Telemedicine Talks

#11 - Building a Safety Net: Insurance Insights for Telemedicine Trailblazers

Episode Summary

Are you thinking about leaving your W2 job for telemedicine? Don’t overlook disability insurance. Dr. Leo Damasco and Phoebe Gutierrez sit down with Jamie Fleischner of Set for Life Insurance to break down why protecting your income is critical when going independent—and how to do it right.

Episode Notes

Episode Transcription

leo: [00:00:00] Hey, welcome back everybody to telemedicine talks. Today we have a treat in addition to my awesome co-host Phoebe, we have Jamie Fleischner from Set for Life Insurance. Now I think this is an important topic for us to talk to and when it comes to telemedicine, in terms of when doctors become their own businesses, right?

And that's what we see in telemedicine nowadays. Now, Jamie is well experienced in insurance. Her specialty is disability insurance and also life insurance. Been doing this for, what, 32 years? And is focusing on independence, really. Physicians, high income earners. Again, the company is set for life insurance.

So welcome. Thank you for gracing us with your presence and talking to us about, I think this super important topic because a lot of doctors when they make the switch, right? Don't know anything about this. A lot of us come outta residency and we are set, there's a pathway, there's a tunnel that we go down and everything's set for us.

We, [00:01:00] most of us go into W twos. And we just signed on. I remember just signing on the line. I'm like, oh great, I have insurance. I'm just gonna check everything off. I asked my HR lady, Hey, what should I sign this one too? What should I max out? And I asked my mom. My mom worked hr, she's do everything.

And that was it. That was the extent of my knowledge. So thank you for are coming on the podcast and educating us on what

jamie: we need to prepare ourselves for. Phoebe. Thanks for having me. Yeah, no problem with, so I think you bring up a really good point. So I think most people when they finish up their residency, they go into a career and they assume they're just gonna stay on that path and that their employer's gonna take care of them.

So they really don't pay attention to insurance or any of this kind of stuff. But one of the most important types of insurance, especially for physicians, is. Disability insurance because it covers your income. Your income is your most valuable asset. So your most valuable asset is your ability to earn an income.

So [00:02:00] every financial decision you're gonna make throughout your entire career is dependent on the fact that you're gonna produce an income and you're gonna have this income flowing in to save for retirement, to buy your house, to pay your bills, et cetera. If something happens, you get sick or injured, and that income.

Stream stops, where's that income gonna come from? So again, a lot of people rely on their employers and there are some policies there and there's some drawbacks, and we can talk about that too. But when you make the decision to go out on your own, all of a sudden you lose a lot of those. I. Types of policies.

And so all of a sudden you're back to square one saying, now I'm on my own. I'm flying by myself. If something happens, if I become sick or injured, how am I gonna pay my bills? How am I gonna pay my student loans, my mortgage, et cetera. And that's where it becomes

phoebe: really important. Yeah. And I think one thing that I thought was really interesting too is I think that it's almost an afterthought.

So a lot of physicians that I consult for when I bring this up, what are your plans for insurance? What are you gonna do [00:03:00] post, W2, they actually didn't think about it because again, to your point, Jamie, a lot of this is just taking care of for them. And so they don't even know what questions to ask.

They don't know what policies to look for. They don't know what makes normal sense versus what doesn't make sense. I think it's gonna be it's awesome to have somebody of your expertise like. Here who's gonna be able to share some of those like little nuggets of information just so you know, they can make sure that they're, getting the right policy, they're asking the right questions and they have all their bases covered.

Exactly. Absolutely.

jamie: , one of the first pieces of advice I would give for somebody who is considering going from being a W2 employee to a 10 99. It's easier to get the insurance while you're still a W2 employee because you can have that income verification. So when you apply for disability insurance, you can't just go out and apply and say, I want $10,000 a month, because that's how much I want.

You have to qualify for it. And in order to qualify, you have to have some kind of income verification. So when you're a W2 employee, you can just show a pay stub and say, Hey, I'm earning [00:04:00] X amount. And they'll allow you to get that policy. Even if you have a group policy, there's always room to supplement, so they'll still allow you to get some, maybe it's a lesser amount.

