Breaking Free from Big Insurance

WEBVTT

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Okay.

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Gentry, welcome to the podcast, man.

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Thanks for coming on.

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Great to be here, man.

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You were standing in the

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wrong place at the right

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time or the right place at

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the wrong time because you

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were standing next to me at

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the APTA PPS conference.

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And I'm super shy and I'll

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just start conversations with anybody.

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And I'm like, hey, man, you know,

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where are you?

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I think I was like, where are you a PT?

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And you're like, well, I'm not.

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I'm like, OK, cool.

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Then why are you here?

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That's interesting.

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So how do you typically

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explain if someone like me

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were to ask you, like, you know,

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what do you do or where are you a PT?

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You're like, I'm not.

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What do you do?

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Yeah, after twenty years,

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I've had a lot of time to

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think of the answer to that question,

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Jimmy.

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So typically I tell people

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and they're a little shocked by this.

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I think some of them,

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maybe not so much the PTs,

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but I just tell them I help

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people get away from the big,

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bad insurance companies.

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that, in my opinion,

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have destroyed our health care system.

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And obviously,

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that causes a lot of curiosity.

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But that's my common answer now is,

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you know, in the past,

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there weren't a lot of options.

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And I think there are more

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and more options becoming available.

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All right.

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So that's what you do.

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But how do you do that?

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How do you help people get

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away from the big, bad insurance company?

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Now, we'll zoom in just a little bit.

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Yeah, for sure.

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So depending on the size of the group,

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right,

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it's harder when you don't have as

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many employees,

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but when you have around a

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hundred or more employees,

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it opens up options to use

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third-party administrators

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that can adjudicate claims.

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You can really tailor

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Your plan,

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you can get stop loss insurance

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to protect your company.

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You can choose a pharmacy

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benefit manager that's not

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one of the big three that's

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owned by the insurance

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companies or vice versa.

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So that's what I do is I

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create tailor-made

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solutions when it comes to health plans.

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So if you're someone,

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if you're a clinic or a

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group of clinics with a hundred,

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we'll just,

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we'll just drop a line at a

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hundred imaginary line at a

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hundred or more.

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You get to now you can come

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in and create or sort of

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get to start to choose your

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own adventure health plan

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for that organization.

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Yeah.

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Yeah, that's right.

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So we've had three this year alone.

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One of my clients, Tim Spooner,

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a lot of people know him.

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He's kind of a pioneer here in Phoenix,

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Scottsdale area.

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He referred me to kind of his group,

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his practice group of

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different business owners

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across the country.

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And so we're fortunate to

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work with several of them this year.

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And we moved them from a

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fully insured plan to a self-funded plan.

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Two of them are in California,

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one up in Washington state,

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and we just finished up

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another one in Pennsylvania.

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So it's not state specific.

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We're licensed and all the

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fifty states can work with anybody.

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So that's cool.

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All right.

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So what problems does this alleviate?

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I'm guessing cost is if you talk cost,

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you got people's attention.

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But whatever doors is it open?

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So I'm guessing,

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I don't want to put words in your mouth,

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but I'm guessing it reduces

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costs or at least to maybe

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make risk a little bit lower.

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What else?

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Like what are the things on

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the benefit side of doing this?

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What would you call this?

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Self-funded insurance for your company,

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for your organization?

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Exactly.

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So it's self-funded insurance,

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but you can go to a

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self-funded plan through

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what we call a book or I'm

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going to use that term Blue

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Cross United Signet.

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Now,

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those are the big insurance companies

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across the country.

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But obviously, it does reduce costs.

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Usually health insurance is

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the second or third highest

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line item on a company's P&L.

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And this helps reduce that overall cost.

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It also improves the quality.

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There's a misconception in our country,

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unfortunately, that if I pay more,

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the quality is higher.

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And in health insurance,

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it's actually the inverse of that.

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It's the surgeons that do

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something more are better at it.

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And so they can charge less

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versus charging more.

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Now,

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where the cost comes in is these

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hospital systems,

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they like to refer to their

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surgeons and a surgery

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inside a hospital setting

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is much more expensive than

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a surgery in an ambulatory

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surgical center.

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So-

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That's one of the benefits

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and the quality is significantly higher.

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So not only does it reduce the cost,

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but it also improves the

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quality for the patients, you know,

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and the members on the health plan.

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All right,

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so pros and cons of each approach,

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let's just go make sure

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we'll stay with the basics

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before we go deeper.

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So the difference is that

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the difference are fully insured plans,

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am I am I safe to call them

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like the typical plans, right,

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fully insured plans?

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Yes.

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Versus self-funding.

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Let's just do pros and cons.

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Give them the quick high

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level because if someone

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really wants to dig into this,

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they're going to call you

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and we'll put your

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information on there and

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we'll share that.

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But do pros and cons of each.

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Yeah.

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So let's start with the cons first.

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The cons of a fully insured

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plan is you're subject to

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whatever the carrier gives you, right?

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In terms of your plan design, deductibles,

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co-pays, out-of-pocket.

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You can't do anything

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innovative within a fully insured plan.

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It is what it is.

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We call it shelf plans, right?

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They're filed with the state.

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They're mandated.

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They have all of the

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different requirements, right?

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So that's a huge con.

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Another huge con of fully

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insured is you get no reporting at all.

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Wait, no what?

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Say that again.

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Yeah.

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No reporting of data of

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where your money is going.

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How is my money being spent

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by the members on my plan?

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I get zero data.

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Now, with a hundred or more employees,

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you get limited data,

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but you don't get full

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access to the data or the

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reporting in a fully insured plan.

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So that's another con.

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Why is understanding that?

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So the business owner you're talking about,

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the person who's funding

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the health insurance,

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why would you want that information?

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And then why can't we get it?

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So in every other aspect of business,

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a business owner has access

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to how things are being,

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where costs are going.

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Sure.

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And if you don't know where

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costs are going,

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you can't control a cost.

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And so I think it's on purpose.

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Um, you know,

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I'm not going to go on the

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conspiracy theories or anything like that,

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but, um,

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You don't get reporting and

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they hide behind HIPAA.

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The insurance companies say, well,

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if you have a hundred employees,

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you could identify people

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and be discriminatory against them.

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That's not correct.

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That's not true.

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So a big downfall of a fully

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insured plan is you get

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very limited reporting and

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because of that you can't

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control where your dollars

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are being spent and the

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quality of it either so

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yeah I mean you mentioned

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that inverse proportion is

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we hear that every we hear

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that every every once in a

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while we definitely hear it

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every four years in terms

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of the us is the lo you

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know the biggest spender in

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healthcare and we're

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thirtieth on the list in

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this and forty second and

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fifty third um so that's

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definitely true all right

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so that's that's number one

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con blind I have no idea

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where this money is going I

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just keep throwing money into a hole

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I don't know how it's being spent.

