From Insurance To Cash: A Podiatrist’s Guide To Better Patient Care

There's so many great treatments, there's so many great options available for the patients that they never get exposed to because of the damn insurance companies.

We've been taught for like 100 years that the symptoms of diabetic peripheral neuropathy are irreversible. There's nothing that can be done to restore sensation or reduce pain. If you're able to restore a protective level of sensation, you've taken that rate of recurrence from about 40% annually Down to less than 5%. So you're looking at a tremendous thing.

All right. Hey everybody, it's Matt Skalogley with the Practice Profit System and really excited for today. We got a real live doctor on the call, on our podcast I should say. And we have Dr. Steven Barrett who is a podiatrist down from Atlanta, Georgia. He has successfully left the insurance race for For everybody's record, he is not a client of ours, but I do think it's important that you hear from others who have made that exit. And today what we're going to be talking about is not just his journey away from insurance-based care, but also the great work that he's doing with neuropathy. So, Dr. Barrett, thank you for joining us.

Oh, my pleasure, Matt. Thanks so much. Appreciate the opportunity.

Yeah. And we did, you know, we had a lot of fun. We did a— I was on— I'm just going to call you Steven because, you know, Dr. Barrett's a lot.

It's a mouthful.

But, you know, I was on Steven's podcast and we'll put the link in the show notes because I think you really need to follow it. But I was on it last week and we were talking about just kind of the rat race that insurance has become. But I want to start before we dive into the neuropathy stuff. How in the world did you ever make the decision to transition from insurance to cash? What was that journey like? What was kind of the impetus?

Well, if you really want to look at it, the impetus was probably Maybe 15 years ago.

Mm-hmm.

But when I first went into practice over 30 years ago, it was a very simple system. You had, you know, common sense medical records. You didn't have to create 5-page notes to get paid for a simple office visit. You— it was a fee-for-service, a real fee-for-service system back then. You took care of the patient. There was no such thing as a preauthorization. And you just did what they needed to have done and sent the claim in. And then within 2, 3 weeks, they'd send you your check for 80%. And, and life was pretty good. And it slowly metamorphosed. It's a hard word to say. It changed.

Yeah, I know. I gotcha. Metamorphosized.

Metamorphosized. There you go. So yeah, and I haven't even started drinking yet. There you go.

Well, we could start. I mean, it's 5 o'clock somewhere, as our boy Jimmy Buffett likes to say. And I am Irish, so it's okay. You know, we can do that.

There you go. So anyhow, long story short, the system changed every, you know, year, 6 months. They would always change the rules and the coverages. And then, you know, so at that point in time, let's say we're halfway through that 30 years of practice, and then, you know, you're in kind of deep and it's hard to get out, right? So, you know, you don't want to keep churning your arms and your legs when you're up to your neck in quicksand. So you kind of just acquiesce and say, okay, this is the system and this is how it works. But then finally, it just got to the point where, you know, I was talking to my partner and I said, you know, if, if I don't go out of insurance and stop this nonsense, I'm just going to have to quit. And I wasn't really ready to quit. I actually enjoy what I do. I really love working with patients. And so that, that was really the impetus But it was kind of a slow drip. Yeah, torture.

You talk about the slow drip torture, just kind of that whole process. What I mean, okay, so if you didn't get out, you were gonna, you were gonna quit medicine. I hear that, by the way, all the time. So what did you do? I mean, you didn't just quit cold turkey. I mean, there's not really a roadmap. I mean, we have one, but we didn't know each other then. There's not really a roadmap to leave insurance. What did you do?

Well, I actually just kind of quit cold turkey.

You know, you're not supposed to do that, Stephen. You know, like, I mean, that's not the best way to like give up heroin, you know, is to go cold turkey.

