Placing You First Insurance Podcast by CRC Group
The Placing You First Podcast spans a diverse spectrum of insurance industry issues to keep you and your clients informed.
Placing You First Insurance Podcast by CRC Group
Uncovering Hidden Challenges: Navigating Problematic Healthcare Exposures
The healthcare insurance landscape is rapidly evolving beyond traditional pain points, creating new challenges for retail agents seeking coverage for specialized risks. From ketamine clinics to advanced med spas, these emerging sectors require specialist navigation to secure appropriate protection. Healthcare has always presented unique insurance complexities, but today's market features several particularly difficult placement categories. While correctional healthcare and locum tenens staffing remain challenging, CRC Healthcare Broker Scott Scheiblin highlights several additional sectors creating headaches for agents and insureds alike. Ready to navigate the complexities of today's toughest healthcare risks? Reach out to your local CRC Group producer for guidance and market access that can provide successful solutions when you hit placement challenges
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Welcome to another episode of Placing you First, the podcast where we explore the latest challenges and opportunities in the wholesale insurance space. I'm Scott Gord, joined by my co-host, Amanda Knight.
Amanda Knight:Thanks, scott. Today we're diving into the complexities of insuring health care risks, especially those that have been growing in difficulty for retail agents. We're joined by CRC Healthcare Broker Scott Scheiblin to talk about what's happening in the market and how wholesale brokers can help navigate these unique challenges. This is the Placing you First podcast from CRC Group.
Scott Gordon:This podcast features news and insights from a vast knowledge base of over 5,100 associates who write more than $35 billion in premium annually.
Amanda Knight:Plus, we give you the latest information on what's happening at CRC this this.
Scott Gordon:This is the Placing you First podcast and now the hosts of the podcast Amanda. Knight and.
Amanda Knight:Scott Gordon. Scott, great to have you back.
Scott Gordon:Yeah, thanks for having me. Well, let's start by talking about the overall landscape. In the past, I know we've talked about correctional health care and locum tenens staffing, as well as known pain points, but beyond that, there are several classes of health care risks that are becoming increasingly difficult to place. So what are you seeing, scott, in terms of the most pressing challenges these days?
Scott Scheiblin:Yeah, I think you hit it on the head.
Scott Scheiblin:What you notice is a lot of the pain point marketing material you'll see from many places do deal with locum and correctional and those are very, very challenging, but what has emerged is specifically the use of ketamine for drug-resistant depression, the expansion of med spas that have really become more of anti-aging clinics with huge expansions to their kinds of things.
Scott Scheiblin:One pain point I would say has been pretty consistent but is not going away and maybe isn't talked about as much, is nursing homes and having doctors go into nursing homes. Then there's also multi-state exposures. A lot of these companies are very entrepreneurial and they're trying to move into new places and with moving into new places, they can be confronted by things like PCF funds that, frankly, if you're not in it all the time, are the types of things that can be incredibly mind-blowingly challenging and bureaucratic. So there's quite a few different spaces where I think it would be helpful to talk about how we can help our retail agents, help insureds, make the process easier, make their life easier for some of these risks that aren't talked about as much but do present very unique and sometimes pretty cumbersome challenges.
Amanda Knight:Okay, well, let's just sort of jump in and see if we can go one by one around some of these challenges and go a little deeper for the benefit of our retail agent listeners. Let's start with physicians working in, specifically working in nursing homes. What would be some of the challenges around ensuring those risks?
Scott Scheiblin:Some of the exposures and some of the classes that we'll talk about are newer. They're emerging. Physicians working in nursing homes is a consistent challenge. It is not one that is new, but it's also not one that's going away anytime soon in terms of the challenges it presents and you know, for a multitude of reasons the need to use outside staffing for services, etc. So the reason that those would be challenging from an underwriting perspective is a physician working in a nursing home is inexorably tied to the actual setting. So when a underwriter is reviewing that individual physician, what we're concerning ourselves with the insured that we've been asked to find coverage for, the underwriter does have to review the nursing home itself. This is one of those exposures where you're reviewing the insured and you're reviewing where the insured works and because of that it means that you're thinking about nursing homes and thinking about the challenges that nursing homes present. So, while it may only be the physician that you're requesting coverage for the multitude of other uh challenges that nursing homes themselves present factors into the equation. Those would be things ranging from the fact that the general public has a pretty low opinion of nursing homes 40%, or so you know, would qualify them as a D or an F on a scale of uh, you know, would qualify them as a D or an F on a scale of a grading system without having any knowledge of it, just a public perception. Wise they would. So that means that juries are less sympathetic to women, already have certain predisposed ideas of the type of care that's appearing in nursing homes, of the type of care that's appearing in nursing homes. That also it factors into what actually does happen in nursing homes and the various stages.
