Episode 11: How Medicare is Killing Your Health

Dr. Jake Berman, PT, DPT explains why Medicare is killing your healthcare – why he has an Out of Network clinic from all insurances…

Dr. Berman drives to give you the Maserati experience – give you what you need, no more, no less and to get you better faster.

(1:39): If you have Medicare and you’re going to Physical Therapy, you just find a clinic in your network and they will cover a certain amount for a certain diagnosis. The PT must justify medical necessity for specific treatments for a diagnosis in order for medicare to pay the PT clinic.
(2:40): Medicare decides what intervention is medically necessary. If they do not think it is medically necessary, they will not pay for it.
(4:00): Medicare cares about ADLs, not Pain
(7:40): Insurance companies follow Medicare’s Lead
(9:19): Before surgery you have to jump through some hoops like PT, injections, etc.
(11:00): BPT is out of network because we want to provide the care patients need, not what Medicare is dictating.
(12:45): BPT will do exactly what you need – no more, no less. We don’t give you what we need to be reimbursed…
(18:80): In Network PT still has to stay in the treatment plan dictated by insurance companies, despite PT clinic plan for the number of patients they see an hour.
(20:19): The difference of treatment at in-network clinic versus out of network clinic is like a Kia dealership versus Maserati dealership – the quality of care, personal care, and the experience.