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Affordable Care Act Discussed by Richard Philippe & Kathleen

Podcast Transcript

Transcript

Affordable Care Act

PHILLIP CRUM: This is our regular feature show from Kathleen Mills of Life Tree Counseling. Kathleen is your host and I am your humble co-host, Phillip Crum, the content marketing coach. Good morning, Kathleen, how are you?

KATHLEEN MILLS: I am well. How are you, sir?

PHILLIP CRUM: I am excellent. I am ruling, as they say in the movies. It’s a wonderful Tuesday morning, and let’s just jump right in and get to our Shameless Promotion section. You have a symposium coming up.

KATHLEEN MILLS: I do.

PHILLIP CRUM: Tell me about it and what does any listener need to know?

KATHLEEN MILLS: Well, this is our third symposium that I’ve personally done and launched, and I think this one is going to be great. We have 11 sponsors – we picked up another sponsor last week – as you know, Phillip, at the Path to Freedom Conference. We’re basically having a business symposium for the Texas mental health professional to help protect, defend, and equip their practice, their agency so they can continue to thrive in doing what they do best, and that is to taking care of many, many people.

PHILLIP CRUM: This is way more than just the show-up-for-three-hours-to-get-your-CEU-credits for ethics that you need every year.

KATHLEEN MILLS: Right. I think so. It’s six hours – it’s all day, and we’re going to be talking about legal issues, business setup issues with two attorneys, we’re going to be having a very candid conversation with two retired investigators pertaining to the complaint process – how that works, how do you respond, how do you testify, and to specifically review<a title=”Chapter 611 Information” href=”http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.611.htm” target=”_blank”> Chapter 611 for all the mental health professional</a>s to brush up on. We’re also going to have some social media expertise from my wonderful co-host, and we are going to be talking with our guest that we have today about the Affordable Care Act.

PHILLIP CRUM: Good. Why don’t you run down a list of your speakers? You’ve touched on a couple of us, but why don’t you run down the list, if you can, by name?

KATHLEEN MILLS: Sure. First of all, we’re going to be having Richard, who we’re going to be talking with in just a minute about the Affordable Care Act and the changes in what I think the mental health professional needs to be equipped to be up to target with. We’re also going to be talking with John Pierce and John Mongogna from Wright Ginsberg Brusilow law firm here in Dallas, and they’re going to be talking about corporate structure, and also reviewing what your malpractice liability does not do for you, and what it will do for you. And just reviewing those specific vulnerabilities that we all have that most of us don’t know about until it’s too late. I’m going to be talking about what I think are the 12 must-haves in order to have a successful business model for private practice. Champ Kerr and Steve Slough are retired senior investigators from the State of Texas reviewing the dreaded investigation process that we all fear but need to know.

PHILLIP CRUM: You’ve got not only the ethics but a lot of information on how to run your business from basic daily business operations stuff to marketing to what happens when the guys with the badge and gun come in the front door.

KATHLEEN MILLS: That is correct.

PHILLIP CRUM: And when is this event, and how much does it cost to get in?

KATHLEEN MILLS: It is April 30th, which is the last Wednesday of this month, and the fee right now is set at about $135, and it’s getting ready to go up next week as it gets closer to the event. It’s at the Crowne Plaza in Addison, Texas.

PHILLIP CRUM: So if someone’s coming from a distance, they can actually stay at the Crowne Plaza.

KATHLEEN MILLS: Actually, we have several coming from far away and they will be staying at the Crowne Plaza at a reduced rate.

PHILLIP CRUM: Excellent. So all they need to do is tell the Crowne Plaza people that they’re with you to get the rate.

KATHLEEN MILLS: Once they register on our Eventbrite registration page, there is a link that directly links to the reduced rate hotel at the Crowne Plaza. So we’ve tried to make it very, very easy for the registrants to do.

PHILLIP CRUM: Why don’t we jump into today’s guest? Would you like to introduce Richard, and we’ll go from there.

KATHLEEN MILLS: My guest is Richard Philippe, and he works for RP Strategies. He’s an insurance broker and he is on the side of helping individuals and corporations purchase health care insurance and he’s going to give us a very good view from his vantage point how the Affordable Care Act has changed the way we look at and purchase a product. And I’m glad to have you here, Richard.

RICHARD PHILIPPE: I appreciate that.

PHILLIP CRUM: I might add before you get started, Richard, that between Richard and Kathleen, you two probably know more than anybody in the Dallas area about the whole Obamacare program and the changes that’s going to bring than anybody I know. So having the both of you at the same symposium is going to be a treat for those who need to wrap up in a hurry. Richard, tell us something we don’t know about the Affordable Care Act – Obamacare.

