurance what type of insurance the patient has they get differential treatment the first thing they look at is not who the patient is or what is wrong what type of insurance they have

00:21:18 because the insurance companies will give them a hard time is that that not the hard time but who makes more money like some of the insurance is they pay more money so they treat patients based on that like for example like medic doesn't pay like I remember where I used to be with this group patients used to be in the waiting room and I remember I was I was seeing my own group of patients and the patient came and says I don't understand I've been sitting here two hours waiting to be seen we're like

00:21:44 sir uh who's your doctor they said my doctor is so and so we're like I'm sorry we'll let them know we have nothing to do with it we're separate practice so in my office I was sitting there my medical assistant went to the the doctors told the whatever this patient I heard the doctor said you know what I don't care they have Medicare they can wait another two hours it's like free I don't care get get the other patient with a PO in I swear to God this is this I heard it twice on two different patients

00:22:12 wow this is like unfortunately it's like this battle I feel like insurance is not doing the right thing some of the doctors are not doing the right thing so guess who suffers the public suffers their the patients are suffering because they're not getting the good care their care is getting delayed denied it's a tragedy and um it's just getting it's just getting worse and worse basically because nobody's looking into this when was the time when you realize things have changed you know I've been 20 years

00:22:40 so I would say about so you started as a surgeon right away right 20 years ago 20 years ago you come out you're thinking everybody wants to help patients do the right thing and you know you don't pay attention you kind of go along with it and then once I started I think about after Obamacare about couple years after I started noticing the change and I think when I feel like what the insurance company start squeezing I think that pushes people doctors to start doing things they not supposed to do because they're trying to be to get

00:23:09 paid more like for example they lowered the reimbursement so guess what you do more aggressive surgeries to keep making the same money or do more surgeries or do more surgeries toow your exactly or push more patients into you know I can begin to tell you I mean there are patients I see I'm the second or or third or fourth opinion they comeing to me they're ready to have surgery I tell them no surgery they're like what I said there was a lady 75y old lady she's like what what doctor my MRI shows me this the three surgeons

00:23:43 have said I need to have surgery I said okay what bothers you what is bothering you um I have a little stiffness here I said is that all that's all right yeah I said you you golf I said you ride your bike I said you go for a hike you swim right you don't have any discomfort other than some stiffness I said yeah I said yeah she said yeah I said so why you want to do s because the doctor told me I said but look think about it yourself for a second you're not in danger you're it they're treating the

00:24:14 MRI not you basically so that I see that too a lot of patients are being told Bas they're treating the Imaging not what's wrong with the patient so for example let's say I get an x-ray of your knee right now and it shows you have moderate Artis but you have no pain are you going to do a knee replacement and it's so risky right this is such a big risk to take and something could go wrong right yes and then there's the cost yeah I mean I saw literally but there's a push from the industry to yes the doctors

00:24:44 like you know I feel like the reimbursements going down like the medical reimbursements going down it's unfortunately pushing P doctors to start doing more surgeries more aggressive surgeries to make up for this loss and that for sure I've noticed the trend what do a neurosurgeon a country artist and a television and radio host have in common they all saw the writing on the wall big Bank sharing your financial information with big government join them as owners in Old Glory Bank the pro Amer online bank that

00:25:18 protects your privacy security and Liberty invest today at own. oldglory bank.com [Music] and before we get into how to fix this whom and you you're coming forward and this is risky for you like usually people from the your space doctors don't want to talk about this why are you doing this because I saw my own dad go to jail he believed in what he stood for my dad used to be the Ministry of Health in Iran was a big position in Iran and he went to jail because he you know he was being forced to do something to

00:25:56 change some hospital rankings against his will and he wouldn't do it he would not give into it they wanted to give him money he said no he was he was not corruptible and and I saw him and when he went to jail when they arrested him they told him all you have to do is to do this come out out and make a statement my dad was like I'd rather rot in jail than to do what you guys I'm not doing this and finally with public pressure because he was the righteous man after four months they rele I saw him and my dad before I went to med

00:26:23 school I remember I was getting on the plane to go to my orientation for medical school this is in ' 95 and my dad said Just remember three things about about medicine you're going to have three priorities in life number one patient care number two Patient Care number three patient care you just remember that and that all and what I experienced in Iran when he went to jail we used to go visit him and what he said has always resonated and when I start seeing things that I feel like they're absolutely wrong I I can't just look the

