Episode Transcript
LUKE: Welcome to the purposeful planning podcast. My name is Luke Jernagan, I'm your host for the day. In my day job, I am the Managing Director for Family Learning at Matter Family Office, but I also work with Purposeful Planning Institute as a member of the Education Development Committee. In that capacity, I'm very happy to be the host for the day. For anybody listening to this for the first time, the Purposeful Planning Institute is a learning center for advisors and consultants serving legacy families and families in business. PPI’s programming is centered on four pillars. Today's topic addresses purposeful family enterprise techniques that explore strategies and best practices across a variety of technical disciplines required in serving complex families. And our topic today is very well aligned with that subject. Our topic is the overlooked financial risk, why healthcare navigation should be a part of every wealth planning strategy, and our guest today is an expert in that field. Very happy to welcome Lindsay Loomis, Senior Vice President of Emry Concierge Health Advocates. Lindsay is a recognized leader in the concierge healthcare space with deep expertise in payer operations, insurance navigation and high-touch client experience in her role, Lindsay partners with family offices and wealth managers to integrate expert healthcare advocacy into their client offerings. Her extensive background in insurance plan design, medical billing and provider networks, allows her to address potential gaps in coverage, cost inefficiencies and logical challenges before they become problems. All right, so with all of that, Lindsay, welcome. I’m really happy to have you.
LINDSAY: Thank you so much. It's great to be here.
LUKE: So tell me about how you got to this place with Emry.
LINDSAY: Absolutely. So by and large, I've spent my entire career in the insurance industry. I started over on the life side, dabbled a little bit in the employee benefit side, then onto the student health insurance side of things, and then finally found myself home here at Emry Health Concierge. The common thread throughout my career has been how to educate the consumer on their benefits and how to create a better health care consumer out the other end. Is there a better option for them? From their benefits perspective, that's what we'll be talking about. Obviously. Are they saving the most money? Are their physicians covered? Are their prescriptions covered? So our work at Emry really encompasses all of these things, plus a lot more. So Emry is full, we're full of professionals that are much like myself, all have extensive backgrounds in the insurance and or clinical setting, and we know the inner machinations of our complex health care system, and we advocate tenaciously for our clients, all the while helping them to understand how their benefits work and save them money.
LUKE: Great. Well, I am really eager to dive into this topic with you. When we first met and were chatting about this before the podcast today, I was thinking about my own experience with healthcare, and just every year that the open enrollment season begins, I feel like they start explaining the options and benefits, and I just everything goes blank. It's so confusing. And I imagine that is not just the case for all a lot of our clients that many of us serve, but really for all of us and and what's exciting to me about this topic we're jumping into is that it really is universal. It's something that everybody is wrestling with. But you see healthcare navigation as a major overlooked financial risk, especially for high net worth and ultra high net worth individuals and families. So tell me more about that. Why do you see this as a risk, and why is that risk so significant?
LINDSAY: Well, yeah, and that's a great question, and one that's not asked enough, frankly. So at the very simplest of explanations, the risk is lack of knowledge and understanding of this industry. So many people underestimate the financial complexities and consequences of navigating the healthcare system. The risk lies not just in the cost of care, but in the lack of guidance around accessing, optimizing and managing that care efficiently. So within that you know there's often hidden costs and over billing. So patients are often billed incorrectly or unnecessarily in some instances and without expert oversight, families may overpay for services. They might miss opportunities for negotiation or fail to file timely appeals, resulting in thousands to tens of thousands of avoidable expenditure. There's also a missed coverage opportunity. So choosing the wrong health insurance plan or mismanaging benefits can lead to coverage gaps, denied claims out of network changes. These mistakes are common, especially during life transitions. You're transitioning out of a job, maybe you're selling your company, going into Medicare, you've gotten married, had a child, whatever the case might be, that's where these really play. And I would be remiss without saying that time equals money. So high net worth individuals and executives often spend countless hours trying to coordinate care, interpret their own bills or secure second opinions, and that time could frankly, be used on their own business or their family. So delegating this to experts not only preserves finances but also ensures peace of mind. I would also add in there that a lot of times, the folks that are taking care of a family are the ones that are responsible for doing these types of tasks, and there's a lot of missed opportunities there that we'll get into a little bit later. The last topic I'll hit upon in this question is delayed or substandard care. So without the proper navigation, patients may face delays in treatment. That's never a desirable outcome, limited access to top providers, or inadequate coordination between specialties that can worsen outcomes and increase our expenditure out the other end. And you don't know what you don't know. And so I would say, you know people who have been in this industry for a long time, we know the questions to ask people that haven't, they just don't. And that's typical of any industry. You don't know what you don't know. You don't know what to ask so, but that's where we come in, and we can really try and mitigate all of that for people.
