The Philip DeFranco Show - PDS 1.20 The Trump Biden Situation Just Got Crazier, Insurance Denials Are Getting Worse & TikTok Resurrected

Episode Date: January 20, 2025

IT'S TRUE. You can go to https://BeautifulBastard.com to get your new "God is Testing Me", "Silly Goose", & "F With Politics" Shirts, Crews, & Hoodies right now. Use code “PHIL” for $20 OFF your first SeatGeek order & returning buyers use code “PDS” for $10 off AND your chance at weekly $500 prizes! https://seatgeek.onelink.me/RrnK/PHIL  For Updates as they come in today go to Instagram: https://www.instagram.com/phillydefranco/ Tiktok: https://www.tiktok.com/@philipdefranco?lang=en X/Twitter: https://x.com/PhillyD Morning Inauguration Coverage w/ guest Alex Pearlman: https://www.youtube.com/live/HlWfOb4mqRU?si=iijuZkvnIBGtkcy1&t=726&list=PLHcsGizlfLMWpSg7i0b9wnUyEZWI-25N3    – ✩ TODAY’S STORIES ✩ – 00:00 - TikTok Unbanned After Just 12 Hours 05:04 - Biden Pardons Fauci, Milley, Cheney & His Family 08:43 - Trump Launches a Meme Coin & It Soars to Tens of Billions 13:13 - Trump Sworn in as the 47th President 13:54 - Sponsored by Seatgeek 14:55 - Insurance Companies Are Denying Life-Saving Treatments to Cancer Patients 23:31 - Insurance Companies Are Also Denying Crucial Mental Health Coverage  31:36 - Comment Commentary ——————————   Produced by: Cory Ray Edited by: James Girardier, Maxwell Enright, Julie Goldberg, Christian Meeks, Matthew Henry Art Department: William Crespo Writing/Research: Philip DeFranco, Brian Espinoza, Lili Stenn, Maddie Crichton, Chris Tolve, Star Pralle, Jared Paolino  Associate Producer on Cancer Insurance: Lili Stenn Associate Producer on Mental Health Insurance: Jared Paolino ———————————— For more Philip DeFranco: Apple Podcasts: https://podcasts.apple.com/us/podcast/the-philip-defranco-show/id1278424954 Spotify: https://open.spotify.com/show/6ESemquRbz6f8XLVywdZ2V Twitter:   https://x.com/PhillyD Instagram:   https://instagram.com/PhillyDeFranco Newsletter: https://www.dailydip.co TikTok:   https://www.tiktok.com/@philipdefranco?lang=en ———————————— #DeFranco #DonaldTrump #Inauguration ———————————— Learn more about your ad choices. Visit megaphone.fm/adchoices

TikTok died and then was resurrected just 12 hours later with many rejoicing, but also many very, very skeptical about what happens now. Donald and Melania Trump launched meme coins ahead of the inauguration that skyrocketed to market caps in the tens of billions of dollars. Biden just issued last-second preemptive pardons for Fauci, Liz Cheney, and others against what he called potential revenge by Donald Trump. We're going to deep dive into some just insane health insurance use you need to know about. And Donald Trump is officially the 47th president of the United States

and is signing executive orders right now like it's going out of style. We're talking about all that today on your brand new Philip DeFranco show. You daily dive into the news, how it's being covered, and how people are reacting. But first, before I stress you out

and or ruin some of your days, let me make a fun, lighthearted announcement. Because thousands of you took to the comments last week, commenting and liking, saying, you need to turn that into a shirt, Phil. God is Because thousands of you took to the comments last week, commenting and liking, saying, "'You need to turn that into a shirt, Phil.' "'God is testing me and I refuse to study. "'Shirt, now.'" And I listened and as of today,

turned it into a drop over at beautifulbastard.com, where right now you can snag one of these guys. They come in shirts, crewnecks, hoodies. Right, you've got, "'God is testing me and I refuse to study,' along with the new, "'A silly goose in this economy line. For good measure, we're also doing a re-release

of the you may not fuck with politics, but politics will fuck with you gear in both censored and uncensored versions. All available at beautifulbash.com this week as we do a special run. But with that all out of the way now, let's start with TikTok. With the scene before the app went dark,

creators reacting in a number of ways, including just shouting and crying at the loss of TikTok that was coming. For some, it's an entertainment source, a utility, a place to find community. But also for others, whether they be small creators or small businesses, this has become a huge economic source for them.

Which is why after it was shut down and then brought back, you had many rejoicing, but also many very, very skeptical. And that seemed to be connected to two main things. One, TikTok's repeated praise of Donald Trump, specifically by name, both in the app itself and in online statements saying, among other things, we thank President Trump for providing the necessary clarity and assurance to our service providers that they will face no penalties providing TikTok to over 170 million Americans and allowing over 7 million small businesses to thrive. Two, as that was happening,

you had Donald Trump laying out a more specific plan saying, I will issue an executive order on Monday to extend the period of time before the laws, prohibitions take effect so that we can make a deal to protect our national security. And then saying, I would like the United States to have a 50% ownership position in a joint venture. By doing this, we save TikTok, keep it in good hands and allow it to stay up. Without US approval, there is no TikTok. With our approval, it is worth hundreds of billions of dollars, maybe trillions. With them then continuing, therefore, my initial thought is a joint venture

between the current owners and or new owners, whereby the US gets a 50% ownership in a joint venture set up between the US and whichever purchase we so choose. Which then had many saying, it seemed like he wasn't just being loose with language, saying that it sounds like he wanted to become a state run social media platform and not just involve a US based company.