Then when you leave and you go out on your own, your individual policy is always portable. It'll go with you and it'll grow with you. Now, if you go out on your own and now your income is, maybe it's lower. You can still maintain that premium and your policy will still pay, and then as your income increases, you can then adjust it accordingly.

Typically, you need to have about a year of income pattern, though, to be able to increase that policy. So that's why it's critical if you're thinking about going out on your own, get your policy first. If you're newly out on your own, you might have to wait a year to

leo: actually apply for a policy and let's say you don't wait, or let's say you do wait and you make that mistake.

Now what's in, in terms of monetary kind of consequences, what happens? Do you, are you stuck with, one, you potentially can't create a policy, [00:05:00] right? Or if you can't, is it a lower policy set number? And then you have to build that up? Because

jamie: this is really interesting.

You have to show the income pattern. So if you are on your own, let's say you go out on your own. You talk to Phoebe and say, and she says, yeah, you need to go out and get a disability policy. You're three months out on your own. You may not even have an income pattern yet. And so they might say, just wait till you have that income pattern.

Circle back with us at six months, nine months. Once you've had a year to show that income. So you really do have to wait until you can show that. Now, let's say your income fluctuates. Let's say it goes up and down. One year you have a great year. The next year it's down. You don't have to keep telling the insurance company what your income is year to year.

So once you get your policy, as long as you pay those premiums, if you go out on claim, you might get paid more than you were or less depending on where you are, but you don't have to keep

leo: adjusting it necessarily. Got it. Got it. And so in that time, let's say you do make that mistake too, in that timeframe where you ha if you do have to wait, so you're just [00:06:00] flying without coverage, right?

So if you go down and that's

jamie: it. And that's the scary part. You better hope you have some good savings. Yeah, just to. Carry you, yeah. And if you do leave, you also can't take that group policy with you. So when you're at a, when you're a W2 employee, you have a group policy.

And so the group policy is generic. It covers everybody. So it says, if you're totally disabled, not working, most group policies will pay you. 60% of your income up to a maximum, usually 10,015, and that's taxable. So a couple of things and how it relates to your audience. Number one, you really have to be totally disabled.

It's not necessarily gonna cover you. If, let's say there's somebody who's doing procedures, maybe they're interventional cardiologist or gastroenterologist or a surgeon, and something happens and they can't do those procedures, the group policy might pay so long as they're not working. If they decide to pivot.

Do telemedicine and earn an income, that group policy probably won't continue to pay them because they're [00:07:00] actively earning an income. So they group policies will require you to be totally disabled. Now, an individual policy, if you have an individual policy on top of your group or you're out on your own, you have something called own occupation.

So in those circumstances, something happens and you can't do procedures. It's gonna pay you your benefit. Even if you can pivot and go do telemedicine. So you're not using your hands, you can just use your voice and and do your telemedicine. You, anything you earn, doing telemedicine will not offset any benefits that you're getting.

So it makes

leo: a really big difference. Now exit question. So when you set up this individual policy, from the group policy, and let's say you're not making as much as telemedicine, does this individual policy, is that based out of how much you're making separate from the group policy, or is it just

jamie: combined all in together?

So when you apply for a policy, they look at where you are at the time of application. So if you're a W2 employee, say you're making $300,000. And you have a [00:08:00] group policy that pays you 10,000, they might let you get another five or 10,000, whatever that amount is, so they will, there's only a limit on how much you can get based on your income and any other benefits you have in force.

Then when you leave, that individual policy can become portable. You can buy more on your own because you're only, you don't have that group policy to offset it. So as an individual, you can buy more. But again, once you pivot, if you don't have that income stream yet, you might have to wait a little bit until you have that

leo: pattern to increase it.

Now, is there a fear that the insurance company will say, oh, no. Now your income's decreased, now your policy's

jamie: less, or. Yeah, they can't do that. So there's language in the contract that they cannot do that. So there's two things that are built into, if you have a good contract, one is called non cancelable guaranteed renew.

It's non cancelable and guaranteed renewable. And in English, what that means is once you have your policy, they can't modify or change your contract. [00:09:00] So they can't come back and say, oh, you're earning less. We're gonna. You need to reduce it. They can't do that. They can't say, oh, you just took a jumping out of airplanes.