Well, you know, sometimes you'll die and then other times you'll survive and, you know, and you get, you get through it. But no, actually for me, it, you know, I left the insurance world in the beginning of 2023, so about a year and a half now. And I think it was the summer of 2022 that I decided I've had enough of this system. And at the end of the year, I'm getting out. And I, you know, and some of that was spurred by one of the insurance agents or not insurance companies, one of the big ones that everybody would know sent a letter that said, hey, we overpaid you for, you know, 4 cases 3 years previously, send us a, you know, a couple thousand dollars. And, you know, that, that was like, no, because you never really overpaid anybody ever, especially us. And, uh, and so, you know, that was kind of like the tipping point for me. And I said, you know, to my partner, I said, I'm, I'm leaving the system or just leaving altogether. And so, you know, that's how we did it.

How did the patients respond?

Well, you know, it's kind of interesting. I think about 85% of them that I thought really loved me, they either stayed because my partner stayed in insurance. So they left me and went to her, which is fine because she's fantastic. And then, you know, about 15% said, no, we'll, we'll do the direct care model. And so that's kind of how that worked.

And did you like set up a membership or they just pay as they go? Like, how does that— how does the pricing work?

Yeah, no, we didn't because we're different than like a an internal medicine practice or a family practice that has more of a concierge level where you buy a you know a year's coverage or or that type of thing. We're just fee for service. So if you come in and you you know need an office visit, it's whatever the office visit you know charge is. And then if you need to have surgery, then you know you just like if you would go to the plastic surgeon's office, they'll give you a quote and. Then you can get a copy of the super bill and that, and, you know, that's a thing that the patient can then send in to their insurance company. And really it's a contract between them and that insurance company, not a contract between me, but, you know, I would suffer the games and the rules that they would play on behalf of the patient. So that's kind of how we did it.

You know, what's interesting is most people, even in the medical field, I don't think they realize that that contract is really between the patient and the insurance provider. You just get stuck in the middle, right? This is what's the what was the okay so but if you lost 15% of your patients, how has the business survived? Did you just start charging more?

They actually they actually pay you for what you're worth, right? And I mean let's face it, if your chihuahua jumps off the table and breaks their leg, unfortunately. For the veterinarian to go in and do an open reduction internal fixation and fix that broken leg, it's $3,000, $4,000, right? And people are used to paying that for their animals.

Hey, I'm Matthew Gallogly, and I'm a Maverick. Well, what is a Maverick? A Maverick goes against the grain. We find our own way. And if you're sick and tired of being pushed around by the insurance companies, come join us. We'll show you the way out. And You'll love medicine again.

So if, you know, we—

How dare, how dare you compare humans to their pets? I mean, come on. I'm kidding with you.

I mean, you can't. I mean, I love dogs much more than I love people, but—

Yeah, because they're nicer. They're always happy to see you.

Exactly.

They don't have an agenda except for they want to walk, a belly rub, or some treats. So that's about it.

Exactly. And they're not like, you know, my kids asking for money all the time.

Everything.

So they just want their, you know, their love. It's all good. But anyhow, long story short, that's how we did it.

Do you wish you would have done it sooner?

Yes. If I look back in history, probably the time to do it was about 2005.

Really?

Yeah.

Why do you say that?

Well, because up until then, it was still— there was still a lot of common sense in the insurance world, and then it just slowly got out of control.

Well, you know what Mark Twain said? The problem with common sense is it's not very common.

That's exactly right.

Right. You know, that's the— that is the— that is the real issue, right? You know, I find it fascinating that, you know, the insurance world— we talked about this on your podcast as well— but it's, it really, it's kind of like I guess I liken it to back in the '20s or the '30s in New York that you— it was just expected that you were going to pay protection money to the mafia, right? Like, there was no, you know, that's just the way it was done. And to me, the, the whole insurance game is just— it's such a racket.

I mean, right.

It's not— they're the only people that it's beneficial to are the insurance providers. It's not beneficial to anybody else.

No, it's not beneficial to the patient, certainly.

Right.

And it's not beneficial to the provider. And they've been very crafty and devious in their administrations over the last couple of decades where they've kind of demonized the providers, you know, and the patients can't understand why their premiums keep going up and that their service level goes down. And they think, well, they must be paying more to the the surgeons or the specialists or whoever's taking care of them. But the fact of the matter is, that's not true at all. In fact, reimbursement rates, as you know, I mean, for let's say a $1,000 procedure that was paid 80% back in 1990, that might be covered at $250 today. Now, what other business in the world or industry in the world has undergone You know, 75% reduction in reimbursement for the same service. But yet at the same time, these providers, their overhead didn't go down by 75%. Not at all.

