Health Insurance vs. Health Plan Podcast Transcript

Mariela Salgado  00:06

Hello, everyone, welcome to My CHN podcast Health Conversations Without Barriers. This is Mariela and the CHN gang.

Olga  00:14

Hi all, I’m Olga.

Lulu  00:15

And hi I’m Tolu, you can call me Lulu.

Mariela Salgado  00:18

So today we’ll be talking about insurances versus health care plans. So actually, we have someone joining us right now. His name is Mike McDermott. Hi, Mike, thank you for joining us today. Please tell people who you are and what you do.

Michael McDermott  00:32

Hi, good morning, Mariela. My name is Michael McDermott. I’m the CEO of Americare Health, I’m now launching a virtual health platform for the state of Texas. And hopefully this will spark your interest.

Mariela Salgado  00:48

All right. Well, thank you for joining us, we do have some questions. And that is mostly because, one we’re trying to know the difference between a health care plan and what health insurance is, we want to ask you, what is your favorite and least favorite thing about the health care in the United States?

Michael McDermott  01:07

In general, my favorite thing about health care is the fact that people that are sick have access to it. Well, people very rarely need health care, but for the people that need it, rarely is it available in the insurance industry, because when you go to use it in the insurance business, all you get as a deductible, and you don’t do very rarely get the access the health care you need. And very rarely is it a price that the family can afford.

Mariela Salgado  01:41

Actually, that’s That’s right. So I would say like, for example, something that happened to my mom, we got the bill right. And it was very high. Obviously, the reason and the reason what the insurance gave me even though we’re paying very high insurance is that we had not met the deductible. So one of those things is how is it possible to even meet the deductible? And like, what does that mean that the person has to go to the doctor several times?

Michael McDermott  02:09

I think that’s a good question. How do you avoid a deductible if the plan is to buy a health care platform that doesn’t include a deductible, our concierge service is built on a platform that allows people to access through Doctor care labs, the important necessities of the beginning of a relationship with a doctor, if you don’t have access to a doctor, I don’t care how many times you need to go and pay for it. What happens when the plan should do that the plan that you buy should do that. So what Americare Concierge does, we started out first by giving you a doctor giving you the lab that you need and do it at an affordable rate from $49 for an individual to $129 for a full family. No deductible no pre existing access to a doctor and your basic health care needs.

Olga  03:03

Yes, makes so that sounds very affordable, actually. And that leads us to another question. So what is the main differences between the health care plan and the Health Insurance?

Michael McDermott  03:16

Health Care Plan is the relationship between you and your doctor? The relationship on an insurance company is between you and their insurance company putting themselves between you and your health care providers. It’s very important distinction, a concierge relationship through Americare is a direct relationship with your doctor in the labs with no middleman in between, with his hands up. Putting it simply.

Olga  03:45

Yes, that makes sense, actually. So another question. So with health care plans? I’m thinking if I have a major health issue, is that going to be covered? Or is that more of preventative visits and, you know, sick visits?

Michael McDermott  04:04

Well, let’s answer that question. But what insurance is, insurance is a way to finance health care needs when the person can finance them. So let’s establish first that you have a doctor and you have labs and you have some health care so you can establish that you have a condition. So now let’s establish a you need financing for that. So you have to have an insurance plan that we do have as a no deductible health insurance plan that allows you financing, immediate financing with no deductible for that condition. Even the federal government offers assisted financial assistance for these platforms for people with low incomes but we actually have that available at a very affordable rate. You have to buy insurance or have the cash if a catastrophic process is needed. If I say, as the doctor, we need to do some testing, and we need to get you in for your gallbladder is about to explode. You’ve got to be able to afford that or you got to have the insurance policy to pay for that. We have both. $49 does not buy you insurance, it buys you a health care plan. Let me make that clear. You have to have both for catastrophic problems.

Olga  05:31

Yes. So So from what you said, it seems like if the best practice is to have a healthcare plan for your day to day needs for your sick visits, and then also have insurance to cover your emergencies or any major health issues, is that I understand that right.

Michael McDermott  05:50

Ideally, that is the way to do it without buying a standalone deductible health care insurance plan. Keep it under the with our agency selling you a no deductible health care plan that way, when the catastrophic event arises, you’re not out of pocket. The insurance plan picks up immediately.

Lulu  06:14

Something that I had is for people who are kind of trying to decide if they want a health care plan or a health care insurance, what steps do you think that they should take in making that decision?

Michael McDermott  06:29

I really think the individual needs a appointment with a health care professional to find out their financial abilities. First of all, we do a lot of healthcare consulting with individuals, families and companies to make sure that their budget fits the needs of the many. So many insurance companies come in with their insurance policy, take this or don’t take anything at all. And if you don’t, they leave. So with our health care plans, we have a variety of low cost alternatives for people that can only afford health care platforms to offer their employees or a family that can say, well, I need to buy this for my family because of those family’s needs. You have to match the family’s needs, with the family’s budget. Otherwise they don’t have they’re kind of stuck, because they can’t see a doctor because they need financial, the ability to see the doctor. And sometimes sometimes they don’t even have that much to see the doctor. So that’s why we kept our rates so affordable at $49.

