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Welcome to The Modern Midlife Collective—where midlife isn’t a crisis, it’s a rebirth. Hosted by Dr. Ade Akindipe, DNP, and Dr. Jillian Woodruff, MD, this is the podcast for women ready to unapologetically own their power, thrive through the ups and downs of hormones, weight, and self-care, and show the world that thriving at 40 and beyond isn’t just possible—it’s your birthright.
Biweekly, we bring you science-backed insights on hormones, menopause, longevity, and sexual health—real tools to empower women in midlife and beyond. With a fearless blend of functional medicine, real-life wisdom, and no-nonsense empowerment, we’re here to challenge the norms, break through the barriers, and help you step into a life of vitality, confidence, and unstoppable strength.
Ready to rise? Let’s do this.
Jillian Woodruff MD (00:00)
So women today are asking more from healthcare. They're asking for more time, more answers, more prevention, more personalization, and honestly, they should. At the same time, many women are feeling frustrated and confused. Insurance premiums are rising. Benefits to them are feeling smaller.
Even with insurance, they're still getting bills, rushed visits, they're not feeling like they're listened to, and they're feeling care. They're getting care that's just not comprehensive.
Ade Akindipe, DNP (00:32)
Yeah, many women are telling us that they leave their appointments wondering ⁓ why they still feel the same way. They're not getting the answers that they're looking for, or they're feeling like their provider didn't listen to them or help them. So we're hoping that today's conversation is not just about who's wrong and who's right. We're not blaming anyone. It's not the medical provider's fault or the doctor or the medical practice.
It's really about trying to figure out what has changed in healthcare recently and why this system often doesn't pay for the kind of care that women, especially women navigating midlife, are actually asking for or frankly that they deserve.
Jillian Woodruff MD (01:09)
Exactly. Okay. Well, let's talk about really what are women asking for. Let's go into a little more depth with that. I'm thinking the big thing probably is time. know, time to sit there face to face with the provider and be listened to, be able to talk about your symptoms and ask questions. They're also asking for comprehensive lab panels and
Probably they've been told no once or twice saying that this is unnecessary. I hate hearing that. you're either you're too young. You don't need to do that. If you have periods, your labs are normal. I'm sure you've heard of people being told this. Lee like irritates me. You know, more prevention, longevity focused care. There's a lot of talk about longevity now. And so it's not just about living longer, but living
Ade Akindipe, DNP (01:38)
Yeah.
yes.
Jillian Woodruff MD (02:01)
with good health. So that's another thing that people are listening for. What are you seeing? What are people asking for?
Ade Akindipe, DNP (02:08)
You know, I feel like, especially now that I made that shift from traditional insurance to direct pay, I think honestly, what they're asking for is reasonable. They don't want that 10, 15 minute quick visit. know, rattle off all their symptoms and then they walk out with a prescription. Just like you said, they want someone to tell them the whole story and just not tell them, it's just stress. If you're getting older.
You know, they are really craving a provider that will take a listen and give them a real plan. How do I manage everything step by step? know, from everything that you do, Dr. Jill, from fertility, postpartum, which I think you do a fantastic job about. You spend quite a bit of time with your patients. I don't know how you do that, but they tell me all about it. ⁓
Jillian Woodruff MD (02:57)
That's why I run late
all the time.
Ade Akindipe, DNP (02:59)
Look at hormones, know, looking at your metabolism and putting, you know, putting all the pieces together is what they want. Someone to help coordinate everything and make it make sense to them. But unfortunately, you know, layered on top of all of that is the money piece, you know, rising premiums, higher deductibles, surprise bills. So often they feel like, why am I paying all of this? But I still don't even, I haven't figured out what I really need.
Jillian Woodruff MD (03:09)
Yeah.
Yeah, I think you when you're mentioning wanting the plan.
What you do more than you're giving them a plan is investigation. So what is the root cause? Why am I feeling like this? Because you have symptoms, but sadly, you know, it would be so easy to practice medicine if every symptom was associated with one cause, right? ⁓ Never like that. So you have to kind of dig in and there's multiple things that cause a problem. So I think they want someone that really will dig in and investigate, taking it back to the beginning.
Ade Akindipe, DNP (03:33)
correct.
