Misty Williams  00:21

Okay, you guys! Super excited today to have my friend Gretchen Bronson on Rosie Radio. If you have been part of our community for a while, you are familiar with Gretchen. I have brought Gretchen into talk to the women who are in Healing Rosie University. 

Misty Williams  00:35

She’s done lots of training around health insurance. How do you get your health insurance to cover stuff? It’s a beast and it’s overwhelming. I feel really fortunate that she has done so much to contribute to educating all of us on how the whole health insurance puzzle works. We’re going to actually talk about that a little bit today. 

Misty Williams  00:55

I met Gretchen, a decade ago, when my journey started. It’s actually been 11 years as of the time of this recording. When I first started grappling with, “Oh my gosh, something’s happening in my body.” And my doctors are gaslighting me and telling me that everything’s fine and normal when it’s not. So my journey took me into a community that I was managing at the time where I met Gretchen, and she was such a shining light for all of us. It was really wonderful to have someone who was experienced with navigating the system because at the time, that’s all we knew to work with. 

Misty Williams  01:33

In the last 10 years, I’ve certainly found things that are more outside the box than we had at our disposal at the time. But Gretchen was kind of a mama bear for all of us. She taught us a lot about understanding our health goals, and how we find a doctor that’s going to actually support us. 

Misty Williams  01:50

We’re going to talk more about that in this interview today, too. What do we do when we’re being told that our labs are normal and everything is fine? What do we do when our insurance company is like those treatments are outside of the box, you’re not going to get them covered? There’s a lot to this journey that’s maddening. 

Misty Williams  02:09

I have appreciated my friendship with Gretchen all these years. I’m so grateful that she is part of our community here at Healing Rosie and that she’s one of the faculty of Healing Rosie University. I’ve actually never said it like that before. But she’s a great teacher and friend, and we’re gonna have an awesome conversation today. 

Misty Williams  02:29

When I met Gretchen, she had a different career path. It was her former career life. Since I got to know her, she has gone to school to become a registered nurse. She’s become a personal trainer and nutritionist. She has been so committed to this path for herself, that she’s learned a lot and all of that learning lights her up. She decided that she wanted to take all of this and be a contribution to all of us. So, I’m super grateful you’re here, Gretchen.

Gretchen Bronson  03:00

I’m glad to join you Misty, as always. I enjoy when we get together and we’re able to help the community that’s out there that’s struggling to fix themselves.

Misty Williams  03:13

Yes, that’s right. That’s what we want to do is fix ourselves. So, I want to talk about finding a doctor because when I first started out, this was the biggest maddening pain point. I beat my head against the wall. I went from doctor to doctor even moving into what you think are going to be the better doctors, right? 

Misty Williams  03:32

So, I found an integrative medicine doctor who had all sorts of credentialing that kind of did the same. He would at least order my labs for me, but I got the same gaslighting ultimately from him. I had my other doctors and I found a functional medicine nurse practitioner in Nashville that ultimately dismissed me from her practice. It wasn’t actually her, it was whoever was over her, because apparently, she was going through some life stress and me saying, “I need to see you more. Don’t just refer me out. I need more help”, was a deal breaker for their practice. They didn’t want to help me more. 

Misty Williams  04:05

So it’s been really challenging finding a doctor. I’ve been fortunate that now I’ve been with the same doctor for eight years, that seems like a really long time for me after going from doctor to doctor to doctor. So let’s talk a little bit about building that relationship with your doctor. How do we find good doctors? Where do we go? You had a really great strategy for kind of interviewing the doctor and I’d love for you just to talk to us a little bit more about that.

Gretchen Bronson  04:31

So I think when it comes to finding a doctor, you have to figure out first what are your goals, health wise. Where your comfort zone is regarding finances, and do you want to leverage your insurance? Those are really the things you’ve got to figure out. Then when it comes to finding the doctor, start narrowing down based upon those three things. 

Gretchen Bronson  05:04

When I started searching for my doctor because the Veterans Administration was not the care facility that was going to really support me as a woman in the early to mid 2000s. And post having children, it was even more challenging because they don’t claim to work with women who have children, or at least they didn’t then (can’t say whether they do that now or not). 

