Medicine Redefined

Dr. Alison Grimaldi, a leading physiotherapist and researcher with over 30 years of experience, shares insights on lateral hip pain and gluteal tendinopathy. She discusses the complexities of hip anatomy and addresses common misdiagnoses, emphasizing that tendon issues are often mistaken for trochanteric bursitis. Dr. Grimaldi highlights the importance of lifestyle changes over corticosteroids and shares practical tips for sleep positions to ease pain. Her work from the LEAP trial showcases how education combined with exercise provides superior outcomes.

Ever felt like your insurance company is gaslighting you? Dr. Altamash Raja shares a real story that turned a routine billing error into a masterclass on how to actually navigate health insurance. From copays and deductibles to hidden tiers and the fine print that drains your wallet - this Progress Note breaks it all down. Join hosts Dr. Darsh Shah and Dr. Altamash Raja as they cut through the noise, explain the system in plain English, and arm you with the knowledge to advocate for yourself next time your claim gets “lost”.TIMESTAMPS00:36 Insurance Negotiations Frustrations06:33 Understanding Health Insurance Terms17:26 Navigating Insurance Plans and Benefits23:56 Navigating Insurance Verification25:52 The Business Side of Healthcare26:37 Challenges in Inpatient Rehab28:41 Understanding Healthcare Metrics31:59 Emergency Visits and Insurance34:10 Planning for Medical Emergencies37:14 Insurance Tiers Explained40:01 Practical Tips for Managing Insurance46:20 Final Thoughts and Recap48:10 Outro and DisclaimerSOURCES[00:06:00] — Premiums, Deductibles, Coinsurance & Copays Explained – Aetna[00:17:00] — HMO vs. PPO: Which Is Right for You? – Humana[00:34:00] — What Is a “Surprise Medical Bill” and What Should I Know About the No Surprises Act? – Consumer Financial Protection Bureau[00:34:00] — No Surprises Act: Balance Billing Rules for Emergency and Air Ambulance Services – Centers for Medicare & Medicaid Services[00:40:00] — Navigating the Insurance Appeals Process –Patient Advocate Foundation

Dr. Darsh Shah and Dr. Altamash Raja sit down with Dr. Nisha Chellam to explore her journey from traditional internal medicine to functional medicine. Together, they discuss the “revolving door” of chronic disease, why she stopped attending supplement-driven conferences, and how she blends evidence-based care with lifestyle change. Dr. Chellam shares how she helps patients uncover the true root causes of illness and reclaim ownership of their health.SOURCES:00:10:00 — Discovering Functional MedicineInstitute for Functional Medicine: What Is Functional Medicine?00:18:00 — Root Cause Medicine ExplainedCleveland Clinic: Functional Medicine Approach00:34:00 — Functional vs. Lifestyle MedicineAmerican College of Lifestyle Medicine: What Is Lifestyle Medicine?00:58:00 — Functional Labs and Data-Driven CarePubMed: The Value of Advanced Biomarkers in Functional Medicine01:06:00 — Metabolic Health and Insulin ResistanceAmerican Heart Association: Understanding Insulin Resistance01:15:00 — Redefining What “Good Medicine” MeansBMJ: Rethinking Medicine — The Movement to Redefine CareContact Dr. Chellam:Linkedin | Nisha Chellam Instagram, YouTube, X | @holisticicon Find Us Here:Instagram, Threads, X, TikTok | @medredefined Thank you for listening! Let us know what you think!

Dr. Leah Houston, an emergency medicine physician and healthcare entrepreneur, shares her mission to fix the broken credentialing system. She discusses the widespread issues in physician credentialing and how AI and decentralized identity can restore autonomy to doctors. Dr. Houston highlights the burdensome timelines and manual processes that hinder mobility. She advocates for digital solutions like credential wallets and real-time license verification to streamline workflows. Her vision includes a future where direct payment models reduce insurance dependency, enhancing care for patients and restoring trust in healthcare.

Darsh and Altamash are back, trading thoughts on what’s been capturing their attention lately - from the tech tools boosting daily efficiency to the appeal of living more “pro-analog.” They dive into the hype and science behind ketones, unpack how GLP-1s are reshaping the way we think about food and cravings, and share insights on what it really means to find preventive, proactive healthcare today. It’s a thoughtful but approachable conversation, blending current events, health trends, and practical takeaways.TIMESTAMPS00:00 Introduction to Medicine Redefined00:33 Current Events and Political Landscape02:10 Random Show Concept and Personal Updates02:44 Writing and Creative Outlets06:48 Tech Tools and Apps for Efficiency10:32 Medical Innovations: Vagus Nerve and Hydrodissection19:48 Breathwork and Meditation Techniques23:49 Exploring Exogenous Ketones28:31 Understanding Brain Health and Mood Disorders29:31 Exploring Ketone Supplements30:52 Nootropics and Cognitive Enhancers32:48 The Future of Social Connection40:44 The Concept of Misogi and Mental Fortitude42:34 GLP-1 and Obesity Treatment49:36 Navigating Healthcare and Finding the Right ProviderSOURCES05:12 | How and Why To Try Alternate Nostril Breathing (Cleveland Clinic)08:47 | Buteyko vs Soma Breathing: Origins, Benefits and Differences (Buteyko Clinic International)14:33 | OU Researchers Explore Vagus Nerve Stimulation for Multiple Conditions (University of Oklahoma)19:55 | Exogenous Ketones: Do They Work, and Are They Safe? (Medical News Today)24:18 | Ozempic Quiets Food Noise in the Brain — But How? (Scientific American)27:42 | “Food Noise”: Do Weight Loss Drugs Stop It? (Health.com)33:11 | How to Find a Medicine 3.0 Doctor like Dr. Peter Attia (Vitality / AWI Longevity Clinic)37:40 | Embracing an Analog Lifestyle: Opt Out of Overwhelm (The Tiny Life)41:05 | “The ‘Boring Phone’ – Gen Z Ditch Smartphones for Dumbphones” (The Guardian)45:22 | Alfred – Productivity App for macOS (Official Site)47:36 | OpenAI Whisper (Speech Recognition AI)

Delve into the surprising truth behind reality TV weight loss with a deep look at The Biggest Loser and its shocking tactics. Discover the dark side of rapid weight loss and its lasting repercussions on metabolism and mental health. The conversation highlights the ethical quandaries of using contestants as entertainment and questions the role of celebrity trainers. Plus, explore GLP-1 medications and their impact on dieting. Through humor and personal stories, the hosts reflect on societal beauty standards and the quest for self-acceptance.