LUKE: So do you feel that one of the risk factors, especially for this client segment, is that, because they have significant financial resources. Instead of spending time digging into bills, trying to negotiate, they're just paying it off and they're talking about it.
LINDSAY: They are. I have recently had a call with a family, and they said, “We need help, because I'm just paying bills as they come in, some of them upwards of $10,000 a bill.”Just because people are of high net worth status doesn't mean that they unnecessarily have to get rid of their wealth. And we want to make sure that that happens. We shouldn't be just paying bills. This is a staggering statistic, but 85% that's 85% of all medical claims contain errors of some sort or another. So we're going to scrutinize those. We're going to look at them and make sure that people are not spending their money on them unnecessarily.
LUKE: Well, that's a surprising statistic.
LINDSAY: I know.
LUKE: So then you find that as you are digging into bills for clients, navigating these costs, that you're regularly finding errors that generally lead to savings.
LINDSAY: 100%, absolutely. I can give you an example of that. So one of our clients—one of my clients actually, an advocacy client—sent me in a bill had me scrutinize that. I went and logged into their portal on the carrier site, went through, made sure that looking at how the claims adjudicated, making sure that everything processed accordingly, and it hadn't, because after further scrutiny, they were billing this particular client for lab work that they had done. That lab work was as a result of their annual physical. With your annual physical, there is no cost share, so it was coded incorrectly on the back end. Went over to the insurance carrier, and the insurance carrier, because it was coded incorrectly on the front end, they associated a cost share with it. So then we picked up the phone, called the carrier, called the doctor's office, had them resubmit the claim in the appropriate manner with the right procedural code and diagnosis code, and there was no cost share.
LUKE: So thinking about the families that so many of us serve, couples in their 50s or 60s, like, what's the average amount somebody's paying for health care?
LINDSAY: Oh, goodness.
LUKE: Or can you, can you even give an average?
LINDSAY: It's so all over the place, because it's not standardized. And if someone's covered under a group insurance plan, they're going to have their own set of premiums. Someone's covered under the market plan, they have their own set of premiums. There's their own set of cost share according to what plan they're enrolled in. So that's it's hard to say, but I can tell you, it's way more than anybody else in the world is paying. Here in the United States, we are over inflated with how much we're paying for the cost of our services and procedures. And, yeah, it's just a little bit insane how much we're being charged for things and to put a number surrounding that, Luke, would be a little bit difficult, because the plans are all so different.
LUKE: Okay, that's fair, but I think many families are probably spending easily tens of thousands of dollars just for regular health care and maintenance, and if 85% of the bills that we are receiving are in error then that is a significant opportunity to get cost and risk.
LINDSAY: Absolutely, absolutely.
LUKE: And then I think, as you mentioned earlier, it's not just the financial cost, but the cost of time that goes into this, and I imagine that is what affects a lot of advisors who might be helping clients with Bill Pay and and other wealth planning strategies where this is affecting them as much as it is the client.
LINDSAY: That's right. And I think the important message here would be something that could take us minutes. Might take someone that's inexperienced, because it's just something that they're doing to support the family that they're working with. It could take them a heck of a lot longer and have errors associated with it, because people are happens dancing through it. They're not really sure what they're doing. So if you compile that on top of it from a cost savings perspective, we're really upside down almost in some of these instances.
LUKE: And you've said that even the wealthiest professionals are spending upwards of a hundred hours a year managing medical bills and claims.
LINDSAY: Yes. So, and like I was saying before, when people are happens dancing through topics and areas that they know little about, the simplest task for us is going to be the most complex task for somebody who doesn't necessarily know what they're doing. And we hear this every single day in our positions and our in our jobs. That the assistant or the personal assistant or whomever is providing this service to the family, and that's fantastic, but sometimes claims aren't filed accurately. We just talked about that. Sometimes claims aren't filed timely. There are timely filing standards that we have to be cognizant of. If you file an out of network claim or any claim outside of the window of opportunity to file that claim you're missing out on any potential reimbursement. Bills are paid without scrutiny because a bill came in, I'm just going to pay it. People don't know enough to scrutinize something. They don't know what they're looking at. They don't know what to look for. So all of these things add up. And I talked earlier about that $10,000 bill that this client, it came in, she just paid it, and my head exploded and stopped doing that. Send it to us. First, we're going to scrutinize it. We look at every single claim, every bill, to ensure people are not spending unnecessarily. That's a big pet peeve of mine. Stop getting rid of your money, like if you don't have to, hang on to it. It's a commodity.