Gretchen Bronson  05:33

But I started looking at what my options were in the DC metro area. Who was out there that kind of did a little functional medicine, who was willing to consider taking insurance or at least helping me file my insurance claims. What I started doing is I started identifying different practitioners, I made appointments, and I was very explicit when I made the appointment. This is not an appointment for me to do a physical this provider, I’m interviewing this provider to determine if we are a good fit, and we are a partnership going forward to help me manage and improve my health overall. I think I interviewed three different doctors, two who took insurance and one who didn’t. 

Gretchen Bronson  06:33

I actually ended up settling on one of the providers who took insurance that was well rated by my insurance company, but who also kind of thought out of the box. She’s part of the ancestral Health Medicine community, very, very pro ancestral health, pro paleo, pro fasting, and she’s modified her practice as she’s learned more. 

Gretchen Bronson  07:02

One of the things that I did when I sat down with her is I told her, I’m looking for a consultant. I want someone who can consult and make recommendations to me on what direction I should take my health based upon your experience. I’m paying you for your education to tell me what you think. Then we can have a discussion about why I’m opposed to something or why I’m willing to consider something. Then I want you to give me research regarding why you want me to do something or why you think I should consider something else versus the track I wanted to pursue. 

Gretchen Bronson  07:48

And the doctor I ended up with was very much open to that. She said, “Yes, I’m a consultant to your health. I’ll give you my medical opinion, we’ll talk about things, we’ll make recommendations and there are certain things as we move on together, we’ll build that relationship. And I was really, really fortunate. 

Misty Williams  08:22

I want to insert something here because I hear this all the time. I love how you just said that. The idea that you’re looking for a doctor to consult with you. Because when I hear in our community which I think is part of the reason why the system is so broken and it stays broken, is people will say things or I hear women say things like, “I just need a doctor to tell me what to do. I just want to find someone who’s just going to fix me and tell me what to do.” That thinking is what keeps us really stuck because we don’t ever put ourselves in the driver’s seat. We don’t ever say, I’m going to be responsible for charting this course and I need people to advise me. But I’m going to listen to my own intuition. I’m going to do research on my own if I need to. I’m going to consult with the peer group that people do this all the time in the Healing Rosie Facebook group. They come in and here’s the issue I’m dealing with. What is your experience treating this issue? My doctors telling me to do this? What do you think? Like, we have to put ourselves in that driver’s seat and consult with doctors to help us navigate this, right? 

Misty Williams  09:31

The mindset of, I just need a doctor who’s going to go and fix it. I just don’t know anyone that successfully gotten better with that perspective. But when you go with a different energy, you get a completely different experience with your doctor. I’m sure as a result of this, that doctor has a lot of respect for you and the way you approach your own health and healing. 

Misty Williams  09:54

Another thing I want to mention that’s along these lines is if you don’t have a doctor that’s going to be open to you evaluating, doing your own research and if they’re not going to be open to supporting you in that way. There’s nothing you can do to convince them. So, someone will come into the group and they’ll say something like, “I need the research to convince my doctor to “X”. It’s an impossible path. You will waste so much time and money, you won’t have the success that you’re looking for, and every day, the disease process is progressing for you. And you’re hoping to win this doctor over, you’re hoping to convince. Doctors don’t have the perspective, most of them, that their patient is going to teach them how to practice medicine, right? That’s just not their paradigm. So you need to find the doctor who is inclined to treat you and approach your healing in a way that’s resonant for you. Otherwise, you kind of find a different doctor. So anyway, it’s my opining, I love how you just framed that.

Gretchen Bronson  11:03

When I came into trying to fix my health. As members of the community have heard my story and my struggles with the VA and everything. I came from a different perspective. I was a government consultant. My job was to go in and consult in my area of expertise for the federal government. That’s what I did. So as a consultant, it made sense to me to approach my doctor saying, I’m looking for you to be my medical consultant. I want your expertise to help me guide this path. In the care I’ve received, Dr. Moghissi and I have discussed several things like I have a genetic predisposition for abdominal aortic aneurysm (AAA), my grandfather died of one. She and I have talked that as I age, a statin may be most appropriate if I am demonstrating signs and symptoms, because that’s what statins were developed to manage. And so she’s like, we may need to approach that. I know that’s not something you want to consider right now. But as you age, if we start seeing these signs and symptoms, we may need to reconsider this. And here’s why. She very much lays that information out for me and we discuss it. We came up with a plan. Sometimes the plan does not align with what health insurance and Centers for Medicare & Medicaid Services deem standards of care. 