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And then, oh,

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magically next year or the

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next time my contract is up,

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it costs more and maybe I'm offered less.

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That's correct.

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So let me just give you one

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example of one of the plans

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that we worked with this year.

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We had an employee that was

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on a very high prescription drug.

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We would have never gotten

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this information from their

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fully insured carrier up in

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Washington State.

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And this individual,

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we were able to assist them

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to get this drug sourced

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internationally from Canada,

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right north of Washington State.

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And they were paying the plan,

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meaning the overall cost

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for this drug was around

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six thousand dollars a month.

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And we were able to get it

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through an independent

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pharmacy benefit manager

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who works with a Canadian pharmacy.

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for roughly fifteen hundred

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dollars a month.

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So a significant difference.

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Right.

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By just going and being innovative,

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getting the same drug,

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it's shipped to the employee.

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There's no member disruption, you know.

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So it's it's very simple.

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There are lots of little

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levers and buttons to push

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within a self-funded health

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plan that you cannot do

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within a fully insured plan.

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Well, you couldn't do it,

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but there's no reason for

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the fully insured plan to

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even look into that.

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Right.

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There's no reason.

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Well, that's right.

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Claims equal premium.

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So the higher the claims are,

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the higher the premium that

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the insurance company can charge.

00:08:44.416 --> 00:08:45.916
And so there isn't any incentive.

00:08:46.096 --> 00:08:47.976
And you have stockholders,

00:08:48.017 --> 00:08:50.336
shareholders that they have

00:08:50.376 --> 00:08:51.937
to increase their pricing

00:08:52.177 --> 00:08:54.418
in order to look better on

00:08:54.437 --> 00:08:55.258
their earnings.

00:08:55.557 --> 00:08:57.119
So there really isn't any

00:08:57.158 --> 00:08:59.139
incentive versus a self-funded plan.

00:08:59.519 --> 00:09:00.619
The employer has every

00:09:00.678 --> 00:09:03.480
incentive to control the costs without

00:09:03.972 --> 00:09:05.673
disrupting the members, right?

00:09:05.854 --> 00:09:07.375
Or at least working with the

00:09:07.414 --> 00:09:08.436
members to try to find

00:09:08.475 --> 00:09:10.197
other solutions and say,

00:09:10.777 --> 00:09:12.578
this health plan is our health plan.

00:09:13.058 --> 00:09:14.779
The better we utilize the plan,

00:09:15.340 --> 00:09:17.662
the better we save money by

00:09:17.861 --> 00:09:19.263
getting drugs outside of

00:09:19.302 --> 00:09:20.423
the country if we can,

00:09:21.745 --> 00:09:23.385
that directly competes with

00:09:23.405 --> 00:09:24.485
your W-II income.

00:09:25.027 --> 00:09:26.447
So if we're more wise with

00:09:26.467 --> 00:09:28.249
the way that we spend our current dollars,

00:09:28.808 --> 00:09:29.690
we can offer better

00:09:29.730 --> 00:09:31.030
benefits and we can reduce

00:09:31.071 --> 00:09:32.432
the costs that we charge to you.

00:09:33.148 --> 00:09:33.447
All right.

00:09:33.467 --> 00:09:35.791
So you throw a few pros and cons.

00:09:36.172 --> 00:09:37.212
What else jumps to mind or

00:09:37.232 --> 00:09:38.094
what else do you typically

00:09:38.534 --> 00:09:40.856
I always ask what what what

00:09:40.898 --> 00:09:42.278
passes the eyebrow test?

00:09:42.359 --> 00:09:44.000
What when Gentry mentions it

00:09:44.041 --> 00:09:45.964
makes like a practice owner go, OK,

00:09:45.984 --> 00:09:46.865
didn't think about that.

00:09:48.393 --> 00:09:49.875
Yeah, well, obviously the cost,

00:09:49.914 --> 00:09:51.336
we do an analysis, right,

00:09:51.355 --> 00:09:53.258
for everybody that we start

00:09:53.298 --> 00:09:55.120
working with or want to, you know,

00:09:55.240 --> 00:09:56.400
start working with us.

00:09:56.581 --> 00:09:58.923
And we look at the overall, you know,

00:09:58.984 --> 00:09:59.524
benefits.

00:09:59.563 --> 00:10:00.586
Typically the first year,

00:10:00.605 --> 00:10:01.405
we don't change the

00:10:01.426 --> 00:10:02.988
benefits at all because we

00:10:03.028 --> 00:10:04.249
want to be able to gather

00:10:04.288 --> 00:10:06.471
that data within the first year,

00:10:06.532 --> 00:10:07.312
year and a half.

00:10:07.793 --> 00:10:09.794
So then we can really start looking at

00:10:10.895 --> 00:10:12.537
are deductibles appropriate?

00:10:12.658 --> 00:10:13.477
Are copays?

00:10:13.519 --> 00:10:14.419
Are out of pocket?

00:10:14.659 --> 00:10:16.881
What other solutions can we be looking at?

00:10:17.023 --> 00:10:18.443
For example, diabetes.

00:10:18.484 --> 00:10:19.806
There are lots of different

00:10:19.826 --> 00:10:21.147
diabetes programs and

00:10:21.187 --> 00:10:22.849
vendors out there that can

00:10:22.889 --> 00:10:24.730
drastically reduce the cost

00:10:24.791 --> 00:10:27.293
and improve the health of employees.

00:10:27.333 --> 00:10:27.615
And so

00:10:28.327 --> 00:10:29.288
Those are the things that

00:10:29.327 --> 00:10:30.128
we're looking at.

00:10:30.187 --> 00:10:33.009
It's really a strategy of we

00:10:33.028 --> 00:10:33.808
have the data.

00:10:34.068 --> 00:10:35.308
Now we can start creating

00:10:35.328 --> 00:10:36.509
the plan based on your

00:10:36.548 --> 00:10:37.710
employee population.

00:10:38.070 --> 00:10:39.070
The great thing about these

00:10:39.129 --> 00:10:40.570
private practice groups are

00:10:41.429 --> 00:10:43.010
most of these employees are young.

00:10:43.551 --> 00:10:44.610
They're out of school.

00:10:45.030 --> 00:10:45.750
They're starting their

00:10:45.791 --> 00:10:48.051
families and they're healthy.

00:10:48.611 --> 00:10:50.392
And so why be pooled with

00:10:50.731 --> 00:10:51.971
sicker risks when you've

00:10:52.011 --> 00:10:53.412
got an employee population

00:10:53.432 --> 00:10:55.332
that's much healthier than

00:10:55.373 --> 00:10:57.113
the general population in our country?