LUKE: Well, I'll share a personal story that several weeks ago, I had the joy of taking an ambulance ride to the hospital, which was great. I'm totally fine. I'm glad you're okay, but it was the first time I've had to do that in a very long time, and I was surprised by how efficient the billing has become, that within two hours of leaving the hospital, later that morning, I got a text from the ambulance company with a bill I had already paid one bill from the hospital. Several others were coming in, and they were all by text. And to your point, my immediate reaction was just to start paying them to have it finished. And in hindsight, listening to you in this conversation, I'm thinking maybe I should have paused and done that in a very different way.
LINDSAY: Yes and I'm sorry you had to take an ambulance ride, but I'm glad to hear you're okay.
LUKE: Yes, I'm fine, but I was impressed by the efficiency of their billing process.
LINDSAY: You should be impressed by the speed of their billing process, maybe not the efficiency of it.
LUKE: Well said. So I think another thing that we all experience is that health care costs continue to rise every year by a lot, which means,it's eating away at a family's net worth. So what are some things that families and maybe advisors can do to mitigate those financial and medical risks?
LINDSAY: Yeah, so you know that I could go on and on and on with this topic. I'll hit upon a few items. This is a really, really important question. First, the elephant in the room is that our health care system is broken. It's broken, it's complex, it's extremely hard to navigate. Second, health care is expensive for several different reasons. There's administrative costs associated with maintaining health care. I'm talking about regulations, coding, claims, billing. The approximate admin costs of health care in the United States is 20 to 25% of the total spend of health care. So I would ask if this speaks completely to complexity, if one quarter of the total spend of health care just goes to maintaining the machine, it might be a little bit broken. Third, the high price of services and products that we have. So in the US, we have higher prices for doctors, hospitals, procedures and drugs than in any other country. As an example, the average cost for an MRI in the United States is approximately $1,300 while in other countries, it's less than half of that cost. In the United States, we have negotiated pricing, which varies between insurers and providers. They're going to negotiate amongst each other to determine their reimbursement rates, rather than a standardized pricing model where the cost is fixed. The fourth topic here is lack of transparency, so consumers typically don't know the cost of the service that they're going to seek out until they get that bill. This is a definite area where we can help. We can oftentimes, ahead of time, do negotiation specifically for out of network claims, ahead of a service, if someone's going to get those done, and negotiate the cost of that service down. Fifth, the fee for service model. So the fee for service model can really be seen as an over utilizer of extraneous expenditures. So providers are paid per test or per visit, which can incentivize them to run tests that may not be medically necessary. Which can over inflate our costs and so on and so forth. I could go on and on and on on this topic, but I would end with this section on prescription drugs. So lastly, prescription drugs. There are new drugs introduced more in the United States than in other countries, and the price of those drugs in the United States are staggering. Pharmaceutical companies can set their own prices, and they're not regulated at the federal level, so we have experience to assist individuals and family and those assisting individuals and families to find lower cost options, perhaps rebate programs or other types of cost mitigating measures that we can save them money just because they're on a high cost name brand drug doesn't mean that they need to be paying the full boat for that drug, and we can look for ways to make sure that that or see if we can have that come down, that cost come down.
LUKE: So you are part of what's called Healthcare Concierge Advocacy. And I think a lot of us are familiar with concierge healthcare. A lot of folks have concierge doctors. What you do is different?
LINDSAY: Yes
LUKE: So explain the difference?
LINDSAY: Yeah. So you think of us in simple terms, we're everything administratively centered around your healthcare. So with your medical, your medical, your dental, your vision, your health care and your flexible spending accounts, all of that would come to us. So all of the administration, back end stuff would come to us. We're not going to ever give clinical advice, and we're not going to compete with your concierge doctor, that they're their own thing, but we will coordinate with them. But I would say that the critical role of a health care concierge advocacy is to ensure that clients are realizing the most of their benefits. Are they seeing in network providers? If they're out of network providers, who's filing those claims? Is there negotiation that's ensuing with those claims? Who's keeping track of their health care spend? How do we know how much we're spending each year on our health care? We can, of course, take our premium dollars, then we know how much we're spending just to have the insurance coverage, but how much are we spending from a cost share perspective? And are there ways that we could be saving to do that? Who is scrutinizing the claims after the services have been rendered already? They are the experts. We know the jargon. We're tenacious, and we fight for the rights of our clients with the insurers and with the providers. I would also challenge most folks to say, “If you have a tax issue, who are you contacting? A CPA, right? You have a legal matter, you're contacting your attorney. You have a medical issue, you're contacting your doctor. But who are you consulting for an insurance issue? Because I can promise you, if you're going to the insurance company, they're not going to be doing the right thing, they're busy doing things to help themselves.”