Gretchen Bronson  12:49

So I have familial high cholesterol. Well, the standard of care is I go on a statin. We have taken 10 years of diet and exercise and have been able to manage that far better than if I had just taken the statin. So you’ve got to advocate for yourself. What are you comfortable with as a patient? We all have that comfort zone. We all know our body. We all know what drugs work for us if we do require drugs. We know what ones don’t. So you have to be able to advocate for what works for you. 

Misty Williams  13:33

Not everyone knows, like I think that you’re extra in tune with this whole subject matter. I think this is why so many women are drawn to you, right? Because you are extra in tune to what’s working and what’s not working. I know there’s a lot of women listening going, “I don’t know if this is the best path for me, I don’t know if this is really what I should be taking. I’m taking these drugs, and I’m dealing with the side effects. I don’t know a different path.” So, if you do have the certainty of what’s working for you, I think that’s great. I also think there’s this big gray area that a lot of us are trying to navigate. Where we’re trying to figure out what are the other options? What else can we do besides take the statin for example, right? This is where taking personal responsibility, being part of a community that can support you as you navigate these things and doing your own research can be really helpful and valuable. 

Misty Williams  14:29

In my experience, I love my primary doctor. She’s actually a nurse practitioner. I love her. She’s been really supportive over the last eight years. But I can tell you that the big breakthroughs I’ve had working with her were not necessarily her idea, meaning I would come to her saying I’ve been doing research on Epstein Barr, and I want to try this protocol to help me with it. Or I would go to her and say, “hey, I just met with the doctor. We did a full gut test and I’m on a protocol, and I would report back.”

Misty Williams  15:”05

By the way, my Epstein Barr hasn’t really flared I haven’t had an Epstein Barr reflare since 2018 or 2019, which for me was awesome considering I was reflaring all the time. But these breakthroughs really came from my advocacy. She’s always been really supportive. She would run the labs. If a prescription needed to be written, she would write it for me. She would give me her perspective and opinion as I was researching different places. That’s really what you want. I think in in a primary doctor. You want someone who is going to be your partner and help you assess. There’s times that I brought things I said, “What do you think about me following this protocol or this approach?” And she would say, “Well, here’s the concerns. I see.” (Because she knows my history, right? “Here’s the concerns I see with that. I think I might do it this way.”

Misty Williams  15:48

A lot of times I concur. I really appreciate that she gives me that perspective. Last year, when I was so frustrated about the extra 18 pounds that I was carrying, and I knew something had to be going on in my body that we hadn’t uncovered and I went to her and pushed, she was a “yes”. Alright, let’s run the oat test, let’s do a mycotoxin test, run a couple extra blood markers, and let’s see if we can figure out what’s really going on here. But it wasn’t her idea. 

Misty Williams  16:14

I think that’s important to understand that sometimes your providers not going to have all the answers. But you want to have that relationship. So you can have those conversations. 

Misty Williams  16:31

Absolutely.

Gretchen Bronson  16:32

Those conversations are very, very important. Having a doctor who’s able whether they’re a nurse practitioner, an MD or a PA, having them be able to say, “You know what, I don’t know, let’s figure this out. We might be able to find somebody who can help.”

Gretchen Bronson  16:50

That’s really the important aspect. Being able to ask those questions. That’s why the consultation, the consultant approach, I think is really, really important. You can find those primary care doctors who take insurance, who are open to that, “I’m your Healthcare Consultant. I’m gonna make recommendations. You have a right to refuse because as a patient, one of your rights is you can refuse certain care treatment and medications that is within your right. A good provider is going to respect that and going to help you find another avenue. 

Misty Williams  17:40

Yeah. 

Gretchen Bronson  17:42

And they’ll be open to other providers providing input.

Misty Williams  17:46

So you just said something that brought to mind something else. I think it’d be great for us to talk about in this conversation is this idea of informed consent. I can’t tell you how many times someone’s come in the Facebook group, especially, and talked about an experience they had as a side effect from a surgery. They had no idea it was even a possibility. 

Misty Williams  18:07

Women that have had hysterectomy is that now we’re dealing with really painful sex. They’re having issues with their entire pelvic region, things kind of collapsing and stuff that they were not informed about where possible side effects from the surgery. There’s a real problem around informed consent. I did not know that there were these major issues or possibilities with my own reproductive system as a result of them removing the cyst, the ovarian cysts that I had along with my left ovary. When we went into the surgery, we didn’t know if we would need to remove the left ovary. 

