Will I lose Medicaid? How can I stop that from happening? How should I prepare in case I lose my benefits? How should I approach healthcare if I do lose insurance? What local resources exist? Dr. Scaperato from Integrity Chiropractic and Nick Angelis, CRNA from Ascend Health Center answer these questions with an inside look of how to best manage your health care. Transcript below.

[Music] Welcome to the Ascend Health Show. I’m your host, Nick Angelis. I’m a nurse anesthetist and the owner of Ascend Health Center. And I’m here with Dr. Scaperato from Integrity Chiropractic.

Hello, Nick. Welcome to be here again. Absolutely. We just had another show, but none of you know that. So, but if you have any neck pain, yeah, watch that other show. We’re going to talk about something even more exciting, and that is Medicaid. So, the big beautiful bill passed, I don’t know, a couple months ago. And since then, I’ve tried to come up with ways to educate patients on how to stay on Medicaid if you’re on it, what to do if you think you’re going to lose it, what alternatives are. Uh, and there’s also a podcast I did with uh, Amanda Katsura from Carve Your Own Path about a year ago. I think it’s probably on our websites or whatever. And that talked about self-pay options of what to do if you want to pay your own money and in which cases you should use insurance, when it’s better to just give someone money and they give you some sort of health service. So, watch that too if you’re really interested in this topic. So, I think what we’ll start with is uh how to stay on Medicaid if you’re on it and you’re worried that you’re going to lose it because somebody’s going to lose it because a lot of money from the system was taken out. So, do you have any advice before I start? Cuz I could talk all 27 minutes about this, but you know, since you’re my guest and all, you should

Sure. Sure. You should contribute as well. Absolutely. I’ll give as much input as I can on it. So, as far as Medicaid, you know, Medicaid is the state uh insurance to help cover your um your costs and and benefits that are required for your health. So, you know, Nick and I before the show were talking a little bit about chiropractic care and Medicaid. And when it comes to Ohio Medicaid, Medic Ohio Medicaid has one of the best chiropractic treatment plans in the entire nation. they tend to all the Medicaid um whether it’s in Ohio or that state up north sorry Michigan fans or doesn’t matter if you go coast to coast follows Medicare guidelines now when it comes to chiropractic chiropractic for Medicare only covers or helps cover treatment to the spine only that means that exams under Medicare are not covered X-rays at a chiropractor under Medicare are not covered uh spinal decompression or traction therapy for disc issues under Medicare is not covered. When it comes to Ohio Medicaid, Ohio Medicaid helps to cover or does cover in full exams to a chiropractor, X-rays to a chiropractor, and adjustments to the spine. Now, if you have any hip or knee or ankle issues or shoulder issues, there tends to be an out-of- pocket cost with that. It does not cover that. It doesn’t cover any of the therapies like traction or cupping in Ohio, but the fact that it helps with those exams and X-rays is a great plan for people looking to keep themselves healthier and maybe not have to utilize other aspects of their Medicaid plan or just make that make that change.