00:10:58.960 --> 00:11:00.120
Um, there's another acronym.

00:11:00.142 --> 00:11:01.302
We can't get too many, too many,

00:11:01.322 --> 00:11:02.644
too many acronyms in healthcare.

00:11:02.683 --> 00:11:03.585
Can't get enough of them.

00:11:04.326 --> 00:11:07.749
Uh, TPAs, third party administrators.

00:11:08.850 --> 00:11:10.032
You said they can be a key

00:11:10.111 --> 00:11:11.332
alternative to these

00:11:11.373 --> 00:11:12.714
traditional insurance companies.

00:11:13.215 --> 00:11:13.695
What are they?

00:11:13.715 --> 00:11:14.596
How do they operate?

00:11:14.716 --> 00:11:15.817
How do they operate differently?

00:11:15.937 --> 00:11:17.820
And what advantages can this

00:11:17.919 --> 00:11:19.181
third party administrator

00:11:19.341 --> 00:11:20.863
offer a business owner?

00:11:22.014 --> 00:11:23.174
Yeah, great question.

00:11:23.195 --> 00:11:25.357
So I like to think of a

00:11:25.418 --> 00:11:26.639
third party administrator

00:11:26.678 --> 00:11:28.421
as the quarterback to the plan.

00:11:29.000 --> 00:11:31.403
So think about like an insurance company,

00:11:31.484 --> 00:11:34.466
customer service, ID cards,

00:11:35.128 --> 00:11:37.330
adjudicating claims.

00:11:38.751 --> 00:11:39.533
They're the ones that

00:11:39.572 --> 00:11:40.894
basically are running the

00:11:40.933 --> 00:11:42.495
plan and are the

00:11:42.975 --> 00:11:44.017
kind of the front forward

00:11:44.057 --> 00:11:46.058
facing of to the employees.

00:11:46.639 --> 00:11:48.380
But it's extremely important

00:11:48.421 --> 00:11:50.003
because they're the ones

00:11:50.043 --> 00:11:51.724
that implement the stop

00:11:51.764 --> 00:11:52.846
loss insurance and the

00:11:52.885 --> 00:11:54.187
pharmacy benefit manager

00:11:54.206 --> 00:11:55.447
and the medical management.

00:11:55.488 --> 00:11:57.549
And so it's really key that

00:11:58.091 --> 00:12:00.192
you have a team of people

00:12:00.232 --> 00:12:00.952
on the third party

00:12:00.972 --> 00:12:02.134
administrator front that

00:12:02.274 --> 00:12:04.316
understand what the plan is

00:12:04.375 --> 00:12:05.477
trying to accomplish.

00:12:06.197 --> 00:12:07.659
And kind of the Bible to the

00:12:07.701 --> 00:12:08.861
plan is what we call the

00:12:09.744 --> 00:12:11.426
summary plan document, right?

00:12:11.446 --> 00:12:12.927
It's the Bible to the planet

00:12:13.068 --> 00:12:14.730
says for every little thing,

00:12:15.251 --> 00:12:16.212
what's covered and what's

00:12:16.312 --> 00:12:18.196
not covered and how things will be paid.

00:12:18.967 --> 00:12:21.510
And so you've got your network,

00:12:21.591 --> 00:12:24.033
you've got your pharmacy benefit manager,

00:12:24.092 --> 00:12:25.995
stop loss, medical management.

00:12:26.294 --> 00:12:27.796
The TPA is the one that's in

00:12:27.836 --> 00:12:28.918
charge of managing and

00:12:28.937 --> 00:12:30.038
coordinating all of those

00:12:30.099 --> 00:12:31.240
different pieces because

00:12:32.140 --> 00:12:33.282
what most people don't know,

00:12:33.902 --> 00:12:35.403
in your Blue Cross plan or

00:12:35.443 --> 00:12:36.365
your United plan,

00:12:36.384 --> 00:12:37.264
you have all of those

00:12:37.304 --> 00:12:38.427
different players right now.

00:12:38.466 --> 00:12:40.649
You just never see them.

00:12:41.208 --> 00:12:41.469
right?

00:12:42.070 --> 00:12:43.009
With a third party

00:12:43.051 --> 00:12:43.910
administrator and an

00:12:44.130 --> 00:12:45.692
unbundled self-funded plan,

00:12:45.732 --> 00:12:46.994
meaning completely

00:12:47.053 --> 00:12:47.833
independent of any

00:12:47.894 --> 00:12:49.355
insurance company out there,

00:12:49.956 --> 00:12:51.817
you get to see how all of

00:12:51.856 --> 00:12:52.918
those different pieces

00:12:52.998 --> 00:12:54.619
function and you get to

00:12:54.678 --> 00:12:55.860
choose best in class.

00:12:55.919 --> 00:12:57.100
Right now we have a very

00:12:57.201 --> 00:12:58.581
limited market when it

00:12:58.621 --> 00:12:59.682
comes to fully insured.

00:13:00.102 --> 00:13:01.423
Maybe in any state you have

00:13:01.485 --> 00:13:02.625
four or five players.

00:13:03.186 --> 00:13:04.626
I can go out to twenty five

00:13:04.667 --> 00:13:06.708
or thirty different stop loss carriers.

00:13:07.269 --> 00:13:08.149
There are hundreds of

00:13:08.190 --> 00:13:09.530
pharmacy benefit managers.

00:13:09.591 --> 00:13:09.711
So

00:13:10.150 --> 00:13:11.333
you're really opening up

00:13:11.394 --> 00:13:13.740
your field to other options

00:13:13.961 --> 00:13:15.504
instead of just four or five.

00:13:17.017 --> 00:13:19.077
Okay, more acronyms, more letters.

00:13:20.138 --> 00:13:23.840
They went from TPAs to PBMs.

00:13:24.240 --> 00:13:26.380
Those are pharmacy benefit managers.

00:13:26.400 --> 00:13:27.461
You talked about an example

00:13:27.961 --> 00:13:29.481
of changing a cost from six

00:13:29.501 --> 00:13:30.342
thousand dollars a month

00:13:30.363 --> 00:13:31.822
for one employee to fifteen, right?

00:13:31.923 --> 00:13:33.703
So pharmacy benefit managers

00:13:34.104 --> 00:13:35.605
and stop loss protection,

00:13:36.245 --> 00:13:36.725
which you'll have to

00:13:36.745 --> 00:13:37.625
explain to me a little bit.

