The challenges of navigating the healthcare system, particularly regarding insurance coverage for medical testing and treatment. The difference between the medical and wellness approaches and emphasizes the importance of customization in achieving optimal health outcomes. The need for patients to actively participate in their health journey and offers insights into how his practice, Pillars of Wellness, approaches personalized care.
Highlights of the Podcast
00:25 - Insurance
02:09 - The way that systems worked out
03:26 - One of the reasons that a lot of medical docs won't pull labs
04:24 - How the system medical system works
05:55 - The things that are really important to your life
07:17 - The starting point
08:45 - Return on your investment
10:21 - Steroids
11:37 - You will feel better
13:18 - Favorite part of the whole thing
14:24 - Where the customization really starts to happen
Dr. Matt Chalmers [00:00:04] So once again, I tell you, some of this might help out with the way that we do things. So, I had a patient come in. I went through the whole executive. They go where we need to start. And the person said, you know, I have really good insurance. Buddy Miles, my doc, he said, Will you let me, put on my insure the blood labs and insurance? And I was like, I don't, I don't care. And I was like, we've have lots of problems with the past, so I'm out of it. So I'll tell your doctor what labs we need. And if they're willing to run them, which most aren't, then they'll be fine after we put it on insurance, I said. But here's the problem is understand that our labs will be substantially more expensive if you try to go through insurance. And they did not. And they were like, oh, that's fine. I just want to check with them and see. So it takes him to his to his doc and to this guy's doc's credit, he actually called me and he was like, hey, man, there's no way I'm going to get this approved. Here's what what are you trying. What are you trying to ascertain? Here's I think we're the big philosophy differences.
Dr. Matt Chalmers [00:01:06] The way the medical works and the way that wellness work are not the same. So the way insurance works and medical and insurance work, they've kind of molded each other. To say that that medical works because of the way insurance works is more accurate than to say that the way insurance works, because medical. But the way it works is you go to a doctor and the doctor says, okay, I've listened to your symptoms and listen to what you're telling me. The problems are. And I think that your problems all come from this one issue. And so I need to run these 3 or 4 labs to verify whether these problems are coming from this issue, so that I can prescribe this drug as the solution to this whole problem. And so that's the way it works. So the reason insurance denies things is if you say, I have this diagnosis code and I want to run these labs to confirm or deny this diagnosis, if you go and I want to run this thing, insurance goes well.
Dr. Matt Chalmers [00:02:07] These three we understand because of the way that systems worked out. And insurance has their own medical team that makes decisions and they go, okay, these three are approved because they have relevance to what your primary diagnosis was. This one doesn't. So for instance, if you say, hey, this person has a really bad sore throat, they feel kind of down. There's their mouth is all red and splotchy. I think they have strep throat. They will approve you to do a blood test for strep and a a oral swab for strep. They will not approve testosterone and, growth hormone levels and things like that because they're like, what does this have to do with strep throat? So we're not going to approve these labs while we do approving pay for these labs. And so that's how a lot of these decisions are made. So when you give them a giant blood lab and they go, what exactly are you trying to prove or disprove? What what are you trying to rule in and rule out? And you go, oh, we're just trying to figure out what they're healthy. They're going to we're not going to approve any of this.
Dr. Matt Chalmers [00:03:09] The other side of that is that as a doc, when you put your name on something and say, I like these labs, the insurance thing calls you back and goes, why? And if you can't come up with a good reason that they flag your account and they say, audit this person and watch the labs are sitting through because they're sitting frivolous labs through, which is one of the reasons that a lot of medical docs won't pull labs because they're afraid. Well, this lab test comes back low. I then have a legal and ivory obligation to do something about it. And if they don't know anything about hormones, which 99% of them don't, even the endocrinologist, they have no idea. So if a lab comes back low or high and they don't know what to do about it, now they're legal. Ovale. So that's the other reason why they don't pull labs. And a lot of the times when they try to figure out what what am I going to do? They go to what's called the standard of care. And so they which is why when you go to five different doctors and they'll give you the same diagnosis, the same drugs and the same things is because when they look at their thing and they go, oh, you have a headache.
Dr. Matt Chalmers [00:04:07] I have the options of Tylenol and Advil to give you right now. And if neither of those work, then I send you to a specialist. If the doctor gives you something outside that list, he's outside the standard of care and he can get in tremendous amounts of trouble, lose his license, get fined, all sorts of things. So that's how the system medical system works. So if you're just like, I want to know if I'm healthy, well, I can run a CDC and ICMP, which is what they usually do. It's funny because people like, I got a lot of blood work done, and there's like 40 things on this piece of paper. 1 or 2 might be relevant. So, you know, that's that's the problem we get into because medicine is what is your one problem. Pick one problem. Today you can only have one. You can't have a system of issues. You can have one problem. And if you tell me that one problem is I'll try to find 1 or 2 labs to pull to confirm or deny that. And then I'll write you a drug based on the results of that. That's how the system works.