Absolutely, you would.
Jillian Woodruff MD (03:57)
and then kind of start there building out that plan, which is what you're doing with metabolic health and weight loss too, and putting that together with hormones because it's never just one thing that's leading to a problem.
Ade Akindipe, DNP (04:09)
Right, right, right, right.
And unfortunately, with the world of medical insurance, you have to have a diagnosis code to fit the bill so you can code for it and submit it to the insurance. it's always that fine line between, okay, what are we really doing here? If it's not an annual where it's fully paid for, is it a problem-focused visit? But sometimes it's not necessarily a problem, it's preventative, something to keep you from getting to the point where you have a problem.
Jillian Woodruff MD (04:35)
Yep.
Ade Akindipe, DNP (04:37)
Yeah, so. ⁓
Jillian Woodruff MD (04:38)
Yeah,
coordination with their other providers because medicine is very regimented and you you're you do.
women's health, do urology, you do gastro neurology, you know, it's all very separate and specialized, which is not necessarily a bad thing because, you know, one person can't be the expert in all things. But who is there to pull all of that together? They want that they want that coordination, they want working with other providers to provide the best care for them.
Ade Akindipe, DNP (04:58)
Yeah.
Yes.
Yeah, yeah. And oftentimes, know, midlife women are dealing with so much. you know, we like we've talked about in other episodes, you know, you have the rising cardio metabolic risk and, you know, the mood changes that, you know, the hot flashes and all of that, combined with whatever else might be going on. So really, it's ⁓ it's important that there are providers looking at the whole picture. But
That's what we're trying to dive in today that, you know, what can you do in this setting of the traditional health insurance? What does it cover? What does it not cover? Understanding what a co-pay versus co-insurance is and all those little things we hear about in the billing office and the doctor's office and our jobs, you know, trying to go back and forth and figure out, okay, am I really getting the quality from paying all these costs every month? Right. So.
Hopefully that makes sense with you over the next couple of episodes.
Jillian Woodruff MD (06:12)
Right, you know what they're desiring, what women at Midlife are desiring, it's not...
excessive. It's good medicine. It's modern medicine, it seems. And the problem is that insurance doesn't pay for most of these things. They aren't paying for prevention. You know, they're paying for acute care. And patients don't want to pay for it either. Understandably, they don't want to come out of pocket for something they think insurance should be covering, especially, or they think they've already paid for because they've been paying for insurance. And that's where a
Ade Akindipe, DNP (06:34)
Yeah.
Jillian Woodruff MD (06:42)
of confusion and frustration comes in.
Ade Akindipe, DNP (06:45)
Yeah,
I saw something somewhere that said that only about a quarter of women report that their menopause-related prescriptions are fully covered, which means some women are paying high co-pays out of pocket. So it's either they'll say, well, I can either cough it up and pay, or they're going to delay that and just try to manage their sentence by themselves, which is pretty unfortunate.
Jillian Woodruff MD (07:09)
Yeah, so medical insurance is very good at paying for certain things and medical systems are very good at providing care for certain things. And those things are acute care, I mentioned, surgical procedures, medical procedures, hospitalizations, and just really short problem focused acute issues. They're like really just trying to keep you from dying. That's what it is, right?
Ade Akindipe, DNP (07:33)
Yeah.
Pretty much just everything that's going to keep you safe, not die, or stable enough that you can control on your own. And of course you have all the other things that sit outside of that, like nutrition, weight loss. mean, now we're starting to see that they're starting to cover some weight loss things, some weight loss medication. So that's starting to come up, but if you need help with...
how to sleep well, how to manage stress, just more coaching around whatever habits that are keeping you from being healthy. Sometimes that's not necessarily covered at all. So you're end up having to pay for your premiums and then having to pay out of pocket for some of these things. So unfortunately your insurance, in my opinion, doesn't really focus on keeping you healthy. It's something that you
probably going to have to take a little bit more effort outside of the usual routine checkups that you do, unless you were sick.
Jillian Woodruff MD (08:31)
Exactly. And actually you brought up weight loss. I definitely want to say that with the coverage from weight loss, really, that's a tricky one too, because it depends on, it's not on your insurance company. It's not like if I have this insurance, I've heard they cover weight loss. It is, it depends on where you got your insurance. So if it's through your employer, the employers choose certain
Ade Akindipe, DNP (08:52)
Yes.