And usually that’s my recommendation. And so if you find a provider that works well for you that’s and all of a sudden there’s something that they feel they should do that isn’t covered then I think it makes sense to actually pay that cost because the a lot of patients I see they either lost coverage or something happened and then their health spiral from there although spiral would be like this. Yeah. Okay. Health spiraled from there. So I I think it is important that uh when you find someone that’s good sometimes you will have to pay money for some like you said the ankle do that that’s going to work out better for you than this seven free appointments it would take for you to find somebody who can take care of that whether it’s paid or not because a lot of times uh when we look at healthcare costs in this country we don’t think okay I have to take time off work or even if you are Medicaid because you can’t work you have to take time out of your life to sit in a dusty waiting room for yet another specialist to possibly mess mess up your care. So, uh it’s not as simple as this isn’t something where I’m like, “Okay, here’s all the ways you can get free care.” Yeah, I’ve done a lot of Groupon that we’re at terrible restaurants, too. So, that’s not really what I’m recommending here. Uh, one advice I would have too is to get a plan ready. So, it’s typical at doctor’s offices, cuz this is meant to be sort of a behind the scenes uh for patients, too, where you just get like, “Oh, yeah, we’ll take care of that if it happens.” No, let let’s get a plan in place. What will we do if you lose coverage? Uh, one example you talked about getting ankles, hips, spines. So, in many cases, this sounds terrible, but for some surgeons, if you’re on Medicaid and they tell you really need to do surgery, yeah, they’re serious. They’re not going to get paid that much to do your surgery, they really think you need it. So, go to the chiropractor, see what other options you have. But if you have Medicaid and you’re afraid you’re going to lose it, then maybe go ahead and have that operation. Um, because you’ll also have that post-op care. Now, I realize sometimes with Medicaid, it doesn’t cover things, but at least it’s a yes or no answer. It’s not the way insurance works in the private market where you’re just nickel and dime to death. It’s like buying a ticket off ticket master like what what was this fee for? This is a convenience co-ay. What’s going on? So, at least it’s cut and dry. You either get the care or you refuse the care. And because there isn’t as much reimbursement, you don’t see as often where like unscrupulous professionals be like, “Oh, yeah, yeah, let’s do that thing for you. Sure, sure. you’ve got good insurance, we’ll do it. So, not not to say that the nonprofits around here don’t make a killing off Medicaid patients. You know, the again, this is your behind-the-scenes look. It it’s very true that the business model of many healthcare organizations is just pile in as many of these patients as we can, get that minimal reimbursement, and they’ll fall apart without it. So, it’s not like anyone’s doing you a favor by taking you on. You should be respected as well as any patient regardless of insurance, right? And you know, one of the things you can do to make it easier for your physicians is, you know, keep up on your paperwork. Know when your deadline is to get that paperwork in to make sure that your Medicaid plan stays active because there there’s nothing that we feel worse about than a patient that comes in hoping to get care, needing to get the care, and their Medicaid is in is inactive, whether because they didn’t get the paperwork in time. um pay attention you know to the you know there’s a financial aspect with it as well you know it’s on a sliding scale or it has has a limit so making sure to keep that in mind too I had a patient that came in like that one time where you know said I you know I had Medicaid ran it said it was inactive and I was like okay well let’s go ahead and uh dive a little bit deeper I need you to dive a little deeper in this she made the phone call and found out that she did so well with her finances the year before that unfortunately she had crossed over that limit to have it. So now we had to figure out, okay, when do we need to get that reinstated, you know, keep in contact with your um with your physicians, whether it’s a chiropractor, the surgeon you’re supposed to see, your primary care physician, you know, and if you have any issues, let us know. You know, there’s some things that we can do. Sometimes we can write a letter, a referral letter for either another practitioner that would be better for you that will be covered under your insurance. Sometimes those letters can actually help you to get reinstated by showing a cause or need for that type of care and this lapse in care with the typical process could actually be detrimental to your health. So it can help to cause an escalation of your case too. So there there’s some things you should do. You should always, you know, talk to your primary care, talk to physician you’re seeing and just ask just ask, “Hey, I’m having this issue. Can you help?” The worst cancer, the worst answer they could give you is I can’t, but let me help you find somebody