As part of our own Jonathan Garber’s webcast series, he continues to interview leaders in the community who share tips and strategies to help us all Thrive during the Coronavirus shutdown. Today, Jonathan is joined by Charles Maurice of the TSI Group. They discuss using your health insurance benefits during the COVID shutdown. What voluntary benefits are and how the insurance landscape is changing.
If you’re a leader and want to share your knowledge with the market, email Jonathan at [email protected]
Good morning, everybody. It’s welcome back to my daily webcast. It’s actually going to be three times a week, but I’m still calling it a daily webcast. That’s false advertising. But this is Jonathan Garber with flying chant media and I’m reaching out to leaders in the community to ask them for their best ideas on how we cannot just survive during the coronavirus crisis and shut down, but how we can truly Thrive and we are still looking to our best lives over for ourselves and for our family. So, I have a terrific guest today Charles Morris from the TSI group. That’s tomorrow’s solution Insurance group that I get that we certainly did Sir. All right, so Charles from the TSI group Charles Morris and Charles. Tell us a little bit about yourself and TSI group. Hey, sis. Well, thanks very much Jon nice to see you. You’re looking good and healthy. Hopefully everybody in the family is too. Yes. Thank God. I work for a company called TSI. We are a supplemental or voluntary benefits insurance company. We’ve been doing this for 20 years, we started when the industry was in its infancy. And now that there are large numbers of companies in the state offering these benefits. We are at the Forefront of not only providing benefits but doing something that very few agencies do which is personalize the plans so that they match with health insurance which would make sense. It’s as opposed to just throwing product out there. But also, we brought technology in, so we’ve invested in our clients. So, we have a software that will not only give information to our clients within 10 seconds. That will also do something completely unique in the industry where we can help our clients file claims in about 10 seconds. So, everything is prefilled we guarantee that the claim forms of the correct flame forms. There is an algorithm inside the system that will help calculate the amount of your claim. So, if you’re not getting paid enough, it comes back and gets you so it’s the next level I would say we are the cutting-edge state-of-the-art and that’s what’s really makes us different from everybody else cool. So that’s something for people to explore but I wanted to talk to you about some kind of economic questions and you’d be my first guess to really get into the economics of what’s going on. I think we are all acutely aware of the economics of the shut down the service industry people losing their jobs certainly temporarily or permanently. Who knows? I’m sure many restaurants and service type Industries will not open again. And so, I’m plugged into that. I think we see that what I’m concerned about and I’ll make it personal for example is let’s say for example, I got Coronavirus. Maybe I would fight it be just fine relatively young for a risk factor. Okay, but if I have to go to the hospital, even for one day just for isolation and observation waiting for test results, and then they give me prescriptions. For example, these are not generic drugs that are seven bucks at the drugstore. These are hydroxychloroquine. No, there’s none of this as generic as he back at who pays for that. Is there a federal program that’s paying people in those sorts of really are they giving you those drugs for free? Okay, so there are predominantly three types of people today in today’s health insurance World. There are the folks who have Private health insurance may be from an employer or the health insurance company people who are covered by a state program like Medicaid. Medicare for the elderly people who are retired and then there the folks who have no insurance at all. And they kind of dealt with in slightly different ways. But at the end of the day it is still a bill that somebody is responsible for should they get hospitalized? So, let’s start if I may with what we like to talk about exposure. So, I often ask people watch your exposure. They look at me blankly deer in the headlights and go huh, I go if you had to spend a night in a hospital, how much would it cost you out pocket? And most of them go I have absolutely no idea but a lot of them have a clue that it’s going to be money. So today the average overnight cost out of pocket as somewhere between a thousand two three and a half to four thousand dollars and that’s from health insurance and we’re going to sort of focus more on the private side because if you’re on Medicare most people on Medicare have a good idea of what their coverage and their exposure is and they have Medicare supplement plans and Medicare Advantage plans things. Believe it or not. The older you get in many cases the much more informed you get because they have to deal with there’s a surprise, right? Especially when you’re on fixed incomes. Sure. There are then the people who have no coverage at all and that is a big risk because if you have no coverage and you get a bill from a hospital, that’s your bill. That’s it. You can negotiate with the hospital but that is your bill for everybody else who has some level of insurance. – well works is that the insurance company has already got what they call pre-negotiated rates with providers. So, you go to a hospital in you have a bill for $25,000 if you have insurance the insurance company comes along as okay. Well, that’s great. But I negotiated rate is 13,000. Whatever. The number is 12,000 15,000. So, you’ve gone from 25 no insurance to maybe 12 13 through the insurance company and then the insurance going desire you are. Mobile for like your deductible. So, you’re in the hospital overnight on my insurance. It’s three and a half thousand dollars for an overnight stay in the hospital and a maximum of sixty-five hundred dollars out of pocket for the year. Assuming that everything that is provided to me as provided in network and kind like a little 101 on medical terms in that work is your insurance company says everything that you get is provided