RICHARD PHILIPPE: RP Strategy Group is all about getting the most of your insurance needs, and there are changes that are happening all the time these days. Just in the last couple weeks, we have seen our first open enrollment for ACA, which is the Affordable Care Act, or better known as Obamacare. That open enrollment was trying to start whittling away the 30 to 40 million uninsured that were supposedly out there, and the ACA people said that they got 7.1 million people to sign up. That ended officially the end of last month and there were some slight exceptions that could have extended it all the way to next

week. But for most people, that ended last week.

PHILLIP CRUM: So the individual sign-up period was over last week and 7.1 million signups. What constitutes a signup? Do you know?

RICHARD PHILIPPE: It’s a very, very loose definition, probably the loosest definition I’ve ever seen. All it constitutes is when you went onto the portal, you had to log in. You had to give some of your information, and that was just so you could potentially see a rate at some point. Once you had logged in, you were considered to be a sign-up. And I did a little research on that, and that’s basically like looking at Amazon, looking for a price or a product, and not actually buying. Amazon actually has 147 million look-sees every day. 147 million. I just thought it was kind of fascinating that they call a sign-up just somebody who looked on the website.

KATHLEEN MILLS: Richard, just to clarify, because I think there’s been some information that has come out through the press suggesting that definition – they’re not using that particular definition of what a signup is. I think they’re promoting the fact that they actually purchased something.

RICHARD PHILIPPE: Right. They are making it sound like they have enrolled 7.1 million, but when you dig into what they’re really talking about; they’re just talking about people who have looked onto the website.

KATHLEEN MILLS: Right.PHILLIP CRUM: This is our regular feature show from Kathleen Mills of Life Tree Counseling. Kathleen is your host and I am your humble co-host, Phillip Crum, the content marketing coach. Good morning, Kathleen, how are you?

KATHLEEN MILLS: I am well. How are you, sir?

PHILLIP CRUM: I am excellent. I am ruling, as they say in the movies. It’s a wonderful Tuesday morning, and let’s just jump right in and get to our Shameless Promotion section. You have a symposium coming up.

KATHLEEN MILLS: I do.

PHILLIP CRUM: Tell me about it and what does any listener need to know?

KATHLEEN MILLS: Well, this is our third symposium that I’ve personally done and launched, and I think this one is going to be great. We have 11 sponsors – we picked up another sponsor last week – as you know, Phillip, at the Path to Freedom Conference. We’re basically having a business symposium for the Texas mental health professional to help protect, defend, and equip their practice, their agency so they can continue to thrive in doing what they do best, and that is to taking care of many, many people.

PHILLIP CRUM: This is way more than just the show-up-for-three-hours-to-get-your-CEU-credits for ethics that you need every year.

KATHLEEN MILLS: Right. I think so. It’s six hours – it’s all day, and we’re going to be talking about legal issues, business setup issues with two attorneys, we’re going to be having a very candid conversation with two retired investigators pertaining to the complaint process – how that works, how do you respond, how do you testify, and to specifically review<a title=”Chapter 611 Information” href=”http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.611.htm” target=”_blank”> Chapter 611 for all the mental health professional</a>s to brush up on. We’re also going to have some social media expertise from my wonderful co-host, and we are going to be talking with our guest that we have today about the Affordable Care Act.

PHILLIP CRUM: Good. Why don’t you run down a list of your speakers? You’ve touched on a couple of us, but why don’t you run down the list, if you can, by name?

KATHLEEN MILLS: Sure. First of all, we’re going to be having Richard, who we’re going to be talking with in just a minute about the Affordable Care Act and the changes in what I think the mental health professional needs to be equipped to be up to target with. We’re also going to be talking with John Pierce and John Mongogna from Wright Ginsberg Brusilow law firm here in Dallas, and they’re going to be talking about corporate structure, and also reviewing what your malpractice liability does not do for you, and what it will do for you. And just reviewing those specific vulnerabilities that we all have that most of us don’t know about until it’s too late. I’m going to be talking about what I think are the 12 must-haves in order to have a successful business model for private practice. Champ Kerr and Steve Slough are retired senior investigators from the State of Texas reviewing the dreaded investigation process that we all fear but need to know.

PHILLIP CRUM: You’ve got not only the ethics but a lot of information on how to run your business from basic daily business operations stuff to marketing to what happens when the guys with the badge and gun come in the front door.

KATHLEEN MILLS: That is correct.

PHILLIP CRUM: And when is this event, and how much does it cost to get in?

KATHLEEN MILLS: It is April 30th, which is the last Wednesday of this month, and the fee right now is set at about $135, and it’s getting ready to go up next week as it gets closer to the event. It’s at the Crowne Plaza in Addison, Texas.

PHILLIP CRUM: So if someone’s coming from a distance, they can actually stay at the Crowne Plaza.

KATHLEEN MILLS: Actually, we have several coming from far away and they will be staying at the Crowne Plaza at a reduced rate.

PHILLIP CRUM: Excellent. So all they need to do is tell the Crowne Plaza people that they’re with you to get the rate.