With a number of people worried that it was now gonna be used as a tool against them. With then a number of people arguing that that might be why we've seen so many right-wing politicians and right-wing influencers flip-flopping their position on TikTok. With many pointing to the likes of Charlie Kirk, Trump, and others who in recent years called for TikTok to be banned

only to now wanna be praised as its savior. So there, I will say there is a fair share of people who have stayed firm in their stance. Or with the likes of Senator Tom Cotton, who has been very anti-TikTok, posting a statement applauding the fact that it was removed from the app store and even arguing that there is no legal basis

to grant an extension to the ban's deadline. You also had House Speaker Mike Johnson saying on Sunday, "'I think we will enforce the law.'" And in general right now, the whole situation feels very messy and chaotic. I mean, you've got Rand Paul and AOC both against the ban, like on the same side for different reasons. Rand Paul even joined TikTok on Saturday

before the ban just as a FU saying in a post. The courts may think there's an exemption to the first amendment. I don't. I joined TikTok today as a form of civil disobedience to the 170 million Americans who use TikTok. Don't give up, don't give in. And then for her part, you had AOC saying there just wasn't enough information proving TikTok's

national security threat and also slamming the way the ban was rolled out and then rolled back. TikTok's decision to name Trump in the notification is a choice. They are signaling that they are privately collaborating. They have agreed to privately collaborate with Donald Trump and the Trump administration. And for all of those concerns that people were saying that TikTok is gonna be used as a propaganda tool by the Chinese, understand they're using it as a propaganda tool for the right.

And then because Trump's the one getting credit and the one who plans to take executive action protecting TikTok, you have some slamming Democrats for allowing this to happen in the first place. Right, with political commenters in the space like Hassan Piker writing, "'Democrats gave an unimaginable W to Trump "'by pulling this insanely incompetent

"'and unpopular decision.' "'Can't believe that Trump, "'who wanted to ban TikTok initially, "'is now getting the most expensive free ad "'by being credited as its savior "'to 170 million Americans. "'Masterclass.'" But as for where things are actually gonna go from here, I mean, you had the Wall Street Journal doing a report today saying comprehensive free ad by being credited as its savior to 170 million Americans. Masterclass. But as for where things are actually going to go from here, I mean, you had the Wall Street Journal

doing a report today saying that China is open to a deal that would keep TikTok here, with the outlet explaining that it is a reversal of the government's previous position, that it would block any forced sale of TikTok. But like with everything else we're going to talk about today, I got to ask you, what are your thoughts as far as the whole situation now, and what do you think is going to happen? Let me know in those comments down below. With just hours to spare, Joe Biden has issued preemptive pardons to protect against potential retribution by Donald Trump. And amongst those being pardoned,

you have General Mark Milley, Trump's former chairman of the Joint Chiefs of Staff. Then you have Dr. Anthony Fauci, the former director of the NIH and the chief medical advisor to the president during the height of the pandemic. And then finally, there are all the members of the House Committee

that investigated the January 6th attack on the Capitol, including Liz Cheney, Adam Kinzinger, and Adam Schiff. And then actually, even beyond that, the pardon reportedly applies to not only members of Congress, but also the staff who served on the committee, as well as the Capitol and D.C. police officers who testified before the committee. And finally, Biden separately announced pardons for five of his family members, specifically his siblings and their spouses, with literally less than 20 minutes left in his presidency. And of course, you know, many of these people, they're folks who Trump or his allies have singled out by name as being deserving of some punishment or prosecution. Like for example, Trump said on social media that Cheney should be prosecuted for what she has done to our country. And in fact, he said that the whole January 6th committee should be prosecuted for their lies and quite frankly, treason. And then, I mean, General Milley, it's been reported that he implied that he's

deserving of the death penalty. But with all that, you know, there have been reports that Trump has sometimes suggested he might not follow through on his threats. Saying that success as president would be his retribution. But then, notably, if people saying, well, he's appointing people like Pam Bondi as AG and Kash Patel as FBI director. People who have also made comments sparking concerns

about who they might go after in those positions. So with all that, you know, you had Fauci, for instance, saying that he appreciates the president's action and asserting that he has committed no crime. You also had General Milley thanking Biden in a statement saying, "'After 43 years of faithful service and uniform to our nation,

protecting and defending the Constitution, I do not wish to spend whatever remaining time the Lord grants me fighting those who unjustly might seek retribution for perceived slights.'" But then notably, on the other hand, not everyone pardoned agreed with the decision. I mean, for example, you had Kinzinger telling CNN earlier this month, "'As soon as you take a pardon,

"'it looks like you're guilty of something. "'I am guilty of nothing besides bringing the truth "'to the American people and in the process, "'embarrassing Donald Trump.' "'Because for 187 minutes, he sat there "'and did absolutely nothing and showed how weak "'and scared he truly was.'" So no, I don't want it.

