Ethical Billing and Coding for Cash and Insurance Practices

But at the same token, if I'm spending $24,000 a year for health insurance, why in the world would I think I'm going to go in and spend cash? Because when I have a very low deductible, I have a low deductible, but what about a person who has a $5,000 deductible? Even though they have insurance, that's kind of like catastrophic. So I have to meld that that's a patient that probably would want to do a prepay. And so at the end of the day, I think as any business, you have to look at the trends and not be afraid to say, hey, if there are a number of people who want prepays, why would I not offer that?

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey, everyone. It's Dr. Sebastian Gonzales, your host for the Restoring Human Movement podcast. Thank you for joining the Movement Movement. This is your first time to the show. Welcome. This is about a 45-minute to hour-long format where you join me and or a guest. And today, we have an interview. Just a warning, I guess, with patients, lay public. You might not care really much about this podcast or the one next week to come.

I do apologize about this for you guys, but this is going to be very valuable for some of the clinicians out there. And what we're doing today is we're going to interview a guy named Sam Collins. He works at H.J. Ross, and it's basically ethical coding and billing. And so, if you guys don't know what that is, it's basically when you go into someone's office, you have always the question of, do you take insurance or not? And so, it's a really challenging question in a dilemma for a lot of the offices out there because a lot of the insurances don't always pay well or they'll dictate what care is paid for.

And so, I've personally had a little bit of a battle over this over the years, and I thought I would have Sam on to help me address more ways to really help people and break down some barriers and make it more cost-effective to them. So, some of the stuff we're going to cover today is actually part one of a two-part series because he had so much great information that I really had to make it a second part. I didn't want to cut him off too much. And so, just know that what I intend on doing with this information anyways is to see how I can blend a little bit more of my cash-based practice to really give excellent care into seeing ways where we can use insurance coverage to help subsidize the process.

So, to be clear, I don't intend on changing the style of the care that I give necessarily. It's more of how can I meet people where they're at. Not everybody is willing to pay X amount of money to have the best exam, best treatment, or whatever I think is the best anyways for their problem. Sometimes all they want is just a quick look, you know. And so, with that being said, if they're not open to the price that I present or the value that I present, sometimes they just won't come in. And that's a detriment, I think, to their ongoing health because I really think I can help these people. And so, I thought I would have on Sam to help me patchwork some of that stuff together so I can see more people, help more people, and hopefully the providers out there can get a lot of information from this too.

So, Sam Collins is from H.J. Ross Company. If you're a chiropractor, he's probably been into your school before. He's really great at presentation. I went to his seminar a couple months ago and I was like, damn, this is a good workshop. So, I'd never personally been to one. I did see him in school about 10 years ago. And so, I was suggested to go by a friend and it was great. Very enlightening. I won't use everything within there, but I think it's always nice to be educated about what is happening with insurance because it changes year to year. So, if this is your first time in the podcast, again, there's a lot of great episodes in the archives.

Again, if you're a patient, I do apologize for this one. However, go back into the archives and listen to some of the case studies, some of the interviews with other people. This one's more of a business-related one. So, for the next two weeks, you might go dark a little bit more, but jump back in after that. If you have not been through this before, I tend to share a little bit of short story with myself. So, hopefully you guys like me as a host. And so, you help follow along this journey that I'm on to improve my clinical skills as well as business skills with this because you can't help people if you have no one to help.

So, I'll share that short story right now and then we'll get straight into the interview with Sam Collins. So, recently I think I had a really good idea for weddings because if you think about weddings, about how expensive they get, people dump so much money on these weddings where they can't afford a house, you know. And so, the venues, all the times they'll kind of coordinate like here's the alcohol you can have, here's the caterers you got to have, and so on. It's kind of like, I almost feel like probably wedding industry is probably one of the biggest industries in the U.S. I might be wrong with that, but for how much they inflated, it's almost like, kind of like the joke is when you buy something medical.

Like, if I bought a table from Home Depot, it would be like $50, but if I bought it from a medical supplier, it would be like $300. Like, it's just a big markup. And so, I was thinking a way around this is like, to get a little bit more freedom and have a better experience with your wedding, here's what I think should happen. I think we go to an Airbnb that has basically like a complex, like, say out in Arizona. Like, you go to Arizona, there's literally these, there's mansions that have like 15 rooms. You go on Airbnb, and they don't cost that much. And let's just say we did a breakdown or so of like, say it's $2,000 a night or something like that.

$2,000 a night, 15 rooms. Okay, cool. Each of our guests are really close bridal parties, wedding parties, whatever they are. Those are the ones who will stay within the house, and if they can pay you like $100, $200 for the room a night, you know, that would be a wash, right? And the cool thing is, you can go over and get all your alcohol at Costco. You can get any of the beer that you want. You're not held to the, you're not, you're not, you're not a, you can get street tacos is what I'm trying to get. You can just get some badass street tacos like a taco truck to come right outside. It probably won't cost that much, and you can be free to do anything that you want to, and you don't have to necessarily move from one venue to another, and you can stay all night.

I'm just saying, I know the tradition is go to these places, and they'll set it up for you, but I think it's a big scam. I think we should just go rent Airbnbs, VRBOs, and just make a badass party, a huge one, right? Everyone can sleep there, hang out, do whatever you want, man. It's like, it'd probably save a lot of money. I'm just saying, you know, that's my way of revolutionizing the wedding industry. If everybody, if anybody takes this advice, please let me know. I've even offered to cook tomahawk steaks for people at their weddings, if they did this. If they did this, I'd cook like four to five tomahawk steaks there, and I'd be the chef, you know, just saying.

Anyways, let's get in the show right now, okay? Okay, so, Sam, why don't you tell everybody about yourself, who you are, and I didn't know you were actually playing football. That was interesting to learn. No, track and field, actually. Oh, I thought it was, oh, track and field. Yeah. What event did you do? I did the 400-meter hurdles. Oh, the hurdles. I chased Edwin and Moses a lot. So, I need to look up some pictures, and I'm going to find some online. I don't know if there's any online or not. I ran with Santa Monica Track Club, but it's, you know, we're talking, you know, late 80s. So, it's been quite a while.

I don't know, but the internet wasn't quite so popular. Well, there was no internet then, so. It's before selfies were a thing, huh? Maybe it was, but I certainly didn't know about it. Yeah. Not too much, but I can give a little background on that. I'm, you know, I'm a chiropractor by profession. My dad was a chiro, worked with him for multiple years. He had a practice from the early 60s. So, from the time I was born, I've always been around chiropractic. I went to Cleveland Chiropractic College in L.A. I went into his office working with him. During that time, I was still competing in track and field.