00:26:56 the other way like it just like it boils my blood because because my dad was in charge of an ER like the Mayo Clinic of the ERS in tran he was pars hospital and he was in charge of the ER and he ran that place like it was everything was based about patient care not money we need okay you know what you need to spend I don't care no this is right for the patient this is what we're doing and I saw that everything was about patient care so here I feel like we've lost that I think profit is becoming more

00:27:23 important than patient care so that's why I'm speaking out and I'm hoping and I have a mentor in residency which I'm proud to share the name Dr Robert Miller who I've talked to a lot and he always he stood up for patient he always said listen we need more people watch he said Watch Dogs he said we need more watch dogs like you stand up if you have more people like you this all this stuff is going to stop so do you think more doctors should come out and speak about what they see in their space yes we

00:27:48 talks among each other privately and people are afraid of retaliation they don't want to speak out because they you know they they feel like their whole life could get ruined and they can't you know they're you know they can if these guys want to ruin somebody they can ruin somebody how would that be like you won't get reimbursements or like other reimbursement of hospitals would start if you see something not right at the hospital the hospital will basically can initiate what's called a peer review

00:28:15 against you like oh you did this wrong here you did that wrong here you know what you we're going to suspend you you can't operate and they're going to drag you through you can go through few years two to three years of you're suspended you can't pract if you can't pratice practice medicine how you going to make money you're done that's why people are afraid they don't speak up and you are not afraid of that no because I feel like the truth and you do the right thing I think always yes you pay the price for it

00:28:45 which I have actually but I I I can't like as I was talking to Dr Miller actually few weeks ago I was telling him about some of my stuff I said do you think I should just be quiet and look the other way he's like no no do not do that because you have a soul you know how you going to sleep it's your conscience that's why I can't and now hum how do you think so I'm sure you have thought about ideas how we can fix this do you have any thoughts what could be a fix to this situation you see I think the the thing

00:29:20 is that we have to start rewarding physicians in every specialty who have good patient outcome over years that's not a difficult data the insurance companies have the data they know for example you know if a foot and ankle doctor spine surgeon let's use my field you're doing the surgeries okay this guy let me see he's doing less invasive surgeries and less patients are coming back for repeat surgery so he's doing surgeries that are costing less that are less less extreme yes and then they're getting less comebacks L exact mistakes

00:29:54 and less medications after less narcotics after they're recovering faster so they're not basically using the system oh they need more therapy they need more narcotics they need more pain management like they're they're getting faster recovery like the surgery is working properly and this the patient is coming so if you have more narcotics afterwards that's not a good sign of course not it means the surgery wasn't that great you have to give somebody 90 like a simple surgery that you have to give him 90 pills of like Norco

00:30:25 there's something wrong with that 90 pills there's a good chance that that patient is going to be addicted there's 30 40% chance that patient is going to be addicted with 90 Norco so I went personally me I was not satisfied with that so in March of 2018 I started doing narcotic free surgery I said you know what this is not good enough we need to start basically doing something about this oput endemic that we have so I started adopting a holistic approach where you know I'm not treating you your

00:30:57 spine I'm treating treating you as a whole like your whole body because at the end of the day whether you operate on a knee hands spine doesn't matter you're operting on a human being what is the the whole body is doing because if the body is falling apart is not optimized how you think you're going to recover from the surgery how you going to recover from surgery so I said and with with what was going on in our Healthcare with poor nutrition that we had and obesity diabetes and this was really affecting outcome

00:31:31 basically you can't ignore I don't no no no I'm just focusing on your spine I don't care no it doesn't work like that so I started basically focusing on God Health probiotics educating the new patients on nutrition important I call it the anti-inflammatory diet not weight loss you could be skinny you're still going to get lecture it's not about being skinny overweight it's about lowering inflammation in the body so if you lower inflammation in the body if you start basically treating people holistically

00:32:00 putting them on proper supplements and nutrition guess what sometimes they actually heal they don't need surgery number one number two if they need surgery now they're optimized and that's how you avoid basically narcotics and they get faster recovery basically so I don't I have another patent pending approach a cocktail I do during the surgery that I injected also at the time of the surgery and that really helps the patients tremendous ly very pain-free after hardly requiring any pain PS after we do