by some got of me a that we’ve relationship with if they don’t have a relationship and it’s out of network and the fees for that a generally little bit higher but let’s stick with that. We’re getting into railroad. Yeah. So, let’s stick with the idea of this deductible pretty much most plants have what they call a hospital deductible and overnight. So, if you get hospitalized for whatever reason I mean, and this is what people seem to be ignoring at the moment. Many things that can put you in a hospital not just covid-19, you know, a lot people finish up in hospital and this time with you because of flu. I mean there are lots of other flus out. We have friend who’s just finished up in the hospital because of their pain, you know, there are lots of reasons you can finish up in a hospital not just the current virus concern. So, when you go there in many cases what’s going to happen is the hospital will get your insurance details. They will then send the bill to your hospital provide your insurance provider. The provider will come back and say okay. This is the bill. This is how much we’re going to pay. This is the responsibility of the patient and then they’re going to send you a bill. And that bill is going to be in line with whatever your exposure is. So, my case one light in the hospital would be three and a half thousand dollars. It’s up to me then. How am I going to pay for that? So, there are a couple of ways you can pay it. The first one is you have the cash. I don’t know that many people who have a bank account that says here’s the money. I have set aside in case I finish up in the hospital overnight or his my out of pocket deductible for a year, which is usually a much bigger chunk of money or you know, God forbid as what happened to me ten years ago. I finished up in diagnosed with colon cancer. Completely healthy now. Thank goodness, but I was diagnosing the week before Thanksgiving. So, I had section I was in hospital about ten days before the week before Thanksgiving and afterwards had some surgery weren’t home and then the following year started treatment, so I didn’t just have out of pocket deductibles for one year. I had to nobody thinks about that. Right my out-of-pocket deductibles $6,500 and because of various billing issues and in that work out of network, I finished up with two years $9,000. Our maximum out-of-pocket bills. I was like, oh my God, where did they come from? Don’t get me wrong absolutely delighted to be alive, you know, thank God for the medical community and my insurance I got great care, but I still finished up with this whole of my exposure of $18,000 that I had absolutely no concept as to how I going have it or how to deal and with it that can be for a lot of things including you mentioned the prescriptions, you know. Talk about cost prescriptions and specialized prescriptions again, you know, the insurance company is going to say this is what you’re going to be responsible for. This is what we’re going to pay and the end of the day, it could be either a drug. They don’t even cover. Which you know, you may say I need it to survive and which case you’re probably going to get it and try and pay for it somehow or you can appeal to the insurance company and maybe they’ll give you some kind of help or not. But those Wheels turn very slowly. Yes, they do. So, at the end of the day the responsibility is your responsibility. How do you pay for that? So, in the old days lot of the hospitals would deal with you directly and say Hey, you know, how much can you afford to give me? And if you really have nothing, let’s say well, let’s put you on a payment plan. Right in the old days the payment plan if you didn’t own anything and you didn’t have any assets and etc. Etc. You could finish on a payment plan. I don’t $50 know food month essentially for the rest of your life today. It’s a little bit different some years back when the hospitals were having a bill in crisis. They went to the state or state management and they said he’ll and State Management said Okay, what’s the problem? So, we just not getting paid enough money were essentially in a hundred percent capacity help, you know, we can’t get any more money from our investors because we’re not making enough and will full. So, what the state said is. Well, how about we get you the money, so they got into business relationships with the banks for the bank started to buy the debt. So, the hospital got the money they needed and now when you get a call from Hospital’s Financial Services And it’s not hospital. It’s the bank and when the bank’s called you and says hi. It’s the financial services department of hospital. How would you like to pay your $5,000 bill? You’re going to pay it if you have money, they may negotiate with you. If you have cash, which is a very great position to be in if you don’t have the cash then they’re going to put you on a payment plan and they’re going to look at your level of income and they may look at your level of expenses and they have in some cases financial aid forms and things like that. At but they’re going to come back and they’re going to say yeah $50. No, we want $150 a month until this has paid off and one of the interesting things, they say is you know, but don’t worry. You don’t have to pay interest twice because you could of pain this bill for three four five years, right? And that is true. You’re not paying interest on it, but they bought your debt for about 50 cents on the dollar in pennies. Right? Right. So, you know, they bought your 5,000 2,500 you’re going to pay back 5,000. They are delighted they are getting 20% year. The alternative is like I said that if you have some cash, which is a great position to be in the hospital often willing to negotiate. So, in my case, I was able to negotiate usually between 20 25% and from the bill by giving them cash. So, if you have cash it’s a great place to be. So, the question is do you have cash? Do you have any access to the cash, or do you have other ways of paying your deductibles? So there are a couple of ways to protect yourself as a consumer against the What is obviously yeah, let me let me ask you a question if I can it is like one of the things that really concerns me. I’ve it’s a couple of concerns is that People afraid to use their insurance. Because they know there’s six seven thousand dollars