who can. So, there’s always an option, but it’s that communication, you know, because listen, we we’d love to be mind readers, but if we were mind readers that we would have people lined up out the door and not have time for anybody because we just be able to walk down the street, read someone’s mind, be like, “Hey, I can help you with that.” But we can’t do that. So, communication with your care physicians is very important. Even with some of the harder and even embarrassing questions, you know, we’re not there to judge. We’re here to help. That would be convenient, though. Like, Nick, let me tell you what’s wrong with me. No, I’m good. All right. You’re now save so much. I’m so rude. Oh, and also this show will be rder than most of them because again trying to give you a behind the scenes look trying to be as honest as possible about what your chances are of getting here because a lot of times so we have patients that often want disability paperwork but it’s really hard to get that uh through unless you’ve been a patient for about 6 months cuz we don’t really want to and we and we charge for paperwork because it takes time. We don’t want to say yeah I think they’re sort of sick. I don’t really know them that well what the limitations are because I do feel that it’s going to be in my type of clinic in mental health where we’re going to see the most cuts because the political climate is one like oh well those people are just sat on their couch so they should go get a job and sometimes they can’t but we need the patient’s help if we’re going to build a case and also there are some cases where we say no we won’t do this paperwork we don’t agree with this that we think that you can do this or that and that’s fine it helps I try to be as honest as possible with patients so they have time to either find somebody else or you know choose what to do rather than just like oh yeah we’ll look into it because that’s not fair to people either. So try to make sure to get straight answers from your provider as opposed to some sort of wishy-washy like we’ll take care of this sort of answer. Um another thing is so with Medicaid you can charge if a patient no shows. It’s just kind of complicated. We don’t because it’s complicated. But you also need to get in the habit of arriving for your appointments because most private insurances we do charge at a percentage like a $50 no-show fee. Uh so getting in the habit of being uh a good patient will also help either if the practice needs to figure out some sort of self-pay bridge program for you or whatever you end up doing. Uh it helps to kind of be on your best behavior honestly. Again, just some insider tips on that. Sure. And not only that, you know, to add on to that too with keeping your appointments. I mean, we’re here to help you get better. But there’s only so much that we can do outside of the office and guide you. You know, our big thing comes when you you come to actually see us. That’s that’s why you’re doing it. We want to help you get better. So, when you miss your appointments or you’re, you know, very sporadic on them, think about when you if you were to try to lose weight. Let’s say you wanted to lose 25 pounds. What do you do? Well, most ca, you know, most plans is you change your diet. You get rid of the bad stuff. Eat more of the good stuff. You exercise, you go to the gym, you know, three, four, sometimes five days a week or doing something outside, something exercise related. You get better sleep, you drink more water, all these things you do. But once you lose that 25 pounds, you can’t go back to just working out one day a week. You can’t go back to eating Dominoes and Taco Bell and drinking, if you remember back in the day, Surge. Do you remember Serge, Nick? Surge. So, I love Serge as a kid, too. Terrible for your health. But you can’t go and have all those bad habits and start, you know, start those up again because what happens? You gain the weight all right back. So, you have to maintain things, too. And consistency is key, whether it’s for making changes in your health, achieving some other personal goal, or anything in life. So the more consistent you are with it, the more results you see. So if you go to the chiropractor, if they say, “Hey, listen. Your spine’s in really bad shape, you’re in a lot of pain, I need to see you two to three times a week for a couple weeks, few weeks to get this under control before we can start looking more in a maintenance schedule. If you come once a week or once every other week, well, maybe just want to go work out once every other week.” Well, you’ll get there some benefit from it temporarily, but then after that five, six to up to 10 days for a week and a half period, your body’s going to be right back to where it was, and there’s going to be no longlasting or repetitive benefit from it. So, making sure to keep your appointments not only helps us with you for anything outside of your care, but also helps you with your care to get the goal to achieve the goals that we have set together and that we want to have you see. Right? So when you when you skip it too, you know, from a practitioner standpoint, and Nick, I’m sure you agree with this too, we want to help as many people as we can. You know, that’s what we’re here for. We’re