KATHLEEN MILLS: Once they register on our Eventbrite registration page, there is a link that directly links to the reduced rate hotel at the Crowne Plaza. So we’ve tried to make it very, very easy for the registrants to do.

PHILLIP CRUM: Why don’t we jump into today’s guest? Would you like to introduce Richard, and we’ll go from there.

KATHLEEN MILLS: My guest is Richard Philippe, and he works for RP Strategies. He’s an insurance broker and he is on the side of helping individuals and corporations purchase health care insurance and he’s going to give us a very good view from his vantage point how the Affordable Care Act has changed the way we look at and purchase a product. And I’m glad to have you here, Richard.

RICHARD PHILIPPE: I appreciate that.

PHILLIP CRUM: I might add before you get started, Richard, that between Richard and Kathleen, you two probably know more than anybody in the Dallas area about the whole Obamacare program and the changes that’s going to bring than anybody I know. So having the both of you at the same symposium is going to be a treat for those who need to wrap up in a hurry. Richard, tell us something we don’t know about the Affordable Care Act – Obamacare.

RICHARD PHILIPPE: RP Strategy Group is all about getting the most of your insurance needs, and there are changes that are happening all the time these days. Just in the last couple weeks, we have seen our first open enrollment for ACA, which is the Affordable Care Act, or better known as Obamacare. That open enrollment was trying to start whittling away the 30 to 40 million uninsured that were supposedly out there, and the ACA people said that they got 7.1 million people to sign up. That ended officially the end of last month and there were some slight exceptions that could have extended it all the way to next

week. But for most people, that ended last week.

PHILLIP CRUM: So the individual sign-up period was over last week and 7.1 million signups. What constitutes a signup? Do you know?

RICHARD PHILIPPE: It’s a very, very loose definition, probably the loosest definition I’ve ever seen. All it constitutes is when you went onto the portal, you had to log in. You had to give some of your information, and that was just so you could potentially see a rate at some point. Once you had logged in, you were considered to be a sign-up. And I did a little research on that, and that’s basically like looking at Amazon, looking for a price or a product, and not actually buying. Amazon actually has 147 million look-sees every day. 147 million. I just thought it was kind of fascinating that they call a sign-up just somebody who looked on the website.

KATHLEEN MILLS: Richard, just to clarify, because I think there’s been some information that has come out through the press suggesting that definition – they’re not using that particular definition of what a signup is. I think they’re promoting the fact that they actually purchased something.

RICHARD PHILIPPE: Right. They are making it sound like they have enrolled 7.1 million, but when you dig into what they’re really talking about; they’re just talking about people who have looked onto the website.

KATHLEEN MILLS: Right.

PHILLIP CRUM: So 7.1… What percentage of those lookie-loos have actually paid for anything?

RICHARD PHILIPPE: They really can’t answer that question. They didn’t build it into the website, supposedly. Of course, we all know that when you’re designing websites, you always want that kind of information because you need to know how effective it was.

PHILLIP CRUM: So they want us to believe that the insurance companies who are providing this care don’t know how many people have paid for it?

RICHARD PHILIPPE: That’s correct. To make it worse, they’re putting a lot of the burden of these new supposedly patients onto the physicians for approximately 60 days. So that person could come in to your office and expect care and you as a provider would have to accept them and you may not get paid.

KATHLEEN MILLS: I can tell you, Richard, that we’ve got a couple of federal exchange clients, if you will, and very well aware that I’m probably looking at maybe 90 days because we really don’t know if they’re covered per se because their premiums haven’t been paid yet, but yet they show up as covered. Does that make sense?

RICHARD PHILIPPE: Yes, it does. This is a real bad burden on small doctors’ offices. Obviously, it’s very misleading numbers, so… (call drops off)

KATHLEEN MILLS: Right. Hello?

PHILLIP CRUM: That ended last month. And I’ve decided that I need to enroll going forward sometime now or in the reasonable future. Can I do that? What’s involved there?

RICHARD PHILIPPE: An individual will not be able to buy health insurance until the next enrollment in November, when it starts over again, unless you have a qualifying event – something that’s outside your control, such as losing your job, getting married, getting divorced, somebody passes away, you have a child. Those are qualifying events. Those could allow you your own open enrollment and you have to purchase within 30 days of that qualifying event.

KATHLEEN MILLS: Hey, Richard, is it 30 or 60 or 90 days?

RICHARD PHILIPPE: It’s actually 30 days. What a lot of people think of as a qualifying event also is when you’re at an employer and you go on COBRA and COBRA gives you the option for 60 days to decide if you want that health insurance from the employer. So at that time, you’d have that many days to pay for your COBRA insurance or you could go to the individual market. And, see, that’s something that’s also different. You know, last year, you would have to – if you had a health condition or an ongoing situation, you might not be able to go to the individual marketplace, so the only thing you had as an option you had was your group insurance or your COBRA plan with your prior employer. Sometimes those can be very expensive. But now the individual coverage’s don’t ask any medical questions. So you’d be able to compare which one might be best for you.