Jillian Woodruff MD (08:56)
There's certain boxes like, I'm going to choose this one that's just a more preventive package, or I'm going to choose this one that includes weight loss. I'm going to choose this one that includes healthy living. So you may not, Blue Cross Blue Shield may cover weight loss, but if your employer didn't choose that, and let me tell you, if you choose one thing, you're giving up something else. So it's not like they're being like, I'm not going to give you that. It's that there's maybe something else more.
Ade Akindipe, DNP (09:05)
Very true.
Yes.
Jillian Woodruff MD (09:23)
that could be really beneficial to most people. And also with weight loss, there's like classifications of the types of obesity. And so if you're not obese with risk factors, then you may not get covered help with weight loss. If you don't have other... Yeah.
Ade Akindipe, DNP (09:38)
Yeah, they want you to try and fail the cheaper ones first before they would want something that's more expensive
because the plants are also trying to cover their costs. They don't want to to pay for all of this if they don't want to. So imagine if something costs a thousand dollars.
Jillian Woodruff MD (09:50)
what they don't understand.
If you keep them healthy, there's going to be less overall costs.
Ade Akindipe, DNP (09:55)
Bingo! Bingo! That's what we deal
with in this world. And ⁓ unfortunately, there's different pockets of try fail this first. And unfortunately, they want you to, like before they would cover Ozempic, which is not necessarily FDA approved for weight loss. But if you get on Ozempic, you could have a side effect of weight loss, but you have to be diabetic first. So there's all these different nuances to...
the insurance plans, what they would cover. If you qualify, whether you qualify, you can have a normal BMI. What is a normal BMI? You can be obese, but still have a normal BMI. All these little things. But anyway, don't want to go down that rabbit hole with weight loss.
Jillian Woodruff MD (10:33)
Well, and
a lot of it is about money and that's where there's this confrontation, right, between doing what's best for us, for patients and money, because it is a business and insurance companies, you know, that's where the manufacturers of Ozempic, they made Ozempic for diabetes. They made Wegovi for obesity. That's FDA approved for obesity. Ozempic is
Ade Akindipe, DNP (10:40)
Yeah.
Mm-hmm. ⁓
Jillian Woodruff MD (11:00)
FDA approved for diabetes management, they're the same exact medication. There's no difference in their formulation. They just gave it a different name and put it in a different type of syringe. But there's no secret. mean, they say this is not it, but that it's the same thing. saying they say it's the same thing. They're not trying to make you, I guess. They're not trying to make you think it's two different things, but it's ⁓
Ade Akindipe, DNP (11:05)
Exactly.
Jillian Woodruff MD (11:24)
a business and by doing that you can charge differently for one than for the other and make it more difficult to get one or the other. So it is a business and everybody wants to be paid in some way and so in healthcare we think it's a human right. It's good for our whole country if everyone is cared for.
Ade Akindipe, DNP (11:25)
Yeah.
Jillian Woodruff MD (11:47)
Preventions especially, it's good for everyone, but there's quite an expense to providing care too that we all have to pay for.
Ade Akindipe, DNP (11:58)
Absolutely. And it's difficult having those kind of conversations because we as clinicians want to provide the best for our patients. We want them to get better. What are your thoughts about having that money conversation with patients when certain things are covered, certain things are not covered? It can be uncomfortable because that's not something we're trained in.
Jillian Woodruff MD (12:18)
Absolutely. It is very uncomfortable to talk about money. I know for a lot of physicians are deeply uncomfortable talking about this. Just like you said, we weren't trained in the business of medicine per se. They've always heard like doctors make the worst business people because it wasn't part of the training. I think that many
physicians went into medicine to serve people and to care for them. And we aren't as aware of the financial realities of care until you take on running a business. And, we both run our own business and you can see it's, it's, it's hard work. So it's not just caring about patients, but thinking about margins and the financial realities of a business. And
Ade Akindipe, DNP (12:59)
Yeah, very.