00:13:37.666 --> 00:13:38.426
Talk to me like I'm an idiot

00:13:38.466 --> 00:13:39.826
because this is a little

00:13:39.846 --> 00:13:40.927
out of my comfort zone,

00:13:41.006 --> 00:13:41.727
but I want to learn it.

00:13:42.687 --> 00:13:44.390
So PBMs and stop loss

00:13:44.410 --> 00:13:45.451
protection play crucial

00:13:45.491 --> 00:13:46.594
roles in controlling costs.

00:13:47.195 --> 00:13:48.756
Walk us through what those things are,

00:13:48.836 --> 00:13:49.758
how those elements work

00:13:49.778 --> 00:13:50.919
together and where business

00:13:50.980 --> 00:13:52.903
owners can go wrong and

00:13:53.023 --> 00:13:54.666
right with their strategy.

00:13:55.990 --> 00:13:56.169
Yeah,

00:13:56.230 --> 00:13:58.551
so let's start first with stop loss

00:13:58.610 --> 00:13:59.191
insurance.

00:13:59.211 --> 00:14:00.030
So there are two different

00:14:00.071 --> 00:14:01.630
types of stop loss insurance.

00:14:01.650 --> 00:14:04.052
You have specific and you have aggregate.

00:14:04.831 --> 00:14:07.072
Specific is insurance on any

00:14:07.332 --> 00:14:08.493
one individual that has a

00:14:08.552 --> 00:14:10.553
catastrophic claim, like cancer,

00:14:10.953 --> 00:14:15.134
heart condition, serious back fusion,

00:14:15.174 --> 00:14:15.394
right?

00:14:15.434 --> 00:14:17.316
These high preemie babies,

00:14:17.416 --> 00:14:19.836
those are examples of a

00:14:19.916 --> 00:14:23.057
catastrophic claim on any one individual

00:14:23.417 --> 00:14:25.698
It could be a spouse or a child.

00:14:26.219 --> 00:14:30.001
And so you buy specific stop

00:14:30.042 --> 00:14:33.424
loss insurance to protect the business,

00:14:33.684 --> 00:14:35.725
the plan from any one

00:14:35.826 --> 00:14:38.048
individual bankrupting the plan.

00:14:39.081 --> 00:14:41.643
So we use the specific stop

00:14:41.663 --> 00:14:43.683
loss to cover any one individual.

00:14:44.184 --> 00:14:46.105
And then we have aggregate

00:14:46.186 --> 00:14:49.126
or umbrella insurance in

00:14:49.147 --> 00:14:50.988
the case that we have lots of claims,

00:14:51.388 --> 00:14:52.688
just lots of claims from

00:14:52.788 --> 00:14:53.929
multiple individuals.

00:14:54.350 --> 00:14:55.431
So you're covering yourself

00:14:55.451 --> 00:14:56.370
from one individual and

00:14:56.390 --> 00:14:57.432
you're covering yourself as

00:14:57.451 --> 00:15:00.033
a whole using the aggregate insurance.

00:15:00.493 --> 00:15:03.054
Now, the insurance companies,

00:15:03.115 --> 00:15:04.394
when you get your renewal

00:15:04.455 --> 00:15:05.775
from a fully insured carrier,

00:15:06.307 --> 00:15:09.970
they increase your renewal on everything,

00:15:10.029 --> 00:15:10.269
right?

00:15:11.250 --> 00:15:12.890
The administration of the plan,

00:15:13.311 --> 00:15:15.513
pharmacy benefits, medical management.

00:15:15.993 --> 00:15:17.312
On a self-funded plan,

00:15:17.754 --> 00:15:18.994
your renewal is usually

00:15:19.053 --> 00:15:20.414
just on your stop loss.

00:15:20.434 --> 00:15:21.556
There may be some minor

00:15:21.615 --> 00:15:24.417
increases to the other pieces of the plan,

00:15:24.976 --> 00:15:25.957
but you're not getting...

00:15:26.837 --> 00:15:28.077
ten or fifteen percent

00:15:28.138 --> 00:15:29.859
increase on the full

00:15:29.918 --> 00:15:31.239
premium that you're paying

00:15:31.698 --> 00:15:33.239
it's typically on just the

00:15:33.318 --> 00:15:35.519
stop loss and you're also

00:15:35.559 --> 00:15:37.039
paying taxes right on your

00:15:37.100 --> 00:15:38.900
full premium with a

00:15:38.961 --> 00:15:39.941
self-funded plan you're

00:15:39.961 --> 00:15:41.280
just paying the taxes on

00:15:41.321 --> 00:15:43.121
the insurance premium for

00:15:43.162 --> 00:15:45.581
the stop loss insurance so

00:15:46.341 --> 00:15:46.881
and then there are

00:15:46.922 --> 00:15:48.243
different contracts you

00:15:48.263 --> 00:15:49.562
know with a stop loss

00:15:49.623 --> 00:15:51.243
insurance you know you have

00:15:51.302 --> 00:15:53.783
what's called uh twelve twelve which is

00:15:54.357 --> 00:15:56.160
incurred in twelve months or

00:15:56.240 --> 00:15:58.645
paid in twelve months or

00:15:58.666 --> 00:16:00.448
you have a twelve twenty four.

00:16:00.548 --> 00:16:01.330
I know I'm kind of getting

00:16:01.370 --> 00:16:02.152
in the weeds here,

00:16:02.613 --> 00:16:05.418
but incurred in the first twelve months,

00:16:05.518 --> 00:16:06.679
paid in the

00:16:07.317 --> 00:16:08.619
full twenty four months.

00:16:09.038 --> 00:16:09.999
So you have different

00:16:10.038 --> 00:16:11.480
contracts with a stop loss

00:16:11.519 --> 00:16:15.221
carrier because as most physical therapy,

00:16:15.282 --> 00:16:16.543
private practices know,

00:16:17.143 --> 00:16:18.683
when you submit that claim,

00:16:18.724 --> 00:16:19.644
it's not always paid

00:16:19.664 --> 00:16:21.346
immediately or sometimes it

00:16:21.385 --> 00:16:23.287
takes a while for the claim

00:16:23.307 --> 00:16:24.086
to be submitted.

00:16:24.147 --> 00:16:25.006
So you want to make sure

00:16:25.027 --> 00:16:26.648
that you're covered by that

00:16:26.707 --> 00:16:29.190
stop loss agreement in case

00:16:29.269 --> 00:16:30.409
it gets filed at the end of

00:16:30.429 --> 00:16:32.130
the year and claims are

00:16:32.171 --> 00:16:34.172
filed like January, February, March.

00:16:34.192 --> 00:16:34.732
You don't want to be

00:16:35.865 --> 00:16:37.125
not having coverage and be

00:16:37.184 --> 00:16:38.985
exposed to those claims.