KATHLEEN MILLS: But you don’t know the provider panel, is that correct?

RICHARD PHILIPPE: In the private marketplace, you do.

KATHLEEN MILLS: Okay.

PHILLIP CRUM: What is a provider panel?

RICHARD PHILIPPE: A provider panel is – you’re talking about a network, basically, and in the exchange, those networks haven’t really been defined, but in the private marketplace, they are very defined.

PHILLIP CRUM: One thing I’ve never understood, Richard, and perhaps you can shed some light, if, under the Obamacare Affordable Care Act, I have to go online to buy insurance and I never been clear as to whether I could just walk into Richard’s office and buy insurance. Or do I have to do it online? That’s Step One of my question.

RICHARD PHILIPPE: That’s pretty fuzzy. We’re in Texas, we’re in the federal exchange, and everything has to be done online. Now, if you’re in a state where you have a state exchange, some of them are using paper apps and things like that. There’s actually one state that has not been able to process one thing online and they’ve had to do all paper apps.

KATHLEEN MILLS: What state is that? Do you know, Richard?

RICHARD PHILIPPE: If memory serves, Maryland or Vermont or something.

PHILLIP CRUM: I thought that was – you may be right, but I recall seeing Oregon somewhere on the Northwest.

RICHARD PHILIPPE: Oregon is another one of those that has done a terrible job with their website.

KATHLEEN MILLS: You’d think they would have done better because they were more of a state exchange prior to the ACA, correct?

RICHARD PHILIPPE: You would have thought. Only 130 million dollars on that website, too.

PHILLIP CRUM: I would have done it for half of that. Richard, one of the things you do for a living is sell health insurance. So, am I hearing you correctly that – and you’re in Texas – if I want health insurance, I have to buy it online and I’ve, as we sit here today on April 8, I have missed the deadline so I can’t buy it unless I have an event. I’ve got to divorce my wife in order to get health insurance and I can’t walk into your office today and buy any kind of health insurance because, in Texas, it has to be done online and, on top of that, I’ve already missed the deadline.

RICHARD PHILIPPE: You need to keep in mind that there’s two different marketplaces. There’s the exchange, which is closed, and it’s done. Like I said with the few exceptions, but then there’s the private marketplace, and that’s still open. That’s open only for those with those qualifying events. But you’re right. Your point was, if I don’t have a qualifying event, what do I have available to me? Well, you really wouldn’t have much except for we can sell you a short-term major medical policy that can last a few months until the open enrollment begins again in November.

PHILLIP CRUM: My point was that an insurance guy like you is almost out of work.

RICHARD PHILIPPE: Well, luckily, I do a lot of group insurance. That’s mostly what my office does is group insurance, and those people can buy whatever they want.

PHILLIP CRUM: I see.

KATHLEEN MILLS: This pertains to the individual more than it does the employer’s company’s group?

RICHARD PHILIPPE: And something else you need to know is that the group can cause a qualifying event. So some of these groups that are getting those big rate increases – if they quit their insurance, then all of those persons at that office are now – they have a qualifying event.

PHILLIP CRUM: So all you’ll be seeing is people with problems, Richard, is that right?

RICHARD PHILIPPE: That’s what health insurance is, really. It’s a whole lot of problems. We’re problem solvers.

PHILLIP CRUM: We’re running out of time, so let’s marry these two things together. Kathleen, you’re in the mental health counseling world, and Richard deals with health insurance. How are these changes – and this is to the both of you, one at a time – how are these changes going to affect the world that group of people out there, Kathleen, that need your services?

KATHLEEN MILLS: We’re seeing it already, but I think the thing that will take some inventory for private practices is to understand that the clients who are coming in either have insurance or they don’t, and the people that have insurance, they’re deductibles have skyrocketed to just an enormous amount of money. Their copays have already gone up so they’re being very frugal with when they come in and how long they come in, because they only have a finite amount of money per month because this has been a very big budget-busting thing for the clients who do have insurance. Their new policies have gone into effect and we’re hearing it. So I think we need to be a very good educator of what their benefits are now. They do know, but they’re very frugal on when they’re going to use their policy because it’s very cost-prohibitive at this point.

PHILLIP CRUM: Are you telling me that their deductible and their copay is much greater than it used to be, so when they come see you, there is an out-of-pocket expense that either wasn’t there before, or has greatly increased? Is that accurate?

KATHLEEN MILLS: That is correct. They’re finding out that they’ve got to meet the deductible. On our end, we have to be very good educators of what their copay structure is with their provider discounts and all that stuff. What it actually is going to be so they can fulfill their deductible. And it takes a great amount of energy and good education for our clients to be understanding of their new policies.

