Tom (00:01.742)
Well, welcome, Neil and Angel. Thanks so much for being on the podcast today. I'm really excited to talk about it because I think what you're doing is truly groundbreaking for a lot of employers out there. So I kind of wanted to start the podcast with a talk about how you came to realize that this type of benefits and
you know, essentially care, real care that you're offering was needed. So how did that kind of start out for you guys? And Angel, if you want to go first, that's okay. And then we'll switch over to Nir.
Angel Saucedo (00:45.081)
So I came from the insurance side. So I looked at it from why we needed it from the insurance side. I worked with different size agencies from startups to regional firms to national firms. And I saw that for the most part, they were about the same. They all cared about quotas. They kept telling their agents, hey, we just need more and more and more.
with really disregard to the client as far as savings. They always try to throw in different technology or additional services or simply like the national agencies. They just say, look, we're so big and we have so much influence. Just that name brand is going to be enough for you to make the sale. And so I came at from that angle and I said, you know what? They really don't care about the actual client. They're just trying to make their sales quota. They're just trying to increase that productivity every year.
Tom (01:08.972)
Mm -hmm.
Angel Saucedo (01:34.907)
year but they're not actually solving the problem.
And so when I found out about direct primary care, I was already doing level and self -funded plans. And so I saw this as a missing link. I said, well, even if you have a line of sight on where your money's going, you still feel powerless of doing actual anything about it. So DPC helps you keep an eye on where everything is. And then you pair that with reference -based pricing, which gives you some sort of mechanism to actually negotiate or control the cost of care.
And so that's where I said, okay, if everyone else is just focused on, let's keep doing things the same old same old, because it makes us more money, there has to be something else. So that's the angle that I came from.
Tom (02:20.43)
Okay, and did you when when you were on that, you know, the insurance kind of side, did you try and explain this to other insurance agents? And what was their what was their reaction when you explained it to them?
Angel Saucedo (02:38.329)
What depends, the older insurance agents, they just felt like, yeah, this just complicates things even more because not too long ago, 2010, ACA rolled out and that was a huge shift for them. And so they were still kind of dealing with the aftermath of all of that. And so learning now a new shift, they just felt, you know what, I'm at the end of my career. I'm just trying to hold onto my book of business, sell it at some point and be done with it. The kind of younger agents, they just felt like,
just wanted to sell. To them it was about, okay, if I sell more premium, I make more money. What you're talking about is lowering premium.
that doesn't really go with my business model, especially the way that most insurance agencies are built for the producer or for the agent to where you'll get a certain amount of commission year one and that commission drops significantly year two. Most agencies don't give out like 40 % commission year one, it drops down to 20 % commission year two. So the incentives for the agent, hey, just keep selling because that's gonna keep your revenue coming in. They really don't have time to address
these more intricate plans or kind of get into the weeds of something, they're just trying to keep up with their quota. So from either angle, there was just no interest.
Tom (03:56.334)
Mm hmm. Yeah. And I and I kind of feel you there when you talk about introducing something new to a a model that has been there for years. Right. Like you get such a pushback. You get like, well, what do you mean? I'm going to make less money up front. There's no way I could do that. You know, and the same thing kind of happens in direct primary care when I talk about it. Like it's like this thing like with older physicians are like, well, I'm you know.
Sometimes I'm close to retirement, I don't wanna deal with this extra stuff. So it can be difficult to introduce new models into such, almost like, it's like a big status quo hurdle for everybody else to kind of adopt it. And Nir, can you kind of explain a little bit to your side, like how you progressed up to the point of understanding that, I need to do something that offers,
company benefits with DPC.
Neer Patel (04:59.587)
Sure, yeah. So my journey kind of started about 10 years ago when my wife, who's a family physician, started her direct primary care practice in Austin, Texas. And I kind of helped her at that time build and grow the practice. And so we started it from scratch in 2015, and we had no idea if this was going to work.
back in 2015, there weren't very many DPC practices. There were probably only a couple hundred around the country. And so we started the practice and we started, you know, delivering really good care to our patients and realized this is what they've been wanting. And they, you know, and then they kind of would tell their friends and family and it kind of spread the word of mouth and quickly realized this is the type of
care and primary care, especially that everybody deserves and wants. And so this is going to work. And so as that kind of started happening and we were educating our community, we started realizing everybody that, you know, everyone in this country for the most part gets their healthcare from their job. And so there's gotta be a way to build this into employer sponsored health plans. If we really want to propel the DPC movement.
and get everybody in the country to experience it and understand what it is and have the opportunity to have a genuine doctor relationship. And so that's kind of when I decided I've got to learn the aspects of the insurance industry that are preventing direct primary care from being a part of those health plans.
