Latest / The ACL Athlete Podcast / 165 | Your Insurance Ran Out. Now What? - Part 2

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165 | Your Insurance Ran Out. Now What? - Part 2 · The ACL Athlete Podcast

• 0:19
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:23
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:33
  SPEAKER_00: I'm your host, Dr.
• 0:34
  SPEAKER_00: Ravi Patel, performance physical therapist and coach.
• 0:38
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:46
  SPEAKER_00: The goal of this podcast is to equip you, the athlete, with the education to make the best informed decision about your care and your ACL journey.
• 0:57
  SPEAKER_00: Thanks for joining.
• 0:58
  SPEAKER_00: Now let's dive into today's episode.
• 1:04
  SPEAKER_00: What is up, guys, and welcome to part two of this two-part series.
• 1:09
  SPEAKER_00: Your insurance ran out.
• 1:11
  SPEAKER_00: Now what?
• 1:13
  SPEAKER_00: If you haven't listened to part one, stop right now and go listen to that.
• 1:18
  SPEAKER_00: And I promise that that'll be something that will be worth exploring and hearing, put it on 2x speed and be able to get through it really quick.
• 1:27
  SPEAKER_00: It's a short episode, but then therefore it can set you up for this episode that we are going to dive into the meat and potatoes of your options and what you can do if you're someone who has had your healthcare coverage, whatever country you live in, whatever healthcare system you have.
• 1:47
  SPEAKER_00: Here in the States, we have insurance.
• 1:49
  SPEAKER_00: So let's say that insurance runs out, or whatever coverage you do has run out.
• 1:55
  SPEAKER_00: So then what do we do?
• 1:57
  SPEAKER_00: So let's get into it.
• 1:59
  SPEAKER_00: The thing that I'm gonna focus on for this part two is my people who are limited.
• 2:05
  SPEAKER_00: So last episode we talked about some situations, and especially people who might have more unlimited options, if you will, or maybe their healthcare is something that is providing them with process of all of it to be able to be covered, to be able to be helped through the ACL rehab process, or let's say just length of time.
• 2:24
  SPEAKER_00: That doesn't necessarily equal quality of care, but you do have the coverage through the length of time.
• 2:29
  SPEAKER_00: So then therefore you had to audit to see like, is this serving me where I am?
• 2:34
  SPEAKER_00: And then I also, you know, propose some questions to you of ways that you can audit that outside of yourself to know, am I getting value out of what I'm getting?
• 2:43
  SPEAKER_00: And also, like, would I take a loved one to this place?
• 2:47
  SPEAKER_00: And maybe it is for a current season or phase, but then maybe it's run as course after that.
• 2:52
  SPEAKER_00: And so that's where we got to know that that could be an opportunity cost.
• 2:57
  SPEAKER_00: But now we are digging into what majority of people will fall into, which is going to have limited coverage or assistance at some point in this process.
• 3:07
  SPEAKER_00: Now remember, this is a nine to 12 month process.
• 3:11
  SPEAKER_00: I'm not saying your physical therapy needs to be covered.
• 3:14
  SPEAKER_00: That would be amazing, but then that's also potentially a limitation of skill set.
• 3:19
  SPEAKER_00: If your physical therapist doesn't have a performance or strength conditioning background, then they will run its course earlier in this process because they can't get you back to more dynamic and more higher intensity things because maybe that's not their experience or background.
• 3:35
  SPEAKER_00: And for side note, in physical therapy school, we don't learn these things.
• 3:39
  SPEAKER_00: We don't learn how to take someone from, you know, post op or post-injury all the way to full return to sport.
• 3:45
  SPEAKER_00: It's a misnomer to think that we do, but when you look at physical therapy education, it doesn't cover any of this stuff.
• 3:52
  SPEAKER_00: It's not a requirement.
• 3:53
  SPEAKER_00: We go through exercise prescription, but that stuff is like so archaic and it's literally like balancing on a bosu ball or like loading someone up with like a theraband or you know, working on uh, you know, certain uh muscles that acting like we can isolate like a certain part of your core to be able to fight all back pain.
• 4:15
  SPEAKER_00: And the thing is, is like we're complex systems, we're in complex environments, so it's more complicated than that.
• 4:21
  SPEAKER_00: So we got to at some point be able to have someone who can prepare us for life and for especially the demands of sport and activity.
• 4:28
  SPEAKER_00: And so this is something where it's really important to understand that there is a strong chance if you're listening to this, your insurance or coverage will run out.
• 4:39
  SPEAKER_00: So then, therefore, we are going to make sure that you are set up to know your options, right?
• 4:44
  SPEAKER_00: And us humans who don't have great insurance, uh, which is majority of America, and of course, limitations in the other countries and their medical system, there's those limits.
• 4:56
  SPEAKER_00: So now we're gonna talk about it's ran out, right?
• 4:59
  SPEAKER_00: Whatever that is, or it's ran its course.
• 5:01
  SPEAKER_00: Now, what do we do?
• 5:03
  SPEAKER_00: Well, let's explore our options.
• 5:06
  SPEAKER_00: I'm literally going to lay out every single option, and it's something that I just want you to be able to see and hear, not really see because you can't see anything, but you can hear it.
• 5:17
  SPEAKER_00: So the thing that is going to start this is you could just stop doing your rehab, right?
• 5:24
  SPEAKER_00: Your your insurance or your coverage has ran its course.
• 5:26
  SPEAKER_00: You could just stop doing rehab.
• 5:28
  SPEAKER_00: We're not going to entertain that here as a part of the ACL athlete.
• 5:32
  SPEAKER_00: Um, if you're listening to this, you're not going to start stop doing rehab.
• 5:35
  SPEAKER_00: And so that's not an option, but it can be an option, and it is an option some people take.
• 5:41
  SPEAKER_00: And this is something maybe because they've been misled and thinking that they are cleared or they've graduated.