Misty Williams  18:56

But there was not a conversation to be had before about, “All right, well, we’re going to do this surgery. Here’s all the risks, right?” There was no conversation about risk. So one of the things that I’ve realized in my own journey is I need to ask the risk questions. I think it’s really important that everyone really takes some mental note of what I’m saying. Whatever the procedure, if it’s a prescription drug, if it’s a surgical procedure, if they’re wanting to remove body parts, especially. 

Misty Williams  19:21

I remember talking to a surgeon, I have nodules on my thyroid. I remember talking to a surgeon about it. He never disclosed to me that to remove the nodules, he would have to take out part of my thyroid. I found that out with my own research and that I would be on thyroid medicine for the rest of my life. I didn’t let him do the surgery. 

Misty Williams  19:36

But informed consent. We’re supposed to have informed consent in our country, if you’re in the US. I think a lot of countries around the world actually follow the same idea too. But I think doctors, they get kind of numb to the risk associated with their procedures. They do them so much. It’s so normalized in their world that they’re not following the basic ethics and rules of informed consent. I think it’s on us as patients to inquire. Ask. Do a little bit of our own research. Don’t just assume that your doctor is telling you everything. Don’t assume that your doctor has your back best interest at heart. Meaning, I’m not saying that your doctor means you any harm, right? But they are moving so quickly from patient to patient. They’re seeing so many people. They have their own stressors in their life that they skip stuff. That’s really, really important, and it’s going to affect your world, your reality, potentially for the rest of your life.

Gretchen Bronson  20:33

It’s that informed consent. I’ve seen good examples working in the hospital of informed consent regarding procedures that are life saving procedures, but with them come certain risks. I’ve seen, like I said, I’ve seen multiple doctors, I work with multiple doctors. The example I experienced regularly is a cardiac catheterization, where they’re looking to go in and place a stent in someone who’s had a heart attack. Or are potentially they’re showing coronary artery disease type symptoms. They don’t know if the vessels are occluded. They haven’t had a heart attack but they’re still showing symptoms. I’ve seen some doctors say, well, yeah, there’s risks, and so forth, and so on. But it’s mostly a benign procedure. Then I’ve had other doctors go, well, the risks associated with this procedure can include stroke, death, paralysis, and they’re going through the whole list. And they’re saying, take your time. Think about it. We’re not doing it today. We’ll put you on the schedule for tomorrow. I will come back in the morning and we’ll discuss the informed consent. 

Gretchen Bronson  21:56

The patient’s been like, “Well, I’m not really sure if I should do this or not.” And I said, you know what, as a patient, you have a right to refuse something if it does not feel good to you. Do not feel pressured. However, if you are concerned medically, and you are concerned about the situation you’re in, those risks might be something you want to take. My position is just to stand here and say, if you want to consent to this surgery or this procedure before, I will sign it. If you don’t, there’s no big deal. I’ve had patients going, “Yes, I need to do this”, and I’ve had patients go, “You know, this just doesn’t feel right.”

Misty Williams  22:41

Right. 

Gretchen Bronson  22:42

I’ve had some doctors say, “I don’t understand there’s a risk for this, they really need this procedure.” I have to go, they have the autonomy to choose to pursue a procedure or not. I mean, we can do medical management.

Misty Williams  23:00

This is the important point. I just want everyone to take away from this conversation is, you get to choose. It’s your choice. So you should never feel pressured. To fill a prescription that your doctor gives you. To do a procedure that you’re not comfortable with. If you need to ask more questions, if you need to explore, hopefully, the doctor is really open to answering questions for you. If that doctor isn’t open, go for a second opinion. If something in your gut isn’t resonant, saying yes, get a second opinion, get a third opinion, if you need to. But we need to make these decisions consciously because a lot of them have lifelong consequences, right? We just need to look out for ourselves. Don’t bone this area in. Well, the doctor told me to do it. 