We're not gonna cover that. They cannot modify your contract. They can't say, oh, we heard you had back surgery. We're gonna exclude it. They can't change your contract. And they also can't change the premium. So it's really important you have that, those clauses in your policy so they can't modify it.

And I have had clients who are W2 employees, they get a decent sized policy and then they start their own practice, whether it's telemedicine or even a private practice. And the first couple years they're not earning as much because they're building and they've gone out on claim. So because they paid the premiums for that full amount, they actually got paid the full benefit because they were paying the premiums.

Wow. The company couldn't

leo: force them to reduce that. Oh, that's interesting. That's interesting. And let's say, a lot of our members or a lot of our listeners are actually looking to pivot and, get out of their brick and mortar and their known w twos altogether.[00:10:00]

What's a timeframe that they should be thinking about this? Sometimes this comes quick, right? For me, it took me a year. I, it was supposed to be doing this for a year or two, and it took me six, eight months to get out. So when's

jamie: a good time to start thinking about this? The earlier, the better.

The earlier you can buy a policy, the better because everything's based on your age at the time of application and your circumstances. So if at the time of application you're healthy, you're W2 and maybe you haven't had your birthday for the year yet, get your policy as early as you can. Because yeah, once you have that birthday, the premiums go up a little bit, so everything's based on where you are at the time of application.

Even if you're thinking next month, you're gonna go out on your own. On the application. As of today, I'm a W2 employee. Here's my pay stub, and they'll let you get that policy based on that criteria. Then the policy goes with you and if you go on claim, it pays you based on where you are at the time of claim.

Now, something else to consider too is based on what we're talking about. Let's [00:11:00] say when you buy the policy, you're doing internal medicine, but then. Down the road, now you're doing all telemedicine, it'll cover you in that capacity. So a lot of people would say I'm not able to do internal medicine anymore.

The company might say, but wait, you're doing telemedicine, so something would have to happen where you can't do telemedicine anymore. Does that make sense? So if, let's say maybe you have some, you're immunosuppressed and you can't go into the hospital now. Yeah, but you haven't been going into the hospital.

You can't necessarily file a claim and say, oh, I'm immunosuppressed. I can't go see patients. They're gonna look at it and say, the last two years you haven't seen people in person. That doesn't necessarily

leo: qualify you for that. Yeah,

jamie: that

leo: makes sense. That makes sense. Yeah. Yeah. And Phoebe are there common questions that you that you run into as well when you talk to the doctors or even startups that that you've found that

phoebe: you have hard to answer.

I. , I think a lot of people are just wondering like when is the right time to do it? Of course the question [00:12:00] is like, what is an average cost? Like how can I tell if it's a good policy or one that is like way over the top?

Typical, what are some key benefits that I would wanna make sure that my policy includes versus, maybe some that are a little bit more, nice to have like stipulations. I think those are like the top three buckets of questions that I'm getting and I know that now I can at least tell them like, you wanna do it while you still have a W2 job?

Because I didn't know the answer to that. Yeah, no, that's

jamie: huge. So that brings up a good point. So a lot of our clients, they come to us and we work as an independent broker. So what that means is we don't work for any insurance companies so we can spreadsheet all of the available options. And so we listen to our clients and find out what's the most important thing to them?

Some people want. The most comprehensive policy. Some people might just say, I, I'm 50, I just wanna get through the next five years. I just need a baseline policy. And they're everything in between. So we listen to , what they need. The younger you are, the less expensive it is.

It's also more expensive for women by about [00:13:00] 50%. It's a lot more expensive for women than it is for men. So we're just more likely to go on claim. Our life insurance is less expensive, but our disability insurance is more just based on risk. So that's something to consider. So if you buy your policy, and I'll just give you a rule of thumb, in your thirties, expect to pay between one and 3% of your overall income, and that'll cover about 80% of your income.

You can never or. It'll cover 60% of your gross, or about 80% of your take home pay. You can never a hundred percent cover your income. That's just the way that they do it. So the older you are, the higher you know it's going to be. So it really depends. It also depends on your medical specialty. So if you're doing.

Internal medicine or telemedicine, that's considered lower risk than if you're doing emergency medicine or surgery. Those are considered higher risk, so they're more expensive. And then they also look at where you're located. So it's more expensive if you're in California than I'm in [00:14:00] Colorado, than in Colorado.