And then you also had Adam Schiff saying, "'It would be the wrong precedent to set. "'I don't wanna see each president hereafter on their way out the door, giving a broad category of pardons to members of their administration. Now Biden, for his part, reportedly considered those arguments.

With sources who spoke to CNN saying that he's been weighing the decision for days now. And he even reportedly voiced a concern that pardoning might imply guilt. But in the end, he seemingly concluded that providing protection was more important than the potential implication of misconduct. With him saying in a statement,

the issuance of these pardons should not be mistaken as an acknowledgement that any individual engaged in any wrongdoing. With him adding, these are exceptional circumstances and I cannot in good conscience do nothing. But of course, as expected, that hasn't stopped fresh criticism from both sides, but especially from Republicans.

Especially since this is after Biden's controversial pardon of his son Hunter, despite his repeated promises that he wouldn't intervene. So you have people like Republican Senator Eric Schmidt, for example, writing on social media, "'The guy who claimed he would protect norms "'continues to bulldoze them in the Constitution "'until the bitter end.

"'Biden truly is one of the worst presidents "'in American history and will only be remembered "'as the guy between Trump's two terms.'" And then, you know, in addition to that, despite Biden's statement, you have many taking the pardons as evidence of wrongdoing. Though all of this is you have some pointing to the criticism and saying,

"'Well, this is exactly why these pardons needed to be done. With a number of people pointing to things like Senator Rand Paul, for example, repeating his claims that Fauci bears responsibility for the pandemic, engaged in a coverup and committed a crime. And there, notably as far back as 2022, Fauci claimed Paul's accusations were sparking death threats against him.

And then in addition to those debates, you have some wondering, can Biden even do this? Where the use of pardon power to try to protect people who have not even come under investigation, let alone been charged or convicted of a crime? There's not really clear precedent there. The closest thing would probably be Gerald Ford pardoning Richard Nixon in 1974, even though he hadn't been charged with any crimes.

But you do have some legal scholars who spoke at the New York Times saying that he is within the boundaries of his authority. But ultimately, we're gonna have to wait to see what happens there with Donald Trump as president. Then, to switch gears back to Trump, Donald Trump is now not only president, he may very well be one of the richest men alive. In theory, I'll explain.

Or because Trump announced on Friday the launch of his own personal meme coin, the Trump meme coin. With it technically being a venture by two companies, CIC Digital LLC, which is an affiliate of the Trump Organization, and Fight Fight Fight LLC, which is a company formed in Delaware earlier this month. And with that, the coin's website says

that 200 million coins are currently available with plans to issue 1 billion over the next three years. Now the coin, as I'm filming, is currently priced at around $40, down from its high of around $72 yesterday, which means that as of right now, the company's holdings would technically be worth tens of billions of dollars,

which is something that would make it enough to move Trump up literally hundreds of places in the Bloomberg Billionaires Index. With that said, it's unclear right now how much Trump actually stands to gain. With, for example, the BBC reporting here, meme coins are used to build popularity for a viral internet trend or movement,

but they lack intrinsic value and are extremely volatile investments. You know, with that, it would be almost impossible to realize that amount of money by selling the tokens without dramatically affecting the price. In fact, as I'm recording the segment, it is still dropping. Though notably, one, that doesn't mean it will continue dropping.

Who the hell knows what's gonna happen? And two, that also doesn't mean that there's no money to be made for Trump. It's really only a question of how much. And then beyond just the figures, this whole thing really kind of ends up being an example of the power and influence that Trump has accumulated and the ethical questions that it raises

when he uses that to grow his business. Or with people saying, you know, this is not the first time we've seen Trump leveraging his position to launch a new product, whether it be Trump branded sneakers, fragrances, and even special edition Bibles made in China. Also notably, you know, this isn't even Trump's first foray

into the realm of crypto, right? He launched his NFT digital trading cards back in 2022. Back just this past September, he and his sons lent their name to a cryptocurrency startup called World Liberty Financial. With the deal there reportedly being that they would get a cut of the sales in exchange for helping promote the new brand.

But also a key thing is that members of the Trump family were reportedly not actually owners of the platform or officers in the company. So this obviously a very big thing, also a different thing, but also you had Melania Trump launching her own meme coin last night. So it appears, right, to be the first time Trump

and his relatives have become directly involved in selling cryptocurrency. Something that is notable because one, it's an industry regulated by the Securities and Exchange Commission. And also with that too, as president, Trump is the one appointing new SEC commissioners at the end of their term. And he also gets to designate one of them as a chairperson. Here, we know his pick. He's named Paul Atkins and he's a big supporter of loosening up crypto regulation. And this is Trump's also reportedly planning to release an executive order designating crypto

as a national priority and giving industry insiders a voice within his administration. With all of that standing in stark contrast to Biden's efforts to tightly regulate the crypto industry out of fear that the volatile market could lead to a future financial crash. Of course, there, it's one thing to have a different approach

to a policy issue. It's a completely other thing to actively be pursuing a direct financial stake in an industry you get to regulate, which is why you have people like one independent crypto analyst based in Hong Kong telling Reuters, while it's tempting to dismiss this as just another Trump spectacle, the launch of the official Trump token opens up a Pandora's box of ethical and regulatory questions. And that is you also had people like a former White House ethics advisor to Obama putting it more bluntly. With him arguing that out of all of Trump's conflicts as a businessman turned president, this may be the

most profound. With him going on to say, quote Trump's conflicts as a businessman turned president, this may be the most profound. With him going on to say, quote, "'He's launching a major new multi-billion dollar venture in the burgeoning crypto industry, where he has the most profound conflict of interest between what he's seeking to gain and his duties to regulate that industry, which now includes himself.'"