PHILLIP CRUM: And what are you having to do, Kathleen, in your office, to meet them halfway, so to speak? Are you having to give up anything to help?

KATHLEEN MILLS: We do what we’ve always done, which we collect so much at the front, but we’re also calling the insurance companies very quickly to see what their structure, their new policy is. By the time they come back for the second visit, we are almost to the penny knowing how much they have to pay, and that’s when we have to educate. So I guess, to make a long story short, we’re really talking with them more to educate them about how this working now for them.

PHILLIP CRUM: Richard, any thoughts on the same subject? What are you seeing? Are people asking or talking about the mental health, psychological health aspects of the health plans, or not? Have you found that so far? RICHARD

PHILIPPE: I think there’ so much change that people right now are really behind the curve. They’ don’t know what to ask right now. If they’re a part of the exchange, they don’t realize that those networks are getting ready to see a massive reduction in size. I think they’re part – they don’t even understand there’s an exchange and there’s a private marketplace.

KATHLEEN MILLS: To add to that, Richard, to be honest, we don’t even know if we’re on the federal exchange at this point. So, yeah…

PHILLIP CRUM: What does that mean?

KATHLEEN MILLS: I mean, let’s say one of the bigger insurance companies – BlueCross Blue Shield, let’s say – we’re on all of the panels within the BlueCross BlueShield network, if you will, but with the federal mandate for the ACA, if you’re on the federal exchange, that doesn’t necessarily mean that the same BlueCross BlueShield provider panel still exists for that particular client. So the client is under the assumption that if they buy, let’s say, a BlueCross BlueShield policy through the federal exchange, they think that everybody’s still on it. That’s not necessarily going to be the case.

PHILLIP CRUM: Richard, have you and Kathleen determined exactly what you’re going to be focusing on at the symposium? Have you nailed those topics yet?

RICHARD PHILIPPE: We’re talking about how they will affect the mental health providers, individual policies.

KATHLEEN MILLS: I think we’re going to review where everything is, basically the individual mandate, where we are with that, the employer mandate, because everybody – well, not everybody, but a lot of people have jobs and you see clients and they work for somebody – we’re going to be talking about that, I’m thinking. But also if you’re a self-pay provider and you think you think you’re not going to be affected by this, I really beg to differ. And I think one of the things I like about Richard a lot is that he knows the business and he’s seeing it before perhaps the providers are in terms of how this is affecting him and his clients, who are employers and individuals, and the federal exchange and all that kind of stuff. So if you think you’re a self-pay provider that you feel pretty comfortable, I would really like you to come to listen to what Richard has to say.

RICHARD PHILIPPE: All the insured out there are getting squeezed from their budget and that means the cash-paying person’s going to have less cash in their pocket, and I guess that’s what Kathleen’s talking about. The self-paying providers are going to see less cash that’s available, and they’re making decisions based on that less cash.

KATHLEEN MILLS: And we’re already seeing that, and to be honest, Richard, we take a lot of insurance and a lot of EAPs and people are being very cost-minded with regard to their health care.

PHILLIP CRUM: We have two minutes left. Let me ask you: Is there any aspect of – this is going to sound like an opinion question, but it’s not. I’m looking for facts here. Is there any aspect of the Affordable Care Act that either of you knows is going to benefit the mental health care industry? Who’s going to benefit from this?

KATHLEEN MILLS: This is just my thought. I think that the inpatient psychiatric alcohol rehabs are thinking that they’re going to benefit from this particular policy.

PHILLIP CRUM: In what way?

KATHLEEN MILLS: The simple fact that, when you have coverage, you can get the care and treatment that you need.

RICHARD PHILIPPE: The benefits were very limited last year in that category for that group of providers you just described. And those benefits have expanded this year. So somebody has converted and is not in a grandfathered plan – they’ve converted to the new ACA-compliant plans, they will see expanded coverage in that area.

KATHLEEN MILLS: And I think that’s the psychiatric and the alcohol/chemical dependency/recovery piece.

RICHARD PHILIPPE: What they’re not going to see, and what they’re not going to see, is expanded coverage for the basic treatment – seeing somebody from time to time. I was going to say that you’re talking about inpatient kind of facilities that could see an expanded use.

PHILLIP CRUM: So if someone’s in the rehab industry, and is listening to this, they can be confident that if they showed up to the symposium, you’ll be there as one of the speakers and they can avail themselves of your knowledge to find out exactly a little bit more – a lot more – about how this is going to work in their industry? Is that fair?

RICHARD PHILIPPE: That sounds fair.

KATHLEEN MILLS: Yeah.

PHILLIP CRUM: Will there be time for Q&A from the audience during Richard’s session, or will it be available afterwards for more discussions?

RICHARD PHILIPPE: I was going to say that I would be thrilled to answer any questions. I think that’s really where people can find out what they really want to know, not what I want to tell them.