Jillian Woodruff MD (13:09)
you know, even if you're not in your own private practice and you're not thinking about these things, someone is, and then they're dictating how you care for patients. The good thing about our practices is that because they are small, we get to care for our patients in the way that we would want, you know, our family cared for. And so the changes and the flexibility that we have
in caring for people is great, but then there's also a downside to that. There's a sacrifice and because you, we, in order to care for people, you need help. You need a team that needs to be paid. You need medications, need exam rooms, equipment, warranties, machines, technology. And all of them want to be paid, right? And then compliance, compliance costs money, making sure you're doing things safely.
Ade Akindipe, DNP (13:47)
Yeah.
a whole lot of technology.
Jillian Woodruff MD (13:58)
your space is clean, you're running things in a, know, things that should be sterile or sterile money. right? So it's not about, a lot of times it's not about, okay, we want more and more money, but if we want to have a business that is sustainable, unfortunately you need more and more because everything continues to go up and.
Ade Akindipe, DNP (14:05)
Human resources, payroll.
Thank
Jillian Woodruff MD (14:25)
If you're trying to deliver this increasingly comprehensive complex care in a system that reimburses less and less and less, but you're still responsible for all the real world costs that increase, increase, increase, it's after a while, it's hard to keep doors open.
Ade Akindipe, DNP (14:42)
It is. And
that's the reality for a lot of practices right now. It's like, where do you find the happy medium where you're getting your patients what they need, but you still have a healthy margin because you need that healthy margin. Yes, you need to have a profit so that you can invest in not just, you know, make money, but you need to the money to reinvest in the business for it to build and expand and hire more people if you need or.
get a bigger space or venture into other services if you want. So yeah, and that's where we can transition that conversation into what that looks like on a patient front. When you go to the doctor's office and they're telling you about all these copays and deductibles, and there seems to be a lot of confusion around that. What does this all mean? It's a lot of financial responsibility, but there's the high deductible plan and the PPO's and everything.
Jillian Woodruff MD (15:27)
There is.
Ade Akindipe, DNP (15:35)
Essentially what that means is when you hear copay, it's just basically the amount, it's not a surprise. It's kind of like a portion of the visit that you have to pay. And then a deductible is more like the amount you have to come out of your pocket before your insurance starts to pay. And then you have what's called co-insurance, which is kind of like a cost sharing. So you're basically splitting the cost.
with your insurance company. So that could be a percentage after you're deductible. So that's some arrangement that you and your insurance are basically splitting the bills. And that can look so different depending on what insurance you have. So from the patient's point of view, it's like, my gosh, I'm paying this monthly premium and then some. So you can imagine how frustrating and confusing it is when you still get a bill.
and they're fighting the doctor's office like, hey, why did I have to pay for this when, you know, and then if you're not getting all of your answers in 15 minutes, of course I can cause a lot of headache and women, you know, I hear you when you go somewhere and you feel like you don't, you're not getting the comprehensive care you need, but you're paying out of pocket, that can be very frustrating.
Jillian Woodruff MD (16:47)
Absolutely. you know, sometimes even many times they the co-pays aren't being collected, whether it's, you know, a patient doesn't bring money or even the office doesn't collect, right? They're like, we'll bill you, we'll bill you. then that's money lost because the insurance company expects that to be received. And so also when you're like, I've paid enough.
If offices don't bill you and they're contracted with insurance companies, that is actually an insurance fraud because the insurance company is like in a partnership with the patient to pay this bill. And they're saying, if you pay this, I'll pay that. And if you don't pay this and we bill you for your portion, your co-insurance, then it's kind of like at fault with the insurance company. If we just forgive that.
Ade Akindipe, DNP (17:36)
Yeah.
Jillian Woodruff MD (17:38)
then we are also in a partnership with the insurance company. It's a whole mess, it's always, you know, it's always, it's your fault, it's your fault, it's your fault. But like nowhere else can you go, like I'm not gonna go for a massage and not pay for that, you know, massage or go for groceries without paying for it. It's kind of the same, even though I want everyone to have health insurance and be healthy, but these things really...
Ade Akindipe, DNP (17:44)
Yeah
Look at what it.