No, it went up by 175%.

Right?

Right. Yeah. If you were coming out today, you were coming out of med school, out of residency, what would you do?

I'd pray that I won the lottery.

Okay, so let's quantify how much we're talking about here because there are different levels of lottery. Are we talking about the big one like the $500 million or the $800 million, or are you satisfied with like just $8 million?

Oh, $8 million probably gets you started pretty good, wouldn't it?

Yeah, I mean, after taxes is about $4.5 million. That'll be okay, right? Exactly. You can survive on that.

Exactly.

If you didn't win the lottery, what would you do?

Well, I think what you would have to do is you really have to probably begin with hybridization, where you are integrating services that are not covered by insurance so that while these patients are coming in and a lot of their stuff is covered, albeit very small, at, you know, at whatever level they decide to reimburse or not, there are other services that they just refuse to cover, but they're needed services and patients usually are willing to pay for them. And so if you can find, well, Like the regenerative medicine space is a very good example. We have a little bit different profile, I guess, because we're dealing with severe pain, neuropathic conditions that, you know, pretty much have pushed people to the end of their tolerance and their quality of life. And so that shifts the mindset a little bit more. So, you know, patients will be willing to actually invest in in their own for, for when they're suffering from that type of a problem.

Yeah, yeah. You know, it's just, it's sad what's happened to the industry. It's, it's sad how, from my vantage point, you know, in the world that we, you and I work in, there's so many— and we're going to talk about the stuff, the work you're doing in neuropathy here in just a minute— there's so many great treatments, there's so many great options available for the patients that they never get exposed to Because of the damn insurance companies. You know, if you think about PRP, I mean, I've had listeners know I blew my elbow out, grade 2 tear. I'm a former golf professional. I've had my back done. I've had my knee done. I've had, I've, you know, I've had like 9 PRP injections. I can't imagine having those injuries 5 years ago and going to get surgery on my elbow. Like, I just can't. I just, the stuff that we have available today is just unbelievable.

Right.

Let's talk about your work in neuropathy because to me, From my vantage point, when I ask my doctors about what can you do for neuropathy, I get a lot of shoulder shrugs.

Right.

So let's talk about the work that you're doing in neuropathy.

Well, let me tell you the story and how I got into it. And I think it really sets up everything as far as what the situation is with some of the procedures that we do and some of the pushback against that from maybe some of the different specialties and some of the different medical associations and everything. But so, in the mid-1980s, my friend and mentor, a man named Lee Dellon, who is a retired professor of plastic and neurosurgery up at Johns Hopkins, made the observation in his clinic one day where a patient that had diabetic peripheral neuropathy who also had carpal tunnel syndrome came in and had his carpal tunnel decompressed and The patient then came back postoperatively and said, you know, this is great. My carpal tunnel pain is gone, but I've now got sensation back in my index finger and half of my ring finger. And he said, wait, wait, we've been taught for like 100 years that this is irreversible, that the symptoms of diabetic peripheral neuropathy are irreversible. There's nothing that can be done to restore sensation or reduce pain. And so then, Dr. Dellen was a fantastic observationist, maybe one of the best that I've ever seen. And, and so we see things all the time, but we don't register them all the time. And so when he registered this, it's like, wait, this is contrary to everything that was taught in medical school, and I've got to do some more work on this. So then he, he figured out that, well, if he decompressed the ulnar nerve and and another nerve in the, in the forearm, that he could restore the sensation and reduce all of the symptoms of the burning and the, and the pain of the neuropathic process itself by these simple nerve decompressions. Now, what was really, what was really very interesting is that him being a professor at Johns Hopkins, he then had to back this up with lab research, right? And so, so he, he did extensive research on Uh, rats where he took his rats and he made— well, he made them all diabetic, gave them an agent called streptozotocin. They got really high blood sugars. They, they were very sick rats, cataracts, you know, high blood glucose levels, the, you know, the entire gamut. And half of his rats, he did tarsal tunnel decompressions in them before he made them diabetic, or soon after.