00:16:39.025 --> 00:16:40.285
So that's kind of a

00:16:40.385 --> 00:16:42.267
generality of what the stop

00:16:42.307 --> 00:16:43.346
loss serves as.

00:16:43.366 --> 00:16:43.787
And again,

00:16:44.427 --> 00:16:46.768
we have access to probably more

00:16:46.788 --> 00:16:47.328
than fifty.

00:16:47.369 --> 00:16:48.269
I know I said twenty.

00:16:48.288 --> 00:16:49.389
That's usually what we try

00:16:49.428 --> 00:16:50.450
to narrow it down to.

00:16:51.049 --> 00:16:53.169
But there's a lot of options

00:16:53.210 --> 00:16:55.130
when it comes to stop loss insurance.

00:16:55.150 --> 00:16:56.811
And our goal is to buy the

00:16:56.870 --> 00:16:58.192
least amount of insurance.

00:16:58.812 --> 00:17:01.113
So as the plan performs,

00:17:01.552 --> 00:17:02.813
we actually raise that

00:17:02.854 --> 00:17:04.653
deductible on the specific

00:17:04.794 --> 00:17:05.515
one individual.

00:17:05.934 --> 00:17:07.194
It's not the deductible that

00:17:07.234 --> 00:17:08.155
the employee pays.

00:17:08.256 --> 00:17:09.915
It's the deductible that the

00:17:09.955 --> 00:17:11.836
plan has as a risk, a cap.

00:17:12.436 --> 00:17:14.137
So on a hundred life group,

00:17:14.157 --> 00:17:15.919
you may have a specific

00:17:15.999 --> 00:17:18.359
deductible of anywhere from, you know,

00:17:18.420 --> 00:17:19.740
fifty thousand or seventy

00:17:19.779 --> 00:17:22.181
five thousand per member

00:17:22.201 --> 00:17:23.121
that's on the plan.

00:17:23.181 --> 00:17:24.622
And then you have, you know,

00:17:24.662 --> 00:17:25.922
that aggregate umbrella

00:17:25.942 --> 00:17:27.303
insurance for the rest of the group.

00:17:29.599 --> 00:17:30.400
you already sort of talked

00:17:30.420 --> 00:17:32.480
about pbms so that's a

00:17:32.621 --> 00:17:33.861
pharmacy benefit manager

00:17:33.881 --> 00:17:34.882
how they come into play in

00:17:34.942 --> 00:17:36.862
terms of thinking

00:17:36.902 --> 00:17:38.442
creatively about costs is

00:17:38.462 --> 00:17:39.563
that like an accurate you

00:17:39.583 --> 00:17:40.963
know that that person's job

00:17:41.003 --> 00:17:42.003
is to think creatively or

00:17:42.044 --> 00:17:45.365
think more responsibly about costs so um

00:17:46.756 --> 00:17:47.895
Maybe people have heard,

00:17:47.935 --> 00:17:48.736
maybe they haven't.

00:17:48.957 --> 00:17:52.196
FTC is actually suing a lot

00:17:52.217 --> 00:17:53.998
of the pharmacy benefit managers.

00:17:54.057 --> 00:17:55.657
We have three major pharmacy

00:17:55.698 --> 00:17:57.357
benefit managers that

00:17:57.417 --> 00:17:58.578
source eighty percent of

00:17:58.618 --> 00:17:59.898
all drugs in our country.

00:18:00.479 --> 00:18:04.000
Express Scripts, CVS and Optum.

00:18:04.880 --> 00:18:06.619
And CVS owns Aetna.

00:18:07.661 --> 00:18:09.221
Optum is owned by United

00:18:09.280 --> 00:18:11.301
Healthcare and Express

00:18:11.342 --> 00:18:12.781
Scripts is owned by Cigna.

00:18:13.621 --> 00:18:16.061
So those three are all

00:18:16.102 --> 00:18:18.201
pooled together and they

00:18:18.241 --> 00:18:20.042
collude and they help each

00:18:20.123 --> 00:18:21.643
other to make more profit.

00:18:22.503 --> 00:18:24.983
And so these pharmacy benefit managers,

00:18:25.344 --> 00:18:27.484
they'll have what are called formularies.

00:18:27.505 --> 00:18:28.765
They're lists of drugs that

00:18:28.785 --> 00:18:30.086
are covered or not covered.

00:18:30.726 --> 00:18:32.246
And they steer people into

00:18:32.266 --> 00:18:33.826
the different drugs that

00:18:33.866 --> 00:18:35.707
they get paid higher rebates on.

00:18:35.807 --> 00:18:37.188
So maybe you've heard of rebates,

00:18:37.228 --> 00:18:37.887
maybe you haven't.

00:18:38.407 --> 00:18:39.949
But a rebate is basically

00:18:39.969 --> 00:18:42.769
just a kickback on higher cost drugs,

00:18:42.869 --> 00:18:44.329
usually specialty drugs.

00:18:44.869 --> 00:18:46.951
And so those rebates are

00:18:46.990 --> 00:18:49.172
paid back to the fully insured plan.

00:18:49.192 --> 00:18:50.372
They're not paid to the

00:18:50.432 --> 00:18:52.752
employer on a self-funded plan.

00:18:53.333 --> 00:18:54.753
Those rebates come back to

00:18:54.794 --> 00:18:57.173
the plan to help offset future costs.

00:18:57.734 --> 00:18:58.835
So that's one major

00:18:58.875 --> 00:19:00.154
difference between an

00:19:00.295 --> 00:19:02.135
independent pharmacy benefit manager,

00:19:02.215 --> 00:19:04.037
one that's not owned by one

00:19:04.057 --> 00:19:05.116
of the large insurance

00:19:05.156 --> 00:19:06.538
companies and the three

00:19:06.557 --> 00:19:07.518
that I talked about.

00:19:08.057 --> 00:19:09.318
Another thing that they do

00:19:09.499 --> 00:19:12.380
is these pharmacy benefit managers,

00:19:12.779 --> 00:19:14.000
the ones that are creative,

00:19:14.020 --> 00:19:17.142
they're looking for ways to reduce costs.

00:19:17.863 --> 00:19:19.323
So you may have seen at the

00:19:19.403 --> 00:19:21.463
end of commercials at night, right?

00:19:21.523 --> 00:19:25.586
These drug commercials for specialty drugs,

00:19:26.306 --> 00:19:28.928
Sovaldi, Manjaro,

00:19:29.048 --> 00:19:31.588
the GLP-I's are very popular right now.

00:19:32.229 --> 00:19:33.049
At the end, they'll say,

00:19:33.109 --> 00:19:34.750
you may qualify for

00:19:34.789 --> 00:19:36.030
assistance for this drug.