And continuing, this may represent the single worst conflict of interest in the modern history of the presidency. And then also notably, we've seen mixed reactions from the crypto community itself. With us seeing, for example, a former executive at Coinbase, one of the world's largest crypto trading platforms, on one hand celebrating the announcement as a vibe shift from the Biden anti-crypto era, but then also going on to say Trump owning 80% and timing launch hours before inauguration

is predatory and many will likely get hurt by it. With all that, it does seem like Trump and his companies are trying to do the best to cover their asses. With, for example, their legal disclosure saying the tokens are not intended to be seen as an investment opportunity, investment contract, or security of any type. And its website also saying Trump memes are intended to function as an expression of support for and engagement with the ideals and beliefs embodied by the symbol Trump. Saying gettrumpmemes.com is not political and has nothing to do with any political campaign or any political office or governmental agency. And then also notably the Trump family business

recently released an ethics agreement. In that agreement prohibits Trump from day-to-day decision-making when he's president and limits financial information about the business that can be shared with him among other things. But here, some have claimed that it falls short in certain areas. Like for example, by failing to ban deals

with private foreign companies, which a big thing was included in the one signed ahead of Trump's first term, which was also criticized at the time. So now with concerns about conflicts of interest only growing, I mean, we're gonna have to wait and see ultimately where this all ends up. But then finally regarding Donald Trump today,

of course he was sworn in as the 47th president of the United States. And if he hasn't already by the time that you're watching this, he's promised to start signing executive orders like they're going out of style. And there, let me say two things. The first being that for any coverage,

commentary, and reactions to that, I'd say go check out the live stream we did of the inauguration. I'm gonna link to that in the description. I covered that live today with a lot of y'all. And two, regarding the executive orders, we're gonna be talking about that in two different places. For a deeper and all-consuming dive,

that'll be on tomorrow's Philip DeFranco show. And then also, as far as the quick turnaround coverage for today, that's gonna be available in three places. I'll be doing breaking news shorts videos over on the PDS News Clips channel here on YouTube, as well as on my TikTok, that's Philip DeFranco, and my Instagram, which is phillydefranco. Follow any and everywhere where you want that news.

And then we'll get right back to the news in just a moment. But first, you know, it's a new year, which means more chances to enter and win the $500 weekly SeatGeek giveaway. Because my team worked with our sponsor SeatGeek to extend the $500 weekly giveaway.Geek giveaway. Because my team worked with our sponsor, SeatGeek, to extend the $500 weekly giveaway. And if you haven't entered yet, just do it. I mean, next week's winner could be you. And from concerts and Broadway shows to sporting events,

our weekly SeatGeek $500 giveaway lives on, and you beautiful bastards have been crushing it. Also, for the uninitiated, SeatGeek is the number one rated live event ticketing app with over 28 million downloads and access to a wide array of entertainment to get you and a loved one out of the house. So if you're new to SeatGeek, you can use code Phil and get $20 off your first purchase. And then, hey, while you're there, just simply add code PDS to your SeatGeek account. And that'll get you $10 off of any of your purchases. And you could be one of our lucky weekly winners. I mean, that's $500 in credit towards any of SeatGeek's 70,000 events. And again, just to over-explain, if you're new to

SeatGeek, scan the QR code and add code Phil for $20 off your first purchase. And then also for SeatGeek veterans, you can add code PDS, which gets you $10 off any purchase. And again, you'll be entered for your chance at the $500 SeatGeek credit, no purchase necessary. But then, coming back to the news, since Luigi Mangione allegedly killed the CEO of United Healthcare, there's been an increased focus

on the medical and health insurance world. And I also mean beyond just stories directly related, like the reports coming out that UnitedHealth was found to have overcharged some cancer patients for drugs by over 1000%. And so with that, I wanna deep dive into two big things today, starting with the news that insurance companies

are denying essential care and life-saving treatments to cancer patients by claiming that they aren't medically necessary. Because that is what NBC found in a recent investigation into these alleged amoral practices. And in the case of Tracy Pike, that denial of treatment may have ultimately cost him his life.

And Tracy was a husband and father of three who was diagnosed with stage four stomach cancer shortly after his 45th birthday. And immediately Tracy started doing chemotherapy and it successfully reduced the size of the tumor that had been discovered in his stomach. But reduce is the key word there, right? The chemo wasn't a permanent solution.