I ran for Santa Monica Track Club. So, I was doing a lot of that, a lot of travel overseas with competitions, you know, made a couple of Olympic trials. Never made an Olympic team, but, you know, I was decent, I guess you could say. So, focusing on that in his office dealt a lot with sports injuries, sports medicine, that style. And then from there, as he was thinking of retiring, I was thinking, okay, well, what else do I want to move out to the Orange County area? And so, I got in touch with H.J. Ross and started doing seminars. This is in 98. And from there, just kind of developed a expertise on coding and billing, although that was always a big deal for my dad.

I mean, he was definitely a business person, as well as being a good doctor. He figured out you've got to have patients and, you know, ones that will pay well. And so, he always told the story of the reason he dealt with personal injury was based on, as a kid, there were a lot of bank robbers. And bank robbers like Bonnie and Clyde would steal from anybody, liquor stores, whatever. So, he talked about this one particular person's name was Willie the Actor Sutton. And he was someone, a very famous bank robber, that took many years to catch him. But when he robbed a bank, he dressed nice. He looked like a business person.

And he would get in and be able to steal because they didn't expect him to be a robber. When they eventually caught him, though, they said one thing, and this is what stuck out to my dad. They said to him, why do you rob banks? And his simple answer was, it's where the money is. And so, one of the things why my dad did personal injury is because he realized, wow, these were claims, even in the late 60s or 70s, that pay chiropractors well. And this is why I think you've seen traditionally, chiropractors owning a lot of the market for personal injury. You see most advertisements like personal injury, business cards, because these people legitimately hurt.

Chiropractic care responds well, but it's paid well. I mean, think of what insurance will pay you $150 a visit without batting an eye too much, pay you as much as $85 for an adjustment. So, why would I turn that type of patient away? And so, that's one of the areas in my dad's office that he emphasized. We also did a lot of things with, we were in the city of Carson, and we were right near the Arco refiner, which was at the time called Atlantic Richfield. Anyway, all these workers had decent insurance. Now, it wasn't great, but it was decent. And we could get a large volume from them that would come in.

And we would get, now this is talking, you know, early 80s, but about $60 to $70 per visit. Now, when you look at the dollars of that compared to today, that was pretty doggone good. The other area that we emphasized were people that work for McDonnell Douglas, which is now the company called Boeing. And this was in the day, I remember this, that my dad had patients where before they understood that women can work and have good jobs, insurance didn't coordinate. And so, if a husband and wife worked at McDonnell Douglas, they could come in and use both of their insurances. The insurance would pay 80% on both, and the patient literally would get like a $60 refund.

Because if you bill $100, they pay $80, of course. Then the other pays $80, it's $160. So, that's when insurance companies said, hey, wait a minute. We can't have that. We're going to coordinate. Which I always find interesting, because if your insurance is acting as a secondary, it doesn't charge you any less. But nonetheless, the cost is there. So, those were areas that we made a great emphasis to. Now, I will still say that we did have a lot of patients that pay cash. Those were not as expensive. We charged $40 a visit. They came and got an adjustment. But we saw probably, yeah, I would say on a low end, 5 to 8 per day, maybe a high end, 15.

We generally saw about 30 to 40 patients per day. But it was a nice part of the business, sometimes a little bit more. But it was something that we got many more patients with insurance, because we're in a blue-collar area. And these people that have insurance expect to use it. You know, someone who maybe has a high-value income or something might be a little different. So, we started working with that. In addition, because we're in the South Bay, getting to the 405 freeway and going towards Harbor City Kaiser, which is one of the bigger insurers, we realized that we couldn't get any Kaiser patients, because Kaiser, of course, didn't cover chiropractic until the introduction of American Specialty Health.

Now, I won't say this was the American Specialty Health that we see today, but the initial offerings in the early 90s paid a little better. But we joined it, and we wound up getting a lot of patients from Kaiser. So, that really supplemented the income, because what we found for Kaiser patients were they were used to Kaiser, which I don't want to put Kaiser down, but Kaiser is, you know, it's an HMO. It's a clinic. They found it exciting that they could call our office and make an appointment, come on in, get adjusted, and it could be within a day. And so, we got a fair amount of people that way, and it was just built by word of mouth.

I mean, you want to develop a patient. So, if you have a cash practice, you want to make sure to develop that person to refer you someone so they understand it. So, I give a story. I teach these seminars to acupuncturists as well, but I have an acupuncturist that I like. She's in Irvine, and I coach at Mater Dei High School, which is a prominent, you know, sports, you know, big high school. Anyway, a lot of parents that are looking for other types of care, sometimes I'll refer them there. But one of the things I tell people before they go to this particular doctor, I'll say, hey, look, she's fantastic.

She is very thorough. She's really good at what she does. I believe you'll really like her, but the one thing I always say is she's not the cheapest, and I let people know. And it's interesting that no one goes to her expecting a deal. They expect good care, and she does very well, but I think it's important for us to understand where are we going to fit the market. I think where chiropractors, we have to look at how do we make our office work. So one of the issues I think that we have to look at is that we are still running a business, and in running this business, would we be able to take this business on the show Shark Tank?

Now, I'm not saying that's my favorite show, but, you know, you know how it works. You go in, they look and go, hey, it costs $10 to produce this thing. If you can make $30, it's viable. So by example, I would say everyone should look and go, if I were to take my practice on Shark Tank, would someone buy it? Is there enough there? I think with most, though, you also have to look beyond the Shark Tank and think of all the things that have come up. I mean, think of the Ring Doorbell, which is now the most popular. I have three of them at my house. Shark Tank turned away. They didn't think it was going to be a good thing, and now that's become, you know, a standard for almost every homeowner.

Well, that being said, the thing I think we have to look at in our profession is how do we grow and change? And I think this is something that younger docs embrace a little bit better. But by example, the store Sears had this beautiful catalog that had all these items that you could order, and they would ship to you, but it would take a long time. So they opened up stores, but no one thought, hey, with the coming of Amazon, did anyone ever think to, why don't we digitize this doggone catalog and create what is essentially Amazon? That's all Amazon is, in my opinion, is Sears. And they just did better with fulfilling.