• 5:47
  SPEAKER_00: Um, and I've talked about this in a previous episode.
• 5:50
  SPEAKER_00: But just because you have finished your plan of care with your physical therapist or your insurance visits have ran out, it doesn't mean you've graduated.
• 5:59
  SPEAKER_00: You've just literally met the capacity of what you were provided with.
• 6:03
  SPEAKER_00: And then therefore, that has just stopped providing.
• 6:06
  SPEAKER_00: And so then that means you're probably not done.
• 6:10
  SPEAKER_00: So then, therefore, I'm sorry if you've been misled that way and you're four to five months out.
• 6:13
  SPEAKER_00: You're likely needing to do more if you're in ACL rehab process.
• 6:17
  SPEAKER_00: So just don't stop doing rehab.
• 6:19
  SPEAKER_00: And so that's not something that we're going to entertain today.
• 6:22
  SPEAKER_00: You can try and see if they'll approve more physical therapy or physio visits, but if you have a cap, then they probably won't go past it.
• 6:32
  SPEAKER_00: You can pay out of pocket.
• 6:34
  SPEAKER_00: And guess what?
• 6:35
  SPEAKER_00: Even if we do the math on an average, you get, let's say, 30 visits, because that's something that we hear quite often.
• 6:43
  SPEAKER_00: Uh, insurance covers you through 30 visits.
• 6:45
  SPEAKER_00: And this is a nine-month process at a minimum.
• 6:49
  SPEAKER_00: It is like, and there's not very many people who are going to be able to do this at six months, not only from the biological healing process.
• 6:57
  SPEAKER_00: We just need that much amount of time at minimum because the research shows that re-injury risk is significantly reduced by um extending this to nine months.
• 7:07
  SPEAKER_00: But the reason for that is that it serves as a proxy for healing biologically.
• 7:12
  SPEAKER_00: But then, two, is also that it allows us to redevelop the qualities and physical attributes we need to get physically prepared again and mentally for the things we're trying to take on, especially if it's a higher level cutting and pivoting sport.
• 7:26
  SPEAKER_00: And so, therefore, when we look at this 30 visits, nine month process at a minimum, even being conservative, that's 15 to 20 weeks.
• 7:35
  SPEAKER_00: That's only five months.
• 7:37
  SPEAKER_00: And I'm gonna call spades spades here.
• 7:40
  SPEAKER_00: So, one of the things with US and healthcare is that there's productivity standards.
• 7:46
  SPEAKER_00: And so then, therefore, I have had friends, I've been in clinics where you know, people have been moved from three times a week to two times a week to maybe one times a week, and their you know, clinic director or regional manager, whoever it is that is in charge of the numbers, right?
• 8:06
  SPEAKER_00: They are coming to them and saying, like, hey, why'd you bring this person down to two times a week?
• 8:11
  SPEAKER_00: They were coming three times a week.
• 8:13
  SPEAKER_00: And then, you know, if they go from two times a week to one times a week, right?
• 8:17
  SPEAKER_00: And you know, there's a productivity standard for any clinic, it's KPIs that they have to meet, and it's based on visits and the amount of reimbursement per visit.
• 8:28
  SPEAKER_00: And so then, therefore, there have been friends that I have worked with and good friends of mine that have basically said their clinic director came up to them and was like, you need to bump this person back up to three times a week.
• 8:42
  SPEAKER_00: And whether it was their insurance was unlimited or it was maybe just because they were like, hey, we need to hit these numbers.
• 10:54
  SPEAKER_00: And so at the end of the day, it's a business, it's a healthcare business, and you gotta think about which one is probably gonna be more dominant.
• 11:01
  SPEAKER_00: And so then, therefore, that can impact the uh visits because at the end of the day, your surgeon will make recommendations.
• 11:08
  SPEAKER_00: It's usually kind of like blank recommendations.
• 11:10
  SPEAKER_00: It's like go to three times a week for eight to 12 weeks, or two times a week for you know 12 to 16 weeks, whatever it is.
• 11:17
  SPEAKER_00: They're gonna kind of leave it up to the physical therapist to kind of dictate that because of what you're needing and how much support you need.
• 11:24
  SPEAKER_00: And this is always gonna come back to the physical therapy clinic, their model, the way that things are built up in terms of the way that they see people and their systems.
• 11:33
  SPEAKER_00: But a lot of times, most physical therapy clinics will start you out three times a week.
• 11:37
  SPEAKER_00: And it's almost kind of like this like general rationalized rationalization, that's a hard word, is just rationalizing essentially that oh, well, they're post op.
• 11:47
  SPEAKER_00: They need a ton of support, they need to come see me three times a week.
• 11:50
  SPEAKER_00: That's good productivity for the clinic, and it's also something that they need, right?
• 11:55
  SPEAKER_00: But if we've got 30 visits, let's say 20 visits, then that's gonna run out really, really quick.
• 12:01
  SPEAKER_00: Let's say it's 30 visits in 10 weeks, that's gonna go away.
• 12:05
  SPEAKER_00: And then we are fighting against this thing where they're trying to meet productivity standards because the clinic has to meet certain numbers, and ethically, it's kind of questionable.
• 12:16
  SPEAKER_00: It's like, no, this person's super independent.
• 12:19
  SPEAKER_00: Um, they have a huge training background, they're very dialed in, they listen really well.
• 12:23
  SPEAKER_00: And for some reason, we're still gonna get them to come in three times a week versus let's stretch these visits out because it's probably what's needed to help prolong the guidance and care someone needs.
• 12:34
  SPEAKER_00: So this is just something to think about as you are, if you're in the middle of trying to navigate, spreading out these sessions and what it looks like.
• 12:43
  SPEAKER_00: Don't get hit in the face with, you know, you've used up all your sessions and it's only, you know, eight weeks in or 10 weeks in, because you've got a long road ahead.