LUKE: Yes, they're not right.
LINDSAY: They're not going to be doing things to help you, the consumer. So more and more executives, entrepreneurs, family offices and wealth managers, frankly, are integrating experts in healthcare because they're realizing a few things. We already talked about the complexity. It's crazy complex. We talked about time savings. They want to be focused on what really matters in life. They have little to no time to spend on advocating for either themselves or their clients. And advice, you don't know what you don't know. We've had people that have been in the industry that still are like, “Oh yeah, I didn't think of that.” But it takes being in it every single day to realize it. And most importantly, they don't want to make a wrong move. By and large, executives, entrepreneurs, family offices, wealth managers, everybody's tasked with maintaining a wealth model and maintaining a certain level, but if you make a wrong move in healthcare, that could be a little bit debilitating for some people. So that's really where concierge advocacy comes in. We're going to take all of that on for you so you don't have to worry about it, and you have peace of mind that it's done accurately.
LUKE: So healthcare concierge advocacy, do you think this is a market segment that's growing or is it an industry that's growing?
LINDSAY: I think it's one that should grow. I think that more and more people are understanding their benefits and what is afforded to them and what they are, frankly, entitled to less and less. And so experts need to come in to kind of mitigate that for them and show them the different avenues that they have. People just don't know. I know I've said that you don't know what you don't know a few times in this call, but it's so very true. You don't know what to ask. And that's not a slight against anybody. It's like me talking with you, Luke, about your job, I wouldn't know what you do, because I just don't know what I don't know. So, the same thing goes for insurance, but where you can mitigate any of those complexities, why wouldn't you try and do that?
LUKE: Alright. So my last question, what advice would you give advisors working with clients who are navigating these challenges?
LINDSAY: My sage advice: consult the experts. And I know that sound—I don't mean it to—trite. I really mean it to be exactly, consult the experts so you know things are being handled accurately. They're being handled timely. You're not wasting money. Of those who have worked so hard to create their wealth and earn it, you're actually showing value by saving them money. We're here to provide guidance and ease the anxiety to those who are charged with managing these aspects for different families, and as I said before, in a world full of complexities, shouldn't you look to alleviate as many of those as possible? And if you have people that are experts in this field, take them up on it, because we're going to do nothing but help. And I know that since being here at Emry, I have to say the team is fantastic. The connections I've made in the industry have been fantastic to meet people like you, Luke, who are just great folks. And we're here to make your lives easier.
LUKE: Well, it is such a huge need. And I think that, again, it's universal. So many people, unless you are a doctor or work in an insurance company, or I bet even a lot of doctors still wrestle with insurance for themselves and their family and understanding this very complex system. And I think that so many of us, I'll speak for myself working in a multi-family office, where we feel like one of our purposes is simplifying the complexity for a family. And it's really wonderful to be a part of something like the Purposeful Planning Institute, where so many people come together to think about how we solve some of those complexities and mitigate that. And it's been really wonderful talking to you, hearing about this very new and very exciting part of the healthcare field. This shows us how to mitigate another risk that a lot of us might not think about.
LINDSAY: Thank you for having me and thank you for the Purposeful Planning Institute, this organization has been invaluable so far. So we're here to help. There's no ask that's too great, if we can help you in any way, we're here.
LUKE: Great. Well, I'm going to put you on speed dial before my next ambulance ride, so that I have you ready to help me out and help me not pay all of those text message bills before they come in. But Lindsay, this has been a lot of fun. Thank you for this conversation.
LINDSAY: Absolutely. Thank you, Luke.
LUKE: And thank you all for joining the Purposeful Planning Podcast. Again, the goal of the Purposeful Planning Institute is to be that learning center for advisors and consultants serving legacy families and families in business. If you'd like to learn more, visit the purposefulplanninginstitute.org. To hear more podcasts, sign up for webinars and find information about upcoming events.