Misty Williams  23:43

I’m thinking of my cousin Jan, who had fibromyalgia. She passed away a couple of years ago, I think she was 54 or something. She had fibromyalgia, rheumatoid arthritis, diabetes, a whole host of things that crept up after her kids left. She had tons of childhood trauma that once her kids left, and she didn’t have that mom job anymore. Now she has to be with herself, and be with all of that. She got really sick fast. I remember talking to her about the medications that she was on and her response to me about even considering another path. Well, what if we could reverse some of these symptoms with some diet and lifestyle changes? What if there’s other paths?

Misty Williams  24:20

She said to me, “Oh, I have to do what my doctor says. They’re going to drop me for my insurance if I don’t do everything my doctor says.” That’s just not true. They can’t do that. It’s unethical. It’s against your rights as a patient. So, don’t believe that lie. If something inside of you believes that you have to do everything, you actually don’t. If you need someone to give you permission to stand in your power, I’m giving you the permission right now. You do not have to do it just because your doctor suggests it. You don’t and it’s fine for you to say no. You shouldn’t be harassed. If your doctor is harassing you after you tell him or her “NO”, you need to find another doctor.

Gretchen Bronson  24:58

I would say that if your doctor or any health care provider threatens to fire you or drop you from their plan or their services, you probably do need to consider someone else.

Misty Williams  25:12

Yeah, totally. I agree. 100%, totally agree. All right, let’s talk about how to find a doctor. You kind of glossed over it a little bit. I have had the dubious privilege of doing this for a lot of people. So I just want to leave people with some resources. So I just did a lot of research for my mom. We had to find a new primary care doctor for her in Oklahoma. It was actually very hard. I needed someone who would be open minded because my mom was also on bioidentical hormone replacement therapy. We were finding another doctor because her current primary doctor was very against it and really tried to put the fear of God in her about doing it. So, I wanted someone that would be open. That also took Medicare, which is like, that’s a hurdle finding a good doctor that takes Medicare in general. The women in our community, by the way, have had good success with this. So I don’t want you to feel like if you’re on Medicare that you can’t find a good doctor because you can. 

Misty Williams  26:04

I spent three hours researching. I looked at IFM. Institute for Functional Medicines website. We’re gonna put all these in the show notes over HealingRosie.com. So if you want these links, I’m going to make sure that they’re provided for you. Institute of functional medicine is a good resource. 

Misty Williams  26:13

I actually like Healthgrades. Healthgrades is great, because there’s patient reviews there. You can put in your insurance and see who takes your insurance. Most insurance websites will have a list of the doctors but I want a little bit more information about how they practice. So I would look in my mom’s area. I believe on Healthgrades, they let you do some distance stuff so that you can be real deliberate about the area that you’re actually searching in. 

Misty Williams  26:50

Then I knew that a DO would be a more open minded mainstream doc. So that was on my list. There’s MDS, too, that are good. Then sometimes it’s a naturopathic doctor. If your insurance will cover naturopathic doctors, you can look for them. But I like Healthgrades for this just because there’s some other cross information that I can use to find a good doctor.

Gretchen Bronson  27:14

I’ve noticed recently, my husband’s been asking for… he’s like, “I need to go back to a chiropractor.” So, I’ve been going on verbal referrals. I’ve been looking on our insurance. What’s been really interesting is our insurance company. And working for a health care system hospital system, I actually have really good insurance, like, holy cow. I didn’t know things were covered when you work for a health system because they really want to prevent you showing up in their system. But they actually have reviews by patients that are in the health insurance that use that insurance to see those providers. That’s been really, really helpful. 

Misty Williams  28:05

Yeah.

Gretchen Bronson  28:08

Try narrowing things down and looking at, do they do x-ray? What are those appointments look like the first time and you can actually deduce whether a provider is going to be a match for you just by looking at what’s on your health insurance website. Healthgrades as well as, look on Yelp. You would be surprised. You think you get a Yelp review for things like going to a restaurant. But Yelp has reviews on patients and doctors. How long is the wait? How friendly and how helpful are the front desk staff? Are you able to get e-visit scheduled quickly? How long does it take you to get an in-person visit scheduled? You would be surprised by just taking 5-10 minutes. You can actually go out and figure it out. I’m like, Oh, hey, this is nice. You can see the pictures of the facility. And a lot of cases on the Yelp and Google reviews.