• 12:53
  SPEAKER_00: So talk ahead with your physical therapist and see what that can look like without losing the quality of care that you need in between those sessions.
• 13:02
  SPEAKER_00: So this is something that's really important that I really do suggest.
• 13:06
  SPEAKER_00: But coming back to this notion of paying out of pocket, you know, your insurance visits have ran out.
• 13:12
  SPEAKER_00: We're looking at this nine-month process.
• 13:14
  SPEAKER_00: And so now we're going to look at insurance or whatever healthcare coverage is not there anymore.
• 13:21
  SPEAKER_00: You can do that with your existing clinic.
• 13:23
  SPEAKER_00: You could pay out of pocket, so you can continue to see the same clinician and pay out of pocket there, right?
• 13:29
  SPEAKER_00: So that's an option.
• 13:31
  SPEAKER_00: You can find a different clinic.
• 13:34
  SPEAKER_00: It can be an insurance-based clinic, but you're still paying a fee for the visit because you ran out of insurance visits, right?
• 13:41
  SPEAKER_00: You can go to an out-of-network or fee-for-service type clinic.
• 13:45
  SPEAKER_00: This is what the ACL athlete is.
• 13:47
  SPEAKER_00: We do not take insurance.
• 13:49
  SPEAKER_00: We do not want a middleman dictating the way that we do things.
• 13:53
  SPEAKER_00: And it allows us to really serve our athletes and do what is right by them versus changing our model based on the way that we are reimbursed and the way that money comes in the door.
• 14:02
  SPEAKER_00: We don't want to do that.
• 14:03
  SPEAKER_00: We want to make sure that we serve you the best we can and also make sure we're serving our team and they are feeling fulfilled by the work that they do.
• 14:11
  SPEAKER_00: And so then, therefore, you pay a fee for service to work with us.
• 14:15
  SPEAKER_00: If you're lucky, you might be able to find an ACL bridge program near you, but these are rare to find and have to fit the right criteria.
• 14:24
  SPEAKER_00: If you are far enough along in a good spot from a range of motion standpoint, strength standpoint, most importantly, symptoms, pain, swelling, stiffness, all those things, um, etc., you might be able to work with a performance and strength and conditioning coach, maybe a personal trainer, but they can't just be random people.
• 14:45
  SPEAKER_00: Just because they know fitness doesn't mean that they know how to help you get back from said injury or kind of a little bit further along with it, and there's a still a big gap to address, they need to have experience working with rehabbing athletes.
• 15:00
  SPEAKER_00: It's very important that you know that and they're not just some personal trainer or some performance coach.
• 15:06
  SPEAKER_00: And to be completely honest, these professionals can take over a little bit earlier than we think.
• 15:12
  SPEAKER_00: Because at the end of the day, after we get out of the post-op rehab phases, really, this is just good strength and conditioning.
• 15:19
  SPEAKER_00: It's just scaled to the athlete's abilities at that current time point.
• 15:23
  SPEAKER_00: That's all that we do at the ESO athlete.
• 15:25
  SPEAKER_00: We provide rehab, sure, and navigate symptoms and all these other pieces, especially in these very sensitive situations or acute situations.
• 15:34
  SPEAKER_00: But a lot of times we're just giving scaled strength and conditioning that is very specific to you, guided to get you back to the specific thing and broken up into these different checkpoints that we have criteria for.
• 15:48
  SPEAKER_00: And that's the way that this can look.
• 15:49
  SPEAKER_00: And a strength and conditioning coach can actually step in a little bit earlier than we think, as long as they have the experience.
• 15:56
  SPEAKER_00: I've got many, many good friends in the Atlanta area who I will refer athletes to given the particular circumstance or maybe even the area that they live in.
• 16:06
  SPEAKER_00: Plus, in most situations, if you are looking at an out-of-network physical therapy clinic or you're looking at some of the different options in terms of uh strength and conditioning or performance, it will likely be cheaper to go the performance and strength and conditioning route if you're talking about finances, just because you're not stepping into this kind of medical type entity that can charge a little bit of a surplus for it.
• 16:30
  SPEAKER_00: So then, therefore, this is an option that can exist.
• 16:32
  SPEAKER_00: This is a huge one, in my opinion.
• 16:34
  SPEAKER_00: And I think one of the best ways to continue getting what you need with a qualified professional, especially for ACLers who are far enough out with minimal symptoms.
• 16:45
  SPEAKER_00: There has to be the caveats here because you can't just go jump ship.
• 16:49
  SPEAKER_00: And the other thing that has to happen is that the person you're working with has to be vetted with this experience.
• 16:56
  SPEAKER_00: The beautiful combination of a physical therapist and a strength and conditioning coach, which is who we all are at, the ACL athlete, they can take you from literally post-injury all the way to return to sport and performance.
• 17:09
  SPEAKER_00: If they can literally surf that whole entire process and be able to take you from start to finish, that's amazing because they can see the whole thing through if that works out.
• 17:17
  SPEAKER_00: But with that said, with most physical therapists, we don't learn this in school, as I said.
• 17:23
  SPEAKER_00: So this is something that you have to pursue outside of this, especially the strength and conditioning side of things, because it's just not something that is in our curriculum, as I had mentioned.
• 17:33
  SPEAKER_00: So then therefore, you got to know what those limits are and then know, okay, is this enough at a point?
• 17:39
  SPEAKER_00: And this is something to talk with your physical therapist about, is making sure that you can be at a good enough place to start working with a strength and conditioning coach, a performance coach, personal trainer, whoever that is involved in this process or you want to have involved in this process.
• 17:57
  SPEAKER_00: And we have plenty of athletes in person and remote who continue to do this in conjunction with working with us, or maybe it was just kind of that time point where we wanted to kind of get them with that person, and that's who's kind of steering the ship at that point because they're set up well enough.
• 18:14
  SPEAKER_00: Lots of options exist, right?
• 18:17
  SPEAKER_00: Next up is finding options online.