00:32:33 give him some pain but I give him tinalo I give him something like Cel bries lria and very low acting opiate is called Tramadol and very few pills and that's it we don't give any more of course there are exceptions once in a while you have a patient difficult of course but I will tell you 90% of my patients we don't give him procet oxy you know we have to adopt basically as a surgeon I think start educating like when I went to residency there was all the focus was on orthopedic surgery muscular skeleton

00:33:03 and stuff it was not focused on the total body the gut health your metabolism you know your pancreas your liver this stuff is important you know it makes a big difference so I think what we can start there by start getting people more healthier and educating patients spending time with the patient well that means you can't see 60 people in the day you have to spend my new patients I spent 45 minutes to an hour my office knows they can tell this my competitors sometimes other people I know they're

00:33:33 seeing 60 people a day or 100 people how can you spend quality time with a patient educating about all if you're seeing 100 people a day these are listen the insurance companies have the data they know on their per month this doctor is seeing this many P they know this he seeing this many patient they know okay this doctor let me see they did 100 surgeries and well you know 70% was Fusion this doctor did 100 surgeries 70% was non-fusion well these guys are doing a lot better they they can easily start

00:34:05 looking at this data but the problem is that they don't they pass the book to the patient so how they increase your premiums your deductibles every year goes up you mentioned that we have had guests on the show that actually become addicted after going to these operations they had an operation and then they they they they actually went in and they took took these pills and they liked it and they got addicted did you see that happening absolutely so that was the thing that was upsetting me because I

00:34:35 feel like I was basically adopting what was taught to me with no not default but this is just it gets passed on every residency you go through this is just the way you do medicine it gets passed on nobody's like critically thinking well is this really right to do it this way so I started basically you know one thing I remember uh I learned and my dad used to say is that never be satisfied with what you're doing even if it's going well always try to figure out could this be better if you don't think

00:35:09 like that how are you going to get better so I was always thinking like okay can I do the surgery better can I treat the patient better so I started thinking you know always getting better and then about 2013 I got introduced to this whole branch of medicine called functional medicine basically integrated functional medicine where it looks at the human body as a whole none of that was taught in medical schools they don't teach that stuff they're teaching you how to push drugs you have high cholesterol here's a drug you have high

00:35:40 hypertension blood pressure here's a drug you have autoimmune oh here's a drug for it but why do you have high cholesterol why do you doesn't get to the root cause the root cause so I learned this guys and they're the root cause and why we have higher cancer we have higher chronic disease diseases neurod degenerative disorders like it's getting bigger and bigger and we're spending the most highest dollar than any other place in the world we're getting worse and worse so these functional doctors are dialing it back

00:36:10 and treating the patient holistically by using food as medicine I was basically I was becoming pre-diabetic if you looked at me at the time I was less than 10% body fat people knew it was amazing shape but I was pre-diabetic you wouldn't believe that I had cholesterol was like going like crazy I had acid reflux so my friends oh here's a bunch of pills and so your doctor friends yeah yeah yeah they're like oh yeah you got to this you got to do I'm like there was a colleague a friend of mine Dr taze

00:36:41 relle Taz TZ IB which I credit her would really opening my eyes and when I talked to her I was like I've never heard of this what is she talking about so I started reading a little bit and I started attending conferences and I actually went to her said you know what let me see if she can and I went to her she got rid of all of my problems but just using food and supplements as medicine basically and I couldn't believe it everyone was like ah it's not going to work dude and that's how I learned in

00:37:06 med school everybody was like you can't lower your cholesterol by 50% that's impossible you need to have you know this is just life you get older but no she I learned from her and I started adopting that practice started incorporating into my own practice and I saw the results where if you treat patients holistically the way I did it it makes a big difference like the patients are like happier less pain much faster recovery and but you know this stuff takes time you got to sit down the problem is the insurance companies do

00:37:37 not recognize any of these extra work basically they're not reimbursable so the doctors are just treat it the same it doesn't really matter if you do eight surgeries a day and you kind of look at it as a factory or or you you do one really good one and you really care about that patient or two good ones they don't care they don't care about that they uh it's unfortunately to me it's like if a guy came out i' I've had I like we had a I had a patient who was a nurse actually and very well High highly

