Latest / Bill of Health / Can You Really Leave Traditional Health Insurance Behind? (Bill of Health Ep.8)

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Can You Really Leave Traditional Health Insurance Behind? (Bill of Health Ep.8) · Bill of Health

• 0:05
  Welcome back to The Bill of Health.
• 0:06
  I'm your host, Bill Feigh, the health insurance guy, and we are continuing
• 0:08
  our conversation today with Richard Walton from Sedera Health Share
• 0:12
  about disruptors in the health insurance and employee benefit space.
• 0:16
  As the saying goes, Richard was so nice, we brought him back twice.
• 0:20
  Richard, if you will, let's get back into it.
• 0:30
  In case you missed the previous episode, part one of this conversation,
• 0:33
  I'm joined by Richard Walton.
• 0:35
  Richard runs the strategic distribution arm of Sedera Health Share.
• 0:39
  One of the things I really appreciate about Richard, always have, is he's trying
• 0:42
  to find differentiators, something new, something innovative to bring to the
• 0:46
  table so that we can get out of this rat race or this treadmill trap that we find
• 0:50
  ourselves in when it comes to benefits.
• 0:52
  It was the frustration of group health space that led him to
• 0:56
  basically make a drastic change and to join Sedera Health Share.
• 1:01
  He was seeing the trap, if you will, just like a lot of my clients do.
• 1:04
  Premiums are going up, deductibles going up, nobody's healthier, and
• 1:07
  so that's where he is at today.
• 1:08
  He left traditional benefit space and basically is all in on health sharing.
• 1:12
  We talked about this in the previous episode.
• 1:14
  His bet or the gamble is real simple, that there's only gonna be innovation, the
• 1:18
  innovation in this space is gonna happen outside of traditional insurance models.
• 1:22
  Basically, with the direct primary care model and the health sharing
• 1:26
  concept is really where we're seeing big change, big disruptions.
• 1:31
  And I, for one, wanna thank him for coming back for the second episode.
• 1:34
  Richard, welcome back.
• 1:35
  Thank you very much, Bill.
• 1:37
  Glad to be here.
• 1:38
  Yeah, thank you.
• 1:38
  If you haven't listened to the first episode on health
• 1:40
  shares, it's episode seven.
• 1:41
  Please go back and have a listen to it.
• 1:43
  Lots of great, useful information in there.
• 1:46
  Basically, it was a health share 101 conversation, what they are,
• 1:49
  what they aren't, how health shares are not insurance, but protection.
• 1:51
  Most importantly, how health shares put you in control of spending and making
• 1:56
  you a smarter healthcare consumer, which is the big push for this pod.
• 2:02
  I'm gonna provide a warning like I did before in the last one
• 2:07
  As I mentioned in part one, I truly, truly, truly, and I mean this, it
• 2:11
  sounds a little hokey, but I mean it, I'm trying to build a community here.
• 2:14
  I wanna make this a place where people come for information, not a sales pitch.
• 2:17
  I am very passionate about this topic today.
• 2:20
  I'm very passionate about health shares.
• 2:22
  I think it's important we know more about them.
• 2:24
  I think it's important that we understand that they have a place,
• 2:28
  and that they could be a viable alternative for a great many of us.
• 2:34
  And having said that, let's jump back into part two here.
• 2:36
  We're gonna get a little more granular here, a little more practical nuts and
• 2:39
  bolts when it comes to health shares.
• 2:41
  But Richard, my first question for you is escaping corporate handcuffs.
• 2:44
  I know that's an important for you.
• 2:46
  But many employees feel trapped, they feel trapped by high deductible,
• 2:50
  high-cost health plans that they really don't use as much.
• 2:53
  They're spending for nothing.
• 2:54
  They're trapped because it's what their job offers.
• 2:56
  They don't think they have any viable alternatives.
• 2:59
  So for someone just tired of that, wanting to explore a transition away
• 3:02
  from their employer plan, what are the primary financial and logistical
• 3:06
  reasons or factors basically that they need to think about?
• 3:09
  What's gonna help somebody make that decision?
• 3:11
  It starts with just a value exercise on you're spending money on premium and what
• 3:18
  sort of value are you getting out of it.
• 3:20
  I really don't want people to think that I'm just wanna tear down the
• 3:23
  whole system of health insurance.