• 18:22
  SPEAKER_00: There's some apps and programs where people do a template and anyone can joy at a low cost, not naming any names here, but I think people here can get focused on the price versus what it actually is, right?
• 18:36
  SPEAKER_00: Or maybe it's just a good marketing situation where it's like it'll solve all the problems, right?
• 18:41
  SPEAKER_00: And so it's general and what's given is given to everyone, right?
• 18:45
  SPEAKER_00: There it's not individualized.
• 18:47
  SPEAKER_00: And while it can help with a very particular subset of this population, and I'm not just talking about one program or one group, there's plenty that exist out there.
• 18:57
  SPEAKER_00: I'm sure some of you can think of some of these.
• 18:59
  SPEAKER_00: But with that said, it can be helpful for a very small subset of this population, but most ACLers can't do a general template program.
• 19:11
  SPEAKER_00: They can't.
• 19:12
  SPEAKER_00: It doesn't address specific needs.
• 19:14
  SPEAKER_00: Usually it's not with a rehab-oriented background.
• 19:17
  SPEAKER_00: And if that was the case, we would solve all of ACL rehab problems with these general templated programs, and everyone would get them, they would be fine, they would go on and go back to sport and do fine, and we wouldn't have these re-injury rates where they are right now, where you can read anywhere from 20 to 40 percent of re-injury risk after tearing your ACL and then trying to get back to sport, right?
• 19:42
  SPEAKER_00: So this is something that we have to consider with this because a general templator program is gonna make it really tough to make it individualized to you because of the uniqueness of this journey, right?
• 19:55
  SPEAKER_00: From the type of injury itself, did you have just isolated ACL?
• 20:00
  SPEAKER_00: Was your medial meniscus impacted?
• 20:02
  SPEAKER_00: Was lateral meniscus impacted?
• 20:04
  SPEAKER_00: Was your MCL, PCL, LCL?
• 20:06
  SPEAKER_00: Was there a bone fracture?
• 20:09
  SPEAKER_00: Did you have an LET combined with your procedure?
• 20:12
  SPEAKER_00: Did you have a bone bruise?
• 20:14
  SPEAKER_00: Did you have some sort of cartilage lesion?
• 20:17
  SPEAKER_00: Did you have an MPFL reconstruction with it?
• 20:20
  SPEAKER_00: There are a number of things you probably are like, what the heck is all this?
• 20:24
  SPEAKER_00: But when you line up 20 ACLs that have ACL injuries, there's usually concomitant injuries that come along with it, right?
• 20:32
  SPEAKER_00: And so then therefore that could impact the rehab and also not only the early phases, but even the middle to late phases.
• 20:39
  SPEAKER_00: The graph type itself can make such a huge difference because of graph site morbidity and also weakness of where that graph was taken.
• 20:47
  SPEAKER_00: Was it the hamstring, was it the quad?
• 20:49
  SPEAKER_00: Was it patellar tendon?
• 20:50
  SPEAKER_00: Was it an allograft?
• 20:51
  SPEAKER_00: Those are all things that are gonna play into this process.
• 20:55
  SPEAKER_00: And while you think an allograph might be like, well, they didn't take it from anywhere.
• 20:58
  SPEAKER_00: Well, guess what?
• 20:59
  SPEAKER_00: We got to slow you down because you're gonna probably be feeling better than you think you will.
• 21:03
  SPEAKER_00: And so then therefore, you're gonna take risks and we got to slow you down.
• 21:08
  SPEAKER_00: And it's also not tissue from your own body, so we got to make sure that thing turns into a ligament.
• 21:13
  SPEAKER_00: So we might need to delay compared to allowing you to go back at nine months.
• 21:17
  SPEAKER_00: Maybe it's a 12-month process, and it depends on your sport too.
• 21:21
  SPEAKER_00: Symptoms play a huge role, and most importantly, the athlete's goals.
• 21:25
  SPEAKER_00: It's hard to be targeted when it's general, and it doesn't assess for your gaps and limitations along the way.
• 21:33
  SPEAKER_00: It's just really hard to do that.
• 21:35
  SPEAKER_00: So, low-cost programs, I would be hesitant, um, especially if it's just uh blanketly applied to everyone.
• 21:42
  SPEAKER_00: If there are ways to assess and be able to go on a particular path based on the deficits you have and things that you are experiencing in this process, then that's something that maybe can work and maybe with technology as we go can be better and better.
• 21:58
  SPEAKER_00: But as we currently stand with technology, we are not at a place where a general program is so independent to a point where it can just automatically make it individualized to you.
• 22:10
  SPEAKER_00: And so then that's the trade-off, right?
• 22:12
  SPEAKER_00: General program, low cost, less specific, doesn't really address the issues that you're having.
• 22:17
  SPEAKER_00: So that's an online option that I know a lot of people will kind of lean towards.
• 22:23
  SPEAKER_00: And again, it's coming back to pricing, and it can come back also to maybe the marketing of saying it solves all these problems.
• 22:29
  SPEAKER_00: When in reality, it was probably just that right person who stepped into the program.
• 22:35
  SPEAKER_00: Maybe they did have good rehab early on and they just needed these particular areas addressed, and it addressed it for them, and they got back to the thing.
• 22:43
  SPEAKER_00: Maybe there were genetics that also played a good role into any program being something that they would have probably done pretty fine with.
• 22:51
  SPEAKER_00: So there are all these kind of caveats with these types of programs because I really do think a subset of the subset of these ACL injuries can work with these things, but it's still such a low percentage because it's not individualized.
• 23:05
  SPEAKER_00: And then this leads me to this point of individualization of rehab.
• 23:11
  SPEAKER_00: Of course, there's in-person options, but I also want to share the online or the remote option that exists.
• 23:18
  SPEAKER_00: And look, I'm not here to sell you anything.
• 23:20
  SPEAKER_00: Do we do remote coaching for athletes?