00:38:12 skilled nurse that she's been in administration right now she came to me she wanted surgery she was out of her insurance had no out of network benefits and they treat us like commodity because she wanted me to do the surgery based on what she heard whatever and stuff the insurance company B were trying to send her to a guy who just finished training 6 months ago to do a big complex surgery like if it's your spine do you want a guy who just finished Fellowship a year ago two years ago or you want them to go

00:38:43 to somebody's experience with a very good track record to do a very complex surgery because I've been I've seen the results that a bad spine surgery can ruin someone's life can you become paralyzed right is that or no it's not even just paralysis that's extreme but it's more like chronic pain like you get dependent on opiates like your quality of life is ruined basically you're getting just pain you you're you can't stand up straight you're you're basically punched over you're you're in so much pain like you're it just ruins

00:39:12 your life they treat you rather than saying you know what this guy so I had to get on a call with a doctor thank God the doctor he actually was good he said you know what this is a no-brainer I'm going to approve the patient to have surgery with you I totally everything you're telling me makes sense I get it I get it you know what no no no that's it approval but the insurance was pushing the patient because I saw the name of the doctors they gave and I'm like none of these doctors have more than two

00:39:37 years of experience doing this because to them it's it's not about the money because they can pay their in network doctor very little very little money unfortunately the hospitals of healthcare I feel like doctors were getting good they don't reward them so they leave so then they have a lot of the hospitals the corporations now Healthcare they're hired these young super young doctors so if you go look at the a lot of the hospitals big hospitals they different departments you'll see couple of really good doctors who are

00:40:09 very good the rest of them are all these super super young people because they don't want to pay them and 95% of the public doesn't really have access to those really good doctors because those doctors only treat royalty or super VIP you know they they only so much time they have that everybody else gets stuck with these guys with the min I you know now do you have any recommendations for the patients basically you know to me is U doctor experience matters you know I can tell you what I know now experience

00:40:38 really makes a difference it's not about your skills even if you have the best skills you come out you don't have experience and I've learned in spine surgery experience really matters so find out the experience how many cases of these have they done talk call the hospital talk to the nurses station that know the nurses know all the doctors who are doing the surgery spine they know all the spin they will tell you who they would go to call the nurses ask references say I want to talk to five patients also read don't just look at a

00:41:07 five star Google review or 2.5 star Google review read the reviews because sometimes I know a doctor who has like two star Google review but none of the reviews are about him as a doctor it's about his office staff it's like terrible so that's not fair to the doctor read this stuff I said get references get multip references basically and especially I think if you're being offered a big operation Fusion operation you know what get another opinion don't just jump into it find out if there are alternatives that can be

00:41:41 done alternative surgeries sometimes patients are not told that get a second opinion put the brakes on and I tell you another thing don't always listen to fearmongering I've had patients who've been told if you don't have surgery in 48 hours you're going to get be paralyzed which is not true you know it's wrong sure super small percentage of the population yes you need emergency surgery no problem but not every patient if you don't have any ongoing like bad nerve damage going on meaning if your

00:42:12 arm is working your foot is working your leg is you don't have that much weakness you don't have that much numbness you're not in danger okay you have time to get a week to get other opinions don't don't if a doctor is really pushing you and just listen to your body get get second opinion third opinion if you have to especially the bigger the surgeries get ask the doctor I I need to talk to five of your patients and and ask question listen the doctor's job is to sit down you know what I do when I finish I never

00:42:41 like come and talk whatever I leave I always at the end I say do you have any other questions listen there are sometimes patients I get it they're asking the same question repeatedly but I never tell the patient okay enough like whatever or you know what I got to go see you know let the the patient basically like you know what no I any other questions thanks okay but if you're seeing there ask the ask the assistant or the medical assistant of surg how many surgery does he do a week if they say he's doing oh 15 20

00:43:11 surgeries a week that's a red flag does he ever you know how many surgery he does in a day because spine surgery I remember my mentor told me that if you can do six really six or seven really good surgeries but do a really good job that's that's very good week six six a week yeah six or seven a week and you can do the job like really well focused on that you don't need to do any more you don't need to do more than that more than that depends listen if there's like I've done like sometimes nine in a week

00:43:40 but there are like little like one and a half hour surgeries you know like you do three of them in a day three of them in a day three of them in a day so that's not yeah no problem but I'm talking like the spinal fusions where they're taking longer and you can ask him how many fusions is he doing basically if they're doing a high volume surgery you know these are the things to how many patients does he see in clinic if they're telling you you see oh we see about 50 60 people A Day In Clinic that's a red