Mariela Salgado  07:44

Actually, I was reading an article regarding that, that I believe it was Golden Corral that the CEO said we gave them you know, the opportunity for our employees to get health insurance get coverage, but a lot of them decided that they can’t do it because it takes more than 100 bucks out of their biweekly paycheck. And they will rather use this 100 bucks or you know, 150, maybe 200 for their family for bills or for food.

Michael McDermott  08:16

You’re mentioning the problem that we have in the insurance world or take this we gave them an opportunity to spend half of their income for what we’re not paying for their insurance. Say the company usually pays anywhere from 50 to 75% of the employee’s cost. But then the insurance company gives you a $5,000 deductible. And most of the employees say well what good is that do me when I had to come up with $5,000 and I’m paying two $300 a month just for myself, not my family. So what ends up happening is of course the executives get what they want, but everybody else gets left out. Part of the Americare Concierge concept is include everybody in healthcare led the executives by what they want to buy into the insurance plan. We’ll be glad to sell that to be we sell everything in the state of Texas and the Medicare Advantage world medicare supplement world group health or individual health care plans, including our own it’s exclusive, no deductible health care access plan. And when I say access, we’re a physician organization so that we allow you to see any doctor’s any facility that you like, we do not dictate where you go or who you seek. Let me also say we did a survey recently, who is really your health care provider. A lot of people said a Blue Cross and a lot of people said well I get my health care over at MD Anderson. We look at the actual provider relationship with the patient. The providers at Blue Cross the provider at MD Anderson. So they’re the ones that actually give you the health care. It’s Dr. John, it’s Dr. Olga, it’s Dr. Mariela, we, the doctors that we represent are the actual health care providers in these situations that allow the patient access. And the majority of our concierge service, the lion’s share of that money is the doctor’s money. We’re just the administrators. So we’re basically a marketing arm for the physician organization to reach out to the patient’s, bring them into health care, and find out what they need for insurance and what they can afford for insurance. If they qualify for free medical insurance. If they qualify for CHIP, if they qualify for Medicaid, where do they belong on the financial scale? And what do they qualify for? So I wanted to kind of bring that into the attention because most insurance guides really come in there with the insurance sales tactic. And that’s not what a concierge service is, what we really try to do is find what the family needs for health care and insurance.

Olga  11:11

Yes, that sounds really important, Mike, that you bring in the healthcare, access to the community. And for those who can afford those expensive insurance plan, they still can access the doctor, they still can feel like they have a doctor and they can contact somebody when they have that issue. So really important.

Michael McDermott  11:34

I think it’s a dignity of everybody that they at least have access to a doctor’s care. I mean, when they get a flu, when they need an antibiotic when they need some kind of health care and health care advice, they have access to it.

Mariela Salgado  11:49

Another thing is, and I think your point that we were getting at is that people think that their insurance is is their actual provider for care, right. So that’s what people are confusing. But another thing is that now I noticed, insurances are bringing in their own providers, right? So they’re like bringing in like their virtual care providers. But still, like the connection with the patient is still very it’s not personalized, because they see so many like people. So even trying to get your information or your records from them. It’s very, I don’t know, it’s very, like robotic. There’s really not personalization there. So how is that different from the service that they give and the service you give?

Michael McDermott  12:38

One of the beautiful points is that on your on your actual landing page for Americare, Concierge errors is your dashboard for your personalized records, your prescriptions, and it’s very easy to work, setting up an appointment with a physician that we have on staff yet your choices of several doctors, several nurse practitioners, depending on what your needs are. I’m a very big believer that nurse practitioners are very good service for our community. That gives you that relationship. And anything out of her skill that can be referred over into this specialist side, fortunately, we do have platforms that will pay for specialty inside our platforms, it just depends on what you’re really looking to do. We also are coming out with behavioral health needs platforms and dental platforms for our community as well to be added on to this as we grow this business inventory account.

Mariela Salgado  13:46

And that includes also pharmacy delivery, right that includes that?

Michael McDermott  13:50

Oh I haven’t really touched on our pharmacy delivery because we are we owned pharmacies as part of our package. So our cost of drugs is a little bit different from your typical retail wholesale division, because we’re a federal clinic. So the drugs that you couldn’t afford in the past, you can now with the concierge service because you’re a member of a federal clinic, you get that concierge service, along with your labs to get the correct diagnosis along with access to the pharmacy. The big problem with health care is I like to give real life examples. So I’m in the poison ivy patch on Friday. I’m highly allergic to poison ivy. I have a concierge relationship. I call my doctor I’m in immediately he calls it into the pharmacy. They drop, ship it I have it Saturday morning. So, I avoid the delays of seeing my doctor. I delay I avoid. Oh I can’t see you until Monday or Tuesday. And next week or even Friday of next week, so that I get my prescription so I avoid the allergic reaction that I could have had from the posin ivy. Something as simple as that could cost somebody to $300 running down to the urgent care, getting the prescription, taking care of it that way. So what are you gonna do spend two or $300.00 with a membership to the concierge? are zero. Now the cost of the drug man, it cost me $5. Okay, I’m guilty, I can afford $5. That’s how this plan is working. And it has worked now for nine years.