• 23:23
  SPEAKER_00: Sure, we do.
• 23:24
  SPEAKER_00: But there's a lot of awesome, qualified people who are doing incredible work in the ACL space.
• 23:32
  SPEAKER_00: So I'm not here to just say like work with us and work with us only.
• 23:35
  SPEAKER_00: Explore your options, find the right flavor for you, just find good care.
• 23:39
  SPEAKER_00: That's all that we literally care about.
• 23:41
  SPEAKER_00: So there's lots who claim who also think they know, but they don't.
• 23:46
  SPEAKER_00: And that's where you have to vet the person, the company.
• 23:50
  SPEAKER_00: We at the ACL athlete, we're open door.
• 23:52
  SPEAKER_00: Ask any questions, see our reviews, our athletes' experiences, and we will tell you if you're a good fit.
• 23:58
  SPEAKER_00: We'll also tell you if you're not a good fit.
• 24:01
  SPEAKER_00: And so this is something that has to have transparency.
• 24:04
  SPEAKER_00: Because we can't leave this ASL process up to chance.
• 24:07
  SPEAKER_00: The point here is that geography doesn't have to limit you.
• 24:11
  SPEAKER_00: You can get individualized one-on-one ACL rehab from anywhere in the world at this point.
• 24:17
  SPEAKER_00: Technology can make this happen.
• 24:19
  SPEAKER_00: With this, should come at the minimum is testing, a clear and structured plan and program that is continuously updated, not just a set and forget it type thing, and support and guidance along the way.
• 24:32
  SPEAKER_00: These are our three important pillars of the process for any ACL or we work with.
• 24:38
  SPEAKER_00: This should be catered to you based on your schedule, time, equipment, et cetera.
• 24:43
  SPEAKER_00: Now, how this model is done will be based on who you're working with, but hopefully they should have the process dialed in enough and be able to explain how that works with you.
• 24:53
  SPEAKER_00: Some have calls, some don't.
• 24:55
  SPEAKER_00: But this is up to you to decide what it is you're looking for and also be open to potentially other ways that this can look besides what you had planned, right?
• 25:05
  SPEAKER_00: Because if they have worked with certain people, then hopefully that they have filtered this enough to be able to make sure you're the right fit and if they propose it.
• 25:14
  SPEAKER_00: And then also being adaptable to that as long as it works for you and you have enough independence with that.
• 25:20
  SPEAKER_00: But if you need someone alongside you and in person, then that might look a little different, right?
• 25:26
  SPEAKER_00: But the investment here is usually much cheaper than any in-person option when you compare that to what you get and the total, especially for at a network services.
• 25:37
  SPEAKER_00: You can even combine these remote options.
• 25:41
  SPEAKER_00: So we have athletes, for example, that will also have some in-person services, whether it's uh prehab, post op, whatever that looks like in this process.
• 25:51
  SPEAKER_00: Maybe they're still going to a physical therapist in person and they like that, but they don't feel that it's like as specific, or they want someone who's a little bit more of an expert in this process.
• 26:01
  SPEAKER_00: And so then therefore they want to work with us online, or maybe they work with somebody else, and they are also having in-person support when that's needed.
• 26:10
  SPEAKER_00: And that can look a bunch of different ways.
• 26:13
  SPEAKER_00: And for us, we have a portion of our ACLers who do love doing that.
• 26:16
  SPEAKER_00: And it's awesome because then it's just this team synergy.
• 26:19
  SPEAKER_00: They get these in-person aspects and then they also get the remote aspects.
• 26:23
  SPEAKER_00: But there's also people who are just like, it's not even worth the time.
• 26:26
  SPEAKER_00: So then, therefore, they just kind of do it on their own and having us guide this process remotely.
• 26:32
  SPEAKER_00: So, whether the in-person pieces are testing, it could be for check-ins or maybe even soft tissue work, those are things that can be also combined with some of these remote-based services, because then therefore you get the best of both worlds if that's something that's important to you.
• 26:49
  SPEAKER_00: But it's not required if you're working with a good professional and team.
• 26:53
  SPEAKER_00: We've had so many people, hundreds of ACLers, work with us and literally go through this process without working with a single person in person.
• 27:02
  SPEAKER_00: Seriously.
• 27:03
  SPEAKER_00: So the thing is that you just got to make sure you kind of fall into this right category that this will work for.
• 27:09
  SPEAKER_00: Cause if we have someone who's never been familiar with their body and they're 12 years old, probably not gonna work.
• 27:16
  SPEAKER_00: So this is something that does work for a very wide net of athletes.
• 27:21
  SPEAKER_00: We've got youth athletes who have maybe trainers involved or physical therapists involved, or their parents are more involved, all the way to you know, CrossFit athletes, to skiers, to BJJ athletes, um, people all over the world.
• 27:35
  SPEAKER_00: And this is very possible with technology and is something that you can do with anyone who you vet who is potentially a good fit for you.
• 27:45
  SPEAKER_00: And so the last thing I want to mention here is your other option, or what many people do because they either don't know where to start, have been misguided, thinking they're cleared or should be good to go.
• 27:57
  SPEAKER_00: And of course, the financial aspect plays into this and it makes it tough whether they want to invest in it, or maybe it's too expensive, or maybe they think they should be at a certain point, so it doesn't make sense to invest financially, right?
• 28:11
  SPEAKER_00: And so then here's your other option YouTube, Instagram, Google, etc.
• 28:16
  SPEAKER_00: The number of calls I've had where people are like, I'm just piecing things together, I've seen it's absolutely wild to me.
• 28:24
  SPEAKER_00: So imagine this you're building a house, and then the builder pulls out 40% of the way and says, Hey, you got this.
• 28:32
  SPEAKER_00: What's next?
• 28:33
  SPEAKER_00: What do you do?
• 28:34
  SPEAKER_00: You start trying to you know finish the rest, but you're not sure the proper steps, the order of operations.