So his doctor tells his wife, Angela, that his best option is to undergo a routinely practiced treatment that combined both chemo and surgery at the MD Anderson Cancer Center in Houston. And after MD Anderson agreed to give Pike the treatment, he and his family traveled from Kentucky to Texas in 2023. But then the night before his first procedure,

Tracy's surgeon calls to let the family know, hey, the insurance you have through your work, Blue Cross and Blue Shield of Illinois, they had denied him coverage of the nearly $40,000 cost of the treatment. Now, as far as the reasoning here, documents viewed by NBC show that the insurer had ruled that the treatment Pike's doctor had recommended

wasn't quote, medically necessary because it was what they deemed experimental, investigational, and unproven. But you have experts saying that's completely bogus with people like Dr. Ashley Sumrall, who's a neuro-oncologist in North Carolina, saying that the treatment is a widely accepted practice and telling NBC,

I remember when it was experimental, but adding that today it is routinely practiced. And for some people, it's a huge life-saving procedure. And this is MD Anderson said, it had been performing the procedure for more than two decades. And then beyond all that, the denial of care also goes against the guidelines

of the National Comprehensive Cancer Network, which is a not-for-profit alliance of leading cancer centers that publishes widely followed recommendations. I mean, the network's guidelines explicitly state that the treatment recommended for Tracy Pike is sought for what they say is a select group of patients after multidisciplinary evaluation and discussion, as well as appropriate clinical context. And so with all this, Tracy Pike's family and doctors thought this denial, it's just going to be a temporary setback and that the appeal would be easy. But then Blue Cross and Blue Shield of Illinois,

they continued to reject the repeated appeals made by Tracy's search. And they did this even as the doctors continued to argue that it was medically necessary because it would literally save this man's life. What we've seen is that when pressed by NBC about why it denied that life-saving treatment, a spokesperson for Blue Cross and Blue Shield

who refused to be identified, declined to comment on the case or say why the procedure was denied citing protocol. Instead, just given this buzzwordy, platitude-filled statement saying, "'We are committed to increasing access "'to safe, appropriate, and effective healthcare "'based on the best available information and research

"'and in accordance with a member's benefit plan.'" But the fact of the matter is that Tracy never received the treatment and in January of 2024, he passed away. And so you have his wife, Angela, saying, she is still just struggling to adapt to life without her husband, telling NBC, cannot help but go back to that month in Texas.

What would have happened if he had had that surgery? Would he have lived? And then just to make this horrible situation even more shitty, after Tracy's death, his family couldn't even receive a life insurance payment because his coverage had ended after he became too sick with cancer to work, which left his family to survive on his social security.

Or you know, another way to put it is that Tracy lost one form of insurance because he was dying of a disease that another kind of insurance refused to pay. And that really just depicts the whole insurance industry perfect. Because unfortunately, Tracy's story, it's not unique. There has been a rising trend of more and more insurers denying care and treatment. And you have outlets like NBC reporting that one of the biggest reasons for this is the insurance industry system for prior authorization requests, which requires doctors to get approval from the patient's insurer before they can provide certain services. Now with that, health insurance companies argue that this process helps them bring down costs because they can make

sure that a given service is medically necessary or require patients to try lower cost alternatives first. But this is your physician saying that there are several different common practices in the prior authorization process that actively undermine patient care. Like first of all, there's a general lack of transparency around the internal rules insurance companies have for how they approve treatment coverage or identify alternative procedures that can be approved.

Because insurers keep those rules private and doctors have to spend time submitting claims only to have them denied. That process, it could be entirely avoided if the insurance companies just simply told doctors what they will and won't cover instead of making them guess and waste time that cancer patients can't afford to waste. And then often, that precious time is already being stretched thin because it can take weeks

for insurers to either approve or deny certain treatments and tests. And then, if and when the request is denied, doctors have to appeal, which is a whole other lengthy process that sucks up even more time. But also, even for procedures that are approved, the system still works against cancer patients and their limited timelines because doctors have to repeatedly seek prior authorization for procedures that are regularly approved. So you have many doctors arguing that, hey, if they have a history of receiving approvals for various treatments or tests,

they should just be able to circumvent the time-consuming prior authorization process. And then beyond that, you have doctors saying another problem that interferes with cancer patients is the fact that insurers require a peer review process where another doctor that they hire rules yes or no on a cancer procedure. And yes, that's even if it's a procedure

that the patient's own doctor recommended. But, and this part is really crazy, the insurance company doctors that approve or deny these procedures aren't always cancer specialists. And that's exactly what happened with Tracy Pike, the insurance company doctor who rejected the life-saving treatment that cancer specialists had recommended was an OBGYN.

And what's more, doctors also say that insurance companies have been increasingly require prior authorizations for more and more procedures and treatments. Like with, for example, the combination drugs used to combat cancer. With a 2023 report from the Journal of the American Medical Association Network

finding that the number of non-specialty branded cancer drugs that require prior approvals rose from 16% in 2010 to a whopping 78% in 2020. And so you have experts saying that all of these different hurdles, they're especially detrimental to cancer patients. For example, Dr. Bruce Scott, the president of the American Medical Association, explained it. Nowhere are the stakes higher than in cancer care, where delays can literally be the difference between life and death. And academic research also explicitly shows that cancer patients are

directly harmed by the prior authorization process. In fact, a study published last year in the JAMA Network found that nearly one in every five cancer patients did not receive the care their doctors prescribed for them because of authorization delays or denials. And again, even just delays and approvals can harm cancer patients. I mean, a 2022 member survey by the American Society of Clinical Oncology shows that 42% of prior authorizations were significantly delayed, resulting in numerous different adverse effects. Also understand when I say adverse effects, more than a third of all respondents blamed the loss of a cancer patient on prior authorizations. And it's not just treatments that are increasingly being denied, but essential cancer screenings as well, which is also exactly what happened to Kay Sue, a cancer patient who was diagnosed with