• 3:24
  Not the case at all.
• 3:26
  Yeah.
• 3:26
  We offer, in addition to health exchange, we're just an option that a lot of
• 3:29
  people have not considered in the past.
• 3:32
  You know what you're gonna get with healthcare, you're gonna get
• 3:34
  deductibles and out-of-pocket maxes, and all of those things matter.
• 3:38
  If you're willing to be curious, and reallocate, and take a new look,
• 3:43
  fresh look at how you manage your own healthcare expenses, and join a
• 3:47
  community of people that have the same mindset, costs go down significantly.
• 3:51
  And it's not really just about cost, it's about freedom as well.
• 3:55
  That's right.
• 3:55
  This was something we're gonna talk about here.
• 3:57
  Actually, we're gonna talk about it next.
• 3:59
  I ask my clients a couple of things.
• 4:01
  How high is your deductible?
• 4:02
  What is your deductible?
• 4:04
  How often do you hit it?
• 4:05
  And most often, there are a few catastrophic cases, but most often,
• 4:10
  Richard, the answer is, "I've never hit my deductible," or, "I maybe
• 4:13
  hit it once when my son broke their arm or leg or something," right?
• 4:16
  They don't hit it, so you're spending those premiums, and then
• 4:19
  you're out-of-pocket for quite a bit until you hit that deductible.
• 4:22
  So whether you think about it in these terms or not, you are a cash pay
• 4:26
  patient, you are a cash pay client, and you should have some say in the
• 4:29
  value that you're getting there.
• 4:30
  I love, love, love that concept.
• 4:33
  Let's talk about networks, though, okay?
• 4:35
  Traditional insurance locks you into something rigid, a provider network,
• 4:39
  usually, not always, but usually, and stepping outside of that network is
• 4:43
  something that most people can't do just simply because either there is very
• 4:47
  little payment to that out-of-network provider or sometimes no payment
• 4:50
  to that out-of-network provider.
• 4:52
  So how does Sedera approach a provider network?
• 4:55
  How does it empower members to maybe escape that?
• 4:58
  Tell me a little bit about that.
• 4:59
  You brought it up.
• 5:00
  I love it.
• 5:01
  Well, Sedera and other health share community's the same.
• 5:05
  We just opted out.
• 5:07
  We just opted out.
• 5:08
  There's no need for a network when everyone accepts cash, right?
• 5:12
  And I jokingly say that we follow the golden rule at Sedera, and it's
• 5:15
  he who has the gold makes the rules.
• 5:18
  It gives us some leverage to say, "I don't agree with that price. We're gonna
• 5:22
  negotiate, and I think we can do better." And if you listened to the episode
• 5:26
  with Lynn Carter before- Super good at negotiating down medical bills Yeah And
• 5:31
  I think what consumers need to know too is we're dealing with made-up numbers.
• 5:37
  When you get the first bill in as a cash pay patient, often
• 5:41
  it's just a made-up number.
• 5:43
  It's not priced like any other service where it's, "This is my labor cost,
• 5:48
  these are the exact items that I need to do to complete this job,
• 5:52
  and here's my profit and overhead." Everyone would be cool with that.
• 5:54
  Like, we're totally fine with that.
• 5:56
  That is not how healthcare is priced.
• 5:59
  That's right.
• 5:59
  That's right.
• 6:01
  And so we're gonna talk a little bit later here about some of those things.
• 6:03
  I wanna go back to a couple of things that you've said, 'cause
• 6:05
  I think it's really critical.
• 6:06
  I think it actually is one of the bigger things that they don't recognize,
• 6:09
  that clients don't recognize is available to them in a healthshare.
• 6:13
  You brought it up earlier in the first episode.
• 6:15
  Let's land on it a little bit harder here, but let's talk about preexisting
• 6:19
  conditions, which are the… usually the first red flag for someone is like,
• 6:22
  how does Sadara help me with preexisting conditions, or how do I handle preexisting
• 6:25
  conditions when it comes to a healthshare?
• 6:28
  So I wanna make sure people that are exploring healthshares realize
• 6:31
  they aren't necessarily left stranded if they transition over.
• 6:34
  Yeah, sure, and I think to get an honest answer to that, we need to address why
• 6:39
  would you need preexisting conditions in a healthshare model in the first place?