So they just look at all of those type of factors. But I think the best thing to do is you contact a broker and just give them your criteria, your information. This is what's important to me. Spreadsheet it out and look at that and then decide which is gonna be the best policy and just have somebody advise you and go through that

leo: process with you.

Nice. Now, what are some pitfalls that you've seen when you're working with physicians that approaches. Subject, common mistakes, what to look out for, things that they're like, oh, no you definitely need to consider this before,

jamie: When you do this process. So I think one of the biggest pitfalls that I actually think is people assuming that their employer's gonna take care of them.

So they just think, Hey, I don't really need this. I'm gonna go work at this big hospital or this big physician group. My employer will take care of me. And I think it comes to as a big surprise as people realize. [00:15:00] That they think of you as just, they can get rid of you at any time or when you leave, you lose your benefits.

The other thing is if you do have a disability while you are employed, you sometimes they categorize you differently and all of a sudden you lose your health insurance and you might lose your life insurance and some of these other types of things. So people don't think about that. And a lot of people just also procrastinate.

They just think. I'll do this later, or I really don't need to do this, or it's not gonna happen to me. I'll, maybe someday if I'm on my own I'll get this, but right now my employer's gonna take care of me. So a lot of people just kick the can and deal with it later. The other thing that you have to think about is in order to get a policy.

Not only do you have to qualify financially that we talked about, but you also have to qualify medically. And so about one in three applications, we either get turned down or some kind of exclusion, your left knee or your back or mental health or any of these types of things. So they only ask you medical questions when you first get your policy.

So they are, they comb [00:16:00] through everything and so it can, anytime you've had any kind of treatment for anything, they will look at it and analyze that. Once you get your policy, you'll never have to answer those medical questions again. You can increase down the road by just showing your income has gone up.

So I think another misconception is people think, when I'll just go buy this when I need it. And they don't realize, that trip to the chiropractor I. All of a sudden now there's a back exclusion. Or they went and saw, a psychologist, they were going through some tough times, a bad breakup and now they have an exclusion.

Like it's really frustrating. So the earlier you can get a policy and go through that process and avoid

leo: that in the future, the better. Now this pertains to a very small subset of kind of telemedicine doctors, and it's really specialized, but I'm former military, right? And before I separated.

There's a VA process and and you go through your disability claim so forth and so on, and there's a few of us that, especially in our community, that are active duty right [00:17:00] now and are thinking about transitioning. Do you want to, do you wanna do your VA disability process before or after?

jamie: Is that gonna affect kind your medical? I usually, so yeah, I get this, I actually get this question more often than you. You would think there's one company, MassMutual, that will allow military physicians to get a policy, but it's only 2000 a month. With 4,000 of increase options, they'll only pre-approve you up to 6,000.

It's not a lot. So if you're, maybe you're still in residency and you have several years to go and you say, I just wanna have some kind of coverage, you can get that coverage if you're right on the brink of finishing up. I'd just say, wait until you're done. And then. Once you're no longer active military, you're gonna have all the options available to you.

And then you can shop it around and you can get more insurance. But yeah, they make you go through that process and the whole disability , but that's not a problem in order to get the insurance though. If you're still healthy, unless you're being, treated for something significant, it shouldn't

leo: be a problem to get a policy.

And specifically the VA rating, so do they look at your VA [00:18:00] ratings as well as part of the whole medical picture?

jamie: So I just had somebody come out. Yeah. So I just had somebody come out, they of of military training and they got a policy and they had to turn in some kind of VA disability form that said Uhhuh, all the different things.

So they turned that in, but the company still came back and said, no problem. Thanks for the disclosure. And they offered them a full policy. So I think it depends on what's on that form. Obviously, if you're being treated for some, let's say you are, you're being treated for, like I said a knee surgery or something.

It would, they would just consider that just like anybody else with a knee surgery and they would just exclude that. Got it. And if they exclude it, they might say, once you've been treatment free for three years or five years, or whatever the extent of the injury was, then they would, reconsider that exclusion.

But those are good questions and those are the kinds of things. Contact me and I can look at that specific

leo: thing and advise you. Yeah, no, because we don't think about these nuances. This specific situation. I personally waited to get VA rated before, or I waited [00:19:00] after to get my I specifically waited to get my VA rating after I got my disability, so forth and so on.