here to serve. We’re here to help. So when you sign up for that, you know, new patient appointment or you sign up for multiple appointments and you miss them, it actually takes away from the care for other people who could have really used that and we had to schedule around it. So, it’s it’s kind of a courtesy thing as well for the other patients in the practice, making sure that they get the time that would work for them, too. And when you skip those, honestly, it’s kind of not fair to them. And we we want to make sure that everybody gets treated fairly, right? Because you we’re if you’re still on Medicaid and again, you’re worried about losing it. You want to optimize your health. Get all the information possible. Maybe see all those specialists so you have a better idea. If I lose this, at least I know what my problems are so I won’t waste a lot of time and money going to all these specialists again. Cuz it’s honestly, you’re talking to me about part of that cuz the chiropractor will say, “Hey, I need to see you in two weeks.” It’s like, “Okay, yeah, see you in a couple months.” So, this is a time to actually prioritize your care. And honestly, what I’m saying by prioritize your care, prioritize the habits so that you won’t need as much health care in case you lose your insurance. And prioritize really optimizing everything that you can so that if you do lose your Medicaid because I honestly don’t feel the answer is, oh, I lost my Medicaid, I better go get some really expensive insurance. There actually are cases, and this sounds, this is not what most health people say. There are cases where like, no, it’s not worth it. Look both ways before you cross the street and hope you don’t get a catastrophic injury. Because unfortunately there are cases where patients are in a survival mode and there are some things that they should have that they just don’t have the money for. And so part of this discussion today is how to take care of yourself using self-pays of getting the most bang for your buck so to speak. For example, at Ascend Health Center, if I was a patient on Medicaid, I would not do ketamine infusions because those cost money. You may lose your Medicaid and then everything costs money. So don’t do that. I would look into things like transcranomagnetic stimulation which is Medicaid will prove it if you failed two or three different anti-depressants. It doesn’t use medication and it gets your brain better long term. So the type of treatments that have long-term results. Uh again I mentioned that you might want to have a surgery if you need one. You really don’t want to start doing all sorts of medical things that could have side effects. So you’re looking for what will my what will the Medicaid pay for? what can I do that doesn’t have a huge risk um of like we talked about neck pain last time neck surgery yeah I’ve sent I’ve told patients okay you need to go to the surgeon and go get your neck surgery but it’s usually a last case resort who really wants their neck cut open unless they really need to um and something like Spravato which can be long-term or short-term again it depends what your insurance will pay for and what the benefits are so you need to start making those decisions and get used to that before cuz it’s like when I go to a restaurant and they say, “Oh, do you want to supersize size this?” I fallen for it several times where I didn’t realize that costs more money. So, you want to get in that habit while you still have a black and white type of health insurance where things get paid for or they don’t, right? And you know, you know, you you really hit the nail on the head there, Nick. you know, I mean, if you’re suffering from depression, you know, getting onto an anti-depressant, you know, sometimes it’s just one, sometimes it’s two, sometimes it’s more, but also it’s figuring out what is the right combination and that can have some longlasting negative effects. Whereas, if they come to you first to check it out, you may have something that is going to have less effects or less side effects rather, you know, negative effects and works just as well. And the cost is a consideration too for medications. So like Mark Cuban has his I think it’s Costco. I’m thinking of the grocery chain something like that. There’s good RX. There’s a lot of different ways to see what medications cost and to have those discussions with your provider of like what are my alternatives if I lose my insurance you know uh and honestly when you don’t have insurance or really poor insurance a lot the answer usually isn’t a lot of medications because those are continual cost. So that is when you’re looking at chiropractic care at some of the treatments we do at Ascent. I mean, we do psychiatry, too, but I’m trying to think of what are ways to augment your care so it fits more of a self-pay model because remember insurance model come all the time. We’ll bill your insurance each time. It’s a five minute visit, waste a lot of time, don’t spend much money. Self-pay model, you give up a lot of your money, doesn’t take much time, you get better results. And usually a hybrid of those two is uh more beneficial, honestly. But sometimes you do have those hard choices to make and your provider should be involved in helping you make those hard