metastatic breast cancer and underwent surgery and chemotherapy. But then in 2018, the cancer moved to her spine and sternum, so she began aggressive immunotherapy treatments and had quarterly PET scans to monitor the cancer's spread. But then this year, Cigna Healthcare denied reimbursement for two scans that our doctors ordered that cost between $10,000 and $15,000 each, with Cigna arguing in documents that the imaging wasn't medically necessary because, quote, it is not supported for routine follow-up or to monitor your condition in the absence of symptoms. But then, Sue's employer actually stepped up and paid for the scans out of pocket. And it was a good thing because that scan in October, it found that the cancer had indeed spread to her liver, with oncologists

confirming that the cancer wouldn't have been found without that scan. But then also a big key thing is that it's not just private insurers that are increasing denials for care and screening. In fact, patient documents viewed by NBC also show that in 2024, Medicare started denying reimbursements for ultrasounds on women at risk of breast cancer, even though they approved identical screenings the year before. And radiologists say those ultrasounds help find cancers that mammograms miss, and they're essential for people with dense breast tissue. Something that, I mean, affects nearly half of women over the age of 40. With also one doctor telling me out here that this move is especially surprising

because it happened the same year that the FDA started requiring mammography providers to tell patients with dense breast tissue that they might need additional screenings, including the ultrasounds that Medicare is denying coverage for. But then when NBC reached out to the Centers for Medicare and Medicaid Services about the reimbursement denials,

a spokesperson said that the coverage had not changed, with them then adding, the ultrasound or MRI scans you are referencing are covered by Medicare when provided as a diagnostic test. If the scans were provided as a screening test, then Medicare is unable to cover those by law. But this, as you had a doctor explain to NBC, that there is only one reimbursement code

for these kinds of ultrasounds, regardless of whether they're a diagnostic test or a kind of screening. And this is Dr. Ashley Sumrall, the neuro-oncologist in North Carolina, told the outlet that she had been seeing this with her patients as well. And she is also worried that this is gonna be a trend

that expands to private insurers as well because they look to Medicare reimbursement for policy. So unfortunately, right now, we're gonna have to wait to see what's happening. It's a horrifying trend that you need to be aware of that we need to talk about, which of course on that note, yes, this is a news show,

but I also want this to be a conversation. So to everyone, of course, generally I I'd love to know your thoughts here. But if you have experience as a patient or as a healthcare provider, I'd love to hear from you as well in those comments. But then also, I feel like what we learned from that last story is that you can almost never be sure if your health insurance is going to cover the treatment that you need, even when it's fucking cancer. And even when the treatment might literally save your life. But what I want to deep dive into from here is how when it isn't cancer or some other physical condition, it can sometimes be even easier for insurers to deny treatments on the basis that they aren't medically

necessary. And to be clear, that is despite the fact that a federal law existing since 2008 requires insurers to provide mental health coverage on par with coverage for other medical services. Because even though that law exists, as of 2021, roughly two thirds of Americans with a diagnosed mental health condition were unable to access treatment. And just like with cancer, the consequences can be deadly. And so with that, we're looking at a series of articles from ProPublica showing some of the ways

that insurers allegedly limit access to mental health care. And one of the most fucked up ways, they're known as progress-based denials. So insurers, they regularly evaluate patients' progress to see if they can be moved down to a lower and usually cheaper level of care. And notably here, they might point to a lack of progress as a reason to deny coverage, or with them labeling conditions as chronic and claiming the patient has reached their baseline level of functioning. But then also on the flip side, if a person does make progress, well, insurers have also used that as a reason to deny coverage, saying that, hey,

there's evidence that the patient no longer needs the care they're getting. And so ultimately, in the words of ProPublica here, doctors are left to walk a tightrope trying to convince insurers that patients are making enough progress to stay in treatment, but also not so much if the companies prematurely cut them off from care. And with mental health, as you might imagine, these types of progress-based denials, they may be more common. Or with something physical, you might just need an x-ray, a blood test, or some other objective measurement. But with mental illness, it's not always so easy to measure progress. Not to mention, progress often isn't linear, with a patient improving slightly one day only to tank the next. And so with that, we need to talk about the story of Geneva Moore. As she told ProPublica, depression, it's been a near constant in her life. And in 2022,

it got even worse. But thankfully, a year later, she began an intensive outpatient program, which included multiple group and individual therapy sessions every week. And with that, slowly but surely, there were signs of progress. And that is reportedly why just a few months into the program, her insurer, Blue Cross and Blue Shield of Texas, said it would no longer pay for it. The insurer's denial letter saying the medical necessary criteria had not been met and telling Moore, you have made progress, you are not a danger to yourself or others. But according to Moore's therapist, that was not her professional opinion.

And with that, she reportedly pleaded with an insurance company doctor, telling him that Moore still had suicidal thoughts almost every day and a plan for how she would take her own life. Even saying that while Moore had expressed a desire to stop engaging in self-harm, she still did so as often as three times a week.