Jillian Woodruff MD (18:05)
you know, chip away at the stability of a practice where larger practices or hospital-owned practices, they have so much more of a cushion. But then if you see they do, there's less of that comprehensive care that they can give because there are specific restraints in order for them to only do what they're being reimbursed to do because that's
what's sustainable, especially if it's a hospital that's, you know, like a for-profit hospital. And so, yeah, if a patient comes in and they've used insurance, but the insurance hasn't really paid anything, this feels awful because you're paying this like thousand dollars a month to go to the doctor. And then you get to the doctor and you're like, wait, why am I being charged this full bill?
Ade Akindipe, DNP (18:45)
Yeah.
Jillian Woodruff MD (18:53)
That happens to me. I take the kid to the allergy doctor and they're like, that's $450. like, what? I already paid so much. But I understand that the insurance company, are there to make money. It's a for-profit business. And the way that they do that is, like you said, keeping their costs low. So really it's...
Ade Akindipe, DNP (19:00)
Yeah.
Jillian Woodruff MD (19:17)
They're great for you have an emergency, you're going to be hospitalized, can bankrupt people. Your insurance is there. But you know, the primary care prevention, know, people may leave those, some of those visits needing more than what they got and feeling frustrated that they had to, you know, pay for this.
Ade Akindipe, DNP (19:39)
Yeah, have you ever
actually read the plan document of your health insurance? Like everyone is supposed to get a summary of what your insurance actually covers. And I'm pretty sure I can safely say that most people don't read it. It's interesting. I actually sat down and read it one time. I'm like, man, it is very specific what the insurance wants to cover and not to cover. Then there's got some exclusion and carve outs, what they call carve out plans and
so much intricate detail that often when, and that's probably what causes some of the confusion. We don't really know what does your insurance really cover. Sometimes I'll tell them, you know what, I can't tell you that when patients come in, they're under the impression that you know, you should have all the answers, but we actually don't. You should be the one to say, hey, I'm gonna call that number behind that card and talk to someone and hopefully you get the answers. But yes, every insurance should come with a
a plan document that says very explicitly what they want and not cover. Again, it can still be very confusing, but just to put that out there, there's a document that actually exists.
Jillian Woodruff MD (20:46)
say also, and I've not read that, that sounds very exciting reading, no it does not, but I will say also that insurance can tell you that things are covered, but they are not. There's always some little exclusion. For example, if you think about bioidentical hormones in the form of a hormone pellet,
Ade Akindipe, DNP (20:51)
Ha ha!
Jillian Woodruff MD (21:09)
They are for men, there are covered hormone pellets that they can get covered by their insurance. But what is left out is the type of pellet, the dosage, meaning in the type of, you need to be extremely, like have no testosterone in order to qualify for these types of pellets. So, but then women will come in thinking that it's covered because it's in their documents.
Ade Akindipe, DNP (21:21)
right.
Jillian Woodruff MD (21:36)
where it's covered for men and men will come thinking that they can also get it but yeah it's a specific type. Yeah.
Ade Akindipe, DNP (21:42)
You have to have zero on multiple
labs, not just once. You have to come in multiple times to show it's really low. my goodness.
Jillian Woodruff MD (21:47)
Yes. Mm-hmm. It's still low. It's still low.
Yeah, I think the level is like, 250, 230 or something. At that point, you're having so many issues. Mm-hmm.
Ade Akindipe, DNP (21:56)
I forget, honestly, it's like I always have to go look at it. Yeah,
yeah, very specific, very, very specific. So yeah, if you have a plan document, read it, ask your insurance questions before you go in until you don't get that bill thinking, well, it's covered. That's where the surprise bills come from.
Jillian Woodruff MD (22:13)
Yeah.
Well, let's go through like ⁓ an example of a patient that would come to see us. So a woman in midlife, let's say she's exhausted, she's gaining weight, she's not sleeping well, she doesn't feel like she's strong, she's losing muscle, she has no sexual desire, and she just, brain fog, short-term memory lapse, and she just doesn't feel like herself anymore.
So she's coming to see you and she wants a hormone evaluation. She does not want to say yes or no, like, yes, you're in menopause or no, you're not. So let's say she's having periods every month. So she's not in menopause and she wants a hormone evaluation. She's probably gone other places and said these things and she's probably been told this is part of aging, right? So what does she need?