KATHLEEN MILLS: I think the goal here is to get the initial information out, like, where we are now, because it’s been changed so much from even two months ago, Richard, when you and I talked the first time, but I think Q&amp;A is definitely more heavy with Richard than on the symposium because this is the really important piece about what you want to do to run your practice and what you need to know to be ahead of the curve.

PHILLIP CRUM: We need to wrap this up, so in ten seconds or less, Kathleen, tell the listeners: Give me one good reason they should show up to the symposium?

KATHLEEN MILLS: Well, I think the one good reason is we’ve got so many great people who are going to be there that you will leave with your brain full.

PHILLIP CRUM: Richard? How about you, sir? One good reason.

RICHARD PHILIPPE: Well, have you maximized your insurance needs? And, also, what’s going on. A lot of people don’t even understand what’s going on.

PHILLIP CRUM: All right, good. And I would say that attending the symposium with all the different types of speakers from the Obamacare discussion to the ethics to the investigating a complaint.

PHILLIP CRUM: The cost of admission to the symposium is still less than one hour with your attorney. So that’s the best reason to show up. I appreciate it very much, Richard. This has been enlightening, and I thank you for your time, and I’m sure we’re going to be doing this again. Kathleen, as always, it’s been fun. Let’s do it again. For the rest of you join us next week and we’ll explore another topic at the industry roundtable. Thank you very much.

PHILLIP CRUM: So 7.1… What percentage of those lookie-loos have actually paid for anything?

RICHARD PHILIPPE: They really can’t answer that question. They didn’t build it into the website, supposedly. Of course, we all know that when you’re designing websites, you always want that kind of information because you need to know how effective it was.

PHILLIP CRUM: So they want us to believe that the insurance companies who are providing this care don’t know how many people have paid for it?

RICHARD PHILIPPE: That’s correct. To make it worse, they’re putting a lot of the burden of these new supposedly patients onto the physicians for approximately 60 days. So that person could come in to your office and expect care and you as a provider would have to accept them and you may not get paid.

KATHLEEN MILLS: I can tell you, Richard, that we’ve got a couple of federal exchange clients, if you will, and very well aware that I’m probably looking at maybe 90 days because we really don’t know if they’re covered per se because their premiums haven’t been paid yet, but yet they show up as covered. Does that make sense?

RICHARD PHILIPPE: Yes, it does. This is a real bad burden on small doctors’ offices. Obviously, it’s very misleading numbers, so… (call drops off)

KATHLEEN MILLS: Right. Hello?

PHILLIP CRUM: That ended last month. And I’ve decided that I need to enroll going forward sometime now or in the reasonable future. Can I do that? What’s involved there?

RICHARD PHILIPPE: An individual will not be able to buy health insurance until the next enrollment in November, when it starts over again, unless you have a qualifying event – something that’s outside your control, such as losing your job, getting married, getting divorced, somebody passes away, you have a child. Those are qualifying events. Those could allow you your own open enrollment and you have to purchase within 30 days of that qualifying event.

KATHLEEN MILLS: Hey, Richard, is it 30 or 60 or 90 days?

RICHARD PHILIPPE: It’s actually 30 days. What a lot of people think of as a qualifying event also is when you’re at an employer and you go on COBRA and COBRA gives you the option for 60 days to decide if you want that health insurance from the employer. So at that time, you’d have that many days to pay for your COBRA insurance or you could go to the individual market. And, see, that’s something that’s also different. You know, last year, you would have to – if you had a health condition or an ongoing situation, you might not be able to go to the individual marketplace, so the only thing you had as an option you had was your group insurance or your COBRA plan with your prior employer. Sometimes those can be very expensive. But now the individual coverage’s don’t ask any medical questions. So you’d be able to compare which one might be best for you.

KATHLEEN MILLS: But you don’t know the provider panel, is that correct?

RICHARD PHILIPPE: In the private marketplace, you do.

KATHLEEN MILLS: Okay.

PHILLIP CRUM: What is a provider panel?

RICHARD PHILIPPE: A provider panel is – you’re talking about a network, basically, and in the exchange, those networks haven’t really been defined, but in the private marketplace, they are very defined.

PHILLIP CRUM: One thing I’ve never understood, Richard, and perhaps you can shed some light, if, under the Obamacare Affordable Care Act, I have to go online to buy insurance and I never been clear as to whether I could just walk into Richard’s office and buy insurance. Or do I have to do it online? That’s Step One of my question.

RICHARD PHILIPPE: That’s pretty fuzzy. We’re in Texas, we’re in the federal exchange, and everything has to be done online. Now, if you’re in a state where you have a state exchange, some of them are using paper apps and things like that. There’s actually one state that has not been able to process one thing online and they’ve had to do all paper apps.

KATHLEEN MILLS: What state is that? Do you know, Richard?

RICHARD PHILIPPE: If memory serves, Maryland or Vermont or something.