if they got a family, they might have a family copay. There are afraid to use the insurance so they’re not going to get treatment for something like covid-19 this I just treated home like Grandma treated flu. I’ll to have chicken soup and hope it goes away. But what so they’re never counted in the numbers, they’re never tested their never quarantine and they’re go through no protocols other than what their grandmother did that’s one concern is that they’re afraid of the cost of they don’t seek treatment and then the kissing cousin to that is they’ve got diagnosed they got prescriptions and they can’t afford to pay either full price for a man. That’s Covered because Insurance may not keep up with approvals for treatment. So, when they say yes, the FDA cleared hydroxychloroquine yesterday, which is think is what happened yesterday. That doesn’t mean your insurance company recognizes then covers that today, but you still May pay several hundred dollars for that and that’s a discounted rate federal government state government. There’s no government agency that’s handing you. A bag of drugs and saying go home and take this you’re not a cute enough to be hospitalized. So, I’m worried about people not even trying and then getting a diagnosis getting a prescription and then being afraid of The Economic Consequences. A lot of people you may not even be laid off or fired. But if you’re a business owner, you may not be taking home a check and so that hundred fifty dollars a month. Could be food, right? And so those are some of my concerns because no one is really I haven’t heard any leader any state federal local leaders say don’t worry. We have a program a meds program. I haven’t heard about any of that of you. I haven’t either the concern you have they very well-founded concern. Because it’s not just now and we’re talking ongoing people’s version or even just being straight scared by the financial impact of having to use their health insurance. You know, I’ve been in I was in the emergency room with my eldest daughter some years ago and saw a mother say to a doctor don’t admit my tongue. You know, what are you going do? we’re to observe and well, how about just come back tomorrow morning vicar and the doctor will wise because I can’t afford the exposure it she said which in say exposure by can’t afford to have my son admitted but in hospital overnight, that’s a scary thing. But you know, it’s we hear horror stories. We hear other people with insurance have horror stories. That’s an incorrect. Right but and people who don’t have insurance who are meeting prescriptions that they can’t get out. They have insurance or they can’t afford the prescription friend of my eldest daughter. Unfortunately passed away Castle an acute asthma attack in the end and she couldn’t afford the prescription because it was a hundred and fifty dollars for the inhaler and they were asking around trying to find somebody that’s down and while it all went down. Unfortunately, the person died, you know, they called an ambulance, but it was all just too late and so it’s not just now, but you know now He’s looking because now everybody is worried. So you have your finger on really on the mark and pulse of this there is no protection if you’re in the hospital and they are treating you they’re just going to treat you if you are at home and they say here is prescription. You’re going to be responsible for paying for that prescription. If you can’t afford it, you’re not going to be getting that prescription as I understand it. I don’t know of any program yet if you have your own. Insurance that is going to cover that prescription. I know there are certain mom-and-pop sort of Pharmacy still who may extend some level of credit to people but I think those are few and far between these but again that’s taking on personal debt and if the insurance company considers the treatment at this stage experimental if you’re in a test grew and they say we don’t know but we think you should Take this you’re back again to what you said before which is timing of everything. Yeah. I know. First of all, the people not wanting to go to the hospital is very real the people not wanting to be treated as very real, you know, the saying if you have certain symptoms, then please take care of yourself because you could finish up infecting not just your family but lot of other people too and that’s very scary. I mean the, you know the numbers of increase overnight in Miami-Dade. You know, you can see that their big problems coming and that’s what they’re saying in terms of personal responsibility. Yeah, now it’s all on you and us kind of get back again to that whole discussion of how do I cover my exposure? So, if you don’t already have the protection and place there are a couple of things you can do with my personal level and there are two levels of protection. You’ve probably seen the Ads on TV for Aflac, right? What does that? Well Affleck is an awesome company when it comes to fool me supplemental voluntary benefits what they say is we help cover the cost that health insurance doesn’t and in many cases we can help put money in your pocket if you have sickness or an injury, and you’re no longer able to work or along those lines, but it’s not just our flag. There are I believe now. 52 companies in the State of Florida who are licensed to provide those types of services. Many years are not so many years ago. It was about a dozen so you can see that this there. He has become much more profitable and much more attractive insurance and at the same time Insurance health insurance. The number of companies has shrunk dramatically from about 12 to about four and a half in the State of Florida. So, you can see that the sort of Scent of these days has gone much more towards supplemental voluntary benefits as we call them. These are benefits paid for by the individual or paid for by the employee. There are two ways to get that one. You can go directly to an insurance company and most insurance companies are in the market will allow you to do that. And you say I want the accident coverage. I want hospital Indemnity plan. I want to get cancer plan. Maybe never diagnosed already diagnosed. Most critical illness heart and stroke plans that’s type of thing along with short-term disability and you can get also simplified issue life insurance. Those are