• 6:44
  Again, voluntary contribution to a big nonprofit.
• 6:47
  We establish a set of rules.
• 6:49
  Anyone can join.
• 6:50
  We love new members all throughout the year.
• 6:52
  There's not an open enrollment with healthshares.
• 6:54
  You can join anytime.
• 6:56
  Yeah.
• 6:56
  The whole model breaks down when you have one person with a $2 million a
• 7:00
  year condition or maybe a, a known super expensive surgery saying, "Yeah,
• 7:05
  this community thing sounds great.
• 7:07
  I'm gonna put my $200 in.
• 7:09
  Community, you guys put 2 million in my pocket.
• 7:11
  This is gonna work out really great for me." That would work
• 7:14
  out really great for that member.
• 7:15
  It does not work out great for the community, and the community just wants
• 7:18
  some fair rules to make sure that the model exists long term in perpetuity.
• 7:23
  Right.
• 7:24
  So because of that, we have a graduated sharing schedule
• 7:27
  based on preexisting conditions.
• 7:29
  So specific to us, and every healthshare's a little bit different,
• 7:33
  but it's conceptually the same, if you've had symptoms or treatment
• 7:37
  in the 36 months prior to your membership start date, we're gonna
• 7:40
  not share for that specific condition.
• 7:43
  Year two, we're gonna share to 25,000.
• 7:45
  Year three- And then 50,000, and eventually becoming fully shareable.
• 7:50
  A graduated sharing schedule, but basically you're building equity for
• 7:54
  your contributions, and that just makes the whole model work for the long term.
• 7:58
  We're a long-term solution.
• 7:59
  And the idea of a pre-existing condition, let me use my brother for an example.
• 8:04
  He's a member of a healthshare, and he, for a long time, has
• 8:06
  had problems with his knees.
• 8:08
  He's been receiving steroid shots in his knees.
• 8:11
  Well, now they're to the place where they need replacement,
• 8:14
  and he is basically finishing up his first year in a healthshare.
• 8:18
  Well, obviously if they look back, he's had those knee problems for a long time.
• 8:23
  He's about to finish up his first year.
• 8:25
  That healthshare is going to agree to share X amount of dollars in year
• 8:28
  number two for that knee condition.
• 8:31
  Now, they're also working with him very closely to try to find a provider
• 8:35
  that the sticker shock has gone away, that they're actually negotiating with
• 8:39
  or looking closely to find someone that actually provides a fair and
• 8:42
  reasonable price for that service so that they can whittle down on his costs.
• 8:46
  So he's basically staring down the barrel of trying to figure out how to
• 8:49
  handle that pre-existing condition.
• 8:50
  But you said it earlier, high blood pressure- Not a thing … or taking
• 8:54
  a cholesterol pill, a statin for cholesterol, what would some people
• 8:58
  perceive as a pre-existing condition that maybe isn't on the healthshare model?
• 9:02
  And specifically, Richard, I'm thinking, is type 2 diabetes something that somebody
• 9:06
  has to worry about coming over, switching from corporate health to healthshare?
• 9:09
  And I'm not trying to set you up for saying yes or no.
• 9:11
  Sure.
• 9:11
  I just honestly don't know the answer.
• 9:13
  So every person is different.
• 9:14
  I will throw that disclaimer out there now, and I'm not a type 2 diabetic, and
• 9:19
  there's any number of ways to treat type 2 diabetes, some of it very expensive- Right
• 9:23
  some of it very inexpensive.
• 9:25
  In a perfect world, my answer would be join a direct primary care doctor or find
• 9:30
  a physician that's gonna help you- Yes … manage that the most cost-effective way.
• 9:33
  Yep.
• 9:34
  And you can definitely navigate type 2 diabetes in a cost-effective way.
• 9:38
  Mm-hmm.
• 9:39
  In addition, you might be able to find a doctor that can help you cure
• 9:42
  yourself of type 2 diabetes with lifestyle changes and exercising.
• 9:46
  Just get you started- Type 2 … on that patient journey to not-
• 9:49
  Yeah … be a type 2 diabetic.
• 9:51
  And there's the thing that I was really kind of going for was if you bundle the
• 9:54
  healthshare with that relationship with the DPC, the DPC provider is going to
• 9:58
  have any number of tools that they use.