Yeah.

He did. And the, the thesis was, is that this is a swelling process of the nerves, and if you open the tunnel that causes the entrapment, then the nerve will not become entrapped. And so he was able— and at that time he made the conclusion that most of the symptoms of diabetic peripheral neuropathy were not necessarily due to the actual disease process on the nerve itself, but rather They were due to the superimposed nerve compression of the swollen nerve in the tight tunnel. And this has been proven now very well. I mean, there's a lot of literature that shows that diabetic nerves are up to 50% bigger in cross-section than non-diabetic nerves. And that's been replicated in the lab with rats, and it's also been studied in humans with ultrasound. And so this is a very well-established thing. Now, if you go back to that time, neurologists would have no problem with the conceptualization that if I have a patient with diabetic peripheral neuropathy and they also have a carpal tunnel syndrome, then I'm going to send them over to the hand surgeon. I'm going to have this carpal tunnel decompressed. There's no— there's probably not a neurologist in the world today that would have a problem with sending somebody over to the hand surgeon to decompress that carpal tunnel, right? And but then there's this giant abyss of understanding where if you take that same concept and say, well, let's go down into the lower extremity, it's the exact same physiological process. A nerve, a nerve that's entrapped in the lower extremity, whether it be the tarsal tunnel or a Morton's entrapment in the forepart of the foot, these in, in the diabetic patient are, are most often due to this compression phenomena. And they talk about, you'll hear the word length or the words length-dependent axonopathy, meaning that it's supposed to start at the end of the body or the toes, and then it's like a cigarette that just burns on its way up. And so the neuropathy gets less severe for the patient usually the higher you go in the lower extremities. So that's the predominant thought of what's going on, but there's, been some very good studies that show that nerves in the lower extremity that do not have a natural tunnel or a normal site of potential entrapment, such as the sural nerve, the patients don't get that. So if it was just this disease that was affecting every nerve, well, how can the sural nerve stand out as an exception? Well, it doesn't have a known site of anatomical entrapment. Now it can become entrapped in certain post-traumatic situations and certain variant anatomy situations. But generally speaking, this is a nerve that doesn't go through a tight tunnel like the tibial nerve in the tarsal tunnel or the carpal median nerve in the hand, right? So that, that really kind of pushes that back. Now here's the, here's the situation. So you can have multiple sites of nerve compression that will give you Almost like a stocking distribution, or if it's in the upper extremity, like a glove distribution of those symptoms. But it's not due to the perceived concept that there is this metabolic disease of the nerve itself. In fact, there's erroneously— there's a lot that believe that diabetic nerves can't regenerate. And the answer is—

Right.

They can regenerate extremely well, albeit slower than a non-diabetic nerve. So, if you take the pressure off of it, and that's like super well-established, but the dogma that gets drummed in people's heads for myriad reasons makes that kind of unrecognizable. Interesting. Okay.

So, what kind of success— like, let's talk about what kind of success do you have with this, right? So, let's give me a typical patient, right? Again, please understand I'm Everybody knows listening, I'm not a doctor, so I'm not going to try and ask any stupid medical questions. But like, let's walk through what do you, what do you see with your patient? Give us a couple of examples.

Okay. So success is a really important word here because what are we talking about? Are we talking about reduction of pain? Are we talking about the ability to restore sensation to a protective level? And maybe we're talking about balance. Maybe we're talking about something like restless leg syndrome, which a lot of restless leg syndrome can be attributed to peripheral nerve entrapment. But let's talk about pain first. So somebody that has tremendous amounts of pain, and you have to make sure that the patient can—

Hey, I'm Matthew Gologli, and I'm a maverick. Well, what is a maverick? A maverick goes against the grain. We find our own way. And if you're sick and tired of being pushed around by the insurance companies, come join us. We'll show you the way out, and you'll love medicine again.