00:19:36.993 --> 00:19:37.996
Well, what that is,

00:19:38.277 --> 00:19:41.304
is these pharmacy benefit

00:19:41.344 --> 00:19:44.351
managers have found a way to work with

00:19:45.083 --> 00:19:47.565
these manufacturers to

00:19:47.704 --> 00:19:50.146
basically find programs

00:19:50.287 --> 00:19:51.288
where those costs can be

00:19:51.327 --> 00:19:53.828
reduced both for the member on the plan,

00:19:54.029 --> 00:19:56.490
as well as for the plan sponsor,

00:19:56.510 --> 00:19:57.291
the employer.

00:19:57.791 --> 00:20:00.233
So their patients assistance programs,

00:20:00.654 --> 00:20:02.576
their copay assistance programs,

00:20:03.016 --> 00:20:04.297
and an independent pharmacy

00:20:04.336 --> 00:20:05.417
benefit manager will

00:20:05.518 --> 00:20:07.398
actually look at those drugs,

00:20:07.880 --> 00:20:09.060
work with the member to see

00:20:09.101 --> 00:20:10.442
if they qualify for those

00:20:10.521 --> 00:20:13.423
programs and reduce their overall cost.

00:20:13.891 --> 00:20:16.733
versus the larger pharmacy

00:20:16.753 --> 00:20:18.055
benefit managers typically

00:20:18.095 --> 00:20:19.517
don't offer those services.

00:20:20.498 --> 00:20:22.058
Some of them are starting to do it more.

00:20:22.920 --> 00:20:23.901
The other big thing that I

00:20:23.941 --> 00:20:25.883
talked about was international sourcing.

00:20:26.022 --> 00:20:27.464
So these independent

00:20:27.484 --> 00:20:28.746
pharmacy benefit managers

00:20:28.806 --> 00:20:30.267
will work with third parties

00:20:30.907 --> 00:20:33.169
to find the drugs that are

00:20:33.709 --> 00:20:35.568
same manufacturer, same labeling.

00:20:36.009 --> 00:20:37.549
It's just at a lower cost

00:20:37.569 --> 00:20:39.750
and shipping it from Canada, New Zealand,

00:20:40.250 --> 00:20:41.131
United Kingdom.

00:20:41.990 --> 00:20:42.971
We have some plans that

00:20:43.031 --> 00:20:45.152
actually get drugs from Mexico.

00:20:46.133 --> 00:20:48.113
So we look at everything and

00:20:48.192 --> 00:20:49.094
see what makes the most

00:20:49.134 --> 00:20:50.233
sense and what the plan

00:20:50.253 --> 00:20:51.334
sponsor feels comfortable

00:20:51.354 --> 00:20:53.375
with and roll out a

00:20:53.414 --> 00:20:54.755
strategy of communication

00:20:54.795 --> 00:20:56.215
to the employees to help them with that.

00:20:56.977 --> 00:20:58.278
Just feels like more transparency,

00:20:58.317 --> 00:20:58.938
more control.

00:20:59.478 --> 00:21:01.278
When you go into anything

00:21:01.318 --> 00:21:02.960
that's sort of franchised out, right?

00:21:02.980 --> 00:21:03.960
Something so huge,

00:21:03.980 --> 00:21:05.259
you're going to have less control.

00:21:05.921 --> 00:21:07.902
It'll feel like you can save some money,

00:21:07.961 --> 00:21:10.041
but when you start to do the math,

00:21:10.663 --> 00:21:11.782
it doesn't really look like that.

00:21:11.843 --> 00:21:12.703
So it feels like you're just

00:21:12.743 --> 00:21:14.663
getting this off the shelf thing,

00:21:14.703 --> 00:21:17.144
so it should cost me less and be better.

00:21:17.586 --> 00:21:18.405
And we're saying, again,

00:21:18.425 --> 00:21:20.287
that's sort of inversely proportional.

00:21:20.547 --> 00:21:21.227
The more you pay,

00:21:21.926 --> 00:21:23.028
you're not getting the best thing.

00:21:23.891 --> 00:21:24.632
That's correct.

00:21:24.912 --> 00:21:25.392
Yeah.

00:21:25.531 --> 00:21:26.772
And employers, I think,

00:21:27.133 --> 00:21:28.834
feel like they're kind of stuck, right?

00:21:28.894 --> 00:21:30.234
They play this game every year.

00:21:30.315 --> 00:21:32.997
I've played it where every

00:21:33.017 --> 00:21:34.057
couple of years they have

00:21:34.076 --> 00:21:35.759
to switch insurance companies.

00:21:35.798 --> 00:21:37.019
They get a ten or fifteen

00:21:37.058 --> 00:21:39.020
percent and we negotiate it

00:21:39.040 --> 00:21:39.840
down to seven.

00:21:39.901 --> 00:21:41.761
It's like this game back and forth.

00:21:41.821 --> 00:21:43.564
And you always ask them,

00:21:43.624 --> 00:21:44.943
why am I getting an increase?

00:21:45.003 --> 00:21:45.184
Well,

00:21:45.664 --> 00:21:47.346
you have some high claimants and it's

00:21:47.405 --> 00:21:48.165
due to trend.

00:21:48.826 --> 00:21:49.007
And

00:21:49.912 --> 00:21:51.512
A lot of employers just fed up with it.

00:21:51.553 --> 00:21:52.353
They're like,

00:21:52.432 --> 00:21:53.534
I'm tired of running on the

00:21:53.574 --> 00:21:54.814
rat wheel and I wanna do

00:21:54.874 --> 00:21:55.594
something different.

00:21:55.614 --> 00:21:56.954
I wanna have control and get

00:21:57.075 --> 00:21:59.476
information that gives me more control.

00:21:59.875 --> 00:22:01.997
And this is more of a necessary evil,

00:22:02.096 --> 00:22:03.478
unnecessary annoyance.

00:22:03.498 --> 00:22:05.298
Like not many PT practice

00:22:05.358 --> 00:22:07.799
owners open to practice to

00:22:07.859 --> 00:22:09.319
think about the third most

00:22:09.359 --> 00:22:10.800
expensive thing on their line item,

00:22:10.820 --> 00:22:11.901
which is health insurance

00:22:11.921 --> 00:22:12.381
for their employees.

00:22:12.401 --> 00:22:13.321
They wanna offer this.

00:22:13.362 --> 00:22:14.721
They wanna create a great culture,

00:22:14.741 --> 00:22:15.643
a great place to work.

00:22:15.682 --> 00:22:17.663
And they wanna have motivated employees.