So I didn't have to deal with that. But no, a lot of us don't think about this. So yeah, definitely sooner the better. , so how do we approach this? What do we need to prepare for? Before we talk to somebody like you, we jump on the website set for life insurance.com and we're like, okay, I'm interested in getting this.

It's important to me, a lot before I transition outta my brick and mortar. What do I need to prepare? What should I get? How

jamie: do I hit the ground running when I talk to you? So a lot of people just come through our website, click on request a quote, and give us the basic information.

And that's enough to just start the process and then we shop it around and show some initial recommendations. And then sometimes we set up either Zoom call or a phone call and go over all of that. That's at least enough information to start the process and see. What people are looking for.

If there's a lot of extenuating circumstances or people have a lot of questions, people also just go on our calendar and set up a time and go over it. 'cause it can be [00:20:00] overwhelming and it can also be a very simple process too, just depending on the circumstances. So people have very. Specific circumstances or maybe medical history or something they wanna talk about, they can also just set up a time to go over it.

If it's more just simple or traditional process, then they can just request a quote and that's generally enough information for us to at least prepare a comparison and

leo: make some recommendations. Got it. Got it. And. How, what's the timeframe from start to finish? Should we expect something like this

jamie: happen on average let's say three to six weeks?

Yeah, three to six weeks longer if you, they need to request medical records even longer if they need military records, as you probably are aware. And some like university hospitals can take a really long time to get those records. But at three to six weeks, on the lower end, if it's, you know that you don't have a lot of medical history, you haven't been treated for anything, it just goes really smoothly.

Two, if you have a great deal of medical history, that's what usually drags the process along. If you apply for more than [00:21:00] 10,000 a month benefit, they'll also require blood and urine test. So where somebody comes out and draws blood and urine. So if you apply for less than 5,000 or less than 10,000 a month, or if you're a medical resident, they just waive that or you're coming outta residency,

leo: they'll waive that.

That's interesting. Hey I was expecting a lot more than three to six weeks to be honest.

jamie: So that's, some are longer if we need a lot of records, but that's just the typical on average.

leo: Yeah. Yeah, no, a lot of the, a lot of the folks getting into, our listeners so forth or our cohort are the people that have been in for a little bit and thinking about something new.

So we may be a little bit down the road, yeah. I'm definitely an old man, so I have a lot of stuff. Thank God I started this process way before I start racking up all the medical concerns. But yeah. No. And now do you have any other questions, Phoebe? Anything else that's.

phoebe: Come up in, in your line of work?

No the only other question I would say is you brought up like some medical exclusions and for people that might maybe avoid this because they're like, oh, I did have back surgery and I did have something happen. Maybe some [00:22:00] like words. To, to those folks, that kind of bucket.

Just because again, like I'm sure that you could still probably find them a policy, even if they do have medical exclusions. You're just, it's

jamie: just a little bit different of a process. Yeah. So usually if you get a medical exclusion, let's say they exclude your back or your knee or your elbow or whatever it is, they usually don't raise the price.

They just won't cover that specific thing. And so some people are like I'm not gonna get a policy if it's not gonna cover my knee. But you also have to think about. All the other things that could happen, cancer or, other types of things that can occur. We weigh it out, but a lot of, so you have to weigh out the pros and cons of taking a policy that has an exclusion.

And yeah, you do get to a certain age where people do start to have, their body starts to break down or whatever. But you have to again, weigh it out and say, okay, but if I don't have a policy, do I have enough in savings? To cover my expenses if something does happen. So sometimes something is better than nothing.

If people do have [00:23:00] significant history. We do also have non-traditional carriers like Lloyds of London or some of those where we can go and find policies that'll cover them. Maybe they're diabetic or they have, some pretty significant health history. We can still typically find

leo: something for them.

Got it. Got it. And is there any concern, let's say you do develop something or let's say you hold off on your surgery and you get your policy and then you have the surgery a month later? I. You said that they can't take anything back, but in those circumstances,

jamie: you know where there is something on the policy called a two year period of Incon contestability.