Ade Akindipe, DNP (23:00)
Hmm, that's a loaded question.
Jillian Woodruff MD (23:02)
You know,
she's listened to, right? She's going to have to talk about all of these symptoms and we want details about when this started, how severe it is. She wants to have her hormones looked at. She wants to have labs done and not just, you know, yes, no labs. She wants to dig into each of these things, which could be connected, may not be connected. And she needs someone to interpret the results of these labs.
Ade Akindipe, DNP (23:05)
Yeah. Yeah.
Jillian Woodruff MD (23:29)
Right? Maybe follow up labs if there's anything that's abnormal. We need to talk about, okay, how can we improve your sleep? Because you're going to be exhausted if you're not sleeping. How can we improve your nutrition? What are things that can help your hormones? What are signs of aging and how do we help you to age with a great quality of life? There may be hormones involved. So she needs counseling on hormones, benefits, risk, right?
a lot of things, which seem these are, it's a lot, it's not going to be in 10 minutes because in a 15 minute visit, you're going to have 10 minutes or less face to face with the provider. So she wants all of those things and she deserves these things. This is good care, right? So what do you think, you know, what do you say that insurance would cover for this woman?
Ade Akindipe, DNP (23:59)
lot.
Yes. Yeah.
I mean, in a good scenario, I mean, the main thing insurance is really concerned about is that they're able to cover up front, you know, preventive care. So things that fall under the ACA, the Affordable Care Act, things like, you know, mammogram, cervical cancer screening, age-appropriate checks, maybe healthy diet.
you know, very basic obesity prevention. know, of course you can teach the patient, here's what you need to do. You need to fix your meals. You need to move more, you know, abstain from alcohol. So these are just like general things that you can get in that visit, usually with no copay if it's tied to a preventive or an annual checkup, right? So you're not taking up a whole lot of time necessarily because it's not symptom-based. So that's usually 100 % covered.
Well, when it gets trickier though is when everything goes beyond that preventative visit, this woman you just described, she has all these other symptoms. If she goes back because she can't sleep, having hot flashes, bring fog, all those things, now it's now problem focused, problem based. And now it's starting to hit deductible, co-insurance, instead of being fully covered. So her office visit may have...
A COPE applied if she has a high deductible plan where you have to pay out of pocket until you reach your maximum deductible for the year, you're paying out of pocket for that because these are not annual or preventative visits. things like if your doctor wanted to look into why you're tired, if they wanted to check your ferritin levels, do some more in-depth testing for your thyroid autoimmune markers.
inflammatory markers, you now we're getting into more, we're looking for root cause, what's happening with you? We wanted to check your hormones. I'm not sure, you know, if all insurances will go into depth of paying for checking your hormones. But often, you know, menopause related things like hormone therapy, non hormonal options or for half lashes that are on the market now, maybe on her plans formulary, but still come with
what they call tiered co-pays or co-insurance. So she's most likely going to be paying on top of what she's already paying in her premium. So if we're lucky, insurance is doing a good job at least checking off all the things that she needs for a well woman's visit, but still may have to pay out of pocket. But the minute everything else starts to go a little bit more, she's having palpitations from...
potentially hot, know, peri-mental pause, all of those things you're going to have to potentially pay out of pocket for. So that's what that looks like. I'm not sure what you're what are your what are your thoughts, Dr. Jill?
Jillian Woodruff MD (26:59)
Yeah, and I would say for this patient, this patient's already had her well women, so she doesn't even need that. So she's just coming in with those issues, right? And so then I would say in a traditional practice, you're thinking, okay, the patient may be thinking, I understand, yeah, I'm gonna pay for my, I'm gonna pay my insurance, I'll pay my copay, I have no problem with that. They're still, they still may not.
Ade Akindipe, DNP (27:07)
This is a problem focused. Yeah.
Jillian Woodruff MD (27:26)
get that comprehensive care, what they may hear is, what is the most important thing you want to address today? Right? Because offices are not set up to go into depth and do all of you just said so many things. They're not set up to do that. They're set up to for the acuity. And in order to keep their doors open, you have to see so many people, right? So you can't there's no time in 10 minutes to address.
Ade Akindipe, DNP (27:28)
No.