PHILLIP CRUM: I thought that was – you may be right, but I recall seeing Oregon somewhere on the Northwest.

RICHARD PHILIPPE: Oregon is another one of those that has done a terrible job with their website.

KATHLEEN MILLS: You’d think they would have done better because they were more of a state exchange prior to the ACA, correct?

RICHARD PHILIPPE: You would have thought. Only 130 million dollars on that website, too.

PHILLIP CRUM: I would have done it for half of that. Richard, one of the things you do for a living is sell health insurance. So, am I hearing you correctly that – and you’re in Texas – if I want health insurance, I have to buy it online and I’ve, as we sit here today on April 8, I have missed the deadline so I can’t buy it unless I have an event. I’ve got to divorce my wife in order to get health insurance and I can’t walk into your office today and buy any kind of health insurance because, in Texas, it has to be done online and, on top of that, I’ve already missed the deadline.

RICHARD PHILIPPE: You need to keep in mind that there’s two different marketplaces. There’s the exchange, which is closed, and it’s done. Like I said with the few exceptions, but then there’s the private marketplace, and that’s still open. That’s open only for those with those qualifying events. But you’re right. Your point was, if I don’t have a qualifying event, what do I have available to me? Well, you really wouldn’t have much except for we can sell you a short-term major medical policy that can last a few months until the open enrollment begins again in November.

PHILLIP CRUM: My point was that an insurance guy like you is almost out of work.

RICHARD PHILIPPE: Well, luckily, I do a lot of group insurance. That’s mostly what my office does is group insurance, and those people can buy whatever they want.

PHILLIP CRUM: I see.

KATHLEEN MILLS: This pertains to the individual more than it does the employer’s company’s group?

RICHARD PHILIPPE: And something else you need to know is that the group can cause a qualifying event. So some of these groups that are getting those big rate increases – if they quit their insurance, then all of those persons at that office are now – they have a qualifying event.

PHILLIP CRUM: So all you’ll be seeing is people with problems, Richard, is that right?

RICHARD PHILIPPE: That’s what health insurance is, really. It’s a whole lot of problems. We’re problem solvers.

PHILLIP CRUM: We’re running out of time, so let’s marry these two things together. Kathleen, you’re in the mental health counseling world, and Richard deals with health insurance. How are these changes – and this is to the both of you, one at a time – how are these changes going to affect the world that group of people out there, Kathleen, that need your services?

KATHLEEN MILLS: We’re seeing it already, but I think the thing that will take some inventory for private practices is to understand that the clients who are coming in either have insurance or they don’t, and the people that have insurance, they’re deductibles have skyrocketed to just an enormous amount of money. Their copays have already gone up so they’re being very frugal with when they come in and how long they come in, because they only have a finite amount of money per month because this has been a very big budget-busting thing for the clients who do have insurance. Their new policies have gone into effect and we’re hearing it. So I think we need to be a very good educator of what their benefits are now. They do know, but they’re very frugal on when they’re going to use their policy because it’s very cost-prohibitive at this point.

PHILLIP CRUM: Are you telling me that their deductible and their copay is much greater than it used to be, so when they come see you, there is an out-of-pocket expense that either wasn’t there before, or has greatly increased? Is that accurate?

KATHLEEN MILLS: That is correct. They’re finding out that they’ve got to meet the deductible. On our end, we have to be very good educators of what their copay structure is with their provider discounts and all that stuff. What it actually is going to be so they can fulfill their deductible. And it takes a great amount of energy and good education for our clients to be understanding of their new policies.

PHILLIP CRUM: And what are you having to do, Kathleen, in your office, to meet them halfway, so to speak? Are you having to give up anything to help?

KATHLEEN MILLS: We do what we’ve always done, which we collect so much at the front, but we’re also calling the insurance companies very quickly to see what their structure, their new policy is. By the time they come back for the second visit, we are almost to the penny knowing how much they have to pay, and that’s when we have to educate. So I guess, to make a long story short, we’re really talking with them more to educate them about how this working now for them.

PHILLIP CRUM: Richard, any thoughts on the same subject? What are you seeing? Are people asking or talking about the mental health, psychological health aspects of the health plans, or not? Have you found that so far? RICHARD

PHILIPPE: I think there’ so much change that people right now are really behind the curve. They’ don’t know what to ask right now. If they’re a part of the exchange, they don’t realize that those networks are getting ready to see a massive reduction in size. I think they’re part – they don’t even understand there’s an exchange and there’s a private marketplace.

KATHLEEN MILLS: To add to that, Richard, to be honest, we don’t even know if we’re on the federal exchange at this point. So, yeah…

PHILLIP CRUM: What does that mean?