Misty Williams  29:21

So if you find a good doctor that you’re curious about or maybe it’s a good doctor. If you find a doctor and you’re searching, you’re like, “Oh, okay. Here’s someone in my area, they seem to be practicing what I need.” You can actually put their name and search with reviews. Then websites will come up that have reviews for that doctor too. So yeah, would have been great a decade ago when we were doing this to have so many great ways to vet before you have to go in and do that first appointment.

Gretchen Bronson  29:44

Right. Like I said, I picked three doctors that I went to and I interviewed and ended up with the one I currently have. But I know the majority of the community in Healing Rosie is going to 5, 6, 7. They’re on their 10th Doctor. 

Misty Williams  30:02

Yeah.

Gretchen Bronson  30:03

and they’re not gaining that traction.

Misty Williams  30:05

Yeah. 

Gretchen Bronson  30:07

I really wanted to support these women and their families and figuring out how we can get them to that consultative doctor, that primary care doctor who’s going to support them in their journey.

Misty Williams  30:23

Yeah. Awesome. Okay, let’s talk about insurance. We’re building a Health Insurance 101, it’s gonna be released in the next few weeks. If you’re on our mailing list, you’ll get a notification about it when we’re ready to launch. Inside of Healing Rosie University, we have lots of training on health insurance. I want to talk a little bit more about health insurance because I feel like you’re kind of the mastermind behind this for all of us. I’ve learned a lot from you about navigating health insurance. So many women in the community have learned so much from you about health insurance. There’s a couple of primary points I want to make. And then we go deeper in all these programs. We’d have a five-hour podcast if we were trying to get into all of this stuff. 

Misty Williams  31:02

But with your health insurance, it is a myth that you can’t find any good doctors to take your health insurance, or you can’t leverage your health insurance with your doctors. There’s absolutely ways to do that. I want to talk a little bit about that during this interview. There’s a lot of things that are outside the box that people want to have covered. If you call your health insurance company and say is this covered, they might say no, but you can still get it covered. So let’s just take those two nuggets just to give people an idea of what’s possible. Expand what your belief in this area because I want all of you to be able to get the help and support you need. 

Gretchen Bronson  31:56

In order to leverage your health insurance, you have to understand the type of insurance you have. Do you have a health management organization like Kaiser? Or are you going through the Department of Defense, TRICARE, or Veterans Administration? Those are probably the three most challenging health insurances to get things covered because their goal is to reduce costs. So they want to do the minimum because they want to keep costs down. 

Gretchen Bronson  32:33

When you’re picking your health insurance, you need to be cognizant at open enrollment. What are my options? What am I selecting? Your preferred provider organizations and your health savings account or your high deductible plans are going to give you more flexibility, and they tend to cover more.  

Gretchen Bronson  33:02

So if you understand the type of insurance you have, you’ll be better off figuring out how to leverage what you have. That said, if you have an HMO, you are still able to leverage those services. But you might have to do things like do outside labs to demonstrate that, yes, you do have issues with your thyroid, you do have issues with some other thing going on that require additional follow up. Because sometimes if things look normal, they’re not going to pursue it in those organizations. But if you can demonstrate your outside normal, they will start looking. So that’s one thing you have to consider. 

Gretchen Bronson  33:53

Once you’ve figured out what type of insurance you have, you need to figure out what’s covered. So if you need something, you need some sort of additional care, you need pre-authorization for something. I always think it’s important to send an email or a letter or through the electronic chat systems that are now there that they keep a record of that, indicating this is what I’m having a problem with, what is covered?

Gretchen Bronson  34:29

So, as I’ve entered perimenopause, my migraines have gotten a lot worse. I don’t really respond to most migraine drugs. I’m very limited on the options. So I messaged my health insurance company and I said, “What are my options for managing migraines?” They said, “Well, you can do beta blockers. You can do Depakote or Topamax or amitriptyline or you can consider Botox. If you haven’t tried any of those medications, you have to try those medications before you can consider Botox. 

Gretchen Bronson  35:14

Well, I had a history of asthma, so I can’t take beta blocker because it puts me at risk for asthma attacks. I have tried Depakote and Topamax unsuccessfully for multiple years when I was with the VA, and had adverse reactions to those. So I now met the qualifications to be considered taking Botox for migraines, fully covered by my health insurance.

Misty Williams  35:45

So what you’re saying right now, I want everyone to hear. I’m going to mark it with a highlighter. Gretchen, I’ve seen her do this the whole time I’ve known her. When she wants something covered, she calls the insurance company and she asks. It is interesting.