• 10:00
  Also, if your A1C is controllable on medication, then they're gonna be able to
• 10:06
  work with you to find a provider for that medication that's going to be reasonable.
• 10:09
  You don't have to have insurance.
• 10:10
  It doesn't mean your traditional insurance model is the only way to go.
• 10:13
  There are several ways to skin that cat, if you will, and so type 2
• 10:15
  diabetes is not something that would be an automatic out as far as I'm
• 10:20
  concerned for considering healthshare.
• 10:20
  Well,
• 10:20
  and to, and, and to your point, isn't the whole point of this to get healthier
• 10:25
  and not just manage a condition?
• 10:27
  Let's get better and not have the condition.
• 10:30
  Yes, yes, yes.
• 10:31
  So get yourself out of that condition.
• 10:33
  I love that 100%.
• 10:35
  Because health shares often operate like cash pay models, potential
• 10:41
  clients, they are worried about that.
• 10:44
  They always think that… They don't always, but one of the principal
• 10:48
  concerns that somebody has when they, when I talk to them about this is,
• 10:50
  "Hey, I'm gonna have to pay cash.
• 10:52
  I don't know that I'm comfortable with that." And you had referenced
• 10:55
  something earlier, and I really wanna land hard on it.
• 10:58
  What kind of behind-the-scenes tools or advocacy does Sadara provide to help
• 11:03
  members, number one, be smarter cash pay clients, number two, negotiate fair
• 11:09
  prices with providers, and to basically actually help you with those bills with
• 11:13
  the sticker shock that you see when you first start getting those bills?
• 11:16
  The first misconception that we need to answer to address this question
• 11:20
  is we want unpaid medical bills.
• 11:23
  This is not a pure reimbursement model.
• 11:25
  We're expecting our community to go pay for everything up front Honestly,
• 11:30
  back to the golden rule, we cannot negotiate a paid medical bill.
• 11:34
  Good luck getting a hospital to actually give you money back.
• 11:37
  It's like, "You know what? We did overcharge you." That's-
• 11:38
  Like, it's not gonna happen.
• 11:40
  So we're dealing with unpaid medical bills, and then we'll walk
• 11:43
  through really two patient journeys.
• 11:45
  A true emergency, go get your medical care.
• 11:48
  You are not in a position to negotiate your emergency care treatment.
• 11:52
  You're gonna get a bill later in the mail, and then get it to us.
• 11:56
  We will negotiate like it's our very last dollar, that medical
• 12:00
  bill down on your behalf.
• 12:01
  So that's an unpaid medical bill.
• 12:03
  And then a more maybe applicable is an elective surgery, right?
• 12:08
  Like, we're scheduling in advance, and that typically involves
• 12:12
  go get a good faith estimate.
• 12:13
  Let's find out how much it's gonna cost.
• 12:15
  That is not an unreasonable question to say, "Give me an idea how much
• 12:20
  this is gonna cost, because I'm ultimately gonna be a cash pay
• 12:22
  patient from start to finish." Yep.
• 12:24
  And that guardrails of submit your good faith estimate to the sharing
• 12:29
  community ahead of time, we know, like, "Yeah, that's a great price.
• 12:33
  Let's do it," or, "No, I think we can do better," or, you know, "If
• 12:36
  you do this in an outpatient surgery instead of the hospital, I think we
• 12:39
  can save a lot." And honestly, a lot of times it's the exact same doctor.
• 12:43
  It's just coordinating that.
• 12:45
  But the other thing, too, is we do upfront sharing all the time.
• 12:48
  The best deals in healthcare is if you pay for it upfront.
• 12:52
  Like, that's makes sense.
• 12:54
  Pay me upfront, I don't have anything to collect from insurance carriers,
• 12:57
  out-of-pocket maxes, deductibles.
• 12:59
  Just pay for it upfront.
• 13:00
  Yep.
• 13:00
  And we love that model where we can just pre-negotiate, pay for it upfront.
• 13:05
  Our members have to come up with really nothing.
• 13:08
  That's a win all around for the member, for the community, for the provider.
• 13:13
  Yeah.
• 13:14
  Yeah.
• 13:14
  One of the things I wanna do, and it's probably gonna be more episodes
• 13:18
  here, we talked to a previous guest about some of those tools that are
• 13:22
  available, MDSave, some others that are out there, and what the work that her
• 13:25
  company does in terms of negotiation.