Absolutely. At all.
Jillian Woodruff MD (27:53)
the libido, the ferritin, the fatigue, the hormones, and blah, blah. So it's number one. And that makes people feel like they're not being listened to because they just told you they can't sleep, they can't, you know, they're gaining weight, they have headaches, they have fatigue, they have palpitations all days. And you're like, well, what's the most important thing? Okay, they're all important. Yes, but that's what the system is set up for. So even if you're like, I'll pay for this or that.
Ade Akindipe, DNP (27:55)
Yeah.
That's the number one thing we want to address today.
Jillian Woodruff MD (28:20)
That's not how the office is set up. You can only do one thing at a time. And it's really difficult to tie things together and be an investigator and coordinate one visit at a time. Like keep coming back, keep coming back, right? So it doesn't mean the other concerns don't matter. It just means the system doesn't allow them all to be addressed at once because insurance visits are, they're acuity based. So prevention and it's,
Ade Akindipe, DNP (28:26)
Yeah.
Yeah.
Jillian Woodruff MD (28:44)
It's simple prevention, like the things you just said, right? The screening tests and things. It's not, there's so much more that we do, right? For prevention and optimization of care that, you know, may not be covered. So if you're not actively dying or bleeding or hospitalized or in an emergency situation, the system often doesn't recognize the visit, you know, as being medically necessary at a comprehensive level, which...
comprehensive level is what you would need to go through all of those issues that you've come in with.
Ade Akindipe, DNP (29:14)
Yes.
Yeah, and even though this woman feels awful, her symptoms are often, will be labeled as chronic or like you said, non-urgent, not severe enough for them to really pay attention. And that's where women always kind of feel like, that doctor or that provider wasn't listening. Well, it may not necessarily be that they're not listening, but so.
Jillian Woodruff MD (29:25)
Mm-hmm.
Ade Akindipe, DNP (29:38)
complexity of what she's living through gets flattened into like a couple of diagnosis, fatigue. And then of course you have your differentials, but she may have an idea what's going on, but you know, the time to kind of get into that is usually not there. So on paper, it might look like a routine follow-up. In real life, it's all you mentioned, sleep, mood, hormones, weight, relationships, know, libido, all the other things that collide at once. So most insurance plans are not built for that deeper work.
that will actually help her. They typically will only cover, they won't cover hormone in-depth interpretation. Again, Dr. Jill, I do not know where you get the time to do this, because I know you do that with me, but okay, you're an angel. ⁓ Those pieces just, it takes time to get any of that done. So a lot of times, sometimes women will go to cash-pay practices, which we're gonna dive deep into later. ⁓
Jillian Woodruff MD (30:19)
You know, you do the same.
Ade Akindipe, DNP (30:34)
to see if they can get some of those things answered because again, it's a fee for service. So they're not relying on the insurance-based time where they have to see maybe 20, 30, maybe they only see five to 10 patients because now they have the time to address a lot of those things.
Jillian Woodruff MD (30:49)
I mean, you brought up there's a tremendous amount of work that patients typically don't see. There's appointment reminders, lab reminders, paperwork reminders. They wanna be reminded of all the things. I do too. wanna like tell me, cause life is so busy. But maybe if there were more sharing in that with patients reminding themselves, that's like a staff member that could be less.
Ade Akindipe, DNP (30:58)
Thank you.
Yes. I wouldn't be reminded. Yes.
Jillian Woodruff MD (31:14)
then more money can go into patient care. Lab tracking, sending messages back and forth through the portal, reviewing all those records, requesting records from previous providers or from other providers and reviewing all those records takes time. then, but insurance, know, there's prior authorizations. It's just things that like kill the love for healthcare. When you have to, you know that there's something, right? My patient could benefit from this, like.
Ade Akindipe, DNP (31:17)
Yeah.
I love prayer roths.
Jillian Woodruff MD (31:41)
Right? And then you're like, I have to
Ade Akindipe, DNP (31:41)
No, I don't.
Jillian Woodruff MD (31:43)
get this authorized by someone who is, you know, by it's their AI system. If you didn't say this specific thing, they're going to deny it. Like, oh, we're not going to pay for this like a life saving thing. And then you have to do appeals and then you have to appeal to and make an appointment to speak with actual a true medical provider that it's not necessarily, I've never had a provider that was actually in gynecology that I've been speaking to you interestingly.