Tom (06:49.228)
Mm -hmm. Yeah, because it's almost like a mystery when you run into it. You're like, what kind of wording do they use? What kind of who am I up against? Who is telling them otherwise? Right. And I think, you know, Angel, you can maybe you can say a little bit about how there is a a you know, there's like a benefits advisor that they have. Right. So.
that benefits advisor is talking to them while you guys are also trying to kind of get in the door and explain something that could be significantly better form. Is that, am I explaining it kind of right there?
Angel Saucedo (07:33.081)
Yeah, your typical benefit advisor that's trying to keep business going, they'll come up with, they'll shed so much doubt on the entire process and really excuses of why the business owner or HR should not roll out this new product or this new plans. They don't provide a solution or an alternative. They'll just say, you got to stick the course. You don't want to cause this kind of disruption in your, in your business. And you know, there's some silly ideas out there. You know, I'll throw out one that just is a bit nonsense to me is they'll say,
well the reason your health insurance is so expensive is because the care has gotten so much better and the technology is better. All of that takes money and research. You're paying for that now through your insurance. And so they just give all these kind of false reasons of just, hey stick with the course, but I always tell you know the employer or the executive, are they giving you genuine solutions? Is there a plan here or just deal with it? It is what it is.
Tom (08:31.158)
Mm hmm. Yeah. And I think like you said near like if a business owner is part of a direct primary care practice, it makes it so easy because then they see the actual difference. You know, and I think I'll just explain a little bit direct primary care for the audience. You know, it's a it's a subscription based practice where you get same or next day appointments, you get your doctor's cell phone, you get a no wait waiting room almost and.
You get an hour with your doctor as well as some practices have wholesale meds and wholesale labs, as well as free procedures and even sometimes free ultrasound included in that practice. So if the business owner goes to that, then they can really see like a massive, massive difference. And I think you had told me last time we talked that a business owner has to be brave.
Like they have to be brave to make this leap a little bit. And can you kind of explain that just a little bit for us?
Neer Patel (09:38.531)
Sure, yeah. So, yeah, we like to say, you know, the brave employers or the courageous employers are the ones that see the benefits. And what we really mean by that is this is different, right? What we're doing is very different from what traditional plans are and what people are used to. In traditional plans, you hand somebody a card with a network name on it that every provider and facility knows, like Blue Cross or United.
And there's no confusion. The patient shows up, they hand their card over and everything goes smoothly. In our health plans, things are different. We're removing the network completely. So we're removing Blue Cross, United, Cigna, and the Humana networks because that is where all the greed lies in the health plans. And so when we remove the network, we remove that greed.
and we're able to pay wholesale prices or cash prices for every healthcare service that people need. The way that we're successful with it is by being a truly full service agency where we're providing white glove concierge service to the employees and their families. So when they need to go outside the DPC office for something to a cardiologist or neurologist or get some imaging, they...
They contact our office, they can call, text or email us just like they can their DPC doctor. And we help set up the visit for them. We bypass the front desk because there's usually educational issues with the front desk person being trained to look for Blue Cross or United on a card and saying, we don't accept your insurance if they don't see that. And so we just bypass the front desk office. We go straight to the billing office. We explain to them our plans have no network.
Our plans have no contracts, no administration. We'd like to pay you right now before the time of service or right after the time of service, but we'd like to pay you immediately and we'd like to know what your cash price is for this. And so that's how we're successful with, you know, quieting down the noise, so to speak. But that's why we say, you know, an employer has got to be courageous is because they've got to see...
Tom (11:40.918)
Mm -hmm.
Neer Patel (11:56.867)
the benefits that come along with removing a network and working with an agency that helps facilitate all these things so that everything goes smoothly for their employees and their families.
Tom (12:10.19)
Yeah, yeah. And do you find that when you tell them that you want to pay them upfront and right now, do you find that there's nobody on the other line because they've they passed out because this is too amazing?