• 13:28
  But there are tools out there that can help you do that.
• 13:30
  There are tools that are available to you that can help you determine pricing
• 13:34
  ahead of time, find out what a reasonable cost is in your area by zip code, help
• 13:38
  you compare what you're being quoted.
• 13:39
  There are cash pay tools.
• 13:41
  However, you hit on something big for me.
• 13:44
  Car crash, you're in the emergency room.
• 13:46
  They're gonna ask for your insurance card.
• 13:48
  You tell them, "I'm a cash pay patient." Okay?
• 13:50
  Yeah, and, and Sadara members are proud cash pay patients.
• 13:55
  Yes.
• 13:56
  Yes.
• 13:56
  And one of the fears, I think, is that, oh, so before they do a single
• 14:01
  bit of service for you, before they let you go home, that you have to plop
• 14:05
  down a credit card and pay for all of that care in advance, and that is
• 14:09
  clinically and factually inaccurate.
• 14:12
  It will be days before they could even get you a line-itemed or invoiced
• 14:17
  statement showing you what you paid for.
• 14:19
  Matter of fact, it could be… How many times have you heard this?
• 14:23
  "I'm getting past due notices, and I just got the itemized- Yeah … bill."
• 14:27
  No doubt.
• 14:28
  Right?
• 14:29
  And so we can't be intimidated.
• 14:32
  I can understand how that would be a very scary process for someone who's
• 14:35
  normally used to plopping down their insurance card, but this is something
• 14:38
  that really gets me going and something that really fires me up is that,
• 14:42
  number one, like you said, the first thing you see is not the actual price.
• 14:45
  That's the sticker price on the Lexus, right?
• 14:47
  You're not gonna pay sticker price on the Lexus.
• 14:48
  Number two, there are things that are available that can help you
• 14:51
  look at that bill and find out where they've billed you inaccurately
• 14:54
  or billed you twice or whatever, help you negotiate that bill down.
• 14:57
  There are tools out there that you know what's fair, and there's, there's so
• 14:59
  many tools available and things that can help you become a smarter healthcare
• 15:03
  consumer or a cash pay patient I think that most people are just unaware of.
• 15:07
  And I'm sorry I'm going on and on here.
• 15:09
  It's just so impressive to me.
• 15:11
  It's really helped me on my journey through this process in switching over
• 15:14
  from a traditional insurance model.
• 15:16
  Yeah, and I think there's easy wins.
• 15:18
  There's easy wins in healthcare in your given community.
• 15:21
  There's easy wins, and it's like, don't do- Yeah
• 15:23
  your imaging in a hospital.
• 15:25
  Do it in a freestanding imaging center.
• 15:27
  It's probably a nicer machine.
• 15:28
  It's the exact same result, and the exact same person's gonna read it.
• 15:32
  So just look for the easy wins, and know that you have the support
• 15:37
  of your medical cost-sharing community to help you navigate this.
• 15:40
  You are not doing this alone.
• 15:42
  Yeah.
• 15:43
  Yeah, and one of the first conversations I ever had with Richard, I don't even
• 15:46
  know if you're gonna remember this or not, but I was talking about this whole thing,
• 15:50
  my big bugaboo, and the big thing that I'm fired up about is becoming a smarter
• 15:53
  healthcare consumer, smarter healthcare consumer, smarter healthcare consumer.
• 15:56
  He's like, "Stop saying that." He's like, "It makes it sound like they're
• 16:00
  gonna have to have a PhD in healthcare and billing and CPT codes." It's not.
• 16:05
  We're just being smarter about how we spend our dollars.
• 16:07
  But the truth is, you don't have to have a PhD. You don't have to have any
• 16:11
  kind of experience in medical billing codes or anything of that nature.
• 16:14
  You're gonna have support from the community.
• 16:16
  You're gonna have tools at your disposal.
• 16:17
  I think that's the big thing.
• 16:18
  The big takeaway I want from people even considering this is that this
• 16:22
  is not something that's complicated.
• 16:24
  It really isn't.
• 16:25
  It kind of reminds me of the scene in The Big Lebowski where
• 16:28
  they're planning the funeral.
