Specialty Spotlight: The No Surprises Act with Plastic Surgeon Jonathan Kaplan, MD

August 24, 2022

In this episode, we spotlight a federal law – the No Surprises Act, with guest Dr. Jonathan Kaplan! Dr. Kaplan is a plastic surgeon, CEO and founder of BuildMyHealth, a website, and app that gives users an estimate for procedures in their area. We discuss cost transparency, how the No Surprises Act affects doctor-patient relationships, and compliance.

Listen to the full episode using the player below, or by visiting one of the links below. Below is the episode’s transcript which has been edited for readability. If you have any questions or would like to learn more, email us at info@byrdadatto.com.

Transcript

Intro: [00:00:00] Welcome to legal 123s with Byrd Adatto. Legal issues simplified through real client stories and real world experiences. Creating simplicity in 3, 2, 1. 

Brad: Welcome back to another episode of the legal 123s with Byrd Adatto. I’m your host, Brad Adatto, with my co-host Michael Byrd. 

Michael: Thanks Bradford! as a business and healthcare law firm, we represent clients in multiple sectors and multiple specialties.

Brad: Yes, we do

Michael: especially healthcare. 

Brad: Yeah! 

Michael: This season, our theme is specialty spotlight. Where each episode we will visit some of the nuances that can be found from a business and healthcare perspective in the various practice specialties. 

Brad: Yeah. Michael, today’s show is going to be really amazing because we’re adding another plastic surgeon on for this special season. We’re gonna be talking about federal laws as a plastic surgeon. This is going to be very interesting!

Michael: Yeah. I’m so not surprised that you’re geeking out about talking about federal law. 

Brad: Yes, my sweet spot. All right, before we [00:01:00] brought him on, you know, you and I, we spent a lot of time, probably too much time, talking about sports. And when I was preparing for the show, I was reading again about college football teams, the recruitment class, and predictions for the season. 

Michael: You were reading about Arch Manning committing to the University of Texas. 

Brad: I know. 

Michael: Is that what we wanna talk about?

Brad: I actually read a lot of that article.

Michael: Well, he is from New Orleans so… 

Brad: Yes, he is.

Michael: Yeah, you probably should have started a podcast on sports. 

Brad: Yes, I think we could or movies. For our audience listening for the first time who don’t know this, Michael is a Longhorn while I’m a horn frog, go frogs, and if we add our law schools to the mix, you’re a red Raider and I’m part of the Wolf pack. 

Michael: I’m not a red Raider. Brad, Texas Tech is where I attended law school.

Brad: Ah, okay. 

Michael: I’m a Longhorn. You gotta pick. 

Brad: Okay. 

Michael: You can be one, you can’t be both. 

Brad: All right. Well, it started making me think about college mascots and their  [00:02:00] nicknames that people have for college mascots and the various types of mascots that are out there. So I thought today before we brought in our guest, I’ll quiz you and you cannot use Siri to help answer the questions. Your assistant, I mean, whomever that assistant is. 

Michael: Mm-hmm. 

Brad: You might not know all of them, but are you interested in this, going through this game? 

Michael: I am hesitant and I’m used to winning, but I’m used to Siri helping me win. So, I guess so.

Brad: all right, you didn’t have a choice either way. So I’m gonna name the mascot and you’re gonna have to answer with the school that the mascot belongs to. I’m gonna start off easy so I can build up your confidence before I crush you. 

Michael: Yeah, basically just like any of our partner meetings.

Brad: Yes. Who are the Gators? 

Michael: Florida. 

Brad: All right. Who are the Buckeyes?

Michael: Ohio State. I feel like I’m getting set up here. 

Brad: who are the Trojans? 

Michael: USC.

Brad: Yes! And actually, there are two of them out there. Troy [00:03:00] is also, but USC is the correct answer. Who are the Midshipman? 

Michael: Navy. 

Brad: who are the Black Knights? 

Michael: Army. 

Brad: Good. Who are the Cavaliers?

Michael: Virginia. 

Brad: All right, you’re doing great. Okay, this is where…

Michael: Did I win? 

Brad: No, here we go. 

Michael: Oh, no.

Brad: that’s the setup. 

Michael: Oh man. 

Brad: Who are the Road Runners? 

Michael: Oh, Texas A&M. 

Brad: No, Texas San Antonio. 

Michael: Oh!

Brad: They’re the Aggies, you know that. Who are the Golden Hurricanes? 