Neer Patel (12:23.491)
They're definitely surprised a lot of the time. They're like, you can do this? Because Blue Cross has never done this. And we explained to them, we absolutely can do this. We want to do this. We want to pay you right now. We don't want to have you waiting for your money for months.
Tom (12:30.55)
Mm -hmm.
Right.
Tom (12:42.958)
Yeah, yeah, exactly. Yeah, amazing. Like it's, that's why I say it's truly groundbreaking. Like it's completely different and it's welcome, you know, especially by the specialists who need it because they tell me, well, that's amazing what you're doing, but how do we fit into all of this as well? So Angel, can you maybe talk about how in the traditional,
insurance -based healthcare with Blue Cross Blue Shield, the premiums usually go up every year, don't they? There's no like, hey, did we do something, can we do something, can we negotiate or something like that? But you guys are a little bit different in your structure with that. Can you expound on that just a little bit?
Angel Saucedo (13:37.689)
Sure, so it's incredibly rare if your rates stay the same. But like you said, nine times out of 10.
that your rates are going up. And they're truly, for the most part, is not a lot of explanation or really justification on why your rate is still going up. Because some companies, they're a little more close knit and they realize, hey, nobody here went to the hospital, nobody here is on some expensive medication, but our rates still are going up. And so what we always explain to folks is that you have to realize that even if your claims are down, you're in a bigger pool with other companies,
Tom (14:00.62)
Mm -hmm.
Angel Saucedo (14:14.395)
and other claims that are being paid. And they're just spreading the risk around, right? That's really what insurance is, just spreading the risk around.
But if you have good years, there's never a credit if you ever have a bad year, right? If you had 10 great years of claims, one bad year, Blue Cross doesn't say, hey, you know what, we're gonna forgive you this year because we actually had 10 good years with you. Never happened. So it's very much in the favor of the network carrier. What we do in our model by moving them to self -funded, you're really kind of your own entity. And so if you have a good claims year, you reap the benefits. If you have a bad claims year,
You know, maybe your rates are going to go up slightly, but every mechanism we put in place to our health plans, since we're paying less for the care, even if you had catastrophic things, we're still able to limit your claims losses. Because again, if you're paying the actual cost of the care without the bloated administration, that's significantly less than anything you'll get on the claim side of Blue Cross Blue Shield. So once an employer understands that, they realize, you know, this is the way to go.
to get away from the network.
Tom (15:24.014)
Yeah, yeah. So they even though it can be a little bit difficult, like initial hurdle overall, they're getting significantly better cost for the care itself and they're getting significantly better care. You know, I was reading what was it? The Kaiser Family Foundation report in 2023. So they were saying that the average annual premium for
like employee -sponsored health insurance was like 8 ,500 single, like, and for a family, it was like 24 ,000 a year. And they also were saying that the rate of insurance premium increase was outstripping or outpacing a lot of these other company profits, as well as like the employee's salary.
So they can't even keep up with this increase in the large insurance companies premiums. So I'm sure some of them are like, they see it on the horizon and they're wondering, well, what can we do? And I think you guys have a excellent solution. And the other thing I was gonna say was, in direct primary care, we have the transparency,
kind of motto that, you know, our prices are upfront and clear. And I think near you were telling me last time we talked that the there's almost no transparency with these bigger insurances. Like they don't they're not going to give you like a breakdown of, hey, your money went here or, you know, here's what it kind of looks like. Can you kind of talk to us about about that part?
Neer Patel (17:17.282)
Sure, yeah. So in a traditional fully insured health plan that's network based, you know, with Blue Cross or United, they rate the premium based on basically three pieces of demographics, a name, a date of birth, and a zip code, right? So there's not really any logic there. Those premiums are rated in 30 seconds, just plugged into an algorithm, someone's zip code and date of birth. So that algorithm doesn't know if someone's...
50 year old and healthy or 50 year old and on 10 medications and going through chemo. So they're gonna, they're gonna overcharge you every single time because the insurance companies will never lose money. And, and then on top of that, once you get the premium, you know, call it six, seven, $800 per employee per month, they just tell you that's how much you owe us, right? They don't tell you anything about breaking that number down and saying out of this $700.
you know, X amount is going to our profit, X amount is going to pay for claims, those sorts of things. They don't give any transparency around the number. And that's the other challenge in health insurance is, you know, people don't necessarily realize that the insurance money or the money that the insurance company is paying on their behalf for their care, there's no magic pot of gold where that money just comes out of thin air.