of the big six when it comes to supplemental or voluntary benefits. There’s also something called gap insurance, which is ideally there to hurt you cover that deductible hospitalization. What a lot people don’t get. I’m not a huge fan. Kind of Gap coverage but there’s obviously a place for all insurance if you plan it, the gap insurance is there to help you cover deductibles, but it won’t necessarily put money in your pocket as well because here’s the reality if you finish up in the hospital you are unlikely to be generating an income because you’re in the hospital. So, unless you can be in two places at once, you know, you’re in the hospital you’re not working. You’re not making money. So my preference which is why obviously I work for tomorrow’s Solutions is the voluntary benefits side because in many cases not only can we cover most all of the deductible but a lot of cases we can put money into the pocket of the person to help them cover the other bills they have That’s what wages and things like that. Whatever it is, you know the end of the day if somebody hands you a check and we generally and I say we the Royal we are an industry that will hand somebody money in a health prices when everybody else is saying pay me baby, baby. From our perspective if I give you a check for three four five thousand dollars. Do you care what it’s for now? You just want to make sure I’ve got money either I can cover that that deductible and maybe I can negotiate the hospital because now I have money, I have money. So, I have a level of strength and position strength I didn’t have before and then what’s left because if you can deduct a negotiate the discount then everything that you negotiate that’s yours. So, you get to keep it You use it towards your bills mortgage car payment utility, whatever Insurance food, we all have pretty whatever it is. So, you know my attitude now is a lot of people looking at what their exposure is. They people Rhett. It’s The Human Condition people don’t look until it affects them directly, but now people are looking in the same with God what happens if dot so my recommendation would be if you have an insurance advisor or you know somebody go talk to them because you can only get insurance from you healthy. She’s that is kind of the rule the best time to get insurance is when you’re healthy enough to get it, you know, I’ve been in the insurance World quite a long time and occasionally, I’ll get a phone call from somebody saying I want that insurance now we go, but we’ve been talking about it for three four five six months what changed nothing works. Something changed. Well, yeah, I had a physical yesterday. My blood pressure is through the roof. I think you know, that’s unfortunate. You’re not going to be able to get that life insurance coverage. You wanted nobody under own until you’ve been on medication for six months or nine months and everything is come down. But why are you know because you get insurance when you are healthy enough to get it as we say, nobody knows you when you’re down and out absolutely so far. So just to cut through some of this because we’re going to have to wrap this Earth and make sure that you know, when you’re in a business you’re in the insurance business at all make sense to you when you’re a lay person and you start hearing certain terms. The eyes rolled back in my head is when I normally hear terms like Gap coverage, I think of stuff around Medicare and Medicaid and the doughnut hole and you can fill the Gap and get a gap policy, but So people understand they can get a gap an individual Schmo like me can get Gap coverage. Between where my insurance leaves me hanging and where I need to be, and I could get specialized policies for cancer or accident or whatever as an individual. I can actually go get these from somebody to levels you can get them individually and you can also get them through your employer, right? So individually go find a health insurance agent. They should be able to help you with pretty much all of those and Again, what I would say is try and get a put together a plan or a package that probably has coverage from a whole bunch different areas so that you can cover all of the bases and then on the corporate side, it’s mostly from the HR. They can bring in a company like ourselves who would look at what is already there. And then come in and then bring a package together a benefit so they work together. So, they’re strong and it makes sense. If something doesn’t make sense employees are really smart today. You know, we’ve got the internet so it’s easy to ask questions. But if something doesn’t make sense to me, why would you do it? So, if it doesn’t make sense to the employee then employers when they bring in benefit companies the health insurance that benefit company together. If it doesn’t make sense, you know, it’s kind of like this if they have low participation by Employees, it’s because it doesn’t make sense. Right? What you need to do is have a company that will come in either with your existing or maybe that needs to be tweaked as well and then bring in plans that work together in unison. So, it makes sense, and everything will be strong. The employees will see the smart and the sense of it and they will take it and then everybody will be protected because let’s be clear about this if you have employees who get sick or have a house crisis in their family. It is very clear statistics show the first people they come to Their employer, right? So, for the employer to protect themselves and for the employee to be protected to really good idea to work with a really good agency advising company who can help you do that. And that’s really what this is all about. But I think there’s also there’s an opportunity for customization there because people circumstances could be wildly different the concerns of a 25 year old in the concerns of a 55 year-old are different in the concerns of people who are just starting to make We have a family think about having kids and those who are looking at grandkids, you know, their needs are very different as well. And this is an opportunity than to customize what they get and what they need. All right, we are out of time, but Charles thank you so much for getting up early and meeting me online to do this. We appreciate your knowledge and time and I thank you very much.