Well, I look at our practices and say, okay, where does this affect us? So look how stores have reacted. Notice Sears out of business because they were old. I'll kind of say that's kind of the okay boomer, if you're familiar with that term, you know, for Sears. Like, oh, no, people will still come in the store. But over time, notice how stores have changed. So a good example for me is running a business, you have to look at what other businesses are doing. So, by example, look at the company Whole Foods. Whole Foods is a pretty neat store. When it first opened, everyone, oh, it's great. But when you go into Whole Foods, it's doggone expensive.

So it's a very exclusive type of store. I mean, I live in Laguna Beach, so there's some areas there that, you know, certainly people probably do their primary shopping. And I'm not saying I don't go into Whole Foods, but I pretty much go to Whole Foods now, and I buy prepared food. But to be very honest, I don't do that much anymore because the pavilions near my house has now opened up a small Whole Foods in there. So you notice Whole Foods struggles. In fact, if Amazon not bought Whole Foods, it would be closed because Whole Foods loses money. Amazon bought it knowing it's losing money, but they're trying to break into the supermarket business.

Well, that being said, notice that stores reacted. So if you go into any grocery store, a Safeway, a Bonds, you'll notice now they have an area that has very similar to Whole Foods. They've got fancy wines. They have prepared food, roasted chicken. They've got poke and sushi. So all of a sudden, that Whole Foods thing didn't work out because other stores reacted. Well, another one, of course, is the 99 Cent Store. The 99 Cent Store is one that I'm not the most fond of going to. I don't think they're the cleanest. I don't like the way they're run. But you know what? My wife's a school teacher, and she goes to those places, and she buys things because she has 30 kids in her class.

So she can buy 30 items for kids to do a craft. It's no big deal if it breaks, and so on. But I still don't care for it. However, if you notice, the store Target has done something I think that's brilliant. In fact, they've kind of run the whole way. Target, you can buy, you know, a $1,200 iPad, whatever. You can also buy designer clothes. But they also, when you walk into the store, there's a small 99 Cent Store right when you walk in. So the next time you go and look, there's about three or four aisles. So I'm saying, as a chiropractic profession, how are we going to embrace changes in society?

So by example, you've probably heard of something called the joint. A lot of chiropractic practices have seen this. It's essentially a prepaid. I think it's a decent model. I'll put it in these terms, though. I wouldn't mind owning a joint. I don't think I'd want to work in one because it has to be a very high volume. So you're going to hire young doctors, kind of grind them. And then when they get burned out, hire a new one. Because it's kind of a turnkey, get them in fast and out. Now, again, not putting it down, but they have a good business model. There are people going, hey, you know what?

I like going to the chiropractor. But if I'm going to go 10 times and have to pay out of pocket, maybe I won't go. So they've created a model where they say, hey, look, what we're going to do is sell you a package. You can buy, you know, 10 visits for $200. Which means 20 each. I'm just using that as an example. And people are interested in that. And so what I offer that in my practice and what I'm getting to is I think in order to be successful, you have to always look at trends and meld so that you offer a little bit of it. In other words, as my dad used to put it, have multiple irons in a fire.

We always did a lot of multiple types of patients because, by example, if you recall in 2007, I'm not sure if you're practicing that or not. 2007 and 2008 was a big downturn. And cash practices really struggled. In fact, many of them probably went out because when the economy is low, that's the first thing someone's going to go, oh, you know, I can do without going to the chiropractor. Well, as the economy picks up, you'll notice people, you know, buying Lululemon yoga pants, going to CrossFit. There's a little bit more income, and right now is a good time. But why not be diversified that if someone wants to come in and buy a prepaid package, why wouldn't I sell that?

So long as I do it legally in the way it's supposed to set up in the law, I would offer that. I would certainly offer and do insurance. So I would say, for example, now this is not going to be for everyone. I know this cash goes to a lot of people. But, for instance, in the state of California, California has a very specific law, Business and Professions Code 657. And that law for California is very unique. We're the only state that has it. It says that when a patient does a prompt pay and not using insurance or doesn't have insurance reimbursement, you may charge them a fee that differs from your regular fee.

So for a cash practice in California, when someone comes in and just wants to pay promptly and not use insurance, you could, say, charge $40 for that visit, but yet in turn charge $80 if it was insurance. And that's completely legal under the law. And I think there's a certain sense to that. When you bill insurance, it takes more time and work. There's definitely administrative, if nothing else. Now, is it worth 100% more? I don't think so. But certainly a 10%, 15%, 20%, maybe 30% difference to me makes sense. Kind of like when you go to the gas station. If you purchase a cash, you pay one price.

But if you use credit card, it's another. So there's incentives. So I would implore that I think the young docs have embraced kind of having a multifaceted practice that allows you to meld. In other words, I'm not going to turn someone away who can afford to pay me. So by example, let's say I'm running a cash practice and someone's had a pretty significant accident and they're a current patient. They go, oh, my God, I really want to see you. And they need to come to me three to four days a week for maybe a month, two months, three months. How many people can afford to pay $75, $100 four times a week for that long?

So certainly that's going to be a deterrent. But if I were in turn to say, hey, you know what, for this case, I'll take your med pay so long as I verify it's good and reasonable. And so, in other words, it allows me to do a little bit of both. The one thing I think most would want to do is be careful of being stuck into one thing. Like, by example, I would not want an office to do only insurance. You can survive on that, but you're very dependent. What if a company changes? What if they move out? What if they change their plan? I mean, what if a plan goes from a really good plan to one that has no chiropractic benefits?

So, by example, though I mentioned California has that good law for the cash discount or prompt pay. At the same token, California for Covered California, which is our, quote, unquote, Obamacare policy, it literally has no chiropractic benefits. So, in 41 states, there are mandatory chiropractic. California, not. So, certainly, would I want to take a plan that's a Covered California plan as a chiropractor? No, because that plan's not going to pay me. I have to take different plans that aren't those that have that limitation. So, my big standpoint is always making sure you're diversified and run the business.

That's why we do our seminars in that way. We try to focus in on the business aspect. We are unique that we try to go, okay, let's talk about the codes that should be commonly billed, why and what they're for. And I'll never take away someone's ability to say they do what they like. But you certainly want to look at what are the best evidence show. Right. And you want to lean towards that, meaning more active care. But at the end of the day, chiropractic works well. We have to make sure people can get access to it. And frankly, when someone has insurance, and I use myself as an example, I have a really good health insurance policy through my company.