The more that an insurance company pays for our claims, the more they charge us. So they're getting it back one way or another. But yeah, the transparency is completely non -existent in fully insured health plans. They don't break the number down at all. They just tell you, this is the how much you owe us. Here's your card. Here's your deductible. Good luck.
Tom (18:53.004)
Mm -hmm.
Tom (19:09.23)
Yeah, yeah, there's no breakdown. And it's very interesting on your website, it says like healthcare for 50 % less with direct primary care. And it's, from my point of view, it's truly like believable, right? Like you are keeping in direct primary care, you keep patients out of the ER and out of the hospital.
and that's where your large kind of claims come from, right? Like that's where, it's in the ER, it's in the hospital where these large bills are coming from. And if you can pair it up with direct primary care, you can definitely save a ton of money on that. And so can you guys tell me, like I know there's some really good stories on your website.
Can you tell me like a great story where this type of healthcare benefits kind of completely turned around a business or maybe a business or I think there's a hospital story as well, but whatever you guys want to talk about, feel free.
Angel Saucedo (20:21.145)
One that comes to mind, I'll do a small business and then if you want to do a larger business. So we had it, we just had an open enrollment or renewal with a smaller business and they previously won a network carrier and they were paying $7, $800 a month. Not only did year one, we lower their insurance. So we went from 700 to 500, but on the renewal meeting, we actually were able to tell them because there's so much money left over, your premium is actually going down 20%.
Now, how would you like to spend that 20 %? Would you like to lower the deductibles? Would you like to contribute to HSAs? How within the health plan do you want to spend the money? They were so shocked. That never has happened in the history of their company where...
on the renewal instead of it going up, not only did they go down, but now they're kind of figuring out how do we spend this money, right? And so that happens when you actually have transparency, when you're having savings, and you have a carrier that's set up to basically pass that savings on to you. So that just completely transformed that company. And so they're excited to continue growing and sharing that with their community.
Tom (21:33.07)
Yeah, yeah, almost unheard of. Like, never, that will never happen with traditional instruments. You'll never, ever hear that. And you said there was a bigger company that you kind of helped out, maybe?
Angel Saucedo (21:49.209)
Yeah, so this was a little ordinary. I'll let you go for it.
Neer Patel (21:53.027)
Yeah, there's a roofing company that we work with that has about 200 employees. They've got several offices kind of spread out all over the country. And they were spending about a million dollars a year with Blue Cross. Actually, funny enough, Blue Cross's headquarters building was right next door to them. And the...
So they were able to kind of see where their money was going with all the ivory towers and everything that they have there. So yeah, spending about a million dollars a year with Blue Cross, getting 18 % or so increases for the last few years. And they just kind of came to us and said, this is unsustainable. If we keep getting 18 % increases every year, we're gonna have to...
Tom (22:24.588)
Ha ha ha.
Neer Patel (22:48.067)
do something, we're going to have to shut down some parts of our business or create new business extensions just to pay for the health insurance. How can you help us? And so we came in, we had them kind of change us to, they did a broker of record change, which is basically just sending a letter to a carrier, letting them know that we're going to change our agency to virtuous benefits. We came in, we managed exactly what they had. We kept
Blue Cross going because we came in the middle of a year of a plan year. So we kept their existing plan going and we introduced ourselves to all their staff as Virtuous Benefits, a new agency that's going to come in and kind of help you guys through claims and, you know, started building rapport with the staff so that we could build trust with them and start to understand some of the utilization things that were going on with healthcare. We also implemented a DPC pilot program.
while they still had their Blue Cross plan. So what that did was it got, you know, the first 30 people that decided to sign up, the company was paying for their membership and it got them to experience direct primary care while they had a network based plan. And they were able to see, I can go to this doctor that spends time with me. I can text them whenever I need them. They're giving me.
way better pricing on labs than I can get when I'm using my Blue Cross card, right? So they're starting to understand these things, medications, I can get them right out of my doctor's office for way less than it cost me through my Blue Cross card. So then that went on for about six months. And then at their renewal was when we kind of flipped the switch and introduced our new health plan that we were creating in the background.
while we were managing their existing Blue Cross plan. And we basically just removed the Blue Cross network completely. We kept everything else exactly the same. So all their deductibles, their copays, their coinsurances, everything was exactly the same as what they were used to with Blue Cross, except there was no Blue Cross name on the card. And then we included some perks. We set up a DPC plan.