• 28:40
  SPEAKER_00: I mean, if the house is up to code, what kind of like equipment?
• 28:44
  SPEAKER_00: I mean, how the heck do they even get to the second level without falling through?
• 28:48
  SPEAKER_00: Seriously.
• 28:48
  SPEAKER_00: Like I watching people build buildings and homes, I'm just like, man, they put that up so quick, and then you know, it's just like this very systematic process.
• 28:58
  SPEAKER_00: And I would know we've been doing it for years and decades and centuries and all the things, but the thing is, is like we still rely on the builder to help guide us, right?
• 29:06
  SPEAKER_00: The the construction management worker, the engineers, everyone who is involved, the architects to be able to help us to design these things and guide us through this blueprint and this process, right?
• 29:19
  SPEAKER_00: And there's always pivots that can happen, even with the housing type delays, right?
• 29:25
  SPEAKER_00: That's something that's pretty normal.
• 29:27
  SPEAKER_00: My parents, for example, they are looking to get a house, and the the builder says, okay, well, this is what we can kind of expect from a time standpoint, but there's no set specific date.
• 29:39
  SPEAKER_00: And that's because they can't control some of these other uncontrollables in their process.
• 29:44
  SPEAKER_00: And so then, with that said, this is something that is just a part of this process.
• 29:49
  SPEAKER_00: So I'm just giving you an example of like how this can feel, especially for people who get cut short or been told they graduated, but they're only four months in.
• 29:59
  SPEAKER_00: I don't care who you are, no one at four months, and Adrian Peterson might be the only anomaly here, is not going to be able to get back to full speed after an ACL injury.
• 30:08
  SPEAKER_00: No one.
• 30:09
  SPEAKER_00: And so this is the thing that we have to consider if you find yourself in this category, but it's crazy because this is the kind of thing it really does feel like you're left to kind of build the rest of the house, but you really don't know how to.
• 30:25
  SPEAKER_00: So then you start going down the Instagram rabbit hole, checking out people who may be specific in ACL and piecing together exercises that they post.
• 30:35
  SPEAKER_00: You've got the previous exercises from your physical therapist or physio, you've got YouTube, so you start piecing all these things together, but then you're starting to be like, well, what do I know that's important?
• 30:45
  SPEAKER_00: Oh, that's a cool exercise.
• 30:46
  SPEAKER_00: Let me add that on there, right?
• 30:48
  SPEAKER_00: I literally just talked to an athlete recently where she was like, I've had two ACLs.
• 30:53
  SPEAKER_00: Um, I'm kind of dealing with problems on both.
• 30:56
  SPEAKER_00: And she's fresher on one side, and she's like, I've just been kind of piecing things together here or there.
• 31:02
  SPEAKER_00: And so then I was like, How do you know where to aim, like what to do?
• 31:06
  SPEAKER_00: And she's like, honestly, I really don't.
• 31:08
  SPEAKER_00: She's like, I just find a cool exercise, I put it on there, and then she's also complaining of pain and all these limitations.
• 31:14
  SPEAKER_00: And I'm like, it's because we just gotta have someone who knows this stuff and is dialed in, literally.
• 31:20
  SPEAKER_00: So I encourage you to explore these options that I've provided for you.
• 31:26
  SPEAKER_00: Don't be the person who just stops and do not be the person who's just scouring Facebook groups, YouTube, Instagram, Reddit.
• 31:36
  SPEAKER_00: Sure, there are places where you can kind of find community and communicate with people.
• 31:40
  SPEAKER_00: Great, go for it.
• 31:41
  SPEAKER_00: But just be careful because I'm warning you of the thing that is this misnomer that makes you feel like you're doing something, but in reality, you're basically just driving down a different path that's not getting you to the destination you want to go.
• 31:54
  SPEAKER_00: You feel like you're doing something, you're driving your car, but you're trying to go north.
• 31:59
  SPEAKER_00: And the thing is, your own kind of doings is leading you west.
• 32:03
  SPEAKER_00: So you're just going to a completely wrong destination.
• 32:06
  SPEAKER_00: So, this is something that I want you to kind of like be able to audit and reflect on, especially as you run out of options, because you need to explore what those options look like and what are the reliable ones that you can lean on.
• 32:18
  SPEAKER_00: So, start with who you think can get you to your goals.
• 32:22
  SPEAKER_00: That's the main number one thing.
• 32:25
  SPEAKER_00: And who you can trust.
• 32:26
  SPEAKER_00: Seriously.
• 32:27
  SPEAKER_00: There's so many people out there doing good work, as I had mentioned.
• 32:30
  SPEAKER_00: So find someone that you can trust that is reliable, that you know in their soul that they want you to get back to the thing, and that they are doing everything they can to help guide you to do that.
• 32:45
  SPEAKER_00: And then make sure that there's a clear plan and a roadmap.
• 32:48
  SPEAKER_00: There's structure to it, where they have the experience, they have the numbers, not just I've seen this X number of ACLs.
• 32:55
  SPEAKER_00: Like, see what the outcomes are like.
• 32:57
  SPEAKER_00: Like, see if there's any testimonials, any type of social proof to help vet and back up what they are saying with their experience, right?
• 33:05
  SPEAKER_00: Where it works for you and your lifestyle, where it falls in line with finances, even if it stretches you.
• 33:11
  SPEAKER_00: And this is the one thing that I am going to really push on you guys because this is usually the biggest hurdle people have.
• 33:17
  SPEAKER_00: And I get it.
• 33:18
  SPEAKER_00: I remember I had a$10,000 out-of-pocket max as a college senior, having an ACL surgery with literally no financial help, working my own job outside of my brother helping with booking the surgery.
• 33:31
  SPEAKER_00: That's it.
• 33:32
  SPEAKER_00: It's an investment, not a cost.
• 33:34
  SPEAKER_00: Your iPhone, new clothes, computer, eating out, going to events, these are all costs.