choices. So you’re taking your limited resources and using them as best as you can. Uh let’s see. Another issue would be um making connections outside of healthcare. So I often said on this show your therapist the need for so many people these days to have mental health therapists is just how our society works. It’s the attenuation of all social constructs. meaning that uh you use Airbnb instead of staying at a friend’s house, you use Uber instead of getting a ride to the airport from your buddy. So, everyone needing therapy in some cases is almost an extension of that. So part of the financial consideration of not having uh a good a good insurance is that you need to form better connections with your friends and family which sounds really crazy but honestly those social there are many patients who um they don’t really need treatment as much as they need a really good friend and that’s actually been part of my treatment plan like okay how can we find you a buddy because it’s going to save you money if we can get you a good buddy here. Yeah. Right. You know, I mean, we we’ve learned about it ever since, you know, we were in grade school that, you know, having a good social construct, having people to support you, whether family or friends can go a long way. You know, it uh gives you somebody that you can confide in with some of those harder choices. You know, you may even get some some sound advice. sometimes not some sound advice, but it’s up to you to to make the discretion of whether it was good or bad that can actually help you to communicate better with your um whether you’re a chiropractor with your PCP or with Nick over here too. So, you know, I’m I’m glad that you talk about that and you you with all your patients because it is very important to to help keep that actually helps to make you get better itself just by um keeping your self-esteem high. Yeah. And it’s it’s kind of fun to put it in a financial way, too. Just like I told you, I went to a restaurant where they didn’t have menu prices, and I was like, all my restaurant food decisions are based on how much is this going to cost. Maybe that’s my own issue, but you can think of it as a cost/benefit analysis. So, you get yourself in such good mental health that you can now have a good relationship with your parents and family. Like, you’ve learned how to draw boundaries. You don’t have to just cut them off. you know how to get the benefits out of being in a family unit even if perhaps you had some trauma or you’ve suffered. So it does become a thing where as you get close connections whether it’s spiritual through a church through social clubs um there’s still groups like there’s still websites like meetup or Facebook groups where you can find people have similar interests uh I have a friend who he owns a therapy practice and they do dungeons and dragons uh group therapy which oh we are doing group therapy at Ascend by the way so that is another option for you so if you get connected then uh especially when you’re talking about fibromyalgia and some of these complex syndromes that have physical and mental uh components to them and can be very expensive to treat. Uh for whatever reason, having emotional connections with others actually helps decrease those symptoms. So, think of that as part of the investment. If you’re worried about losing your insurance, then you you may just want to look into the social people that you have around you and see what you can do to have stronger connections. Yeah. You know, we are very social beings and we’ve been that way ever since the very beginning. So again, being in a a group setting, I know for some people it can be a little unnerving, but you never know who you’re going to meet. You may make a a best friend. You know, when I went to college, that was one of the things I was looking forward to was just being able to to meet some new people and connect. And I actually still talk to quite a few of them. Same thing with chiropractic college, you know. Yes, it was definitely uh a bit nerve-wracking moving out of state, going to, you know, a place that I didn’t know the most about. But by by create by getting myself into a good solid social situation and environment, it actually helped me to thrive. It didn’t hinder me. So, and if there are work requirements too for Medicaid, that might be a way that you can find something that you actually can do to keep your Medicaid because none of this is, oh, you should make more money, get off Medicaid, and get commercial insurance. I don’t have commercial insurance. I think it’s a racket. I don’t I in principle, I don’t believe in it. Yeah. So, and there are other options like I use Christian Health Share Ministries, uh, where it’s a self-paying negotiation. Um there’s and even here in Northeast Ohio like Balogna Insurance it’s a buddy of mine who does a lot of it’s figuring out for people if we know what kind of health care they should get. Um if you need a self-pay therapist uh carve your own path or alternative therapeutics are two very good therapists in the in like the Akron area. Uh, and a lot of times when you look at self-pay rates for things, you do end up spending less time at some of these practices because it’s already built in that no one’s going to be there more than they need