EP 9
The Health Insurance Illusion
About this episode
Dr. Naqvi and Dr. Ahmed break down how confusing US health insurance really is, explaining premiums, deductibles, co-insurance, copays, and out-of-pocket maximums in plain English. They share real war stories of prior authorization denials, peer-to-peer reviews with non-specialist reviewers, and the difference between HMO, PPO, EPO, Medicare, and Medicare Advantage plans, plus why cash-pay and direct care models are gaining ground.
What we cover in this episode
- how health insurance deductibles and premiums work
- what is co-insurance and out-of-pocket maximum
- prior authorization denials for surgery
- peer-to-peer review with non-specialist doctors
- difference between HMO PPO and EPO plans
- Medicare vs Medicare Advantage explained
- why doctors stop taking Medicare patients
- cash-pay and direct care medical models
- surprise medical bills and explanation of benefits
Your hosts
Dr. Humayun NaqviPreventive Cardiologist · West Houston Heart Center
Dr. Adil AhmedOrthopedic Surgeon · Baylor College of Medicine