So, and then they decide, they usually will help you, but it's a lot of time to go through those things while the patient's just waiting, like, where's my medicine? Or why can't I book my surgery? And you're like, I'm trying. And then they want detailed instructions, which I love, because I like details. then they lose the instruction, you gotta repeat them over and over. And then there's also that medicine changes, there's new treatments.
Ade Akindipe, DNP (32:14)
Yeah.
Yeah.
Jillian Woodruff MD (32:34)
there's new research. So there's the studying, right? We're, you're, you're always in some sort of class. We're always learning. And, you know, we have a love for learning. There's lifelong learning, but it does take time, different medications interact with each other, different treatments that not for this person or it's good for this one, like all of that takes work and that's unpaid, right?
Ade Akindipe, DNP (32:42)
ways.
Yeah, absolutely. And sadly, all of the money that goes towards longer visits or more clinical staff and all of that, it goes towards navigating insurance. So a lot of times you spend so much time trying to understand, trying to explain why we are needing that reimbursement and it's getting smaller and smaller. lots of frustrations around the system.
Jillian Woodruff MD (33:21)
Yeah, I was talking to someone, a patient the other day about all of these, like making our systems more efficient and using how does AI come in, digital platforms. And these things can make the work more efficient. So there's less that you're doing outside of office hours, but it also, it is not free to have a HIPAA. So that's your... ⁓
Ade Akindipe, DNP (33:40)
Yeah.
Jillian Woodruff MD (33:45)
your privacy policy, privacy, compliance systems to have these platforms costs a lot of money, right? Yes. Secure communication. Even that. Yeah. So it's not for a lot of physicians. This becomes a career. The career they imagined when they went into medicine, it's very different from the reality. you know, especially you have this calling to care for people.
Ade Akindipe, DNP (33:50)
AI notes, right? Even that costs money just to get the AI to help you with your notes cost money.
Jillian Woodruff MD (34:10)
to heal people and then it becomes this job dominated by administration and documentation and billing and paperwork and so you're clicking boxes and fighting denials and you know working you know on behalf of the patient and you want people you want to see people living healthy and you feel like there's something you can give to that.
Ade Akindipe, DNP (34:21)
Yeah.
Jillian Woodruff MD (34:34)
But what happens are providers just start leaving healthcare because it isn't what they imagined it to be. And it is difficult to fight, you know, from the inside.
Ade Akindipe, DNP (34:41)
Yeah, yeah, definitely seeing a lot of that. Yeah, yeah, it can feel very frustrating
when you're trying to help, you know, the very patients that you went to school for to learn to treat. unfortunately, the system wasn't designed for the kind of care women in midlife are experiencing now. And that tension is definitely showing up everywhere.
Jillian Woodruff MD (35:01)
Yeah. So, you know, when practices are closing or changing how they operate, so hopefully there are other ways and we're going to talk about it. But it's not random. It's not random that this change is occurring and, or it's not because providers have stopped caring or they don't want to, you know, care for patients anymore. It's the, there's different care systems that are arising to address these issues that we discussed today.
Ade Akindipe, DNP (35:12)
Now.
Yeah, and I can't wait for our next episode where we'll continue to talk about this conversation by talking about what those models look like, how insurance still fits in, and how to think about all the options that you have. If you have insurance, if you are willing to invest in your health by paying more out of pocket so you can get the best care you deserve.
Jillian Woodruff MD (35:50)
Absolutely, I'm looking forward to that one too. And we can both talk about our models of care. But thank you all for spending time with us today. We thought that would be quite a bit to put in today's show. this is the first part and you'll have to come back to the second part. But thanks for being willing to sit with a complicated conversation that we're having. And if this episode brought up questions or experiences or frustrations that you want to share, please.
Ade Akindipe, DNP (36:10)
Yeah.
Jillian Woodruff MD (36:16)
Share them with us. We'd love to hear from you. Email us at connect at modernmidlifecollective.com. Thank you. Bye.
Ade Akindipe, DNP (36:25)
Thank you.