In this episode of the Balls Deep podcast, Dr. Joe Pazona and co-host Cat Williams pull back the curtain on the healthcare insurance industry, exposing the complex, often frustrating world of medical billing and insurance that impacts both patients and providers. This episode is a candid and passionate discussion of why the current system feels broken and what it means for both sides of the healthcare equation. Keep reading to learn more about the health insurance system and its impact on both patients and physicians.
The Hidden Costs of Healthcare Insurance
Dr. Pazona starts explaining the administrative mess that comes with running a practice within the insurance system. He shares the burdens physicians face, starting with insurance enrollment — a draining process costing thousands of dollars per provider and often taking months to complete. After enrollment, physicians must navigate complex contracts with little negotiating power, leaving them at the mercy of insurers who determine their fees.
Despite being a highly trained specialist, Dr. Pazona candidly reveals that the fees physicians receive for patient visits are often less than what you’d pay a plumber or a tow truck driver. Meanwhile, the cost of operating a medical practice — staff salaries, electronic health records, and other overheads — keeps rising.
The Nightmare of Insurance Eligibility
For patients, presenting an insurance card seems straightforward, but behind the scenes, the doctor’s office must verify eligibility. It’s not uncommon for patients to carry expired cards or unknowingly switch plans. And it gets trickier: even within a single insurance provider, there are multiple sub-plans with different rules. Mismatched information can result in claims being denied weeks or months later, leaving practices — and sometimes patients — unpaid for services already rendered.
Dr. Pazona likens the system to ordering coffee: imagine ordering a latte at Starbucks and being asked which “coffee insurance” you have, only to find out halfway through your drink that your insurance doesn’t cover the vanilla syrup. This level of absurdity, he says, is what medical practices endure daily.
The Labyrinth of Claims
As services are rendered, the billing process begins. However, this step is not straightforward. Medical practices must use third-parties known as clearinghouses who are responsible for submitting the claims to insurers. It could take anywhere between thirty to sixty days to receive approval, assuming they are approved at all; however, a lot of claims are outright denied. Claims could range from patients being enrolled in a high deductible plan without them knowing to incorrect coding. These denials often result in the burden being passed to patients, months after their visit.
A chilling example shared in the episode was a cyberattack on a clearinghouse company that left Dr. Pazona’s practice without payments for two months, forcing them to operate without income. Ironically, the clearinghouse was owned by the very insurer responsible for paying claims.
Why It Affects Your Visit
The financial strain on medical practices explains why many doctors must see as many patients as possible in a day, often resulting in rushed visits and long wait times. This volume-driven model is a direct consequence of declining reimbursements from insurance companies over the years. Dr. Pazona calls this system “bullshit,” advocating for a model that prioritizes patient care over bureaucracy.
Alternative Models: A Glimmer Of Hope
Towards the end of the episode, Dr. Pazona makes some suggestions claiming that such models could potentially assist the once strong bond between the patient and doctor. He hints that the new model Pazona MD will use in 2025 will be doing that. This cliffhanger leaves listeners eager to learn how practices like his might break free from the insurance chaos while remaining sustainable.
Takeaway for Patients
It was a clear element of the conversation that the insurance system brings about unnecessary headaches for both the patients and the physicians.For patients, understanding their coverage and advocating for transparency in healthcare billing is crucial. For physicians, exploring alternative practice models may be the key to sustaining their passion for medicine without sacrificing quality care.
Dr. Pazona will talk about new things that will be coming to his practice during the next episode, and we’ll be sharing it with you soon! Remember, information is the most powerful tool you can possess when it comes to looking after your health — take control!
To learn more about Dr. Joe Pazona and Pazona MD, visit our website.
Disclaimer
This podcast is for informational purposes only and does not substitute professional medical advice. Always seek the guidance of your healthcare provider for any medical conditions.