00:22:18.705 --> 00:22:19.446
And they've got to become an

00:22:19.507 --> 00:22:20.468
expert in this every time a

00:22:20.508 --> 00:22:22.351
contract negotiation begins

00:22:22.371 --> 00:22:23.192
or every time a contract

00:22:23.251 --> 00:22:24.173
ends and another one begins.

00:22:24.492 --> 00:22:25.233
And that sucks.

00:22:25.795 --> 00:22:27.236
But if you're one of these big companies,

00:22:27.256 --> 00:22:27.936
if you're one of those big

00:22:27.977 --> 00:22:28.817
three you mentioned,

00:22:29.358 --> 00:22:30.480
you're just going on math.

00:22:31.517 --> 00:22:32.857
and you knowing what what

00:22:32.897 --> 00:22:34.357
else is being offered so

00:22:34.377 --> 00:22:35.078
you're saying this is my

00:22:35.118 --> 00:22:36.259
best offer take it or leave

00:22:36.298 --> 00:22:37.640
it well now there's there's

00:22:37.660 --> 00:22:38.901
these different options so

00:22:38.941 --> 00:22:39.701
for business owners

00:22:39.760 --> 00:22:40.541
listening we'll talk about

00:22:40.622 --> 00:22:41.781
real world impact for the

00:22:41.882 --> 00:22:42.643
practice owners who are

00:22:42.663 --> 00:22:44.083
like okay either I need to

00:22:44.163 --> 00:22:45.183
pay attention to this or

00:22:45.203 --> 00:22:46.144
I've been hit with this

00:22:46.825 --> 00:22:48.605
health insurance costs are

00:22:48.625 --> 00:22:49.486
a huge line item as you

00:22:49.506 --> 00:22:50.646
mentioned the I think you

00:22:50.686 --> 00:22:51.446
said the third most

00:22:51.527 --> 00:22:52.667
expensive one typically

00:22:53.008 --> 00:22:55.048
whatever two salaries and overhead

00:22:56.508 --> 00:22:57.689
Yeah, and then health insurance.

00:22:58.130 --> 00:22:59.711
What's one immediate step

00:23:00.230 --> 00:23:01.392
practice owners can take to

00:23:01.432 --> 00:23:02.332
start getting better

00:23:02.372 --> 00:23:05.134
control over those insurance costs?

00:23:05.413 --> 00:23:06.075
And then how can your

00:23:06.115 --> 00:23:06.894
approach you're talking

00:23:06.914 --> 00:23:07.776
about make a tangible

00:23:07.816 --> 00:23:09.777
difference in their bottom line,

00:23:09.797 --> 00:23:10.817
their P&L statements?

00:23:12.219 --> 00:23:12.699
Yeah,

00:23:12.719 --> 00:23:15.000
this is going to sound like a kind of

00:23:15.019 --> 00:23:16.220
a strange answer.

00:23:16.519 --> 00:23:16.681
OK,

00:23:18.101 --> 00:23:20.001
get get your broker to start looking

00:23:20.102 --> 00:23:21.442
outside of the book as the

00:23:21.521 --> 00:23:22.942
major insurance companies.

00:23:22.962 --> 00:23:24.563
There's lots of companies

00:23:24.583 --> 00:23:25.303
that are starting to

00:23:25.363 --> 00:23:27.564
develop and even for smaller companies.

00:23:27.624 --> 00:23:27.824
Right.

00:23:27.864 --> 00:23:29.105
Not just the hundred plus,

00:23:29.164 --> 00:23:30.384
but there are other

00:23:30.424 --> 00:23:32.046
companies that are coming to market.

00:23:33.557 --> 00:23:36.240
that can be viable options, right?

00:23:36.700 --> 00:23:38.301
So one of the things that

00:23:38.442 --> 00:23:39.563
drives down costs

00:23:39.603 --> 00:23:41.644
significantly is what's

00:23:41.663 --> 00:23:43.465
called reference-based pricing.

00:23:44.125 --> 00:23:45.247
So instead of having a

00:23:45.326 --> 00:23:47.808
network of doctors like Blue Cross,

00:23:47.868 --> 00:23:49.109
United, Aetna, or Cigna,

00:23:49.650 --> 00:23:52.592
you can actually work with one of these,

00:23:52.932 --> 00:23:54.094
I call them bundled,

00:23:55.013 --> 00:23:59.397
non-carrier-owned solutions.

00:23:59.417 --> 00:24:00.518
And there are various ones

00:24:00.558 --> 00:24:02.000
in different states out there now.

00:24:02.680 --> 00:24:03.820
where they can do what's

00:24:03.861 --> 00:24:05.541
called a level-funded plan,

00:24:05.862 --> 00:24:07.242
where you're still paying a

00:24:07.303 --> 00:24:08.903
monthly premium into the plan.

00:24:08.923 --> 00:24:10.285
And then at the end of the year,

00:24:10.904 --> 00:24:11.865
you can look at how your

00:24:11.905 --> 00:24:12.746
plan is performed.

00:24:12.766 --> 00:24:13.946
You get limited data.

00:24:14.227 --> 00:24:15.208
It's better than what you

00:24:15.228 --> 00:24:17.088
get with the major insurance carriers,

00:24:17.128 --> 00:24:18.088
but it's still limited.

00:24:18.670 --> 00:24:21.010
But it's kind of a middle step, right?

00:24:21.050 --> 00:24:22.332
If you're not ready to go

00:24:22.811 --> 00:24:24.212
down the full self-funded

00:24:24.252 --> 00:24:25.993
plan that I've been talking about,

00:24:26.473 --> 00:24:27.474
there are other options

00:24:27.515 --> 00:24:28.576
kind of middle of the road

00:24:28.615 --> 00:24:30.636
called level-funded carriers, right?

00:24:31.203 --> 00:24:33.084
And there are more and more coming about,

00:24:33.243 --> 00:24:33.545
you know,

00:24:33.565 --> 00:24:35.644
I was just at the Rosetta Fest

00:24:35.684 --> 00:24:37.005
Health Rosetta Conference a

00:24:37.045 --> 00:24:38.346
few months ago in DC,

00:24:38.885 --> 00:24:39.685
and there were probably

00:24:39.726 --> 00:24:40.885
three or four new ones that

00:24:40.945 --> 00:24:42.066
I'd never heard of before.

00:24:42.645 --> 00:24:44.307
So I think that that's something that,

00:24:44.807 --> 00:24:46.126
you know, smaller groups,

00:24:46.247 --> 00:24:47.267
it's a solution that they

00:24:47.287 --> 00:24:48.228
should be looking at.