• 16:30
  At the very end- Yeah … he's like, "This is our most affordable urn." And
• 16:33
  he's like, "Just because we're bereaved doesn't mean we're saps." You know, by
• 16:37
  seeing the, the prices, the true prices in healthcare, again, I think that's every
• 16:42
  American's superpower, is we can shop.
• 16:44
  We are consumers.
• 16:45
  We can shop, and if you give us the information, we can make the evaluations.
• 16:49
  Like, just if you were buying a pickup truck, if you could save $1,000 by going
• 16:54
  one town over, you would ask your buddy for a ride one town over 'cause I'm
• 16:58
  going to buy a truck to save $1,000.
• 17:00
  Yeah.
• 17:00
  I'll buy you a steak dinner- Sure … or some good Texas barbecue on the way home.
• 17:05
  All right, well, we can talk about that.
• 17:07
  All right.
• 17:08
  With so many options, so many different kind of health shares, so
• 17:11
  many different kind of the things that you could do alternatively than the
• 17:14
  insurance model, smart consumers wanna know about long-term sustainability
• 17:18
  in the health share community, the financial strength, the backing.
• 17:23
  How does Sedera ensure financial stability and community longevity
• 17:26
  going forward so that we can ultimately trust these sharing communities?
• 17:30
  Is there anything specifically you want to talk about from terms of how money
• 17:33
  management or fiduciary responsibility, those kind of things for Sedera?
• 17:37
  I think the lens to answer this question is we're proudly not an
• 17:41
  insurance model, and if you were asking-
• 17:43
  Yep
• 17:44
  … if I worked for Blue Cross Blue Shield or UnitedHealthcare, my
• 17:47
  answer would be, "Well, we're sitting on reserves of $10 billion."
• 17:50
  And it's like, well, that's great.
• 17:53
  Will you pay my claim when I need help?
• 17:56
  And that answer- Yep … is not always yes.
• 17:58
  Correct.
• 17:58
  They deny stuff all the time or you went out-of-network.
• 18:01
  The way that Sedera and the medical cost-sharing communities work is we
• 18:04
  have a very different set of values, of we're intentionally non-profits.
• 18:09
  We are not seeking profits out of this model, right?
• 18:13
  So I liken- Yep … it to a cash flow and can we sustain the big blows?
• 18:18
  And big needs come all the time.
• 18:20
  We see them all the time.
• 18:21
  Sure.
• 18:21
  We also negotiate those down like it's our very last dollar.
• 18:24
  The community's putting funds in those that are big community fund every month.
• 18:29
  It's always replaced.
• 18:30
  Right.
• 18:30
  And it's more of a cash flow and how big is your membership model versus
• 18:36
  how much money are you sitting on?
• 18:38
  Yeah.
• 18:38
  Okay.
• 18:39
  Yeah And it's track record.
• 18:40
  Do your research.
• 18:41
  Talk to you, it's like, "Well, here's been my experience with
• 18:43
  Sedera," or talk to your DPC doc and they said, "Yeah, we love Sedera."
• 18:47
  Our success comes from our reputation for doing what's right.
• 18:52
  Yeah.
• 18:52
  And I would also say, too, that most people think medical cost-sharing is
• 18:57
  we're all just gonna say a prayer at the end of the month and hope we have two
• 19:00
  nickels to rub together to fund this.
• 19:02
  We're actually a very sophisticated operation.
• 19:04
  Our members have faith in us to help them-
• 19:07
  Yeah
• 19:07
  … when the big stuff hits in their life, and we take that commitment very seriously.
• 19:11
  We're always looking at are we growing fast enough?
• 19:14
  Do we have enough to honor our commitment to our members?
• 19:18
  Yep.
• 19:18
  And we do.
• 19:19
  Like, we take that very seriously.
• 19:22
  Well, I'm gonna say something here too, maybe a little bit
• 19:24
  of behind-the-scenes pool.
• 19:25
  You mentioned something earlier.
• 19:26
  There's a lot of people in this space, in the insurance space, that
• 19:29
  are rent-seekers, I never heard that before, that are looking for a payout.
• 19:33
  I will tell you, when I first started researching this model
• 19:36
  and I said, "Yes," I made a commitment, I wanna be in this space.
• 19:39
  If I wasn't committed, if I wasn't a zealot, I may not be in this
• 19:43
  space because, listen, this is not something that is generous
• 19:47
  in regards to the payouts, right?