Dr. Matt Chalmers [00:05:03] So that's the thing I'm railing against all the time. Why it doesn't work for once, that if you walk in and you go, doc, look at my throat, it's red and splotchy, it hurts to swallow and I feel gunky. I'm pretty sure I have strep and they swab you. They go, yet you have strep. Here's an antibiotic. That system works, correct? But if you don't have an easily diagnosable problem, if you have a system wide failure, which is what, 99? So people that I see have the Western medicine model doesn't work at all. So that kind of brings us to the the how, why we do what we do. And, you know, I tell everybody that we're writing custom stuff and then, you know, husband wife will come in and we'll do the same thing, the same test, the same figure out, you know, when we start, you go, how is this custom? I have to find a place where we're starting. I have to find a starting point. And so what we try to do is we try to figure out, okay, we're going to do a broad actual system test.
Dr. Matt Chalmers [00:05:54] I'm going to look at the things that are really important to your life. We're gonna make sure your heart's working. We're gonna make sure your hormone system is working. We're going to make sure that your nutrient function is where it's supposed to be in your allergy functions, where it's gonna be. The vast majority of people, if we get their parasites gone, we get their liver cleaned up a little bit, we get their kidneys cleaned up a little bit, we get their gut ready to go, and we get their hormones rebalanced, and we touch their diet a little bit. They're gonna be substantially better than they are. But the customization happens when we start working with the actual patient. And when you have people who have sat down with me, they've heard this, this, this before, but it's the ROI, right? So when people come in, I always tell them it's not.
Dr. Matt Chalmers [00:06:35] My job is to give you all of your options. Your job is to figure out what of the options works for you in your life today. And what ends up happening is you guys get to help really direct where this goes. Because here's the key thing that, you know, I think everybody needs to know. It doesn't matter what I want you to do. It doesn't matter how much I want you to do something. It doesn't matter why I want you to do something. If you don't choose to do it, it's not gonna get that. So you guys are limiting reagent every single time. So that's why it's. That's one of the things that makes it customers. What are you willing to do? And a lot of times, again, this is something you guys have heard before when we figure out where you're starting. Right.
Dr. Matt Chalmers [00:07:17] The starting point. So we do all the heart checks, we do all the blood checks, we do the eastern medicine checks, we do all the different checks. We know where you are today. Then we have to figure out where you want to go. And so we get the point and the point. Because without where you're starting and where you want to go, I have no direction I don't know. Well, what are we going to do? How are we going to do these things? Is it safe to do these things? So we get where you are today, where you want to go. Here's where the fun comes in. As people start to get better. They start to come in and they're willing to do different things. And so what I hear all the time, if something to this effect, where they come in and they go, I don't want to be as big as you. I don't want to be. I don't want to do the crazy things you're doing. I don't want to be as tight as you are. I don't want to get on stage. I just want to have the energy to feel like I can get through my day. That's all I want.
Dr. Matt Chalmers [00:08:04] You know, if I have to go to the gym, I will, but I don't really want to. I don't care about how I look. I just feel miserable all the time. Cool. That's that's easy. That's that's appointment. And then as they start feeling better, they start coming back. And maybe it's a month from it's six weeks and then back in they go, hey there. I told you I didn't want my arms to get any bigger. Well, let's just say theoretically, maybe I want to discuss that. What would that entail? Or. Hey, I haven't been going to the gym, but I got this energy, and I think I've got some time. Maybe I would want to start talking about going to the gym. How does that entail? So what is happening is that point B moves and it keeps moving.
Dr. Matt Chalmers [00:08:43] And the reason it keeps moving is because you get a return on your investment. So I always tell people if you gave me $10 -20 back and you gave me 50 and I gave you 150 back, you give me a thousand, maybe $10,000 back. You give me all your money. You're like, oh my gosh. The return on investment you're getting is amazing. I want to dig into this really hard. But you took three or 4 or 5 different small steps to see results, and then you. Okay, I'm willing to dedicate more time or energy or money or whatever to this, this endeavor because I'm actually getting returns. Finally, because a lot of people that I work with have worked with, people for weight loss or they've worked for health or they worked with or whatever, and they try to do 1 or 2 of the five things required. They didn't really get good results back. So this is I didn't get those good results back. They're a little hesitant to dive in headlong, which is fine. This is where the customization happens.
Dr. Matt Chalmers [00:09:36] So for instance, we'll talk to people and I'll be like, your testosterone is low. We need to get that up. And here we go. I don't really feel comfortable with testosterone. I'm like, all right, we have that discussion. But again that's your call. Or you know, hey, you should really be doing coffee enemas. And they're like, I'll do anything besides stick something in my butt. I'm not doing that. All right. Cool. And so we do something else. And then as we go along, you'll come back here. All right. I'm feeling a little bit better. I'm more comfortable. Let's talk about doing this. And then what happens with that one is six, eight, ten weeks later and they come back and they go, I am so mad at myself for not doing this earlier. And I'm like, I know, and a lot of things will go. But I felt like it was cheating. I felt like, you know, like I've been told since I was eight years old that steroids are cheating and steroids are bad and steroids. You're crazy.