Gretchen Bronson  36:04

The worst thing they can do is say no. 

Misty Williams  36:07

Right. People, you can ask. They’re going to tell you how to get something covered, they’re going to tell, “yes”. 

Misty Williams  36:17

If you want to know how to get something covered or if something is covered, you need to call them and ask. Now, if you get to the point where what you want to pursue, they say,  “This is not covered.” What do you do?

Gretchen Bronson  36:20

They will. 

Gretchen Bronson  36:31

So, a great example is my kids. We were looking at trying to get palatal expanders covered, especially for my son because he was having severe ear infections. He was having a lot of issues. I talked with the biological dentists. I talked with my son’s auto laryngologist and she was like, “Oh, I’ve seen research that if we do a palatal expander, not only will it open the station’s tubes, it will also prevent obstructive sleep apnea long term.” 

Gretchen Bronson  37:13

She wrote up a two-page letter. She’s like, “I will write you a letter that requests them to cover this for your kids.” And she wrote up a two-page letter, she cited all the research, and we had been asking, we’ve been talking back and forth with United Healthcare. Unfortunately, they declined to cover it. However, I found out through working with my dentist that approximately four years later United Healthcare started covering palatal expanders a 100% because of the research that’s out there that shows it prevents sleep apnea. It can prevent additional diseases that will cost more money in the long run. 

Gretchen Bronson  37:59

So you may not get it covered. But ask, always ask. I will tell you this, if you’re looking to pursue something, say you know, you want to pursue a certain type of care or a certain type of treatment and they keep denying it. My first question is, who is the medical expert in this region of care. So if you’re looking for endocrinology, who is the endocrinologist that looked  at the research that determined that this is not appropriate for coverage. Nine times out of 10, they didn’t have a subject matter expert, review the claim or the request. When you ask them for the subject matter expert to do the review, they will nine times out of 10 approve it. The worst thing that can happen is they say no.

Misty Williams  38:59

So what if the subject matter expert reviews and they decline?

Gretchen Bronson  39:03

So that’s one of those things. The subject matter experts have to cite specifically, why it’s not appropriate for coverage, so forth and so on. In my experience, I’ve rarely seen subject matter experts decline something. A lot of times the insurance companies don’t actually have that subject matter expert on staff, so then they have to go out and hire somebody. 

Gretchen Bronson  39:22

So just asking that question, who is the subject matter expert, the medical provider that you had in endocrinology with a specialization in bioidentical hormones for the management of migraines? Review this. Nine times out of 10 they’re gonna say, “We don’t have one and we can’t afford one.” They’re just gonna go, “It’s cheaper to approve it than to hire the subject matter expert.”

Misty Williams  40:02

Is this a requirement by law that they have a subject matter expert?

Gretchen Bronson  40:07

It’s not necessarily a requirement. But they’re supposed to have somebody who is a… if you’re requesting endocrine, they’re supposed to have an endocrinologist review the request or the denial. They don’t always have those experts on their staff. 

Misty Williams  40:27

Yes. 

Gretchen Bronson  40:29

Nine times out of 10, the people that are denying the claims are individuals who work for the health insurance company. They may or may not have a background in medicine, as a doctor, a nurse, nurse practitioner, a physician assistant, they may not have any background but they’ve got a checklist. They’re going through the checklist and they’re reviewing the checklist. If it doesn’t meet the checklist, they’re not going to approve it. So you got to ask and you have to pursue. You have to be diligent. You have to keep asking.

Misty Williams  41:07

Yeah, awesome. Well, this has been so juicy. I love that you’ve come on and wet all of our appetite for what’s possible. I am a believer in all of this stuff because it’s radically changed my life learning how to advocate well for myself. I love that you are such a stand for that for all of us. Advocating and not only are you a stand for it for us, but you show us how to do it. So thank you so much, Gretchen, for spending time with us today. I love it. You guys, we’re gonna see a lot more of Gretchen. 

Misty Williams  41:38

We have Health Insurance Secrets coming out. So you guys will be able to get some really great training from her if you’re in Healing Rosie University. You’ve already seen some of the awesome training we have. So I appreciate you. Thank you so much. Thanks for joining us, everyone. See you soon.

Gretchen Bronson  41:54

I’m glad to join you guys. Have a great day.