Neer Patel (25:11.267)
that included some perks. So the perks were all of your primary care through your DPC is completely free. You don't have any co -pays or co -insurances as we know, right? So that's all included. Also, if your DPC physician wants to order any blood work, not just your annual panel, but any blood work at all throughout the entire year, that's gonna be completely free to you. In addition to that,
Tom (25:24.174)
Mm -hmm.
Neer Patel (25:40.131)
Any imaging that your DPC physician wants to order for you, x -rays, MRIs, CT scans, ultrasounds, all the plethora of imaging that's out there, if your DPC wants to order something for you, it's completely free. You have no cost at all. And then in addition to that, if you need one of our 1 ,100 generic medications that's on our generic list, we've...
bolted on a mail order pharmacy that's going to send those medications to you for completely free when your doctor prescribes it to that pharmacy. So those were all the perks that we were able to include in the DPC plan. We also saved them about 10 % on the front end. So their premiums every year were about 10 % less. But on the back end, we were putting...
we were putting a significant amount of money into, you know, that was being set aside to pay for claims that would potentially come back to the company or roll over for the following plan year. And so whereas Blue Cross was charging them a million dollars a year and keeping every single cent of that money, we now have, you know, about $400 ,000 or so that's out of that million that has the potential to roll over the following year.
Tom (26:48.48)
Mm -hmm.
Neer Patel (27:05.763)
and they're paying less every month than they were paying before. So to say that the executive team is thrilled is an understatement. And then just to see kind of our agency in action, you're always going to get some noise when you implement a plan like this that's different, that doesn't have a network, right? The employees, even though we tell them, please reach out to us, let us help you get your appointment set up at your cardiologist.
Tom (27:17.676)
Mm -hmm.
Neer Patel (27:33.539)
A lot of them forget what we say when we present to them right after we leave. And so they go try and use their insurance card somewhere and then they get that kind of front desk robotic answer of, you we've never heard of this insurance, don't take it. And so people were a little bit frustrated the first month, but we were kind of jumping on every single, you know, concern that came up to us immediately. And so within,
Tom (27:45.582)
Mm -hmm.
Neer Patel (27:58.977)
you know, two or three weeks of the plan starting, we got everybody settled down, we got everybody's appointments set up and there are providers understanding how everything works. And so then after that, it's just been smooth sailing and very quiet and everyone's super happy. So, so it's been a very good success story for us.
Tom (28:21.002)
Well, that's yeah, go ahead.
Angel Saucedo (28:21.145)
expand on it just a little bit, Tom, if you don't mind. So again, at the beginning, as you said, there was a little noise, but now we have patients or employees that call us and say, Hey, I realized now it's the provider giving that pushback or creating that noise because they don't, they don't, they don't understand how they're not accepting payments right over the phone. They're, you know, confusing the process. So it's rewarding to see now that the employees are now defending us and going to their provider and saying, look,
Tom (28:36.91)
Mm -hmm.
Angel Saucedo (28:50.969)
They're not the problem, you're the problem. How much is it they'll pay you over the phone? So that's been rewarding to see.
Tom (28:53.696)
Right.
Tom (28:57.422)
Yeah, that's a very interesting piece of the puzzle because it is so foreign to, let's say, a non -DPC doctor that you are getting paid upfront, right? Or that this type of benefit exists. So I think one of the other puzzle pieces that you guys really seem to do well with is that you did this kind of hybrid transition for them where...
it's a little bit more, it probably feels a little bit more safer to them. Like I'm talking with a physical therapy group that has about 30 people. And when they talk to me, when I was originally talking to them, they're like, well, we have these people that are under the insurance and how are they gonna get benefits? Like the people with...
chronic problems like diabetes, like one of them has diabetes and other stuff like that. And they're like, well, how would they get access to specialists? And at the time I didn't have any answers for them, you know, cause I didn't know that people like you existed. So, you know, I can imagine that when you talk to them about this kind of hybrid transition from full insurance, you know, with Blue Cross,
to virtuous benefits that they feel a little bit more comfortable. And then with those perks, it kind of helps drive the other people who are still kind of on that Blue Cross plan over to direct primary care.
Angel Saucedo (30:32.547)
Very much so, as much as people complain about the cost and even some of the customer service with the network.