Michael: Tulsa. 

Brad: Oh good. All right, this is bringing it all together here. Who are the Raging Cajuns?

Michael: Louisiana.

Brad: Louisiana who?

 Michael: Do they call it Louisiana State or just Louisiana? 

Brad: Well, it’s Louisiana Lafayette. 

Michael: Lafayette. Oh, well that’s technical.

Brad: Yes, it is. 

Michael: Yeah. One of my son’s friends got recruited to go play for the Raging Cajuns.

Brad: There you go. Well, you know, I brought in the [00:04:00] mascot talk for different reasons. Obviously, we were into some football talk before, but today’s guest is kind of interesting. Like us, he has two schools that pull him in. He is both a Longhorn, hook ’em, and a tiger, an LSU tiger, that is. And so I was preparing for the day’s show, and I also found out that he has a nickname. So not only is he a Longhorn and a tiger; he has his own nickname. Well, let’s bring him on, and then we can quiz him.

Michael: Get some disclosure on that. 

Brad: Yes.

Michael: Okay. Well, today’s guest is Dr. Jonathan Kaplan. He is a board-certified plastic surgeon. Originally from Alexandria, Louisiana. Did I say that right?

Brad: Yeah.

Michael: I always am a little self-conscious when I pronounce anything relating to…

 Brad: Louisiana.

Michael: Yeah. As you mentioned, UT undergrad, Hook’em, and LSU med school. He completed his plastic surgery fellowship at Cleveland Clinic. He is the owner of Pacific Heights, plastic surgery in San Francisco, [00:05:00]  areas of focus range from facial to the body and cosmetic surgery as well. Nonsurgical procedures. He is also a businessman.

Brad:  Mm-hmm.  

Michael: He’s the CEO and creator of build my bod, now known as build my health, and a prolific speaker and writer. In fact, you and I shared the stage with Jonathan at a conference in Chicago a few years ago. 

Brad: That’s right! 

Michael: Jonathan, welcome! 

Jonathan: Thanks for having me! Y’all got all that right, good job on the research. 

Brad: We’re gonna put you on the spot right away. And so these are kind of the questions that you could not have prepared for. Are you a Longhorn or are you a Tiger? 

Jonathan: I’m a tiger!

Brad: all right! I thought I could answer that one being a boy from Louisiana. 

Jonathan: Four years at Austin, but a lifetime in Louisiana up until 2013 until my wife and I moved out here to San Francisco. 

Brad: There you go. Well, that might help me with the next question, which is the follow-up. Who [00:06:00] or how did you get that nickname? Dr. Bae? 

Jonathan: Oh yeah! So Dr. Bae is my social media nickname. Dr. Miami is a plastic surgeon in Miami and his CEO, Rosie Zion, came up with the name for me because I’m in the San Francisco bay area. I would be Dr. Bay, but we spell it B a E instead of B a Y just to sound a little more hip for the millennials and the genZers.

Brad: That’s nice. I saw that and was like, I’m assuming it has something to do with San Francisco, but you know, you never know. 

Jonathan: I could have been from Tampa bay. 

Brad: Yeah. 

Michael: yes. 

Jonathan: But yeah, patients come in now and they don’t always know my name is Jonathan Kaplan. They think I’m Dr. Bae and they’ll call me that and I’ll just answer to it.

Michael: That means your marketing and social media are working really well.  

Brad: That’s better than what most people call Michael, but we can’t say that without being believed. So that’s good. 

Michael: Yeah! Let’s keep it…

Brad: family-friendly? 

Michael: Yes. 

Brad: Okay.

 Michael: All right. Well, that’s cool.[00:07:00] Obviously Brad alluded to talking about Federal Law today, but I’d love to get a little context and part of your story about how and why you started the app build my bod. 