I basically pay no, well, I shouldn't say basically, I have no deductible. I have, if I go to a specialist, a $25 copay. If I go to a regular, you know, non-specialist, a $10 copay. If I go out of network, it's no more than $25. So, in other words, it's a pretty doggone good policy. So, when I go to the doctor, I always use my insurance because it pays well. But you know how much it costs me for that? $2,000 a month. Now, I don't pay the whole thing. My company pays a chunk of it. But at the same token, if I'm spending $24,000 a year for health insurance, why in the world would I think I'm going to go in and spend cash?

Because when I have a very low deductible, I have a low deductible. But what about a person who has a $5,000 deductible? Even though they have insurance, that's kind of like catastrophic. So, I have to meld that that's a patient that probably would want to do a prepay. And so, at the end of the day, I think as any business, you have to look at the trends and not be afraid to say, hey, if there are a number of people who want prepays, why would I not offer that? Why would I not offer a prompt pay? Why would I not take insurance? Be very diversified and not stuck on one thing. Okay. So, you hit a lot of points in there.

I made a couple notes along the way so we can circle back on a few. Probably the – I'm trying to think of what the listeners are going to be thinking about. And if they're not in California, they're thinking, shit, what do I do in different states about that prompt pay? Like, is there other rules? I know it's probably – Okay. So, now, here's something interesting. I'll give you – the state of Minnesota actually has a similar law that they can do the same. So, when I say California, I should clarify. That's Minnesota also. Minnesota says so long as you're not billing insurance. So, California, Minnesota, you've probably heard of the thing, Chusa, Chiropractic Health USA.

In most states, you have to do kind of the Costco model where the patient to pay cash has to join this group. And then because you're a member of the group, you can offer them a different discount. Otherwise, you really can't offer a cash discount. So, what I tell people to do is you can offer a cash discount, but what can you do in a state that doesn't have these laws? So, let's just say you're in New York or Nevada, Texas, whatever. Under the Office of Inspector General, which is, you know, overseeing the U.S., they've made an opinion that a provider can offer anywhere from 5% to 15% prompt pay discount or a so-called bookkeeping discount.

So, let's say my normal visit is $100, I could have a cash patient pay $95 to $85, and it still would be fair to bill the insurance $100 for that savings, that you're not doing the extra work. So, you can give a very small, but I just tell people, be careful, it's small. I mean, I don't think anyone gets excited on a 10% sale. So, it's not like you're going to go, oh, my God, instead of 100, it's 90, let me come, you know, 10 times. But at least it offers something where I think there's some incentivizing the patient. Now, that is not included, that is exclusive to hardships when necessary. But what I tell people is don't create a hardship to get around.

A hardship should be legitimate. The person otherwise wouldn't get the care, put them in such financial peril. That should be more the exception than the rule. But generally, in most states, can you at least give a 10% to 15% pay at time of service compared to billing insurance? Absolutely. So, I'm guessing, like, the whole point of, like, not giving the insurance company doesn't necessarily want a big cash discount as opposed to what they, because they would want the discount as well, I'm guessing. It's not really fair to have both. The idea is that you can't bill someone more when you're billing to third party.

Now, again, California and Minnesota have laws that are different from that, but in most other states not. And to me, it shows kind of the, for lack of a better term, the conspiracy of insurance in a way. I find it interesting, like, by example, you're familiar when someone joins a company like a Blue Cross Blue Shield. When I join that plan, my regular fee is $100, let's just say. But when I join the plan, because of my contract with them, I'm agreeing that it's $50. Now, I can do that legally. So, that means when that Blue Cross Blue Shield patient comes in, my $100 fee goes to $50. That's legal.

But what's interesting, it's kind of like the mafia in a weird way. So, you can't offer a direct discount to your patient just because you want to. But if you involve a third party, the insurance company, then you can. So, notice how insurance companies, when you're not connected with them, oh, no, you can't charge us less. But when you're connected, you can so long as they're making money on the deal. So, I think it's one of the things that this is why people get so frustrated with insurance because they see the lack of fairness that why shouldn't a doctor be able to charge a little bit less?

Now, here's where the 10% or 15% comes in because the part I would argue is that should you really have a 50% difference for someone paying cash? Now, here's what I would look at. How much money does it cost to bill insurance? Now, let's just say you have a staff person, they take some time. It certainly costs money, but does it cost 50% of the actual charges? And I think this is where we have to kind of come to some type of end point to go, okay, if we're really charging $25 for cash, how in the world could it be $100 for insurance? I certainly think there's a cost to doing business. But when there's that much difference, I think it's certainly showing that someone's probably trying to milk the insurance, if you will.

Yeah. So, that's something I would be a little bit concerned with. I even tell docs in California that go ahead and offer a discount, but don't make it ridiculous because I think your patients figure it out, too. They're going to go, wait a minute. If I pay cash, it's $25, but when I use my insurance, it's $100, and my co-pay is $15. How does that make sense? Yeah, yeah. You can tell that you're kind of cheating the system. And so, I don't want to appear that I want to be fair and reasonable. And I would certainly say I wouldn't probably do much more than 15% or 20%, but at the same token, I think it's fair and reasonable.

Where I would make a difference is people who want to buy a package. Let's say you commit and say, hey, I want to come in for 20 visits, or I want to buy 20 ahead. I would give them a pretty steep discount because I got paid ahead of time. The only thing with offering something like that, and I'll make clear to everyone, verify your state allows it. Most do, though. But the big issue is that the patients have to buy a specific number of visits. So, one of the things with prepays where people make mistakes are they'll say, hey, for $100, come as much as you want for this month. And that's not allowed because it's like you're an insurance.

You actually have to sell a service. You can say, for $100, you can come three times, or $100, you come twice. And the reason for that is that it still has to be a fee for service. So, that way, if I spend $100 for four visits, and for whatever reason, I'm not going to come into any more visits or whatever, if I come into half, I get half of my money back. It also means that the doctor, let's say you offer a prepay package, and for whatever reason, you're moving or you don't want to have this patient come back, you could tell them, I'm canceling on my end. And refund them a pro-rate a share of what they paid.

I do think that's viable, and that's why the joint works, because people are interested. I have a friend that just had a baby, and she was just telling me that what she did was she got eight visits a month, and she was paying $200 for these eight visits. And she goes, it was great. I was going for eight visits because it was pre-pregnancy. And she went in, and she did that for four months. And I thought, wow, that, to me, was a pretty good business model, because what if you get 10 patients like that a month? That's $2,000. She came in. She goes, the thing that was interesting that she said to me was, she goes, it wasn't a fancy visit, but she liked it because she came in.