KATHLEEN MILLS: I mean, let’s say one of the bigger insurance companies – BlueCross Blue Shield, let’s say – we’re on all of the panels within the BlueCross BlueShield network, if you will, but with the federal mandate for the ACA, if you’re on the federal exchange, that doesn’t necessarily mean that the same BlueCross BlueShield provider panel still exists for that particular client. So the client is under the assumption that if they buy, let’s say, a BlueCross BlueShield policy through the federal exchange, they think that everybody’s still on it. That’s not necessarily going to be the case.

PHILLIP CRUM: Richard, have you and Kathleen determined exactly what you’re going to be focusing on at the symposium? Have you nailed those topics yet?

RICHARD PHILIPPE: We’re talking about how they will affect the mental health providers, individual policies.

KATHLEEN MILLS: I think we’re going to review where everything is, basically the individual mandate, where we are with that, the employer mandate, because everybody – well, not everybody, but a lot of people have jobs and you see clients and they work for somebody – we’re going to be talking about that, I’m thinking. But also if you’re a self-pay provider and you think you think you’re not going to be affected by this, I really beg to differ. And I think one of the things I like about Richard a lot is that he knows the business and he’s seeing it before perhaps the providers are in terms of how this is affecting him and his clients, who are employers and individuals, and the federal exchange and all that kind of stuff. So if you think you’re a self-pay provider that you feel pretty comfortable, I would really like you to come to listen to what Richard has to say.

RICHARD PHILIPPE: All the insured out there are getting squeezed from their budget and that means the cash-paying person’s going to have less cash in their pocket, and I guess that’s what Kathleen’s talking about. The self-paying providers are going to see less cash that’s available, and they’re making decisions based on that less cash.

KATHLEEN MILLS: And we’re already seeing that, and to be honest, Richard, we take a lot of insurance and a lot of EAPs and people are being very cost-minded with regard to their health care.

PHILLIP CRUM: We have two minutes left. Let me ask you: Is there any aspect of – this is going to sound like an opinion question, but it’s not. I’m looking for facts here. Is there any aspect of the Affordable Care Act that either of you knows is going to benefit the mental health care industry? Who’s going to benefit from this?

KATHLEEN MILLS: This is just my thought. I think that the inpatient psychiatric alcohol rehabs are thinking that they’re going to benefit from this particular policy.

PHILLIP CRUM: In what way?

KATHLEEN MILLS: The simple fact that, when you have coverage, you can get the care and treatment that you need.

RICHARD PHILIPPE: The benefits were very limited last year in that category for that group of providers you just described. And those benefits have expanded this year. So somebody has converted and is not in a grandfathered plan – they’ve converted to the new ACA-compliant plans, they will see expanded coverage in that area.

KATHLEEN MILLS: And I think that’s the psychiatric and the alcohol/chemical dependency/recovery piece.

RICHARD PHILIPPE: What they’re not going to see, and what they’re not going to see, is expanded coverage for the basic treatment – seeing somebody from time to time. I was going to say that you’re talking about inpatient kind of facilities that could see an expanded use.

PHILLIP CRUM: So if someone’s in the rehab industry, and is listening to this, they can be confident that if they showed up to the symposium, you’ll be there as one of the speakers and they can avail themselves of your knowledge to find out exactly a little bit more – a lot more – about how this is going to work in their industry? Is that fair?

RICHARD PHILIPPE: That sounds fair.

KATHLEEN MILLS: Yeah.

PHILLIP CRUM: Will there be time for Q&amp;A from the audience during Richard’s session, or will it be available afterwards for more discussions?

RICHARD PHILIPPE: I was going to say that I would be thrilled to answer any questions. I think that’s really where people can find out what they really want to know, not what I want to tell them.

KATHLEEN MILLS: I think the goal here is to get the initial information out, like, where we are now, because it’s been changed so much from even two months ago, Richard, when you and I talked the first time, but I think Q&amp;A is definitely more heavy with Richard than on the symposium because this is the really important piece about what you want to do to run your practice and what you need to know to be ahead of the curve.

PHILLIP CRUM: We need to wrap this up, so in ten seconds or less, Kathleen, tell the listeners: Give me one good reason they should show up to the symposium?

KATHLEEN MILLS: Well, I think the one good reason is we’ve got so many great people who are going to be there that you will leave with your brain full.

PHILLIP CRUM: Richard? How about you, sir? One good reason.

RICHARD PHILIPPE: Well, have you maximized your insurance needs? And, also, what’s going on. A lot of people don’t even understand what’s going on.

PHILLIP CRUM: All right, good. And I would say that attending the symposium with all the different types of speakers from the Obamacare discussion to the ethics to the investigating a complaint.

PHILLIP CRUM: The cost of admission to the symposium is still less than one hour with your attorney. So that’s the best reason to show up. I appreciate it very much, Richard. This has been enlightening, and I thank you for your time, and I’m sure we’re going to be doing this again. Kathleen, as always, it’s been fun. Let’s do it again. For the rest of you join us next week and we’ll explore another topic at the industry roundtable. Thank you very much.

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