Jonathan: Yeah! Back when I was in Louisiana, I finished my fellowship at Cleveland, kind of at the Cleveland Clinic in 2007. I was employed by a hospital, like we were talking about earlier, before hurricane Katrina in New Orleans in 2005, which changed a lot of things in Louisiana. One of the things is it made a job available in Baton Rouge because it was a big population shift from New Orleans to Baton Rouge. So, our lady of the lake hospital in Baton Rouge hired me in 2007, and I went into practice as an employee of theirs. I noticed that patients were always calling and asking how much things cost, you know, particularly cosmetic procedures, but also how much they were gonna owe out of pocket for insurance-based services. It is just like the two ways doctor’s offices typically handle those questions [00:08:00] about how much things cost is one, Oh, we can’t tell you the price over the phone. You gotta come in for a consultation, which just aggravates the hell out of the patient. The other option is to go through all the pricing and give them all the details, which takes 10, 15 minutes. Next, the patient says, oh, okay, thanks. I hang up and you never have any idea who they are. I figured there had to be a better way of sharing pricing information with patients. So, we started out with an iPhone app called build my bod because it was more about aesthetics and you know, fast forward we’ve shifted the name to build my health because we’re dealing with medically necessary services as well as cosmetic services. Now consumers can go onto a doctor’s website and use either the chatbot on their website or a price estimator on their website. The consumer can check pricing even specific to their insurance and find out how much something costs, but only after they put in their contact information. So the idea is it generates leads for me or for the doctor who’s using it, [00:09:00] but it gives the patient that instant access to pricing information, which they really have so much trouble finding anywhere else. I was involved in price transparency from a very early stage. I remember because as an employee of the hospital, it was their intellectual property. Back in 2010 and 2011, I’m asking the hospital, Hey, do y’all want to pay to help me develop this idea? Because again, it’s your idea. So me talking to a hospital about price transparency in 2009, and 2010, you can imagine how uninterested they were. Considering that in 2020, when these federal laws were coming out, telling hospitals, they were gonna have to start showing pricing in 2021, they were suing like crazy, trying to keep that from happening. 10 years earlier, they definitely weren’t interested, but thank God they weren’t interested. And they signed over the intellectual property to me. So very, very good ending to that story. 

Brad: Yeah! I still remember, you know, the first thing we talked about earlier, being on stage with you in Chicago and listening, to you talk about that platform. [00:10:00] And I was sitting next to Michael like, that’s so ingenious to come up with that idea and realize a way in which to help. Put it out being transparent, which is funny because you have voluntarily come on here, audience members, that, we did not force him to come on here to talk about federal laws. Cause generally speaking, when we have, a surgeon or a special class surgeon. The idea of talking about federal law is not something that excites them. And today, audience members, we’re talking about the no surprise act. And this is something that’s relatively new to the industry. As you said, it’s been around a little bit longer, but it’s just been released. And you were so interested in this. You actually, co-wrote an article with, a Senator, actually from. My own home state, Louisiana. And it was actually in Newsweek and you embrace it. So maybe you can kinda share with our audience why you were excited about learning about this bill and how, why you were sharing your information in Newsweek.

Jonathan: Well, first of all, I wasn’t nervous about coming on and talking about NT. You just said I should be nervous about [00:11:00] coming on and talking about that. I volunteered to do it. 

Michael: he does that to me all the time. 

Jonathan: So the way it really started out, as far as me writing that article with US Senator Bill Cassidy, who actually is the coauthor of the no surprises act, which, was implemented on January 1st, it was a bipartisan bill. US Senator, bill Cassidy, a Republican from Louisiana Maggie Hasson a Senator from New Hampshire. That’s democratic. They wrote that act together. And my relationship with Bill Cassidy started out in med school. He was one of our professors. He’s a gastroenterologist or specialist in liver diseases by training. So I met him back in med school, fast forward to 2007, 2008, and 2009. When I released the build my bod iPhone app for price transparency, he was a state legislator. And went on to become US Congressman. But anyway, he saw that I’d been released; that he saw that I was in Baton Rouge. He called my office and I’ll never forget when the front desk lady came in, and said, Hey, there’s a, [00:12:00] At that point he was a state legislature, a legislator. As I said, she came in and was like, yeah, bill, Cassie’s on the phone for you. Do you want to talk to him? I was like, yeah, I’d be happy to talk to him. And so he was always a big fan of what I was doing in price transparency, back all those years ago. And so. The no surprises act, which was,  passed in December 2020, went into effect, on January 1st, 2022, this year, and once that went was implemented. I reached out to him about writing an article together about the no surprises act. And so we wrote that, and it got published in Newsweek, and, enjoyed writing that with him. But basically, the idea of the article is just to give a very succinct overview of the no surprises act and how it really affects almost everybody, always referred to it as a Trojan horse of healthcare legislation because people think it just deals with surprise bills, but there’s so much more inside packed inside of it. And I feel like it actually affects doctors and [00:13:00] providers more than the Affordable Care Act does. I mean, this is a huge bill that kind of nobody knows about.