• 33:40
  SPEAKER_00: These are just wants.
• 33:41
  SPEAKER_00: They're not needs.
• 33:42
  SPEAKER_00: Your health is an investment.
• 33:44
  SPEAKER_00: And I'm not saying don't do those things.
• 33:46
  SPEAKER_00: Do those things.
• 33:46
  SPEAKER_00: Live it up, do life, enjoy those things, but find a sweet spot of that give and take.
• 33:53
  SPEAKER_00: I promise you, I promise you that the investment with the right person or group will be more than worth it in its weight when you're not anxious about your plan, can't do the things that you love because of pain or lacking strength, and most importantly, getting you back to what you love most, seriously.
• 34:12
  SPEAKER_00: And it fires you up as a human.
• 34:14
  SPEAKER_00: You can move, you can use your body without fear.
• 34:17
  SPEAKER_00: That's freaking worth it, man.
• 34:18
  SPEAKER_00: It's so, so worth it.
• 34:20
  SPEAKER_00: So take that step back, audit your process.
• 34:23
  SPEAKER_00: Lots of options exist.
• 34:25
  SPEAKER_00: And I wanted to lay these all out for you.
• 34:27
  SPEAKER_00: I'm not saying one's right over the other because it's different for each and every single ACL or and their situation.
• 34:34
  SPEAKER_00: The context is so, so important.
• 34:36
  SPEAKER_00: And for you, it you might say, like, this is not right right now, but maybe it is in three months, right?
• 34:42
  SPEAKER_00: And so the thing is, is like, don't think that this is something that's gonna cover you through this whole process unless you're just one of these minority of minorities.
• 34:50
  SPEAKER_00: So think about this as also in certain seasons and phases of life where maybe this worked for that period of time, but maybe now it's time to kind of close that and be able to step into this new option that I think is gonna set me up for success.
• 35:04
  SPEAKER_00: So that's why we have to reflect and make sure that we can audit this process.
• 35:10
  SPEAKER_00: The other thing that I'm going to say and say very clearly is don't blindly trust and assume your insurance or healthcare system will get you all the way there.
• 35:21
  SPEAKER_00: If you go into it knowing it won't, then you're already ahead of most people and you can start planning.
• 35:28
  SPEAKER_00: Whether that's in-person options, remote options, geography is literally no longer a limit with technology, and we've helped hundreds of ACLers all over the world, from the US to UK, South America to countries like India, Indonesia, and Australia.
• 35:46
  SPEAKER_00: Literally all over the world.
• 35:47
  SPEAKER_00: Technology can do that now, and it couldn't before, but it can now.
• 35:52
  SPEAKER_00: So don't limit yourself to what geography is unless you really feel like you are one of those people in that category that really needs in-person support.
• 36:03
  SPEAKER_00: But to be completely honest, it's only maybe 25% of the actual total ACL population because of different factors like maybe age or experience with movement of their body or the complexity of the injury.
• 36:17
  SPEAKER_00: But I would say majority of people can work with this in some capacity.
• 36:22
  SPEAKER_00: So don't count it out, even though you're like, ah, I don't know, they can't like move my knee and do all this stuff.
• 36:27
  SPEAKER_00: You know, if your physical therapist is really doing a lot of manual work, or if they are, you know, kind of touching your knee and moving your body around for a lot of the sessions or for a very long period of time, I would almost question like how much they are doing that is effective, because majority of the process should be mostly you doing the stuff, you being guided with this and you being taught how to do some of this stuff.
• 36:52
  SPEAKER_00: And it works with plenty of ACLers, as I have mentioned.
• 36:55
  SPEAKER_00: And so this is something that can be effective for you.
• 36:58
  SPEAKER_00: So don't limit yourself on this.
• 37:00
  SPEAKER_00: And if you're listening to this, knowing it will run out, your insurance, your coverage, whatever that is, and it more than likely will, just expect that.
• 37:09
  SPEAKER_00: What's next for you?
• 37:10
  SPEAKER_00: Don't be reactive, be proactive, and have a plan in place so it can be seamless.
• 37:16
  SPEAKER_00: Seriously, it will literally be the best thing, and you'll look back and be like, man, that was so clutch, and I'm so glad I did that.
• 37:25
  SPEAKER_00: Just make sure there's testing, reliable and valid testing to measure your strength, your range of motion, your power ability, your jumping abilities, how you can cut different angles and positions.
• 37:37
  SPEAKER_00: But make sure there's testing to understand where you're at, a baseline, checkpoints along the way, making sure you're ready to do the thing based on what the current research and science has shown us, right?
• 37:48
  SPEAKER_00: Make sure there's planning and structure and individualized programming.
• 37:52
  SPEAKER_00: You have a long-term plan, you know what that roadmap looks like, and you also know short term what you're aiming towards.
• 37:58
  SPEAKER_00: What do those numbers look like?
• 38:00
  SPEAKER_00: What is the structure of the day in and day out of what you need to be doing, whether you're going to see someone in person, whether it's remote or combined, right?
• 38:08
  SPEAKER_00: You need to have that structure because more than likely that in-person even is not fulfilling everything that's needed, and you got to do stuff outside of that, right?
• 38:17
  SPEAKER_00: You might have changes in your schedule where you got to be on your own to do that.
• 38:21
  SPEAKER_00: And so much of my ACL rehab process on both knees, even as a high schooler and a college student, there's so much I had to do on my own.
• 38:29
  SPEAKER_00: Go in the gym, do my own workouts, being able to build, and that is something that I had to know and had to make sure that I planned accordingly too.
• 38:39
  SPEAKER_00: And sometimes it wasn't great because I wasn't guided very well, and sometimes it was very helpful because I did have that guidance in certain parts of it.
• 38:47
  SPEAKER_00: So make sure you have structure and you have an individualized program, not a general program, not a protocol or a template.