So when you file an application, they will ask you, do you have any upcoming surgeries or do you had any history? And if you have a claim in the first two years, they have the right to investigate. So if they knew that, you got your policy and you were already scheduled for a surgery, they're probably not gonna cover that.

So you have to be careful on that. 'cause they can just rescind the contract. I've had people who get a policy and then, [00:24:00] six months later they get into an accident, they'll still look through everything. Obviously they didn't anticipate that. So you do have to be careful of that. So you do wanna make sure you disclose it.

'cause if you don't and then you go have that surgery and file a claim, they might be able to prove that you already had that as a preexisting condition

leo: and they wouldn't have covered that. Got it. No, super important. Now I know we're coming up on time, but I always love asking this question, what are things that we, that you found that a lot of doctors don't know to ask?

What should you know? What don't we

jamie: know usually that we need to know? One of the things a lot of people ask is, how much should I get? It's, and it's just like anything else, and I think people also need to assess their own personal situation to figure out if something happens, how much you need to have.

So it's almost like asking a realtor what kind of house should I get? It's it depends on what you want. What are your needs? How many bedrooms do you need? And what's your budget? And it's the same for disability insurance. So you wanna look at what does your [00:25:00] household look like?

Are there two people that bring in an income? Or maybe it's just one. What are your expenses? Some people live to the full extent of their income. They have a lot of loans or a lot of expenses, and some people live well below their means. So I think you also need to assess how much you really need to have, and what Phoebe had said before too, is you don't always need every bell and whistle on your policy either, maybe you don't need all of the features.

Again, like the house or a car analogy. What are the most important things to, for you? So I think, but the biggest question, a lot of people are like I don't know where to start and I don't know how much I should get. And I think you have to look at your own situations and look at your own budget and say, okay, if something happens to me, here's how much I need to be able to pay my bills.

And then

leo: that's the best starting place. And I'm sure you and your team are well adept into walking somebody like me that definitely has that question right through that process and getting

jamie: through.

leo: So that's awesome. Absolutely. Absolutely. That's awesome. Now any closing [00:26:00] thoughts? Any closing,

jamie: drop the mic kind of statements?

No, I don't think so. If somebody already has a policy or they got it a long time ago and they're saying. Did I get the right kind or I haven't really reviewed it, or I bought a policy and I never heard from my agent or broker ever. So they can come to me. I'm happy to talk them through it and walk them through.

And one other thing that I do like to emphasize is we, it's. Not only important to get a policy, but it's also important to review it as things change. So you might have people who bought a policy maybe during residency, and now you know, 10 years later they're going into telemedicine. They might need to adjust their current policy.

Maybe they already have something, but they don't even know what to do with it. So it's really important to review things as your circumstances change. So I say every probably three years to reevaluate your policy, just to make sure it's doing what it needs to do or any kind of life change, job change.

You get married, you get divorced, you have a child or buy a house, or any kind of big shift in any kind of life changes. You [00:27:00] wanna just make sure that your insurance is up to speed, because what you don't wanna have happen is you get a policy and you forget about it. 5, 7, 10 years later you have a claim and then you say, oh my God, I can't even remember if I'm covered.

Am I gonna be okay? Am I gonna be able to sustain my household? So it's really

leo: important to keep it up to date. That's something else I need to put on my to-do list then I'm probably like 10 years late on that. Oh, geez. No, thank you so much. So this is Jamie Flechner. Thank you for joining us on telemedicine talks other than looking you up on set for life insurance.com.

Is there a better way to contact

jamie: you or is that the preferred way? That's the best way. We have a contact forum. We have a quote request forum. We have a calendar link.

leo: Everything's on our website. Awesome. Awesome. And we'll include your website to link it to our website as well. And so if anybody has any questions, concerns, also any specific questions, concerns for myself, Phoebe definitely drop us a line at Phoebe at telemedicine docs or [00:28:00] telemedicine talks.com or leo telemedicine docs.com.

Awesome Jamie, thank you so much for taking your time. This has been enlightening really, 'cause again, this is something that's just really not a. Big issue until it becomes one. And it's a scary thing when people do make that jump from, W2 to their own. That happens a lot in telemedicine.

jamie: So thank you so much for your time. I appreciate

leo: it. Thanks for having me. Appreciate it. Appreciate it. Awesome.