The doctor sat with her, evaluated her, adjusted her, and she left. So, she was in and out in, like, 15 minutes. She was satisfied because she wasn't wanting a whole bunch of other, you know, rub-a-dub and all that. And I just thought, hmm, kind of an interesting that I hadn't even talked to her about. We just happened to mention, because I went to visit the baby, and I thought, well, theirs, to me, is a good model. You have to look, what is my business model? How do I get these people in? So, just thinking on just a couple things on this. So, I guess the first is, so, let's just say, I'm going to talk rough numbers.

And say you build an insurance, like, for a, let's just say, a lot of listeners are, they're, I guess, quote-unquote, exercise-based, active-care-based clinicians. So, I'll start using those terms a little bit just to see if they kind of apply across the board. Let's just say we're going to do a therapeutic activity at $100 for an insurance. Can you cash or, sorry, prompt pay it for $75, since that's, like, a $25 discount? What state, if they're in two states, you could do that would be California and Minnesota. Those are the only states that allow that much difference. Let's just say California, to keep things simple.

I know that probably listeners are like, damn, I wish you were talking about my state, but it's going to be too hard to go across the board. Well, I would just say any state but Minnesota and California, keep it simple. The most they can do is 15%. Got it. Okay. So, say that $75 on that, but if someone says, well, okay, so your normal rate for that activity is $75, but I want to buy a 10-pack, does that now go down even further, and is that no longer applicable as much because it's a prepaid package, not a prompt pay? Right, exactly. So, I'll give an example, and this is in most states, but I use Oregon and Texas because they actually wrote laws on this.

They've realized that this model is out there, so they wanted to put some safeguards for the public and for the doctor. And what they require is there's no set amount that you can't discount. So, so long as they're buying a package, there's no limit of the 15% is just the package. What's clear in both states, though, is that it cannot involve insurance at all. So, when a person buys a package, they can't, in turn, take the receipt for the visit and submit to insurance. It's got to be just a connection between the patient. And that way, it allows you, like, let's say you could go, hey, my 10-pack is $50 a visit, but if you buy a 20-pack, it's $40.

If you buy a 30-pack, so in other words, the more they purchase, the cheaper, kind of like, you know, a Costco, bigger the package, you know, the bigger the savings. So, it allows some solidarity for the doctor to not be hemmed into all packages are the same. You know, you could have packages for different prices. The one thing I have not seen anyone do, what constitutes a package? Certainly, one visit is not a package. But would five? Would 10? So, I say with that, would two? Interesting. I would say not one, because one starts to get, but what if you say, hey, buy two? That might be something viable.

The thing that I think we have to keep clear, though, is that it can, in turn, be used for insurance purposes. So, they can't turn it in and bill to insurance. The patient has to clearly understand they're buying this, and this is just interaction between them and the doctor. What happens on the other end if they did submit it? I know in California it would be different, but I know that with, we talked about, when I was there at your workshop, we were talking about Medicare. And if you're not part of Medicare. Okay, let's throw this out. Medicare, this is not allowed. Okay. Yeah. Federal plans don't go for this at all.

So, the Fed says no, because under federal rule, they see it as potentially an incentive. In other words, you're incentivizing the patient by giving them the package to incite them to bill some other covered services. So, on a federal level, this is a Medicare no. That's why you'll see often when you see these advertised, or if you've ever seen advertisement for, you know, all new patients get a free first visit or a free exam, that's absolutely allowable. So long as you don't bill insurance for it, except it has to exclude federal. So, Medicare, also WorkCop. Now, a really quick break for myself to talk about myself.

So, we are going to do a workshop promo today. Again, this is March 30th for students only. It was really popular with the SCU crowd last year. And then there's a doctor one that gets CEUs 12 hours, April 25th, 26th. Last year, we did it kind of like a class reunion for SCU Fall 2008, but everyone's welcome now too. So, the way I'd like to address these, like why should you come to this workshop? Well, if you struggle going to other workshops and then putting the pieces together of how we want to use this with this case, I'm going to lay out a good five-step plan of how to figure out when to use those things, and I'm going to show you some of the things that I use pretty successfully in my clinic.

So, I call it putting it all together. I have no real big biases against what you could use and what I would use and what you would use. So, it's really dependent upon whatever works in that situation. So, obviously, I guess we do all have our own biases, but if you show me something, I'll be extremely happy. So, think of this like friends getting together and just figuring out what works and what doesn't and how to really explain when we would use certain things and what situations to get the best patient outcome. And at the end, we're going to have a good old party at the garage. We're going to bro down and have some steaks, tomahawk steaks, maybe some poor man steaks, which is tri-tip.

Beers and wine and so on. So, again, students, May 30th and doctors is going to be April 25th, 26th. CEUs are available. Message me on Instagram, that is performancehb, or email me directly, seb at p2sportscare.com. It's in Huntington Beach at my own clinic. So, 20 spots or so. It's going to be capped for sure because my clinic is not big. So, please reach out, first come, first serve. See you guys then. Got it. And so, with those people who are, let's just say, say we're in California and someone buys the prepaid package and let's just say it goes down to $20 a visit or something like that. So, if they submit those to their insurance, then are they going to, the insurance on the other end won't say, what the heck is this?

A CPT code for $20 and it's, why do you guys charge us $100? So, they're good with that. Yeah, well, the answer is, yeah, one, generally people aren't doing that because here's what you have to do if that's the case. You can only, let's say someone buys a 10-pack for $500 and they're $50 a visit. Now, I can give them a receipt for their $500, but there's nothing I can provide them to bill insurance until they've actually had the visit. So, each visit they would come in, I then could give them a receipt for a prorated share of $50. Then they could submit to the insurance. Now, again, you have to decide, well, what code, am I going to bill an adjustment code or otherwise?

But, based on the rule, there is, if someone were to question, and I've never seen it, but if someone were to question, hey, how come we received this week a 98940 for $65 and we got this from the patient for $25? Well, because the patient bought a package. Now, this is why in most states you're not going to use insurance. And I'm not saying you can in California. You can, but remember the provider has to be out of network for that. Got it. So, the third network, these things kind of, the things we just kind of spoke about for packages, and that's kind of washed away. Yeah, because now you're inside the network.