Successfully be operated on. You would never want to do surgery on somebody that is so vascularly impaired that they're not going to heal. That's not the— that's not the patient that you're operating on. So they have to have— they have to have adequate vascular perfusion. They usually have to be less than 300 pounds just because of, you know, the larger people become, the more edema they have, it compromises their wound healing, these types of things. That's one of the things that you'll see in the literature. But let's talk about pain. So if we, if we have the properly selected patient, we have about a 90% success rate in the reduction of pain or elimination of pain. Now all patients don't get a complete reduction of pain, but they get a significant enough reduction in the pain that they're usually very, very happy. And one of the first questions that they'll ask you on the first visit after their surgery is, when can I do the other leg? Right. So that's kind of indicative.

It's almost immediate. Is it a lot like carpal tunnel that it's like literally that immediate?

Yes. From a pain standpoint, you will oftentimes see patients in the wake-up in the PACU and they'll say, yeah, I can feel the bottom of my foot. You can tickle the bottom of their foot and they'll retract from it. And this is literally minutes after the surgery has been completed. Now, for restoration of sensation, we're not as good at that. All right, success rates are about 70 to 75%.

And that's still amazing though, Stephen, 70 to 75%.

Yes, it's fantastic. That's because—

that's fantastic. Look, if you go— okay, so think about this. Like, I think everybody thinks that when you do— we say this in the regen space all the time— I'm like, if you can take their pain from an 8 to a 4, they're thrilled, right? Right.

Right.

I mean, so 70%, that's phenomenal.

Well, and not only is that phenomenal, but it's phenomenal for another reason. And that is because once a diabetic patient has a diabetic foot ulcer and they get that healed, the recurrence rate is up to 40% annually. Now that means that you've healed this ulcer, you've spent a lot of money healing it, The patient's gone to wound care centers, lots of different biologics may have been used, it's expensive care. And then all of a sudden, if you're able to restore a protective level of sensation, you've taken that rate of recurrence from about 40% annually down to less than 5%. So you're looking at a tremendous thing.

Wow.

Yeah, so, and the literature is there. I mean, I'm not just, this is not just our clinical experience, this is well-published literature now. in 2024, how many, what's that, 40 years since the time Dallin discovered these things in the '80s, right?

Yes.

So, the science is there, but yet the acceptance is, neurologists for some reason still have a hard time. A lot of endocrinologists have a hard time until they see the results. And then it's kind of funny how they'll call you up and they'll say, wow, I'm pretty shocked, I didn't know this. And this patient really looks good. And so, you know, but there's still this pushback. I mean, we have an association that's called the Association of Extremity Nerve Surgeons. It's got about 200 surgeons in it. It's got orthopedic surgeons, plastic surgeons, podiatric surgeons. We've got some PhDs, everybody that has a focus and an interest in this one thing, as well as other peripheral nerve issues. And there's been a lot of effort into trying to get this, like, let's say, On the main stage of the American Diabetic Association, and there's a faction of folks that say no, there's no evidence whatsoever. And it's kind of like a bunch of guys still yelling at you that the earth is flat.

This is how I feel when I go to orthopedic surgeon events. Yeah, and we have our booth up, and you know we don't teach how to do regenerative therapies, but they'll start to question us and. I've learned to train my staff to go over all the level 1 studies, and it's really fun to watch them like debate one of my staff members and watch my staff members be like, here's this, here's the evidence. Have you heard of PubMed? Right. Go look these up. There's only 12,000 studies that show that this works. So yeah, it's fun. And then they still want to deny it. They're like, no, it can't be. But yeah, it's fascinating. So is this okay? So you're not doing this under insurance. You're, they're paying cash for this.

Yes. Yeah.

What do they pay?

It's $12,500 a leg. And that includes about 7 or 8 nerves that are decompressed. And that includes their whole care, you know, for that leg.

And what's the resistance on that? Do you get a lot of resistance from people on that?

No. I mean, they either want it or they don't, you know?

Yeah.

And then there's much less resistance for the second leg because they know the results of the first leg.

So I want people to hear that. You know, you would think— if you think of people that have peripheral neuropathy, right, what do you think? What do you think the regular person thinks of the demographic of that patient? They think it's a more Medicare, Medicaid type client? You think it's— what do they— is there— do you think there's a stereotype, stereotypical person in their head?