Michael: Yeah. I’d love to just kind of, at a high level, talk about kind of, what are, what are some of the big elements to it that, that impact doctors and practices.

Jonathan: No, I definitely am at a high level, because when I first started talking about this act and doing webinars, it took like 45 minutes to an hour to really talk about the whole thing. So I’ve gotten really good at being succinct so, let’s first talk about whom it applies. It applies to pretty much all doctors, dentists, therapists, hospitals, and surgery centers that have to some extent complied with this. That’s on the provider side, on the consumer side. It’s easier to say to whom it doesn’t apply to it. Doesn’t apply to people with Medicare, Medicaid, medical or Indian health services, or the VA because they have different surprise billing protections in place. Okay. So that’s the first thing that it affects. But as far as the major parts of the no surprise act, [00:14:00] there are three main parts. And that is that it helps reduce the chance of surprise bills in emergency situations. Like when you go to an ER, it. With people getting surprise bills if they’re getting out of network care. So if you go someplace and it’s not in the network of your insurance plan, then this helps minimize the chance of you getting a surprise bill, but there are exceptions to it. And then, and that’s for a non-emergency situation. That second example. And then the third part of the no surprise act is. It protects people when they’re not using insurance or they’re self-paying or they’re uninsured, and self-pay actually includes aesthetics, even though I don’t think they meant for it to. But those are the three parts of emergency surprise bills, minimizing that, minimizing surprise bills, and non-emergency situations. And then minimizing surprise bills when people aren’t using insurance.

Michael: Good Job. 

Brad: Yeah. Nice. 

Jonathan: Thank you. Thank you. 

Brad: It’s like you actually knew about this and actually [00:15:00] have spoken on it or something. 

Michael: Yeah, I was gonna say no. So, an element of the no surprise act, requires that patients receive something called a good faith estimate upfront. And I’d love for you to talk a little bit about what that, what’s, what does this require, and, you know, kind of counsel you would give to practice on how they should do a GFE.

Jonathan: Right. So the good faith estimate, the GFE is specifically for people who don’t have insurance. Or choosing not to use their insurance and just really quickly, why would somebody choose not to use their insurance? Because sometimes it’s actually less expensive to pay for that MRI out of your pocket versus submitting it to your insurance. Cause if you haven’t met your deductible, then it could actually end up being more expensive. So, the good faith estimate is specifically for people, uninsured choosing not to use their insurance self-pay and self-pay, even though it’s not written in the Le to the letter of the law that pay includes aesthetics. And so a good faith estimate means that if you’re [00:16:00] getting a procedure. That’s more than three days away. And there are maybe multiple providers involved. Like you’re getting an operation at a surgery center, you’re paying cash for it. There’s a surgeon’s fee. There’s an anesthesia fee. There’s an operating room fee. Maybe there’s a lab fee. The doctor has to give the patient a good faith estimate. That includes the estimate for all of those services, not just the doctor, and the surgeon themselves. But everybody involved, the patient has to receive a good faith estimate at least, at least three days before that procedure is. And then also, in addition to that, the thing that the good faith estimate includes is a disclaimer. If the patient gets a surprise bill after the fact it’s more than $400 more than what they expected, then they can launch a dispute against the doctor. And in that case, the doctor can either explain why, oh, that additional bill was something that we couldn’t have expected. It was like an emergency situation. Or they can just like, say, don’t worry about paying the bill, but if, like the doctor insists on [00:17:00] them paying the bill and it’s maybe found to be incorrect by an AR by an arbitrator. Then the no-surprise exact penalty could be upwards of $10,000. So, wow. That’s the thing with the good faith estimate. So, in addition to surgical procedures, this is where, since we’re talking about, you know, I’m a plastic surgeon, maybe thinking about med spas, cosmetics, things that it doesn’t really include. It, you don’t, you know, if somebody comes in for like one and done Botox or a filler. You don’t have to give ’em a good faith estimate for that. But if they’re like signing up for a membership or a subscription where there’s multiple sessions involved, laser hair removal, they, they know they’re gonna be coming back in the future that, does require a good faith estimate based on the way I’m reading the law. It’s the same reason why a therapist, if you’re like going for psychology,  going to a psychologist or psychiatrist, that if you’re going for multiple sessions, they have to also provide you with a good faith estimate if you’re paying out of pocket. So just to clarify nothing in Congress’ act or in [00:18:00] the Center for Medicare and Medicaid Services, who wrote that CMS, who wrote the regulations? They never mentioned aesthetics. They never mention cosmetics. So why am I including it? Well, because they use the word self-pay, a lot of different organizations are saying that self-pay includes aesthetics. And so, because they don’t ever mention aesthetics, I have to extrapolate from what they are saying. So, for example, if they use in their example, regulations that if you’re going into a lab to get blood. Just a one-and-done walk-in blood test. You don’t have to get a good faith estimate. So that’s how I’m extrapolating that to the instance of Botox or fillers.