• 19:48
  I'm not helping people for the money here.
• 19:50
  It is a nonprofit situation.
• 19:52
  Obviously, as a person, if it connects you with Sedera or a healthshare,
• 19:55
  there is compensation involved, but let me tell you something, it is
• 19:58
  reasonable and appropriate, and it is considered based on the model, right?
• 20:02
  I really appreciate the fact that we're all trying to be better healthcare
• 20:05
  consumers and smarter about the way we spend our money, and certainly healthshare
• 20:08
  communities are doing that as well.
• 20:10
  I wanted to make sure that got out there for sure.
• 20:12
  Richard could go on and on and on and on and on, but we're gonna do a
• 20:16
  little bit of the Jargon Jar here just to kinda transition to the end here.
• 20:19
  It's time for the Jargon Jar, my friends.
• 20:23
  The Jargon Jar is where we take a confusing, intentionally muddy topic
• 20:26
  in the insurance industry and we translate it into plain English.
• 20:30
  And again, we're gonna stick to the healthcare space here, and we're gonna
• 20:33
  address the topic of claim versus need.
• 20:37
  Richard addressed the fact that an insurance claim is a legal obligation,
• 20:41
  but sometimes those claims don't always necessarily mean you're going to get paid.
• 20:47
  In the traditional insurance space, you submit a claim which implies a contractual
• 20:51
  obligation or a right of payment.
• 20:54
  In a healthshare community like Sedera, you submit a need from a
• 20:57
  specific medical incident, illness, or injury that requires the financial
• 21:02
  assistance from the community.
• 21:04
  I love this because the need reframes that whole thing.
• 21:07
  It reframes the word and the process from an adversarial corporate
• 21:11
  transaction into something that truly is community-based, right?
• 21:15
  It is a community-supported request for help.
• 21:19
  Remember, ladies and gentlemen, you don't have to, but you would typically
• 21:22
  combine healthshare membership to help cover the big-ticket emergencies or
• 21:26
  critical illnesses with some sort of viral or in-person direct primary care.
• 21:30
  That direct primary care is usually taking care of the little stuff.
• 21:34
  Honestly, the runny noses, the strep throat, the ear infections, the chronic
• 21:38
  neurological conditions that nobody could seem to solve like I had, the type two
• 21:42
  diabetes that we talked about earlier.
• 21:44
  Typically, where 80% to 90% of your healthcare is delivered, that
• 21:47
  DPC partner is helping you, right?
• 21:50
  The healthshare in community is there for something larger in nature where
• 21:53
  you truly have a need, and that health community is gonna step in and help
• 21:57
  you meet that need, and I love that.
• 21:59
  I love that.
• 22:00
  Richard, it's not a surprise anymore.
• 22:02
  You know it's coming, but there is another five for fighting.
• 22:08
  Five for fighting, Richard.
• 22:09
  I'm gonna ask you five rapid-fire questions.
• 22:11
  Don't think, just answer.
• 22:12
  Sometimes these answers can be a bit controversial.
• 22:15
  If you were here last time and listened to us, Richard made the mistake of thinking
• 22:18
  that Texas has the best barbecue, but we're gonna go ahead and let that slide.
• 22:22
  Richard, you travel quite a bit.
• 22:24
  Window, aisle, exit row, or never fly when you can drive?
• 22:27
  Richard Walton, what do you prefer?
• 22:30
  I prefer the aisle.
• 22:32
  You prefer the aisle, okay.
• 22:33
  This is an important question.
• 22:34
  I'm asking the hard-hitting ones today.
• 22:36
  Richard, Coke, Pepsi, Mountain Dew, Dr. Pepper, coffee, Red Bull, or
• 22:40
  Monster, Richard Walton, how do you put the pep in your step, sir?
• 22:45
  Lots of black coffee.
• 22:47
  Lots of black coffee.
• 22:48
  I wasn't sure if you were gonna go Texas on that answer and say Dr. Pepper.
• 22:51
  No, lots of coffee.
• 22:52
  All right.
• 22:53
  Hey, Richard Walton, if someone is considering a health share, how would
• 22:56
  you specifically, sitting across from them, help them address the concerns
• 22:59
  about being a cash pay patient?