Dr. Matt Chalmers [00:10:24] And steroids are horrible and terrible because you've been brainwashed into that. And I get it. You've been lied to a tremendous amount, and it's very, very difficult to walk away from those lies because you were told to trust these people. You did trust the government and the doctors. It's true that the information they gave you was slighted to make money for them, not to heal you. And you didn't know that. And the copy in my I is one of my favorites because it is literally the only thing I've ever seen where the fastest, the best, and the cheapest option is a one.
Dr. Matt Chalmers [00:10:55] One thing. Usually you get to pick two of those, but you get all three with the coffee and it is the best thing for your liver is the cheapest way to affect your liver is the best way to affect your liver. However, you've got to take the time and you got six and then you're back. So that's that's I guess the downside to that. But those are some of those things. And so as people start to be like, okay, now I'm going to do this, now I'm going to do that. The thing that, you know, and people ask me all the time, like, well, do you sell supplements? Do you sell hormones? What do you sell? My goal, because I don't care where you get a lot of this stuff, as long as it works. The goal is to sell you on the idea that your life can be better than it is today. If you'll just do some things to manage take, you know you need the chemicals that get the good chemicals in you. Get the bad chemicals out, you will feel better. Start exercising. You will feel better.
Dr. Matt Chalmers [00:11:41] Start working on your mental peace. Start working on your mindset. Start working on the way you view the world and your life will start to get better. So that's the idea. That's what we're trying to do. That's why when people come in, they go, they look at the executive physical, they go, oh, I already had the echocardiogram with my when the cardiologist and I've already had a sleep study with, you know, my primary care grant. Bring me the information and we'll take it off the price. What we're done. Like part of the price is take the laps. I just need the information. I don't care where we get it. We just need the information because it all paints a picture of where you are today.
Dr. Matt Chalmers [00:12:15] And once we can figure out where you are today, this is a definitive point of where your health is today. And we can come up with with your goals and your desires and you know, whatever is going on with your family and your needs, we can figure out a a point, b a direction to go to, even though the goal is to never actually get there. I want you guys to keep being like, well, what if I did a little bit more cardio? What if I did a little bit more exercise? What if I clean my diet up just a little bit more like, I want that point me to continually move, because that tells me that you're on a health journey. That means that you're satisfied with the with what's going on. But you want more. You want more health, you want more benefits. And so as that point B starts to move, that's where everything becomes customized. And it's funny, the amount of people who told me I don't want to get on stage or I don't really care about losing weight, or I don't want my arms to get any bigger or I don't. I'm not. I don't really care that much about my back.
Dr. Matt Chalmers [00:13:05] Who, you know, two, three, four months later, come back in, they go. All right. So if I did want to start my bat a little bit more, if I did want to work on my acting a little more, if I did want to work on this a little more, what does that look like? That's always my favorite part of the whole thing, because that's really where it starts to customize, right? Because it's like, look, we've we figured out what your health was. We've, we've we've recognized everything it's going to be say we fixed the things that were critically dangerous. Like if you have sleep apnea, getting a CPAp is critical to your long term mental and, mental psychological like. Parkinson's. Alzheimer's. Dementia. It's really critical for that. Epilepsy. It's critical for hormone functions, for energy, for all sorts of things.
Dr. Matt Chalmers [00:13:44] So once we've done the safe stuff and you've started to customize these things, you start taking the symptoms that you want to do better, the life quality you want, and you start doing the things we start, you know, when we really start growing it of that piece, that's where it gets fun for both you and me. That's where the real customization comes in. Like when I work with athletes and I'm like, when you ate that, how did you feel in the middle of practice? How did you feel at the end of practice? How did you feel the next morning? You're like, well, I was I was tired and that little practice. All right, we increase your fat. So we need to increase your carbohydrates. We need to change the glycemic level of your carbohydrates, whatever we need to do as we customize it to really dial you in. That's the fun part.
Dr. Matt Chalmers [00:14:23] And that's where the customization really starts to happen. So that's kind of where this happens. But the starting point is really important. So when we get all the labs, when we get all the stuff in, we can move forward. The reason why insurance doesn't pay for this stuff is because. They're trying. They've set up a model that works best for them. And if you guys want to, I can do it. An hour long super in the weeds lecture of why insurance doesn't pay for things. But I think the only people who would really care about that are other practitioners. So I'm not going to do that. But there's a there's a lot of reasons why insurance can deny what you're, what you guys are asking for, especially if you're asking for wellness from a sick care model. Right. So sick care to sick care. Wellness does wellness. Asking these guys to understand, allow and pay for these things, it's just not you're not going to do that. So that's one more that it. So I went very long day but that's sorry. so if you guys have questions or you guys are looking for a place to start with your health, give us a call. Just go to Pillars of Wellness. Accommodate that knocked out. But that's kind of where everything starts. So if you guys have any questions, it was called. So thanks for your time.
As always if you have any questions, please send them to Questions@ChalmersWellness.com
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Dr. Matt Chalmers
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