Brad: Yeah. All really good points by the way. And I love it. How you’re able to explain it from your perspective, from the industry, from being, a physician, obviously, and especially, there was a lot of debate, we won’t go into that right now. But whether or not it does or does not apply to cosmetics, and much like you have articulated right now, because of the way it is written. We definitely think that’s and if you are in the cosmetic space and [00:19:00] based on how you explained it, also, we agree with you that that’s something for, that even a plastic surgeon whose cash only should be considering.  

Jonathan: Right! And one additional thing I wanna mention is that the CMS Center for Medicare Medicaid Services, who wrote these regulations, they’ve come out with several clarifications. Since this bill went into effect on January 1st, several clarifications have been made about lots of things, and they’ve never been. Included or excluded aesthetics. So they’ve had the opportunity to clarify this and they have chosen not to.

Michael: Yeah. Interesting.

Brad: I guess the plastic surgery, lobby’s not strong enough yet. Well, so let’s take a step back, and, obviously, you brought in transparency for so long, that you have a very good vision as to what this looks like. Obviously, 10 years plus ago, the hospital wasn’t even interested. In understanding what transparency is. And, as we, as you saw, I just saw an article in another hospital fighting it still to this day. So talk about if I’m a, a practitioner and this is the first time I’m hearing about this because I just didn’t know about it. What are some of the challenges that I [00:20:00] need to think about as I run the medical practice that I should consider?

Jonathan: Well, I think the first thing is that you have to be prepared for a lot of patients calling and saying, oh, I heard that I have a right to a good faith estimate. And just calling over the phone and asking for that, because already for plastic surgery, people are always calling, asking for pricing. I think the first thing people need to realize is that when somebody’s calling, asking for a good faith estimate, you don’t, you don’t have to give them a good faith estimate. A good faith estimate is very actual, now it’s very legal. Specifically legal codified documents. It’s something that the federal government is requiring, the no surprise act. So when somebody’s calling over the phone asking for a good faith estimate, just to understand that they’re, they’re just asking for an estimate. All right. So don’t, don’t let your office staff get freaked out. Like, oh, we have to create this official document and email it to a patient we’ve never met. No, that’s not the case, but you have to understand that patients are going to think that they have a right to an estimate I think it’s good practice as I’ve developed this platform, you know, I [00:21:00] think you can generate leads in the process of, providing people with estimates. But the thing is that. You don’t give that patient an estimate, just an idea of what something is gonna cost over the phone. They’re gonna think you’re non-compliant with the good faith estimate rule of the no-surprise act. And so you have to worry about them calling your medical board or writing a Yelp review saying that you’re non-compliant now they’re wrong? No question about it. You’ll have to give a good-faith estimate. Sight unseen, but it doesn’t matter. It’s still an annoyance that you’re gonna have to deal with the medical board. Potentially. You’re gonna have to deal with this review and like good luck going on and responding to that review saying, oh, well, we don’t technically have to give you a good faith estimate according to the no project and explain all those details. People are gonna fall asleep before they finish reading the rest of their, responses. So I think that the first thing is that doctors just have to be more open with providing. Now that’s a nuisance to have to be answering calls all day about estimates. So that’s why I talk about putting a chatbot or price estimator on your website to just make that whole process automated, let the patient figure it out on their own.[00:22:00] You generate a lead; you add it to their email database. At least you benefit your providing estimates on your terms. So that’s one aspect of it. The other aspect of it is that this is really gonna be, a heavy lift for a lot of practices. Is that when somebody comes. I keep going to plastic surgery, for example, but this really does apply to more doctors, but for, in a plastic surgery practice, let’s say a patient is interested in breast reconstruction. They come to that doctor to get a breast reconstruction, but that doctor is outside of their network. Well, now to avoid that patient, getting a surprise out-of network bill, if, the doctor wants to do that procedure outta network, which they do cause, they’ll get reimbursed. The doctor’s office now has to, get the patient to sign a consent form, saying that they’re agreeing to give up their surprise billing protections in this non-emergency situation. And sign this document saying that they’re prepared to get a surprise out-of-network bill. After the fact, as long as they sign the consent, you can send a bill after the fact because it’s not [00:23:00] an emergency situation. The other thing that’s a heavy lift for the doctor, though, is they have to provide the patient with a really good estimate of what their out-of-pocket expense is going to be. So you can’t just say, oh, the rate that I am charged for this breast reconstruction is $75,000. No, that’s not good enough. You’ve gotta find out how much they’ve paid towards their deductible for their out-of-network deductible, their out-of-pocket, maximum for the year. What is co-insurance? Then you have to provide them with that estimate based on what they’ve already paid towards those deductibles. And that’s if they even have outta-network benefits, if they don’t have network benefits, then you can give ’em just like the big number saying you owe all this. So that’s gonna be a, a tough job for these practices to get consent and also to really give a good estimate to the patient. I mean, our platform helps ’em with that. That’s obviously the lead into, like, we can actually help ’em solve that problem. But, again, it’s like the biggest problem, I think, is most doctors just don’t even know this bill exists. Patients don’t know this bill exists. The ones that do know this exists, just think about it, [00:24:00] it applies to surprise bills when it actually applies to a lot more than that. And the people that are even aware of it just don’t think it applies to them. So I think those are just those educational hurdles we’re dealing with right now.