Now, here's something interesting. Can a patient refuse to use their insurance? Oh, interesting. Every patient has a right to say, I don't want to use my insurance. And in doing so, they could forbid the doctor from billing. This is kind of under HIPAA. I could say, hey, look, I don't want you to send these records to anyone. I'm just going to pay cash. So, they can do that for federal plans, too. They're using their insurance. But the issue is, once they do that, then neither they nor you can ever submit to insurance. So, a patient really has to make a decision. Generally, for packages, I don't think you're using it for insurance.

That's the whole point of it. Now, if someone, let's say they have a really high deductible and they're going, look, my deductible is $5,000 and I don't want to pay your $100 regular fee, can I pay the package? I would argue, sure. But the only way you can submit is, until they've had the visit, you can submit visit by visit to count towards deductible. And there's no problem there. With the guys being, I always look at it from this standpoint. Make sure no one's being cheated. In other words, I don't want to be hitting the insurance for $200 when the patient's paid me only $50. Clearly, we're cheating this system there.

So, as long as it's dollar for dollar and no one's being cheated, so if the patient's paying $50 and the submission to the insurance is the same, then there's no one that's being cheated, no one's being misled, I think you're okay there. You just have to remember that would be out of network. If you're in network now, when you have to bill, you're bound by the contract. So, here's an example I got. We do a service called the network. And with the network services beyond our seminars, it's a service, once you join, I become part of your office in a way you can call me or email me with questions.

Well, here's a question I had this week. There was an office offering this cash discount in California, but he was doing it to patients that he was in network with. And so, when they submitted the bill to the insurance, if you submit a $50 bill, they're going to reduce to their allowed rate plus pay percentage. Well, if it's the prepaid and you're now submitting $25, they're going to allow less than that. So, it turns out he now owes the patient a refund based on that amount because he's in network. So, this is where you really have to decide if a patient wants a prepaid, my rule would be this is not insurance.

Because if you're in network, you may wind up having to charge even less because you still have to submit to the insurance the amount. So, you really want to make it clear that the patient says, no, I do not want to use my insurance. I really think that it should be for patients who otherwise say, look, this is much better for me out of pocket. Let's not bother with insurance. There are times that it's not worth it. I mean, frankly, if someone has a $5,000 deductible, going for a package of visits to a chiropractor even for $500 is going to be 10% of that deductible. You're probably not going to meet it unless you're very ill.

So, I think people who have high deductibles should know that and say, hey, look, you've got a $5,000, you have to be real, you have to darn near go to the hospital and be half dead before you use it. I'm 50, you know, I've never once when I had a deductible ever met it because I've not been to the doctor but five times in my adult life. Yay for me. At the same token, I would say that's not for everyone, but a lot of people to say, and that's the reason for the deductible because it makes people go, well, you know what, I'm just going to pay cash because my deductible is so high, it's not going to make sense.

It's really meant to be, for a lot of people, insurance is catastrophic. And it's not true health insurance. Now, this is where the variation comes. I think people who buy insurance themselves, unless they're getting a heavy subsidy, probably buy higher deductible policies. And as a consequence, they're buying insurance like if something bad happens. I think there's a lot of them out there, actually. I think it's- Oh, there's a ton of them. I mean, it's like car insurance. I mean, what if you have car insurance with a $1,500 deductible? Unless you're in a pretty significant accident, you're paying out of pocket for that.

So, I tell people, why report it to the insurance? Right. Like someone keys your car, like it's always going to be under $500. Yeah. You know, actually, I was thinking about it, like probably some of the listeners, a lot of the listeners are students. And so, as they get out of school, they're probably going to think, at least I wrote down some of the barriers that I kind of have thinking, because I'm a small office. I don't have a big staff or anything. Like, is it worth the time to incorporate business? Like, say, calling insurance verification, what percentage of time do you have to follow up on claims and things of that nature?

Is there- I think people spend way too much time verifying insurance because you're going to get on the phone, you're going to wait 15, 20 minutes, and then you're going to get someone that's going to give you very vague answers. You know, if you ask them, well, how much do you pay for this? They're never going to tell you that. What diagnosis do you pay for? They're just going to say, well, it has to be medically necessary. So, you're getting very vague. So, I think people spend way too much time thinking they're going to get this great information. So, in today's age, particularly for students, they're all familiar with being online.

If you were to go to a site called Avality, which is one that basically for the Blue Cross, as you go there, you can do a quick perusal if there are benefits. And you'll just see it says chiropractic. It'll probably say the number of visits. All I care about, actually, is, is it cumbered? Because you're not going to get the nuance. You're going to waste your time asking nuance. But here's what you do, though. The best verification for an insurance is to bill it. When I bill it, I get real information. I'm going to get, did they pay it, did they not? And I'm also going to get, what did they pay for a code?

So, what I think offices need to do is to keep a spreadsheet of the insurances they bill, the codes they bill, and how much they allow or don't allow. Now, that always seems daunting to most people, particularly if they're like, oh, my God, the reality is most of us bill no more than five insurance companies. So, I'll give an example even for you. You've got to think, okay, there's Blue Cross, Blue Shield. There is Aetna and Cigna. There is UnitedHealthcare. Now, there's some other small companies here or there, but those are going to be the big four to five. Outside of that, there's not a whole lot.

So, once I have someone that's, let's say someone works for the local school district and they have, you know, the Blue Cross Blue Shield policy. When they come in, I verify that they have a policy with it. Okay, great. There's benefits. Fine. I bill it. Then when I get paid, I'm going to mark down each code that I bill and what it allowed. So, that way, when the next person comes in that works for the same school district with the same policy, I don't have to verify a darn thing. I know and I can tell the patient, hey, your co-pay is going to be $16.20. And, I mean, think of it this way. When you go to a dentist or medical doctor, you ever notice how they know exactly what your co-pay is?

I mean, to the penny. And it's because they gather the information. And so, what I think people need to do is keep a spreadsheet of their five common insurances. So, 98940, what does this one pay? What does this one pay? I think it also gives you a way to look and go, well, what's the better paying insurance? So, by example, I had someone the other day that was shocked. They were billing an Aetna POS. Now, it's not what most people think with POS, but it's called a point of service plan. And if someone comes in with a PPO point of service plan, those generally pay 100% of what you bill unless your fee is way over.