Well, I think you probably would have— if you, if you divided it up, you'd probably have a pretty large subset that would fall into the Medicare group. But, you know, then you can have folks that are younger that, you know, are very affected by it. And so they would be your more traditional third-party insurance.

Yeah. You know, what's fascinating about this, and I asked the question because whenever we talk to somebody about making the transition to cash, they immediately think, my patients don't have that kind of money. I don't work with a wealthy group of people. I'm working with people that are middle class. They're not going to pay anything for that. But you're finding that to be different.

Yeah. And I think that part of why we find that different is pain and horrible discomfort is a pretty motivating thing. We have kind of looked at our patient population over the last 10 years, and it's probably 15% of our population is suicidal. These are very serious Yeah, these are very serious conditions. And until you've had kind of the experience of having a nerve cut, it's hard to imagine what some of these poor folks go through. But it's a very motivating thing not to be able to feel the floor, to have balance, to worry about falling. And think about just the cost, even though you have insurance, think about the cost that would still be out of pocket if you're going through a wound care clinic to try to get an ulcer closed. That doesn't even factor in the burden to the caregivers trying to get this patient to the wound care center, all this other stuff. And they probably will end up paying a significant portion of that just in their copays and their other things that, you know, their portion that wouldn't be covered, the deductible and that type of thing. So when people really look at it, I think they're able to make some good economic choices.

Yeah, that's a big component that most people don't realize. So the latest data at the time of this recording is 60% of Americans have what the government government considers a quality healthcare plan. I really don't know how they come up with the phrase quality healthcare plan. That's, that's, there's probably a whole comedy bit you could do on that.

Right.

But the average out-of-pocket after the average out-of-pocket deductibles after paying the premiums for Americans in 2025 is going to be $18,500. This is the last study I saw. So, right?

Yeah. That's incredible.

Right now, I think it's like $14,000 or $13,000, whatever, you know, whatever the number is. And there's all kinds of factors that But if you think about, they're paying the money anyway, right? Right. And if you look at how much is being taken away— I had a friend of my wife's just had radical double mastectomy, had breast reconstructive surgery, and the insurance company last year paid for the connections for nipple sensitivity.

This year they do not. Yeah.

And so, you know, they just, nope, sorry, we're not going to do that anymore. Well, you know, And she still had probably whatever, $25,000 out-of-pocket expenses or $50,000 or whatever it is. So going back to the procedure, so, and then they see a reduction in the foot ulcers as well, you said? I want to make sure I heard that correctly.

Yeah. So the annual recurrence rate of a diabetic foot ulcer is about, depending on the literature source, it's up to 40%, but it's between 20% and 40%. So you get this ulcer healed and you don't do anything for it, Then you're going to have a 40% chance of that ulcer coming back. So it's it's it would be like treat being treated for cancer, and then 40% you're going to have it potentially. You know, you're you're out of remission back into into the disease state. Now one of the things one of the things that that nerve decompression surgery has been proven to do is to improve the microcirculation. In the area on the plantar aspect or the bottom of the foot in the area that the wounds usually are. And so there's basically the capillary perfusion that is impaired because diabetes is a process that causes a thickening of the basement membrane of the tiny little arterioles and capillaries. And then there's this other phenomenon called pressure-induced vasodilation, which is a very interesting concept. But in a non-diabetic patient, when you stand on your feet, it changes the way the blood is shunted between the skin and the deeper structures.

Oh, okay.

And it's increased by pressure. So when pressure's on, it changes the circulation so that that skin that's under pressure can get the adequate perfusion to protect it and keep it from breaking down because of an ischemic event. So you're able to restore those things. There's a couple of studies that have been published where they've actually done this in patients that had open ulcers, and they heal very quickly after the nerve decompression, faster than they would without it, because you're restoring the sympathetic system that's controlling this perfusion phenomena in the skin itself.

Wow. Now, are you teaching other doctors how to do this? What is— how What does it take to learn how to do this? Like, what— tell us, let's talk a little bit about this.