That's all they know. And it works for what they needed up to that point, right? And so having an advocate, a true advocate that says, no, we're not going to create any more headaches for you. We're doing this for you. We're going to call those providers. We're going to set up payment arrangements. Use us. One of the differences between our agency and your typical agency is we don't just show up once a year to give you bad news. We're with you throughout the year, throughout every claim.
Tom (30:44.396)
Mm -hmm.
Angel Saucedo (31:07.001)
And so that builds a lot of rapport with the employees to where again, now they feel comfortable. Hey, I just got to call you, let you figure it out and then just tell me when it's ready. Whereas before they got to call a 1 -800 number, they got to deal with somebody at the front desk and that frustration just grows. So really having an advocate goes a long way for them.
Tom (31:24.974)
Yeah, so another interesting point you kind of said there was that you can come in in the middle of the year and give them benefits. So they're not locked into this. Or I should ask, do they sign a contract with you guys or how does that detail kind of work with these benefits?
Angel Saucedo (31:48.505)
So we have a consulting agreement. It's typically a 12 month contract, a 30 or 60 day notice. And if they want to terminate for whatever reason mid year, we've never had someone terminate a consulting agreement. But it just gives them that peace of mind that this is how we're compensated. We don't get a commission off a premium. We have set fees. These are all the services that we provide for you. So it feels like, again, this is a long -term commitment, not just, hey, let's see what happens and let's try it out. They know that we're going to be there for the entire
Tom (32:16.876)
Mm -hmm.
Angel Saucedo (32:18.459)
plan.
Tom (32:20.494)
Yeah, yeah, hence the name.
Neer Patel (32:21.443)
And the insurance is always a 12 -month agreement. But like you were mentioning, so when you're on a fully insured plan, you can basically start and stop those at any time. So there's not really any enforcement on any 12 -month agreement with a traditional fully insured plan. So the analogy I use is it's kind of like auto insurance. You can switch it at any time.
Most companies don't like to put their employees through open enrollment more than once a year. So that's one of the hurdles with that. But if they see numbers that make sense in the middle of the year, moving to a level or self -funded plan through one of our plans, sometimes they're like, yeah, let's just get rid of it now and let's flip the switch and move to one of your plans mid -year.
Tom (32:55.062)
Mm -hmm.
Tom (33:16.398)
Yeah, yeah, because they probably realize what's going on. So how do you, do you, when I'm thinking of hospitalists and specialists that you set up, or I wanna ask, do you actually set up these networks or is it like they just go there and then they give them the card and then they kind of explain? Because I'm trying to understand, is there kind of a,
a certain amount or type of doctors that need to be in the area to maybe support these types of benefits.
Angel Saucedo (33:56.345)
So that's the beauty of what we do. There is no network. You could literally go anywhere that you want in the country. And the reason we can say that is because every provider in the country, whether it be a hospital, a specialist, primary care, they take money. They take cash.
And so all of them already have either self -pay, cash pay, private pay, they kind of call it maybe a different term, but it means the same thing. If you have no insurance, this is the price that we charge you, right? And so that's what we do. We call them and say, what is your cash price for X amount of services? Again, so -and -so is going to show up. These are the services they're going to get, and we're going to pay you at the time of service. So you don't need a contract. You don't need an agreement. You just need to pay them, right? And so once you get over that hurdle with that provider, they're going to pay you.
Tom (34:37.164)
Mm -hmm. Mm -hmm.
Angel Saucedo (34:41.083)
like, that's how it should be, right? And it's like, yeah, that's how it should be because that's what we're doing.
Tom (34:47.31)
Yeah. Yeah. And you know.
Neer Patel (34:47.874)
A lot of the folks in the self -funded arena kind of talk about direct contracting as well with facilities and providers like you were kind of mentioning. We don't necessarily do very much of that because we feel like that's another form of a quote unquote network restriction. Even though there's no network in doing that, it's still a restriction where you're saying you're telling someone you have to go here, right? They don't like to be.
Tom (34:58.422)
Mm -hmm.
Neer Patel (35:15.939)
People don't like to be told where to go. And so that's the reason why we don't really, we don't really gravitate towards this direct contracting kind of health Rosetta sort of model, because there's no reason to have to force somebody to go somewhere. Every provider and facility in the country, like Angel mentioned, they take money. And so we just simplify it and we say, what's your cash price? How about we just pay that right now or right after the patient's done with their visit and everyone's happy. and so that's kind of how we do things.