00:24:48.887 --> 00:24:49.387
The risk,

00:24:49.688 --> 00:24:52.448
there is no risk for them versus

00:24:52.468 --> 00:24:53.709
with a self-funded plan,

00:24:53.729 --> 00:24:54.788
they have taken on a little

00:24:54.808 --> 00:24:55.868
bit more risk on that

00:24:55.949 --> 00:24:57.189
specific deductible.

00:24:57.809 --> 00:24:59.670
So that would be just,

00:25:00.393 --> 00:25:01.794
You have more power than you

00:25:01.855 --> 00:25:04.517
think you have as a business owner.

00:25:04.998 --> 00:25:06.098
And you really need to start

00:25:06.138 --> 00:25:07.500
pushing these advisors and

00:25:07.519 --> 00:25:09.481
brokers like myself that

00:25:10.403 --> 00:25:11.605
may not be aware that there

00:25:11.625 --> 00:25:12.685
are other options out there

00:25:12.705 --> 00:25:14.366
when there truly are.

00:25:14.426 --> 00:25:14.748
Love it.

00:25:14.768 --> 00:25:15.107
All right.

00:25:15.147 --> 00:25:16.650
So if someone is out there nodding,

00:25:16.690 --> 00:25:17.269
number one,

00:25:17.349 --> 00:25:18.411
how can they get in touch with you?

00:25:18.451 --> 00:25:20.473
Like throw out the easiest way, website,

00:25:20.534 --> 00:25:20.753
email.

00:25:20.773 --> 00:25:23.096
What would you tell people to call you?

00:25:23.135 --> 00:25:23.636
How do they get you?

00:25:24.337 --> 00:25:24.518
Yeah.

00:25:24.557 --> 00:25:25.659
The best way to get ahold of

00:25:25.699 --> 00:25:27.099
me is just send me a text

00:25:27.180 --> 00:25:28.040
on my cell phone.

00:25:28.520 --> 00:25:28.681
Um,

00:25:28.881 --> 00:25:30.623
four eight Oh five one eight three nine

00:25:30.663 --> 00:25:32.003
four two emails,

00:25:32.183 --> 00:25:35.365
simple JD Harris at Mahoney group.com.

00:25:35.826 --> 00:25:37.267
And then my LinkedIn profile

00:25:37.428 --> 00:25:39.989
Gentry with a J. So I'm the

00:25:40.049 --> 00:25:41.109
only Gentry Harris out

00:25:41.130 --> 00:25:42.050
there that I'm aware of.

00:25:42.391 --> 00:25:42.770
Smart man.

00:25:42.791 --> 00:25:43.291
All right.

00:25:43.311 --> 00:25:44.353
Last thing we do on an episode,

00:25:44.373 --> 00:25:45.393
we call it the parting shot.

00:25:45.432 --> 00:25:48.194
What's, what's your last idea?

00:25:48.296 --> 00:25:50.057
Mic drop moment, soapbox statement.

00:25:50.076 --> 00:25:51.117
You want to leave with the audience?

00:25:51.137 --> 00:25:51.518
What do you got?

00:25:53.378 --> 00:25:55.221
Yeah, so like I said before,

00:25:56.124 --> 00:25:57.886
I think business owners are

00:25:57.926 --> 00:25:59.349
the sleeping giant when it

00:25:59.390 --> 00:26:00.332
comes to health care.

00:26:01.173 --> 00:26:02.335
You have more power than you

00:26:02.375 --> 00:26:03.116
think you have.

00:26:03.766 --> 00:26:05.727
And don't be afraid to try new things.

00:26:06.866 --> 00:26:08.027
There are some things out

00:26:08.067 --> 00:26:09.847
there that can be damaging

00:26:09.887 --> 00:26:11.367
and not good solutions,

00:26:11.887 --> 00:26:14.249
but just find an advisor

00:26:14.429 --> 00:26:17.108
that has experience in self-funding,

00:26:17.609 --> 00:26:19.029
ask them pointed questions,

00:26:19.170 --> 00:26:21.990
ask them for references, look on LinkedIn,

00:26:22.050 --> 00:26:24.951
talk to other PT practices

00:26:25.031 --> 00:26:26.751
that are doing self-funding.

00:26:27.357 --> 00:26:28.679
and really do some homework

00:26:28.719 --> 00:26:30.320
because at the end of the day,

00:26:30.381 --> 00:26:32.162
it's extremely advantageous.

00:26:32.643 --> 00:26:34.664
There is a solution to fix healthcare.

00:26:35.265 --> 00:26:36.626
We've just been told otherwise.

00:26:36.826 --> 00:26:38.708
And as Jeff Gold,

00:26:38.788 --> 00:26:39.930
one of the direct primary

00:26:39.970 --> 00:26:41.810
care doctors said at a

00:26:41.851 --> 00:26:42.991
conference that I attended,

00:26:43.373 --> 00:26:45.074
we are addicted to a system

00:26:45.335 --> 00:26:46.115
that is broken.

00:26:46.836 --> 00:26:47.896
And it's time for us to get

00:26:47.957 --> 00:26:48.897
off of the addiction of

00:26:48.978 --> 00:26:50.839
health insurance and fully insured plans.

00:26:51.584 --> 00:26:52.044
Well said.

00:26:52.163 --> 00:26:52.724
All right, Gentry.

00:26:52.765 --> 00:26:54.286
Thanks for making this at least palatable,

00:26:54.326 --> 00:26:55.246
even for someone like me,

00:26:55.286 --> 00:26:56.906
understanding like, listen, first of all,

00:26:56.926 --> 00:26:58.567
if someone takes something away,

00:26:59.068 --> 00:26:59.989
there's another option.

00:27:00.148 --> 00:27:01.589
You don't have to just go with these,

00:27:01.869 --> 00:27:02.269
what'd you call them?

00:27:02.289 --> 00:27:02.911
Bucas again?

00:27:03.070 --> 00:27:05.571
Blue Cross Blue Shield, United Healthcare.

00:27:06.532 --> 00:27:09.075
So there's alternatives.

00:27:09.095 --> 00:27:09.795
You don't have to.

00:27:10.494 --> 00:27:11.635
And there's people along the

00:27:11.655 --> 00:27:13.596
way to help you to figure that thing out.

00:27:13.636 --> 00:27:14.657
So you don't always have to

00:27:14.678 --> 00:27:15.638
go with these big giants

00:27:15.659 --> 00:27:16.618
and the off the shelf things.

00:27:17.299 --> 00:27:17.599
Gentry,

00:27:17.619 --> 00:27:19.300
thanks for making this understandable,

00:27:19.361 --> 00:27:20.902
even digestible for someone like me, man.

00:27:21.836 --> 00:27:22.380
Thanks, Jimmy.

00:27:22.400 --> 00:27:23.365
Appreciate your time, man.