Yeah, that's a great question, Matt. So the Association of Extremity Nerve Surgeons, the group that I referred to previously in this conversation, they teach 2 courses a year, an advanced and a fundamental course. And that this surgery is a big part of that training. There's a lot of other training that goes on. And then the other part of the association's Education is that we have a microsurgery training in conjunction with Mayo up in Rochester. So, when somebody goes through those 3 courses, they're pretty, you know, they're pretty well geared up to start doing this surgery. So, there's probably, you know, a good 200 to 250 surgeons throughout the United States that are doing this. It's not that we're just the only ones that are doing it. But yeah, the The other thing that we've done is we've had fellows over the last 5, 6 years. And so the fellows will then train with us, and then they'll go out and, you know, set up their practices, and then they'll train more people. And that's really what we're kind of trying to do as well. So there are ways to learn this.

So are they— and are they all doing it cash, or are some running it through insurance?

How— No, I probably think that I might be the only one that's Not in insurance for this. I don't know any— yeah, I don't know anybody else in the nerve world that has taken the dive.

Okay. How does that work then at the surgery center if you're paying— if they're paying cash? Does the surgery center give you— they give— sometimes they'll give you a hard time in the regen if you're doing, you know, in that space.

Yeah. And for this, they're, you know, it's covered procedures so they can use their insurance for their hospital fee or their surgery center fee. And then again, that's between them and their insurance company. But, you know, it's just like plastic surgery. You know, sometimes because it's an elective procedure in plastic surgery, they may have to pay for the facility fee. And that might be what you're referring to in the regenerative.

Right.

But these procedures are all in the CPT. They're covered procedures, albeit they cover them at an extremely low reimbursement rate. But that doesn't negate the fact that the insurance companies will view it as a regenerative or a plastic. elective procedure, and so they, they will usually pay for that portion.

Okay. And how long does the procedure take?

It depends. Like, some, some patients need a few more nerves than others, just depending on their clinical presentation. But usually we're in right around an hour, hour 15 minutes. Okay. So it's not— yeah, so horrible procedure, right?

I mean, and if you're doing it via insurance, you might be paid, what, $1,000, you think?

Uh, maybe if that.

Maybe if you're lucky, $750, right? So that hour, let's just say it's an hour, so you can make $12.50 for the hour, or you could make $750 for the hour.

Well, and here's the thing.

Yeah, simple math.

I don't understand why people don't do this more. Well, I think they're scared. And, but here's the thing, right? So insurance companies, and I don't think people know this, or let me rephrase that. I don't think a lot of people know this. And that is the insurance. Let's say you do 5 procedures on a patient. And in this situation, they need 5 procedures. Okay. They have 5 nerves that are compressed that need to be decompressed. And the insurance company will pay 100% for the first one, maybe 50% for the second procedure, maybe 25% for the third, and then the rest is free. Now, yeah, you can't go to the damn grocery store and say, you know what, guys, I'm only paying for the first 15 items today, the other 5 or 10 are free. Okay, you're gonna give me that. So it's a whack system, you know. And, you know, then that leads to more cost too, because They just a lot of folks will just do maybe one or two of the nerves and then bring them back for another time so that they can get the insurance coverage and that type of thing. Sometimes that's necessary. You have to stage procedures, but sometimes it's just inflicted by the insurance company. So they're you know they're ending up costing themselves far more money than if they would have just rightfully paid to begin with. But they're not they're not that smart. It's kind of like, how long did it take Medicare to approve, you know, kidney transplantations? And, you know, it only saved them maybe $200,000 per patient from dialysis costs.

You know, it's, it's, I really, it frustrates the hell out of me. I almost have to laugh because it's just so idiotic where they, how they come up with some of this stuff. I mean, I understand why they do. They make a lot of money, but dear God, it's just, The, what the, the con that they have put on us as American citizens is pretty fascinating. That this, what we've actually bought into. Yeah. Um, what else? Anything, any final thoughts that you want to share on this? And then feel free to let people know how they can get in touch with you if they want to find out more or, you know, tell us about your podcast.