I mean, if you bill $300 for an adjustment, they're not paying that. But he couldn't believe it because he was billing 98940, one to two region manipulation for $75, and they literally paid the whole thing. And he's like, this can't be right. I'm like, no, that's now people who have that plan aren't your rank and five. Workers, however, these are going to be people a little higher up on the food chain. And you're going to see a lot of difference. My daughter-in-law works for a, I can't mention the name, but a high-end internet-based company. And her plan pays phenomenally well. In fact, they have now a chiropractic office that goes into her office twice a week.

They own like seven floors of this building you're in. And they go in twice a week and treat patients there because the plan pays a little over $100 per visit. And so they figured out, wow, and the co-pay for them is $5. So the people go in. So that particular one, and why I'm bringing this up is new companies, young people like chiropractic care. They grew up with it. It's not the people, the old days where people go, I don't know what those people are doing. They're cracking necks or something. That's really changed. Young people get it because most young people have been to a chiropractor and have a good result and understand what it's doing.

And that's why I think a cash practice thrives because people go, you know what, regardless of my insurance, this keeps me functioning. It makes me feel better. And so you want to look at it. I mean, I will go to lecture at Palmer College three times a year on the West Coast here. And they don't, they're not doing it currently, but they used to always take a tour of Google because Google has five chiropractors that work inside Google. They just have, and they just treat, there's no insurance, they're just treat, but Google has some pretty good health benefits. So does Apple, you know, so does Microsoft.

I go up, in fact, when I do my seminars in Seattle, I never realized the hotel we're in is two doors down from the main Microsoft headquarters and all the doctors, oh yeah, it pays great. They have good benefits. These companies, you got to realize if someone is a tech person, that average person is making over $100,000 a year of income. Those are people who have good benefits. If you're dealing with someone who works at Walmart, and this sounds awful, but a Walmart worker is making, you know, anywhere from minimum wage to $12 an hour, they're not going to have great health insurance. Right, right.

And so that's a person, they're either going to pay cash or not use insurance. So that's one that's probably not going to come and see you because they don't have the income. They don't have the insurance. And so in a weird way, you kind of have to cherry pick. It's kind of like how life works. We all would like things, but there's certain, like, I would love to have a Bentley. The reason I don't have one is I can't afford a $400,000 car, but they're very cool. If I went into Bentley and said, hey, will you get me? They're not. That doesn't mean the car that I have is not a nice car. But at the same token, I know within those limits.

So think of the same way for any other business. If you're in the right area, those can work well. I have a couple of practices that they do 100% cash and do exceptionally well. What I will say in a cash practice does, though, that's a little different. They're better at a report of findings than most. They're really good at explaining to the patient what's going on and how this is going to improve them, almost like a trainer. So you mentioned active care. Think about it. I go to the gym. For those that know me, most people look at me and go, Jesus, I just live in the gym. But when I go to the gym, most everyone at my gym knows that I'm a chiropractor.

And you may not be surprised. Almost every time I go when it's crowded because people have gotten to know me, someone will ask me, hey, where's your office? People who work out want chiropractic care because they want to continue to work out. They're obsessed with it. So there's a good market for that. And I will say people who belong to a gym have higher than average incomes, which means they either have better jobs or can afford to pay cash. So by example, you're familiar with CrossFit, I'm sure. Right. I think CrossFit is a fantastic way of training. I think it's not for everyone because it's hard.

You know, the average person at 50 years old should not be doing clean and jerk and then wonder why their backs are hurting. But when these people join these, they're expensive and they want to keep doing it. So would they be willing to pay cash? So if you're dealing with that type of group or think of people who ride bikes on the weekend, you've ever seen these guys that look like Tour de France, you know, those bikes, if you're not familiar, cost $10,000 to $15,000. The clothes that they're wearing are probably $300,000 to $400,000. They're riding 200 miles on the weekend. Do you think their back's going to be a little sore on Monday and they want a treatment so they can ride the next weekend?

Of course. Can they afford it? Sure. Because if you can afford a $15,000 bike, you can certainly pay a $50 chiropractic visit. So for those people then, so the ones that can afford the cash practice or the, well, they can afford to pay something, but they want to use their insurance, what kind of, what maybe conversation might you have with them where, because they, like the barrier is, well, I have this policy. I want to use it. But, um, we, as the provider, aren't necessarily sure that we want to use that insurance or not. Well, so here's how you, I had this question this morning from someone.

When someone comes in, can I diagnose tenderness, spasm, subluxation? Absolutely. I think that's something I can always find. Is there always some type of tendinopathy with a lot of people? Yes. You know, just life is overuse. Could there be other types of strains and sprains? Yes. Now the clear problem is going to be at some point they're going to go, it can't be all year. And so the difference is, can these people flare up? So what I'm going to try to do for them is to utilize their policy to the benefits that they allow. I would say most people are going to probably be afforded easily a good 12 to 18 visits without much problem per year for little flare ups and dings and dings, if you will.

It's the problem of if a patient's trying to come twice a week all year, that starts to sound like maintenance. In other words, if you smell fish, it's probably fish. So you have to look and go, you know what I tell patients? And this went to, I said, you're going to go ahead and bill, you're going to tell the patient, I can't guarantee your coverage, but you know, we'll go ahead and bill when it maxes out your insurance says so, then you're on your own. And some policies are just more generous than others. So being here in Southern California, I'll give one that's interesting. The ILW, which is International Labor Warehouse Workers Union, which means longshoremen.

For anyone that is in the South Bay, so meaning Torrance, San Pedro, City of Carson, Lameda, any of those areas, doctors of chiropractic, they're probably are the most lucrative in the state of California per capita. For the simple reason, there are about 12,000 people that are insured through this company. They spend about 20, this is going to sound crazy, but $28 million per year is paid for chiropractic benefits under that policy. They're allowed 40 visits a year, and it's almost open-ended, meaning I think part of it is it's a hard job. I mean, a longshoreman is not an easy job. So they afford these people a little bit more generous care, I think, with the idea being that it keeps them working, keeps them happy.

Their families come in, they do massage, and they literally pay 90% of the billed amount. So that's a really good policy. Now, that's one, if you treat it all 40 visits, you're probably okay. They're just less scrutinizing. And I'll never say they're not scrutinizing completely, but they're a little bit more generous based on the work. Now, if you take the other side of that, if you deal with the ASH-type policy, say with Blue Shield, they're going to, after five visits, go, hey, what's going on? What do we want to see here? And the tough part for us as chiropractors is chiropractic adjustments actually work very well.