And finally explaining she was only starting to process her grief and trauma over her earlier sexual and emotional abuse, but still had no healthy coping skills. And so the therapist said she asked for just 10 weeks, 10 more weeks, she said, and Moore would be able to leave the program. But that doctor, he apparently wasn't convinced

and reportedly told the therapist that he would be upholding the initial denial. With then internal notes obtained by ProPublica claiming that Moore exhibited an absence of suicidal thoughts and saying that her symptoms had stabilized and that she could participate in a lower level of care, which one, obviously doesn't line up with what we just heard, and two, made it so that this woman was unable to pay the $350 a day that it cost to stay in the program without coverage, so she left. Whatever progress she had made, it was all but erased. Right by her last day in the program, records reportedly show that more suicidal thoughts

and intent to carry them out had escalated from a seven to a 10 on a one to 10 scale. Within just a few hours of her last session, she was driving herself to a hospital getting admitted to the ER. With that then being the start of a weeks-long downward spiral that would reportedly lead her to harming herself

more frequently, drinking more often, and ending up admitted into a psychiatric hospital. With that, all of that ironically costing her and Shore way more than it would have if they just kept covering her in the first place. I mean, just that stay in the psychiatric hospital, it cost nearly $40,000. And those remaining 10 weeks in the intensive outpatient program, the treatment that they denied, that would have cost about $10,000. And so with that, two things. First, I want to say at the time of ProPublica's reporting, at least, Moore was still struggling, but doing better. She had reportedly stopped drinking and harming herself. And secondly, while we can't say exactly how many stories like Moore's there are, we can say for damn sure that she's not the only one. Or with just ProPublica, for example,

saying it's identified dozens of lawsuits over the past decade in which judges have criticized insurance companies for citing a patient's improvement to deny mental health coverage. And a very notable thing, at least with a couple of them, they involved one of the doctors who denied Geneva Moore's coverage, a man by the name of Timothy Stock. And what you need to know with that is that Stock and other insurance company doctors, there's guidelines they use to determine how well a patient is doing and ultimately whether the company should continue paying for care. And of course, these companies, they claim that these guidelines are independent and evidence-based. The only problem is they're sometimes using guidelines they've just come

up with themselves. With one of the most commonly used ones, for example, being called Interqual, and it's produced by a unit of UnitedHealth's mental health division, which is called Optum. In an interview, several current and former insurance employees, notably from multiple different companies, they reportedly told ProPublica that they were required to prioritize the proprietary guidelines their company used. And big key thing, that is even if their own clinical judgment made them think differently. So Timothy Stock, for example, he reportedly cited a set of guidelines known as the MCG. And that is another of the most commonly used ones, and it's been developed by a company called Hearst Health. And besides Geneva Moore's coverage in 2016, Stock reportedly referenced

them to deny coverage to a teenage girl who is in residential treatment for major depression, post-traumatic stress disorder, and anxiety. And then in another case, he upheld the denial of coverage for a girl with a long history of mental illness just a few weeks into her stay at a facility, claiming that she was, quote,

making progressive improvements. But then, less than two weeks later, according to court records, she self-harmed. To the judge, then eventually ruling against the insurer and writing that Stock and another doctor, quote, unreasonably ignored the weight of the medical evidence showing that the girl continued to require residential treatment. But Stock, he's still practicing. And in fact, according to ProPublica, across the country, insurers continue to rely on doctors like him whose judgments have been criticized by courts. Right. I mean, you have other examples like Dr.

Barbara Senner. She once wrote that a patient was not suicidal when, according to medical records, she was actually actively planning to kill herself. But then the resulting lawsuit, which was against United Behavioral Health, not Senner, make it all the way up to the Ninth U.S. Circuit Court of Appeals. And there, in a unanimous opinion, the judges wrote that Dr. Senner's independent evaluation and coverage decisions were based on obvious factual errors. With also the lawyer who represented the hospital saying that after that, she didn't think any insurance company would ever work with Senna again. But in fact, over the next 10 years, United and other insurance companies

continued employing Senna, even as her decisions continue to be singled out in court cases. In fact, according to ProPublica, she has been referenced in at least 12 lawsuits alleging that insurers wrongly denied insurance coverage to patients who needed intensive mental health care. Four of which ended in confidential settlements

with no admission of wrongdoing by the insurers, and three in judgments finding the insurance company had improperly denied coverage, one of which was appealed and then settled. And of course, with all that, there's some who say the fact that big companies can so often just shell out some cash to avoid any admission of wrongdoing or real consequences, that is a major problem. But in any case, there is a lot more, even beyond all that, that ProPublica has highlighted. Like, I mean, another example of a big problem, there's these so-called ghost networks, which basically describes when health plans list providers who supposedly accept that insurance, but who aren't actually available. With the reality being that there are often nowhere near

enough available therapists and insurance networks to serve all of the people seeking care. With very notably, literally hundreds of psychiatrists speaking to ProPublica, and many saying they left the network because of problems with the insurer. While the shortage of insurance-covered therapists is bad in itself, these out-of-date registries that don't reflect the actual availability of care, they make things even worse. For example, one person reportedly moving to a new city

knowing he needed mental health care and thinking he'd be able to find it. But instead, he ended up just trapped in this so-called ghost network and later was found dead. Even though some states have tried to tackle this, most reportedly aren't even trying and issues are still widespread. With part of the issue there being that

even massive insurers are often regulated at the state level. With, for example, ProPublica finding that United's algorithm program had been deemed illegal in three states by 2021. But then also saying it hasn't stopped it from using similar methods in other states. With mental health advocates claiming

every single jurisdiction in which the company operates would need to be successful in bringing a case against. And so with all this, I would recommend if you want every single detail, I'm gonna link down to sources and articles in the description below. But in the meantime, I gotta ask, what are your thoughts with this?