Michael: I’m curious too. When I was, obviously we started the episode talking about the build my health app. When this came down, when the no surprises act passed, how did that impact your current processes? It sounds like it does a great job dealing with this kind of early stuff. Does it also help you with this technical good faith estimate, in the process as well? 

Jonathan: It does. And the reason that we were so well prepared for the no surprises act is. Back in 2021, which is ancient history. Now there were some other laws that came out from CMS called these price transparency rules that required hospitals to show pricing on their website. So that was a precursor to the no-surprise act. They’re separate things, but we were already collecting all of this data from hospitals, getting that all loaded into our database. [00:25:00] And so we were already preparing, what’s called real-time eligibility, meaning that the doctor’s office could use our platform to let the patient, not only know how much the procedure’s gonna cost but how much they’re gonna owe out of pocket based on how much they spent towards the deductible and everything. So we’d already built out all that technological plumbing on our platform. So once the no surprises act came out, in addition to giving patients, those quotes, those estimates, once they came in for a consultation, we were now able to just add in the disclaimer for the good faith estimate, add that into our platform. So again, the platform already included all of this, information, and the ability to provide a quote to the patient after a consultation; we were just basically inserting the verbiage that CMS requires.

Brad: That’s so cool. 

Michael: That’s really cool.

Brad: And I think, and the transparency for our audience members, I think they should, before we let Jonathan roll outta here, full transparency, right before we started this audience members, we learned a lot about our relationship[00:26:00] that Jonathan and I did not know. Number one, he was a few years ahead of my cousin, at LSU med school. Number two, I graduated with his cousin,  from high school. And then, number three, he actually knows my dad, the orthopedic surgeon, and. Doesn’t know, Michael’s dad, the plastic surgeon. So all the transparency I wanna give to our audience about someone that we, we just met, all, we just figured all this stuff out right before the show started.

Michael: Small world magic in the podcast room. Yes. Well, I have to applaud you because you managed to take a topic, a federal law that many of our audience didn’t know about, and do a great job, phenomenal job making it, meaningful. Understandable. I mean, maybe the key is we just need to get non-lawyers to explain the law.

Jonathan: Yeah. I, I feel bad because, you know, people are like looking at this and they’re hearing about this law for the first time and they’re [00:27:00] probably overwhelmed. And, you know, even though I try to make it as succinct as possible, you still have to learn all this new terminology, like, you know, out of pocket, out of network deductibles, out of, You know, out of pocket maximums, end-network out of network, it’s all very confusing. And the good faith estimate is not like the estimate. You have to give the patient if they’re trying to get an out of network service. So it’s just all very convoluted, but you gotta distill it down and you gotta learn it and, you know, reach out to me if you have any questions, cuz I can, the truth is if they just keep listening to your podcast over and over again, it’ll all start to sink in. They keep hearing the same terminology over and over again.

Brad: Well, for audience members, we’ll definitely put links, for both. Build me, build, my health, build, and, and Jonathan website itself. So you can actually learn more about his, his, his, his app, and who, who he is so that you can reach out if you have questions on, on this, on this act.