Yeah. So, you know, we've had some good episodes on this on our podcast, The Pod of Inquiry, and you can go to podofinquiry.com. And they'll see your podcast when it comes out in several weeks. They can reach out to us at U.S. Neuropathy Centers, and we're on the web, so that that's a good way to contact us. There's a lot of literature if they want to do a literature search on this, so that they they know that what we're talking about is actually true and real, contrary to what their other practitioner may tell them that the only thing I can do for you is give you a prescription for gabapentin. Or something like that, you can just look up nerve decompression surgery, diabetic peripheral neuropathy, that type of thing, and the literature is there.

Okay, great. Well, this is fascinating to me because we get a lot of patients that come in that have peripheral neuropathy, and a lot of my doctors are— they don't really know what to do. So, and I think that this is fantastic, you know, The— I have a, I have a friend of mine who has this really, really badly, so much so that he crashed his $120,000, 750-horsepower Jeep into the wall because he thought he was hitting the brake instead of the accelerator.

Okay.

And right, because he couldn't feel anything in his feet, right? And, you know, I see the pain that he goes through walking, you know, he has to go in and get his foot for wound care a couple of times a month. I mean, just the pain that he goes through. I can tell you this, as soon as I'm done, I'm going to be sending him a copy of this and say, you need to listen to this and go see Dr. Barrett.

You know, and Matt, if I could mention one other thing, we've talked about diabetic peripheral neuropathy, but, you know, if somebody looks up neuropathy or causes of neuropathy or the physiology of neuropathy, you're going to get inundated with hundreds of different types of neuropathic processes, and it's very complex, but There are 2 things that you can divide all of the neuropathies in, and that is true disease-state neuropathies that have no compression.

Right.

And then disease-state neuropathies that have a component of compression because the nerve is swollen. So, or, you know, just frankly entrapped. And a good example is chronic pain after total knee arthroplasty. We see so many patients who They've had their total knee done. It's perfect. The orthopedic surgeon has done an immaculate job. Everything's lined up perfectly on the imaging, but yet this patient still has, you know, continued pain. And oftentimes it's because of one of the major nerves that, that's a terminal division of the sciatic nerve called the common fibular or common peroneal nerve. And that nerve will get entrapped. And that's a simple 10-minute procedure. That all of a sudden this knee that they can't figure out why it doesn't have the normal range of motion and why it was still painful when everything was set perfectly, it's just because this nerve is pinched. And it wasn't that the surgeon did anything wrong, it's just that the manipulation of the, the extremity to get that implant in and that type of thing causes this entrapment. So that's something that's like a grand slam home run for these patients.

Wow.

Because they've gone through all of this, but then You know, it's kind of like getting over the finish line. They've ran 95% of the race and they just gotta finish that last 500 yards and now they can. So if you think about it from a conceptual standpoint of, is there a compressive component? That's good because we can decompress that. Now, if it doesn't have a compressive component, then we have to treat these folks more traditionally, you know, pharmacy, medical management, these types of things. There are some other things that we do, but— That, that's an important thing because if, if patients are able to, to know that, now all of a sudden there's a way to take care of it that isn't just giving them drugs.

Yes. Yeah, it's so critical, so important. Any final thoughts? Anything else you want to share, Steve? I want to make sure—

I want to make sure I cover everything. I appreciate the opportunity coming on and sharing this knowledge because a lot of people can be helped, but they're told by mainstream There's nothing that can be done for you.

So there's always something that can be done. There's always something that can be done.

Exactly. There's always— I tell the patients there's always another rabbit in the hat. I just gotta find them.

Yep. We've got to find a different hat and a different rabbit. That's all we got to do.

That's right.

As I always like to say, somebody's already figured this out, right? And or they've tried and maybe their breadcrumbs lead you to another place. So great. Give them your site one more time. Stephen, so that way they can find you?

Yeah, go to usneuropathycenters.com. You should find us. There's a lot of information there. Or you can go to our podcast website, which is podofinquiry.com, all one word.

Great. All right, Stephen, thank you so much for taking the time. And I've enjoyed this, man. I enjoyed getting to know you. I look forward to hanging out with you some more very, very soon.

Likewise. Enjoy the rest of your day.