Dr. Shawn Arent, a leading expert in human performance, discusses fascinating insights on female physiology, debunking myths about the menstrual cycle’s impact on athletic performance. He reveals the critical roles of thyroid hormones and their connection to metabolism. The conversation also touches on the influence of catecholamines in stress and energy during training. Arent speculates on the future of performance enhancement through GLP-1 agonists and myostatin inhibitors, providing a fresh perspective on optimizing health and performance for athletes.

Join Dr. Shawn Arent, a renowned professor in exercise science, as he unpacks the complexities of cortisol and insulin. He clarifies cortisol's essential role in stress and athletic performance, while also addressing the risks of chronic elevation. Dr. Arent shares insights on nutrition's impact on hormone levels and the importance of tracking hormonal markers for athletes. With science-backed facts, he challenges common social media myths about hormones, helping listeners rethink their approach to training and recovery.

This engaging discussion tackles the question of whether medicine is still a worthwhile career. The hosts share personal stories of burnout and reinvention, highlighting the emotional and financial pitfalls of the medical profession. They encourage listeners to embrace diverse career paths and break free from conventional constraints. The conversation also explores the psychological aspects of healthcare pricing and the importance of authenticity in patient care. It's a motivational journey for anyone reconsidering their place in the evolving world of medicine.

In this episode of Medicine Redefined, Dr. Darsh and Dr. Altamash sit down with Dr. Vince Marchese, sports medicine physician and founder of Apex Medicine, to explore how transparency and direct pay models are transforming healthcare. We break down why traditional insurance creates confusion and barriers, how clear pricing empowers patients, and what happens when physicians reclaim time to focus on care - not paperwork.TIMESTAMPS00:00 Introduction to Medicine Redefined00:35 Meet Dr. Vince Marchese01:13 Journey to Sports Medicine01:37 Breaking Away from Insurance02:06 Life as a Direct Pay Practitioner09:33 Understanding Insurance Complexities10:27 The History of Insurance11:56 Navigating the Insurance Maze15:37 The Case for Direct Pay17:31 Empowering Patients with Knowledge41:39 The Insurance Dilemma42:00 State Mandates and Penalties42:58 Self-Insurance and Cost-Saving Strategies44:40 Catastrophic Insurance and HSAs52:04 The Benefits of Direct Pay Models55:02 Building a Patient-Centric Practice01:04:31 Scaling and Future of Direct Pay Medicine01:11:44 Support Systems and Taking the Leap01:16:03 Closing Thoughts and ResourcesSOURCESHealthcare Spending & Insurance Costs[00:16:01] “51 cents of every healthcare dollar goes to insurance” – In fact, CMS and KFF data show [1, 2] private insurers cover ~30% of U.S. health spending, and federal/state programs ~51%. Administrative overhead is only about 7.4% of spending [1]. [00:10:00] Average premium costs – Kaiser Family Foundation reports that in 2024 the average annual employer health insurance premium is ~$8,951 for single coverage and ~$25,572 for family coverage [4], illustrating why monthly premiums can seem “crazy high.”Policy & Regulations[00:31:54] Balance billing protections (No Surprises Act) – Effective Jan 1, 2022, federal law bans surprise/“balance” bills for most emergency and certain other out-of-network services [5, 6]. For example, CFPB explains that patients generally will no longer face balance bills for emergency care [5, 6] under the No Surprises Act.Health Savings Accounts (HSAs)[00:43:30] Triple tax advantage of HSAs – HSAs are truly tax-advantaged. According to IRS rules and financial guides, HSA contributions are tax-deductible, earnings grow tax-free, and qualified withdrawals are tax-free [7, 8]. Bank of America and IRS publications both highlight this “triple-tax” benefit.[00:44:17] HSA contribution limits – For 2024, IRS rules allow $4,150 annual HSA contributions for self-only HDHP coverage and $8,300 for family coverage [7] (The podcast guest’s “~$4,000” estimate for solo coverage aligns with the $4,150 limit for 2024 [7]).Price Transparency & Cash Payments[00:21:30] MRI cash prices – Pricing guides show that uninsured (cash) MRI costs vary widely. For example, a 2025 SingleCare review finds a national average MRI cost of ~$1,325 (range ~$400–$12,000) without insurance [9]. A cash-pay platform (MDsave) reports a $1,335 average for an MRI, with their cash price as low as ~$805 [10]. These sources confirm that self-pay MRI prices can be far below billed/insurance prices.[00:21:30] Cash vs. negotiated prices – Studies show many hospitals set their cash (self-pay) rates lower than insurer-negotiated rates. For example, one analysis found 60% of insurer-negotiated hospital rates exceed the hospital’s cash price for the same service [11], and a JAMA-published study reports that cash prices are often below the commercial prices insurers pay [12]. In short, paying cash (or high-deductible plans) can sometimes cost less than the “discounted” insurance rate.Referenced Book[00:21:24] The Price We Pay – Dr. Marty Makary