• 38:54
  SPEAKER_00: This is something that is individualized to you based on the deficits that should be addressed based on your testing.
• 39:00
  SPEAKER_00: And then therefore, you should also have as the third piece that I mentioned, and most important, having an ACL expert in your corner to support and guide you.
• 39:10
  SPEAKER_00: Before I was like, maybe you can kind of get away with a generalist or someone who's seen some ACLs here or there.
• 39:16
  SPEAKER_00: The more and more I'm in this space, the more and more I'm like, you gotta have someone who knows ACLs, man.
• 39:21
  SPEAKER_00: And you gotta know that they work with them, they have good outcomes, they've seen a variety of cases, variety of graph types, and they are dialed into this rehab process and are alongside you.
• 39:34
  SPEAKER_00: And they have that in their repertoire.
• 39:37
  SPEAKER_00: They can navigate all the tough situations, be able to have a good conversation with you in the good times and in the bad times.
• 39:44
  SPEAKER_00: There's so many hard conversations that I've had to have with athletes in a number of different ways.
• 39:49
  SPEAKER_00: Our team talks about this all the time.
• 39:50
  SPEAKER_00: Communication is so key.
• 39:52
  SPEAKER_00: And making sure our athletes are supported and guided, just like that GPS man.
• 39:57
  SPEAKER_00: You get in your car, you turn on that GPS, and you're like, all right, I got to get to X destination.
• 40:02
  SPEAKER_00: We've got these three different routes.
• 40:04
  SPEAKER_00: It accounts for the time, it accounts for the scenic route, it accounts for maybe some pit stops along the way.
• 40:10
  SPEAKER_00: That is your physical therapist, your coach, your ACL expert.
• 40:14
  SPEAKER_00: You're in the car driving.
• 40:15
  SPEAKER_00: We're not gonna do the exercises for you, but we are gonna give you every single thing possible for you to get to that destination that you need to get to.
• 40:24
  SPEAKER_00: And so that's what's gonna be so key because it's gonna be more calibrated and fine-tuned, and you're gonna probably have an easier process in all reality if you have someone who is an expert in ACLs.
• 40:37
  SPEAKER_00: So, this is something that I want to encourage you guys to audit and look at and make sure that they have at least these three pillars and can speak to these three pillars, and make sure that this is the person who is right for you.
• 40:50
  SPEAKER_00: It's gonna take that auditing and in all honesty, knowing that it's probably gonna take some investing, but I promise you it is very well worth it from the anxiety, the mental health to the plan and knowing that there is somewhere that you are heading, there's direction, there's light at the end of the tunnel, and you've got someone that you really trust to help kind of get you there.
• 41:14
  SPEAKER_00: That's gonna be really key.
• 41:15
  SPEAKER_00: And so these are options for you guys.
• 41:18
  SPEAKER_00: If you are at this point of running out of insurance, maybe you've been in this world where your healthcare coverage hasn't been helpful, or maybe you're just getting started and you've got all the things at your disposal.
• 41:31
  SPEAKER_00: Start planning now and have a plan A, plan B, plan C, heck, even have a plan D.
• 41:37
  SPEAKER_00: Just see how that looks, explore those options and see what's the right fit, right?
• 41:43
  SPEAKER_00: Find what's the right fit, be flexible, be willing to invest because it's investing in your health.
• 41:49
  SPEAKER_00: It's not some cost that you're just like, ah, like that wasn't worth it.
• 41:53
  SPEAKER_00: If it's the right fit and they can get you to that end goal, I promise it will be worth it.
• 42:00
  SPEAKER_00: And I'm gonna be really honest here.
• 42:01
  SPEAKER_00: I wasn't expecting this episode to go so long based on what I had planned out, but I was just on some random tears and some things I wanted to talk about.
• 42:12
  SPEAKER_00: So I apologize.
• 42:13
  SPEAKER_00: I was trying to make this literally such an even spread, part one and part two, but it was part two heavy because we were getting into the meat and potatoes of it.
• 42:22
  SPEAKER_00: But I hope that this was helpful, team.
• 42:24
  SPEAKER_00: If you have any questions about this, if you're in this situation and you're like, hey, I need some help, can I just talk to somebody or do you have any recommendations?
• 42:32
  SPEAKER_00: Literally send me a message, email, whatever it is to be able to help you in this process.
• 42:37
  SPEAKER_00: That's what we care about most.
• 42:39
  SPEAKER_00: We do not care if you work with us, of course, we'd love it, but at the same time, we just care about you getting really, really good guidance.
• 42:46
  SPEAKER_00: And for the people who choose not to work with us, that's the thing that I stress to them.
• 42:50
  SPEAKER_00: It's like just make sure that you have these three things and you find someone to help you navigate this process.
• 42:57
  SPEAKER_00: And most importantly, do not do it on your own.
• 43:01
  SPEAKER_00: If you are someone who has a loved one and were faced with the same challenge, would you tell them to do it on their own?
• 43:08
  SPEAKER_00: Would you tell them to invest?
• 43:10
  SPEAKER_00: If you were building a house and you had a builder alongside of it and they are 40% in and then they back out, or they just are like, sorry, the job's done on what I can do because of what's being paid for, what would you say?
• 43:25
  SPEAKER_00: You'd be like, Would you build the house?
• 43:27
  SPEAKER_00: Would you keep building it?
• 43:28
  SPEAKER_00: Probably not.
• 43:29
  SPEAKER_00: You'd find someone else who is qualified and will do the job.
• 43:33
  SPEAKER_00: Also for a house that you're gonna live in, right?
• 43:35
  SPEAKER_00: So you're gonna make sure everything's up to code, up to the standards, and this is no different here.
• 43:41
  SPEAKER_00: So I hope that this was helpful, guys.
• 43:43
  SPEAKER_00: If you need anything, we are here at the ACL Athlete.
• 43:46
  SPEAKER_00: Until next time, this is your host, Robbie Patel, signing off.