• 23:01
  I would remind them that they buy everything else in our economy in
• 23:05
  cash, and they have the skillset to do it, and they are not alone.
• 23:09
  We are here to help before, during, and after, navigate being a cash pay patient.
• 23:14
  Okay, love that.
• 23:15
  Willie Nelson, Beyoncé, Buddy Holly, Selena, Townes Van Zandt, or Travis
• 23:22
  Scott, Richard Walton, who is your favorite Texas musical legend?
• 23:26
  I love Buddy Holly- Yeah … from Lubbock, Texas.
• 23:28
  I'm from Amarillo.
• 23:29
  Lubbock's are, like, two hours- Yep … down the road.
• 23:32
  Buddy Holly- Yep … invented independent music, and I love him.
• 23:36
  I love it.
• 23:36
  I love it.
• 23:37
  Hey, in just a few words, Richard, can you let our listeners know who might
• 23:40
  be a good candidate for a health share?
• 23:43
  We said at the top of the very first episode that it's not for
• 23:45
  everybody, but just a few words on who might be a good candidate.
• 23:49
  I honestly think medical cost-sharing plans, if you smartly pair this with
• 23:52
  direct primary care, is an awesome fit for 85 to 90% of people out there.
• 23:59
  Young families, 100%.
• 24:01
  If you're a young family starting out, please, please, please be smart about this
• 24:05
  and use the savings that you would have over an insurance plan to come join us.
• 24:10
  Take your savings and then start a 529 plan for your kids or whatever you may do.
• 24:15
  But that being said, we work for anyone and everybody, and a good
• 24:18
  litmus test is when's the last time you hit your insurance deductible?
• 24:21
  And if the answer is- Yes … it's been decades, then I think you're
• 24:24
  probably a good fit for us.
• 24:26
  I love that.
• 24:27
  That question, by the way, has changed, have reframed a lot of the conversations
• 24:33
  I have had this calendar year in 2026.
• 24:36
  It's absolutely a great one.
• 24:38
  What's your deductible, and have you hit it?
• 24:40
  Let's reframe our thinking.
• 24:41
  I love that.
• 24:42
  Richard, hold tight.
• 24:43
  Special thanks again to our guest, Richard Walton from Sedera Health Share.
• 24:48
  Richard was around for two episodes.
• 24:50
  He's a busy man.
• 24:51
  He's the hardest working man in show biz, but yet he spent a couple episodes
• 24:53
  with us here, so I'm grateful, grateful, grateful for the time and being so
• 24:57
  generous with your time and your talents.
• 24:58
  I love that, and I appreciate it.
• 25:00
  If you are an employer or an employee, and if you've ever thought about shopping for
• 25:04
  plans or coverage or becoming a smarter healthcare consumer, be sure to follow
• 25:07
  along, TikTok, YouTube, and Instagram, Bill Phi, The Health Insurance Guy.
• 25:10
  Subscribe to the pod on Apple or Spotify.
• 25:14
  Give us a review.
• 25:15
  We'd love to have your thoughts.
• 25:16
  If I can personally help you explore your options, head on over to
• 25:20
  Core360BenefitsGroup.com and schedule a 30-minute consultation with me.
• 25:23
  Again, I want this to be a place for information, so even if you don't
• 25:26
  schedule it with me, schedule it with somebody that you know and you trust.
• 25:29
  Find this information out 'cause I think it could be, honestly, and I'm
• 25:32
  not trying to use hyperbole here, I think it could be life-changing,
• 25:34
  certainly budget changing for you.
• 25:36
  So be sure to explore this if you can.
• 25:39
  Mr. Walton's information is gonna be in the show notes.
• 25:41
  If you wanna contact him directly, feel free to do so as well.
• 25:44
  You'll get good information there.
• 25:46
  Thank you so much for listening to The Bill of Health.
• 25:48
  I want you to be smart, shop smart, and protect your wealth,
• 25:53
  and we will see you next time
• 26:03
  This podcast is provided for educational purposes only and
• 26:04
  should not be considered legal, tax, investment, or insurance advice.
• 26:06
  Individual circumstances vary, and the listener should consult qualified
• 26:08
  professionals regarding their specific healthcare and financial situation.
• 26:10
  Opinions expressed are those of the host and guests and do not necessarily
• 26:12
  reflect the views of any insurance carrier or affiliated organization