Mariela Salgado  15:42

So if I was a small business owner, like let’s say, I have a restaurant and I have, you know, waiters bartender. How would this plan help me?

Michael McDermott  15:53

Well, first of all, you offer your bartenders in your waitstaff, something that very few people have been. this plant hasn’t really existed for 49 years. As an insurance salesman for 30 years, I would actually go into the restaurant and say, Well, hi I’m with Blue cross or Cigna and say, We have this wonderful $5,000 deductible plan, that’s $600 a month. How many do you want? Well, the bartenders nearby say, Well, we’re we don’t want any of that. So now what happens is I come in with a health care package. Now these people have access to the doctor in their lab and pharmaceuticals. And they have health care, the basic dignity of what an employer and what this insurance really started out to be, say, back in World War Two, the Hartford came out with an idea because there was a freeze on wages. So they offered health care benefits to their people. So what happened is that it just expanded for the years that it’s been under the hands of insurance companies, and it has become the deductible the expensive proposition of health care insurance versus your health care plan.

Olga  17:04

Yeah, this is very good, Mike. I feel like those are employers that, you know, in service industry, they need to start giving their employees some kind of benefits. Because that seems not fair. I’ve worked in the service industry for a while. So I know how hard how hard this work is, and you, you get, you can get injuries and you can get, you know, you get tired, you can get sick from your job. So they should offer those benefits.

Michael McDermott  17:34

And then you’re also looking to is, the first thing or doctor comes to you through your phone app or through a virtual app, you do have access to go into one of our nine clinics down in Brazoria, but everything is the state of Texas, mostly based on a virtual concept. Truck drivers. People that need access to their prescriptions that are on the move. Also, if I’m sick, I don’t want to go to the doctor. Well, I want my doctor to come to me. And if I need a refill on a prescription, why do I want to go to the doctor’s office around a bunch of sick people. And why don’t want to go to the pharmacy? If I’m sick and infect everybody there and or get coughed on hacked on the pharmacy. You know, we just went through a pandemic, at least we could do something to engage the population and give them some kind of access where the doctor comes to you just like we’re doing here.

Olga  18:36

Yeah, that the pandemic changed that dynamic for everything. And I think the healthcare industry is changing more towards having more virtual access. And I think that’s beautiful. That’s that’s the future.

Lulu  18:49

I think we’re on the cutting edge of creating a good solution for most people that need the access to just just health care. Let them buy the insurance as they feel needed, and what is needed for their individual families. They’re our consulting division. And let us consult with those people to find out really what they need, really what they want to buy, not so much of what’s just being offered by the Big Five monopolistic health care companies.

Mariela Salgado  19:21

Another question would be do you think, for example, now I was reading about how now companies are educating their employees about health insurance terms, right? Because before I even started working here, I had no idea what copay deductible. All these terms were. Do you think that would help like the workforce to understand what they’re looking for how to talk to you know,

Michael McDermott  19:48

The most misunderstood things in America are legal, health care and financial when we need a divorce and we need legal work were lost, and boy do we pay for it? When we need health care, we’re at the mercy of the insurance salesman. And financially savings program where we’re the fate of Wall Street. We all know where that is and cryptocurrency and all that. So our job of consultants with the current concierge plan is education. And we do that on all meetings when we do enrollments for companies. We go through there and we explain the necessity of what do you need for your hospital coverage. This is for your doctor care. We are offering doctor and labs and your basic necessities of health care. If you don’t have a doctor, you have access to a doctor, you got nothing and they’re not even going to refill prescription. Let’s come in and pay. So this is at least it gives you that.

Olga  20:55

Thank you, Mike, thank you for making and clarifying those differences for me because that that was really confusing. But now I think I got the clear vision and I can make my choices for my health care.

Michael McDermott  21:09

Well, you just seen an appointment with me for what you want to buy. And we’ll take care of that sider. But check out everything you need to know about Americare Concierge on Americare Concierge.com. We’ll have a video very informative video up as of the 15th. We’re going enrollments, August one and we’re doing September one will be effective and live for the state of Texas. Thank you girls. I’m gonna do this anytime. Thank you.

Mariela Salgado  21:44

Thankyou.

Lulu  21:45

Thanks, Mike.

Olga  21:46

Thank you.

Mariela Salgado  21:48

Alright, so don’t forget to demonstrate your love by sharing this podcast with your friends and family or giving us a review on Spotify or iTunes. If you have a negative review, send us an email. But thank you and until next time,

Olga  22:00

Thank you bye bye.

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