Tom (35:16.43)
Right.
Tom (35:47.854)
Yeah, yeah. And that's that's the best way because again, you're not locking them in to choosing a certain doctor, which they may not like. Like they may not like that doctor, you know, or maybe that doctor's male and they prefer female or vice versa. And so I think not locking somebody in this, you know, that is kind of like the ideal dream that they, you know, that they get good that good health care that's actually paid for.
And so one of the other questions that I get is, well, what happens if, you know, I have an employee that has to be admitted for ICU or they have cancer or some type of severe, you know, illness that's long lasting. Do they, does the employer have to pay for that or how does that work for them?
Angel Saucedo (36:43.161)
So every one of our plans has something called stop loss insurance or reinsurance. Basically, there's a carrier that we built in that covers these large catastrophic claims, right? So there's protection for both the employer and the employee. Now, the beauty of having that in addition to our net negotiating is that because there's no contract with that hospital or that cancer center,
we're able to negotiate directly with them, right? One of the things that people don't realize about a network plan is that you're, when you're signing up for Blue Cross United, you're agreeing to their predetermined contracts that you have no access to. And that when you do kind of see them behind the scenes, they're not in your favor, right? So when we go directly to that hospital and say, okay, this person was in the ICU X amount of days, it costs X amount of money. Again, what is the cash price for this?
not the network price, not the contracts that you've already signed up. And to give you a quick example, we had somebody here locally go to a local hospital that had some back issue that ended them in the ER. They got a hundred and eight thousand dollar hospital bill.
And they of course were shocked and scared and what's going to happen. Of course we said, look, you don't have to pay that. That's just them thinking a network is going to pay them. So they're kind of overcharging. Once we got done with the negotiation, that bill was $24 ,000 all in fully paid for by the stop loss carrier. So that's what we're able to do when you don't have a contract. Now they kind of have to negotiate because they've already provided the care, right? And so they're obviously wanting to get paid. And if you pay them faster,
Tom (38:19.468)
Mm -hmm.
Angel Saucedo (38:22.939)
Right a carrier will pay them six months later and they'll fight them every step of the way We'll say hey look if we paid this today walked out of here How much do we owe you and we're able to get a significant reduction same for the cancer center a lot of cancer centers If you ask them, hey, what's your cash pricing if I don't have any insurance with us? The price significantly reduces because again, you're paying them faster They're not cutting a piece to the carrier and it just simplifies it so that's why we're confident in saying that even if
everything the same happened to you. You had an ICU, you had a cancer patient. Even if that happened to you the next year that we implemented this, you're still paying less for the care because we're removing all the overcharging that a network does.
Tom (39:07.916)
Mm hmm. Yeah, you're essentially they are paying for direct care, whether it's a consultant, whether it's a hospital, they're literally paying for that. They're not paying for the hope of care, you know, which like traditional insurance is right. Like it's a hope, you know, they're actually getting real care, you know, for their their employers. And another common question I get is,
Angel Saucedo (39:26.233)
and
Tom (39:38.222)
does this comply with the, I think with the ACA, right? And so what do you usually tell them when they kind of ask that question or do they ask that question?
Angel Saucedo (39:51.481)
No, that's a common question. We say it's an ACA compliant plan. So it has all the preventative stipulations that the ACA requires. We kind of have to say this is a real insurance plan. This is not a health share or some other version of that. This is a real federally regulated health plan that falls under ERISA. Right. And so once they hear that, they're like, OK, that's that's my biggest concern. If it's compliant with all the laws in place.
Tom (40:05.9)
Mm -hmm.
Tom (40:18.638)
Yeah, yeah, because they don't want to get in trouble. Being, you know, putting up a false plan.
Neer Patel (40:22.851)
of our job.
Part of our job as advisors is to make sure that we're keeping our clients compliant in every single aspect that they need to be compliant in as related to benefits. And so we do all the things that are necessary to stay up to date on all things compliance related. And we make sure that our clients are aware of every area of compliance that
they need to do to keep themselves compliant. So that's one of the other attributes of, you know, kind of what our agency provides is, you know, that consulting on making sure that everyone remains compliant.
Tom (41:10.902)
Mm hmm. And have you ever.
Well, I guess I should ask this whenever you go to actually on a backtrack just a little bit, whenever you go to introduce these benefits to the employees, how does that how does that process look?