And I want you to think of yourself, anyone listening, think of it, when you've hurt your back, how many visits when you go to the chiropractor does it take to get better? Now, I'm taking out of the loop someone who bulges a disc or something, but I'm talking your typical, I slept awkwardly, I twisted funny, I overdid it at the gym. I would best most of those patients within five visits or about two weeks are pretty good. And the difficulty is chiropractic feels good, so people want to keep coming, even though it's not corrective from an insurance standpoint. So on that line, what we have to remember is that some carriers, when they're tired, we have to say, what's my diagnosis and does this patient need more?

Now, here's the difficulty. If I treat you in five visits and you're 90% better, they're not going to authorize another five. They're not going to authorize another 90%. So the difficulty is, is you have both spectrums. Some can be more generous, some are less. And I'll go back to circle back to what I said, cherry pick what's better. Like a cash practice cherry picks. You don't treat homeless. Now, I'm not saying you never do, but you wouldn't on a regular basis, you wouldn't stay open. So you certainly cherry pick a certain type of person to come in that can afford it. Don't be afraid to do the same thing with insurance.

Some insurance can be very good. Some can be awful. So when you take insurance, always know because I take one doesn't mean I take the other. You might say, hey, I accept Aetna, but I only accept the Aetna PPOs. I don't take the HMOs. So when you opt into these things, go ahead. In Newport, he only takes if you have a PPO policy. If you have HMOs, he won't accept you. Now, that doesn't mean he won't accept you as a patient, but he won't accept your insurance. So if you're willing to pay cash for an HMO, he'll take you, but the PPOs he'll take because they pay better. And he just goes, Sam, I learned this because the HMOs are too hard.

It's why when people join ASH, they're so frustrated because you're dealing with five visits. Now, the other side of the spectrum, I have a friend that practices in Murrieta, which is, you know, the Inland Empire of Southern California. And he's talked to me, this has been about a year, but he goes, Sam, 90% of my practice is ASH because people who live in that region work for several companies, but they all have ASH. He goes, but you know what I've learned? I've learned to make it work. And so even though he's getting anywhere from a low end of 26 to a high end of about $50, the patients come in, they get a good adjustment, and they leave.

So he's a very high volume practice now. He literally sees like 70 people a day. Damn, I couldn't imagine. But he adjusts and goes, that's hard to do, in my opinion. But he says, he goes, if I didn't do that, I was going to have to move because this is 90% of the people who live here have this type of coverage. And so it's knowing where you go. So one of the things I think you want to look at when you open a business is think of how any other business opens. Trust me, Trader Joe's doesn't just go, oh, this looks nice. They do a lot of demographics for the area. And I bring up Trader Joe's specifically, statistically, a chiropractic practice.

Trader Joe's will do very well to open up within a relatively close distance to a Trader Joe's. Because Trader Joe's opens in areas where people can afford. Trader Joe's is a cool store. They have inexpensive things, but they're hitting a certain market. Whole Foods, not so good. Because you notice most Whole Foods are closing. So I'll take that one off. But the other one is Costco. Statistically, people who shop at Costco have the highest per capita income of anyone in the U.S. So if you open near a Costco, that tells me you're in an area where incomes are a bit better. And if you think of it, think of where Costco's are located.

By freeways. And therefore, would I want to be within a relatively short drive to one? So look at how other – because a lot of cars just go, oh, look, this is a great strip mall. It could be awful because there's nothing to sustain it in that area. Where do these people work? Is it very blue-collar? Blue-collar can be great. But when we say blue-collar, if someone works for the city of Los Angeles, absolutely. If you want to have a good insurance patient, deal with a city or state worker. In fact, deal with a federal worker, and they always have chiropractic benefits. So if you can deal near a federal courthouse or marshals or anything like that, oh, my goodness, their benefits are fantastic because that's the type of insurance they have.

Sam, thanks so much for being on. Again, that's Sam Collins from hcarosscompany.com. I do suggest going to his workshop. If you guys have not been before, there is Con Ed credits there as well as – it's really not that expensive considering some of the other workshops you've probably done for techniques and so on. But he's right. It's really the only one that will really make you – it will make you money because it's a business-related one. And we all need to be better business owners because if we don't, then who are we going to see to help, right? You can have the best techniques in the world and be able to help a ton of people.

But then if no one shows up at your door or is willing to come in because of X, Y, and Z barriers, then you might not see anybody. So, again, this is part one. We're going to have part two next week. So stay tuned in for that. Now, I've had a couple people ask me. They're like, you know what? Or they've messaged me. They said, you know what? I can't wait to the 18th. I'm like, what the heck? What are they talking about the 18th? I'm like, oh, yeah. The 18th of January is going to be the movement meetup, all right? So all the listeners are welcome to come. If you're not in California, I apologize, but, you know, you can always fly in or drive in if you want to.

It's a nice place to go in the wintertime. It's going to be at Sandy's at the pier in Huntington Beach. There's a Sandy's Bar and Grill. It's right at the end of the pier. I'm going to be there from about 5 to 7. You can surely just come hang out. You don't have to tell me you're coming. Just show up. Bring some friends. I'm hoping that people that have listened to this show have very like-minded ideas, and it's a way to build each other up, you know? It's like bro-ing down, hanging out, exchanging ideas, see what's going on with their business, our business, whatever. And I hope to have other professionals from our field as well.

There might be a podiatrist there and a primary care doctor, a couple strength and conditioning coaches, chiropractic students, chiropractors, PTs. Hopefully we get a good array of different people. So everybody's welcome, even ATCs and massage therapists, personal trainers, whatever, right? Just as long as you know that there might be some very raw conversation going on, and hopefully everybody learns a little bit about things they might not know about already. So even if nobody shows up, I'm going to be there from 5 to 7 having a beer. I'll probably have a blue hat on that says Fountain Valley Barons on it, just in case you're looking for me.

I'll be that guy with the red rose hanging out by the bar. So come hang out. Everybody's welcome. So, thanks for being part of the movement. Again, if you're listening to the show, you're part of the movement now. Thank you for being part. And feel free to share this with one of your colleagues who think they need to know this information. The only way this show continues to grow is if you share it, all right? I do almost no marketing for the show other than a couple posts here and there. And I don't make any money from this podcast. I honestly don't. And so when you hear those sponsorship, when you hear the sponsorship ads, that's only if you buy.

That's the only way we ever make money or the only way I ever make money on this show. So it's a passion project and I'm just learning as we go. And hopefully if you guys want to support, that's probably the easiest way to support. But I'll see you next week. Thanks for being part of the movement.