What are your experiences with all this? Which actually is kind of the perfect note because it brings us to the final thing today. Let's do some comment commentary, right? Let's talk about what y'all said on the last video. And I'll start here by highlighting on the most popular non-news comment that read, Phil, don't add Sundays.

Remember the burnout days. As much as I want to get filled in more, you and your team don't need that extra. Which I will say, one, I love your face. Thank you for looking out. But two, don't worry. I'm an expert in feeling out my burnout these days. Also three, if the beginning of this year is any indication,

we have no shortage of stuff to fill these shows with. I mean, we're at 30 minutes and still not getting to everything that we want to in a day. Then also four, what I'm wanting to accomplish with this show over the next one to three years, like economically, it's gonna make sense to add a fifth show. And you also don't have to worry about the quality because number five, today's show was actually going

to be what the Sunday show was on the 26 because number five, today's show was actually going to be what the Sunday show was on the 26th. Because this is embarrassing, I actually forgot that today was gonna be MLK Day. And so the team has that day off. So this show was shot on Friday when I went, Oh my God, I can't believe I'm so embarrassed, I forgot. And so I repurposed it to be the Philip DeFranco show release

for Monday and then live stream the inauguration today. But y'all understand, I love you, I appreciate you, but I love me the most. And like with anything else I've added and tested and then dropped off, I will never put the core show at risk for failure. But with that said, as far as the other comments, those were about the news.

You know, those were generally split between the Elon Musk controversy and scandal, the Supreme Court and the porn ban and transnational adoption. Starting with Elon Musk, with generally most of the comments could be summarized here with, what the hell is this guy doing?

Right, a lot of people laughing at Elon, seemingly misunderstanding who Asmongold's editors are, right, thinking that they're like some sort of overlord boss when they're just partners or employees. Y'all saying things like, did Musk mistake YouTube editors with newspaper editors? Editors on YouTube are not the boss, right? Others adding Elon quote, check out these spicy DMs with me and Asmund. With an Asmund saying, but yeah, that's basically how YouTube works. And it did

leave me personally wondering like, is Elon Musk just like really ignorant to like how the ecosystem works there? Or like, was he so blinded by anger about this situation that he just, he saw what he wanted to see in those DMs? But yeah, then also we got comments like, just remember, same guy engaging in petty squabbles and lying about his gamer credentials wants to establish his own colony on Mars and presumably set the laws you would have to live by

when you're there. But then regarding the Supreme Court and the porn ban, we saw people saying, quote, it's hard to parent my children is the dumbest excuse from a lawyer. If your children have too many devices for you to monitor to keep them safe until they're over the age of 18, then don't give them the devices all at once. Yes, if you have the funds to give your children everything they could possibly want, then it's your right to do so. However, don't blame the

websites or the internet that you don't teach your children to use responsibly or monitor for the bad things that happen. That's where being a parent comes in. You know, that was something a lot of you just kept hammering, saying the irony of Alito acknowledging the younger generation knows more about tech than older people, but actively sitting in a lifetime appointment in the highest court of America as an elder making law on new technologies. That's a little bit of saying the quiet part out loud. And if you are concerned about your children accessing adult content online, then you should educate yourself on solving that problem. Why is it potentially my problem that you can't parent your kids? And then finally, I can't go through all of them,

but it was so interesting to see people sharing their experiences with transnational adoption. There was some of y'all sharing things like, I'm a Chinese adoptee, and I was one of the ones who got lucky. My adopted parents loved me with their whole hearts and gave me the best life they could, and I love them. But I have always and will always wonder

about my birth parents. I don't have any resources to find them, but I would give almost anything to know if they're wondering about me and tell them I'm okay. I have friends who are adopted, but they were born here in the States. They've found siblings and other relatives by tracing the paperwork backwards and DNA testing.

I can't do that, and it's so, so heartbreaking sometimes. Adoption, transnational or not, is a highly complex system run by complex and often corrupt people. I can never quite bring myself to disparage adoption as an idea, but I do feel very deeply for both adoptees and birth parents who just wanna meet and love each other. And I will say, like, if you go into the comment section,

there are a lot of different stories kind of scattered around, and thank you to everyone who shared opinions and shared their stories. But that, my friends, is where your Monday evening, Tuesday morning Philip DeFranco show is gonna end. Of course, I'll see you more this week. I got a brand new show for you this Tuesday,

Wednesday, and Thursday at 6 p.m. Eastern, 3 p.m. Pacific. Also, friendly reminder, snag what you can while you can over at beautifulbash.com, including this guy. Finally, let me just say thank you for watching. I love your faces, and I'll see you right back here tomorrow.