to because of the cost. So, it it is one of those money time trade-offs sometimes. Sure. And the ones that you mentioned, you know, carve your own path as well as blog insurance, know them as well. Very fantastic people to work with. So, so it helps to get your connections before this happens. So you because you know when we talk about rich people what do they do? Why are they rich? It’s because they have all these connections everywhere. So you should mimic that and a lot of times I have patients like no I’m just on medic like no you have absolutely the time and the resources and let your providers help you and find another provider if they won’t help you to look at all these options for you so that if it does happen you’re not stranded. you have a plan and if it doesn’t that way you know that you have something because a lot of our patients they will change insurance several times throughout the year and in order to have the continuity of care it helps to always have a plan of what is my next step or what should I do next right so now is the time to actually utilize your Medicaid plans if you have them to to better yourself if you’re looking to start chiropractic care um if you are over the age of 21 you get 15 visits per year but a lot of people have chronic chronic issues. They have issues that don’t get resolved in F-15. And there’s something called a prior authorization that chiropractors can do to request and typically get approved for further treatment for their visits. And it’s up to your chiropractor to know how to do that. And from my experience and my own research as far as chiropractic care for Ohio Medicaid plans, I have seen nothing involving that there’s going to be any major changes to them. Even with the the big beautiful bill passing and everything else, I have found that the I still get the visits typically approved, you know, as long as the documentation is correct, as long as they’re shown for medical necessity, which there always is. And, you know, patients get the care that they need, even if it tends to be a little bit more long-term than we anticipate. For um for people under 21 years of age, so you know, uh infants, kids, teenagers, they get 30 per year. But it’s the exact same process and I have the process is still the same. It hasn’t changed even with this and I have not seen anything showing that it is going to dramatically change as far as chiropractic care is concerned. So and again Ohio Medicaid tends to be one of the best in the country because they help cover the cost of or even cover the cost in full from a chiropractor when you see a chiropractor exams, x-rays as well as treatments to the spine. Absolutely. And part of this is so for insurance to pay anything, we sort of have to build a story. So it’s typically the therapist and the nurse practitioners, not my role in in my clinic. But that’s part of it. So if you’re worried about this, talk about make sure it gets in the notes. I tried this job. Here’s what happened. This is why I can’t work or you know, here’s my situation. Here’s why I can’t do this. Because I mean, it’s a terrible game to play, but it is a game. And we’re here to make sure you get the best health. So again, if you do have some sort of government healthcare that doesn’t have a cost for you, yes, optimize your health. That is your job right now. Do everything that you can to get as healthy as possible. If you no longer have it, then it’s not this terrible thing to no longer optimize your health to say this isn’t worth it for this appointment. Great. You welcome to the economy where it’s much healthier to make those decisions and be out of survival mode. Because a lot of times we see patients in survival mode. They’ll take my time, take my money, get me better. And if you can get out of that mode, then you can make these principled economic decisions and you’ll be at peace with it because you’ve decided, I’m going to spend my money on this instead of that, and that’s great news. I think the American uh obsession with being 100% is really overrated. So, get yourself healthy and then you can make those decisions and you can be at peace with whatever you decide and discuss it with your provider and get their input on it as well. So, that’s my two cents about this. Thanks for joining us for the show today and again you can ask us any questions you want. Uh my email is an anggeleshealthcenter.com. I’ll answer your email if you’re not my patient or whatever. Uh you can also call the office 3307544844.

I have about a thousand different resources that I give to patients. Um and same for you if you’ve got any questions about chiropractic care or what the best step is if they have any muscular skeletal issues or anything that’s in your uh repertoire. Yeah, sure. Sure. And I’m located in Fairlawn over by Summit Mall and I have a lot of pamphlets and a lot of papers as well that could be handed out. Um, you know, my number and my email address and website have shown up periodically on the screen there. Um, you know, you can email me at [email protected].

You can also visit my website and go to book an appointment. That’s intro.com. Or you can give my office a call.

All right. Thanks for joining us today. Yeah, thanks Nick. You are watching WCTV Wadsworth Community Television.