Angel Saucedo (41:35.545)
So we're heavy on education. We always talk about the business side of medicine, because again, an employee just knows what they know. And so one of the things we tell them is, even though we're opening up this network and you can go anywhere you want, you have to understand the business side of medicine. And one of the examples I give is if you go see a doctor says, hey, potentially I think you might need a surgery, go see a back surgeon or some sort of surgeon.
When you go to that surgeon, you have to realize, especially if they work for a big hospital system, that surgeon gets a very high salary. They have a quota that they need to meet, perform certain amount of surgeries throughout the year, and they have bonuses tied to however many surgeries they perform. So if you're a patient that comes in, has insurance, and they're one surgery away from their bonus, what do you think they're gonna recommend, right?
So the employees need to, or if they're on a medication, sometimes you'll have somebody say, I'm on a maintenance medication for the rest of my life. Well, have you had a doctor actually find out why?
your body is reacting this way. Because if you don't even understand why you're taking it, then you may just be giving that doctor extra money because they get markups on some of that. The drug brick comes in and buys everybody lunch, right? So we help them understand that we're not saying that they're doctor or maybe someone's are used to our bad doctors, but we help them see the influence.
that a network carrier has on the way a doctor practices medicine. And of course, we've seen it throughout the years with the opioid crisis and things like that. So once they understand that and we transition to, hey, this is think of it as a team doctor, right? Every sports team in the country has a team doctor. And so that's the experience that we're trying to give you. And then obviously, if you need to go outside of that doctor outside of primary care at UPC, we can we can help guide you on some of the things that you may need. Most of the time, if you need to
Angel Saucedo (43:33.371)
need a surgery or something. Nobody gets data on, well, how many surgeries has this hospital performed?
many complications have they had? What's the differentiator, right? Funny enough, the hospitals actually have ratings, but Blue Cross will never tell you their rating or UnitedHealthcare will never tell you their rating. So sometimes just empowering that employee to say, look, you're no longer just a hostage, right? You now are the actual consumer that you can shop around. You have data to make an educated decision. They really start, you start winning them over. And of course we help them through the process, but they have to understand that,
Tom (43:50.574)
Mm -hmm.
Mm -hmm.
Angel Saucedo (44:10.317)
Just because this is what they're used to doesn't mean that's the best for their care.
Tom (44:18.366)
Right, right, and understanding the kind of perverse incentives that are in the background that are never seen by the patient, right? Like they don't understand that, look, if I don't do this, then I don't get paid, like in the traditional insurance model. And the patient's like, well, why do we have to do this? Or, you know, why can't I do this?
And then understanding how the insurance limits their time in the room, as well as the medications available to them, like you were saying. And it's true, the insurance does direct surgeons as well. And people who are specialists and driven heavily on procedures, it tells them, hey, this is your quota, the hospital has to make these quotas.
to essentially also fight the insurance squeezing them as well. So it's like kind of another game that even at the hospital level that they actually have to play there.
Well, I think we're kind of coming to the end of the podcast and I really appreciate you guys talking with me and can you tell people where they can find out more about virtuous benefits?
Neer Patel (45:43.619)
Absolutely, yeah. So, you know, they can visit our website, www .virtuosbenefits .care, and our contact information is there, our phone number, our email address. They can email us at info at virtuosbenefits .care. There's a live chat on our website that they can chat with us there as well. We're happy to educate any employers that are interested in kind of learning more about
you know, our model and how things work and how to get a quote. We're happy to educate any other DPC physicians on, you know, how this all works and how, how we're able to kind of help them grow their panel and, and help them work with employers. So anybody that wants to run anything by us, we're more than happy. Please feel free to reach out.
Tom (46:36.366)
Great, thank you. Yeah, that's very encouraging words. I think business owners who can actually call you and get you on the phone, I think that's gonna be very helpful to them. And especially with the fact that you can help them save on their bottom line and really give their employees the great healthcare that they are looking for in today's kind of confusing insurance -based world.
Well, thank you guys so much for coming on and maybe later on down the road we can do a part two.
Angel Saucedo (47:07.449)
Thank you, sir.
Neer Patel (47:12.675)
We'd love that. Thanks so much for having us, Dr. Tom. We appreciate it.
Angel Saucedo (47:12.697)
Sounds good.
Tom (47:15.438)
All right. Yeah, thank you guys. Thanks so much.