Michael: That’s awesome. So what we’ll do next is we’ll say goodbye, Jonathan. We are really grateful for your time [00:28:00] today. We’ll go into a commercial and then on the other side, we will try to keep the energy up, talking a few legal insights. We can’t drop down into lawyer talk, Brad. Okay.

Jonathan: Okay. 

Michael: Thank you!

Jonathan: No problem. Thank you!

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Brad: Welcome back to Legal 123s with Byrd Adatto I’m your host. Brad Adatto I’m still here with my co-host, Michael Byrd. Now Michael., We have the season and we have these special spotlights, and this is the first episode of the entire season where we had a doctor [00:29:00] come in and the spotlight was on a law of all things. The no surprise act. So surprise audience members. We had a plastic surgeon come talk to us about federal law.

Michael: Well, let’s maybe we should just talk about some medicine and you know how to operate on patients next.

Brad: Yeah.

Michael: And I can tell you, he did such a good job. I’m gonna be careful to steer clear of trying. Add anything to his no-surprises act, but I will say what jumped out at me when he was talking about them. Expectations that he’s finding that patients are carrying now that they are becoming aware of these terms, like good faith estimates. And so they, because of price transparency, they’re calling on the phone and saying, Hey, I want to, I wanna know how much it’s gonna cost. And the observation he made that, you know, the risk is they’re gonna call the medical board.

Brad: Mm-hmm 

Michael: Or they’re gonna go online is a ripple effect of the no surprises act that I had not thought of. Until today. [00:30:00] And you know, if, if you get an investigation letter from the medical board, hopefully when you answer the letter, you’re able to squash it and they’ll see that there was not a violation, but as you and I know sometimes Pandora’s box gets opened. And even though that itself is not a violation, it’s a gateway to compliance inside the rest of the practice on other things. And, then if they go to social media, and we’ve talked about this before, you have to be super careful about how you engage or whether you engage, because, of HIPAA. Is there, are they, are they patient or not? Are they not patients? And there’s a whole bunch of kind of ripple effect compliance issues that also flow from that.

Brad: Yeah. And I think, you know, the important part to take away is for audiences that it’s already difficult enough to run a medical practice. And this is just another piece of the compliance that you have to follow [00:31:00] through. And probably the most simple thing that you can do is be active in how you give them that information. There is a good faith estimate, that you can give on paper. I know that on Jonathan, on his website, the no surpriseact.com

Michael: surprises. 

Brad: surprisesact.com. That’s an “S” in Surprises. Thank you, Michael, that if you go to him, that website, you can actually download the information that would be required to, be able to help, give that, that information to the patients. I know for our access+ members, if you actually go to your portal, that we have a no surprises act toolkit, where you can actually download the same information, but the point is., as you’re doing this, you know, make sure that you’re documented correctly, that you’re showing them, that if you are giving it to ’em, that you’re documenting it by putting it in the medical, PR record. So that if there is something, that there is an investigation, you can show that, oh, no, here’s the piece of paper. This is all the information that we gave them. This is [00:32:00] consistent with the form that, that the federal government wanted us to use. And, not only did they get it and sign it, it’s in their medical records, but Michael, believe it or not, we are out of time today. Any last-minute takeaways about mascots or nicknames?

Michael: That Arch Manning is going to play football for the Texas Longhorns. 

Brad: Well, Michael, again, we’re at a time. And so we are excited for next week where we have. Especially spotlight on scoliosis. It’s a type of special type of spine surgery. That is very, very unique. And we have one of the best surgeons coming in to talk to us about this. Dr. Richard Hostin.  

Outro: Thanks again for joining us today. And remember, if you like this episode, please subscribe and make sure to give us a five-star rating, and share it with your friends. You can also sign up for the beta dot newsletter by going to our website@byrdadatto.com Byrd Adatto is providing this podcast as a public service. This podcast is for educational purposes. Only this podcast does not constitute legal advice, nor does it establish [00:33:00] an attorney, client relationship reference to any specific product or entity does not constitute an endorsement or recommendation by Byrd Adatto. The views expressed by guests are their own, and their appearance on the program does not imply an endorsement of them or any entity they represent. Please consult with an attorney on your legal issues.

ByrdAdatto founding partner Michael Byrd

Michael S. Byrd

ByrdAdatto Founding Partner Bradford E. Adatto

Bradford E. Adatto

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