00:44:06 flag from 8 to 5 really can see 60 people and give them quality how many minutes are you spending per patient these are the things basically but patients have to be proactive ask questions you know don't feel like you're rushed basically you shouldn't feel rushed we have heard from some doctors that the problem in the healthcare is a lot of patients have no idea what's the cost yes they don't know what cost what they will find out afterwards you know you might get a surprise bill you either get a surprise

00:44:39 bill or your insurance will pay for it so you might have gone through a surgery that cost five times more somebody could come and see one doctor and pay double the other doctor or go to a hospital that cost like five times more another another one do you think this is a big factor that's causing a lot of these problems in the healthcare or do you think there is a way to solve this I think some yes because by law all hospitals were supposed to put on their website the transparency there was a law

00:45:09 that was P few years ago the transparency law the hospital supposed to publish exact amount they're charging for every surgery but unfortunately that hasn't happened and nobody is holding hospitals accountable for that hey this is a law you're not doing it some hospitals are they're not doing it and yes you could go one hospital that says an appendectomy let's say your appendix out one Hospital say 10,000 another hospital says 60,000 or knee replacement One hospital says 15,000 another hospital says 880,000 same exact surgery

00:45:39 basically so to me the part of the problem is also the bigger the hospital corporate they tend to charge more because they're also because they have a lot of patients because the bigger the corporation the big name hospitals they tend to command more from the insurance companies so for example a simple let's say appendectomy One hospital could get paid because of their contract could get paid let's say 10,000 another hospital for the same surgery is going to get paid 50,000 from the same insurance company

00:46:11 from the same insurance company yeah so doesn't matter Edna United Blue Cross doesn't matter same insurance is going to pay one hospital this much another because of the contract because of the power One hospital has so that's how I feel Healthcare cost increasing because when these bigger hospitals are charging this much and then eventually they're starting to buy out all the little guys so now for example a freestanding Healthcare facility I'm sorry Imaging there was a place I knew I used to send

00:46:40 my patients if they needed cash $150 to for a CT scan now they got bought out by a major Hospital basically so now the cash price for that is like $450 same CT same Tech same everything no difference because now because they commanded the same times the price so the reimbursement now for the same Imaging because I remember I talked to the radiologist I'm like hey why did you guys merge it they're like yeah the reimbursement simply so now because they bring their contract so now the same thing is being paid three times four

00:47:14 times more because the insurance is paying for it right or they have a better deal with the they have a better deal they have a better contract so this is our contract you need to pay and unfortunately the insurance companies when they get squeezed ultimately they squeeze you know the consumer the Pati basically they either charge more or they might not approve the or approve it yes that's exactly right I mean we know they they charge more because you know our premiums have gone up the premiums have

00:47:40 gone up every year and part of the problem like is there's also a monopoly that's happening with the insurance industry in different counties and States before Obamacare we used to have I could go as an individual and look at the list I'm like okay you know hm you know what I want to get for example I want to get this one here and you know what the premium was I remember the premium at the time was like $200 and I had amazing Insurance my deductible was less than less than $2,500 and I could go to

00:48:11 anywhere in the country get it done when ObamaCare came guess what you don't have a list anymore you only have one major Insurance individually in California that 90% are can only get that's all you get so now they know have the Monopoly they can also control that deny you know because you don't have where you you don't have any other choice basically so now they can increase your premium like my premium every year is going up deductibles get a little bit more co-pay increases co-pay used to be 10 20 now

00:48:42 it's like you know 50 60 70 80 you know it's going up basically for the same thing because I feel I get it the insurance companies are getting squeezed because the hospitals are charging more they've created Monopoly it's like this kind of a system where the hospitals and insurance or profit is like basically becoming the center point for all of them so one squeezes the other one the other one squeezes around the the patients basically Dr Hooman Melamed Orthopedic spine surgeon it was great to have you in California Insider thank you

00:49:11 very much it was a pleasure I loved it thank you very much let us know what you think of this conversation with Dr Melamed do you think the Health Care system has become more about money than patient care you can always reach out to me by emailing me at caka california.com or make sure to comment we read all of your emails and comments we'll see you next time