Scott Scheiblin:Nursing homes can be used as shorthand for, I think sometimes, or does get used as shorthand for various settings, various levels of care. You know, from assisted to rehab to et cetera, care. You know from assisted to rehab to et cetera, um, but at its core this is generally people who are older or who are health compromised. So the potential for severe severity or the potential for claims themselves exist because these people um need care and maybe have comorbidities, have some age-related degeneration, things like that, and without being insensitive to it, it's also a place where people pass away. So the potential exists for that to just be the reality of the patient base, or I shouldn't say the potential, it is the reality of the patient base. And then nursing home claims when you were, if you were to look at them not strictly from a physician standpoint, but if you looked at them as a more macro thought, and that does encompass GL and other parts. But the average severity of nursing home claims by some estimates is like a million.
Scott Scheiblin:So an underwriter reviewing a physician to work in a nursing home has to think about the fact that they are working in a nursing home and what challenges the nursing home itself presents. They have to review them as not only the individual but as the individual and the setting. And that means that whereas when you insure a nursing home itself, you might get X premium for it and you're preparing for the GLPL claims that are associated with, but you're getting a premium that you feel is adequate for it, when you're insuring the individual physician, you're insuring an individual physician in a setting that you think has the potential for severity or at least claims, but you are not getting that kind of premium for it. That individual physician is not going to generate six figures for their premium. So they want to be pretty stringent and pretty strategic in where they will write these physicians, because if the pricing is going to be, for example, $7,500 for someone that may be doing bed sores and other care within. They can't afford to write volume. That could lead to more claims. That could lead to severe claims without having done the due diligence.
Scott Scheiblin:So, long story short, it can lead to a lot of questions, can lead to the need to really present the insured in the most positive light. There are challenges that you may just not be able to overcome in terms of what facilities they happen to work at. I think where the usage of a knowledgeable broker is especially helpful is that the questions that underwriters are going to want to have are not captured necessarily in applications for physicians. They are the extra questions we can provide. Those extra questions provide a bit of a roadmap of how to present the insured and what the underwriters are going to want to know to be comfortable the insured and what the underwriters are going to want to know to be comfortable.
Scott Scheiblin:So ultimately it's not the phrase, I guess, death by a thousand paper cuts of getting these. You know, one round of questions comes in, you get another round of questions. We try to preempt and get ahead of that and we also are targeted in who we go after. You could easily go and send it to a multitude of markets that just literally will not write the risk and that will only delay the inevitable, which is getting it to the appropriate markets and getting the pricing reflective and the terms reflective from the markets that actually will write it. So that's where the challenges present and where CRC is helpful and can be helpful in making this an easier process for an exposure that is consistently difficult and has no reason to think it's not going to continue being consistently difficult.
Scott Gordon:So another emerging challenge is the rise of ketamine clinics and the market's growing fast, you know. But there are a lot of concerns around treatment protocols and liability. We've heard a lot of stories about some high profile abuse of ketamine lately, you know, administered wrong. No one monitoring all that stuff. So what should agents know about placing coverage for these types of clinics?
Scott Scheiblin:Yeah, I mean, obviously the recent news you know puts more of a focus on it. But really, ketamine at this point it is utilized for drug resistant depression. However, there's only one FDA approved actual delivery method for it, spurbato and an intranasal one. The others are all off-label use so they're allowed but they are not FDA approved quote unquote for that. So when underwriters are looking at a risk and they're looking at, they want to know how's it being delivered. They want to know the protocols behind the patient selection.
Scott Scheiblin:You know, are you just letting somebody off the street say, hey, I don't feel good and get ketamine Like, or or is this coming from a primary care provider? A psychiatrist referral? That's the requirement to have it. What are your protocols around monitoring? You know you give the dosage, whether it be intramuscular or through iv. How long are you with them? Is this part of a guided therapy? If so, who? You know? Is this through a psychiatrist? There are also questions of like.
Scott Scheiblin:While it's deemed I would say I I want to choose the words carefully it's been used as an aesthetic safely, so it's not deemed as necessarily dangerous. However, with that awareness, use an aesthetic, you have safety protocols around using an aesthetic. You have resuscitation, you have monitoring, you have, you know, have checking blood pressure before after all of those things? Are those present in your clinic? Are you utilizing those? So underwriters are not.
Scott Scheiblin:There's limited markets, but markets that are open to many different forms of this. But they want to know all of these various factors up front in order to evaluate how much they like the risk, how safe they feel the risk is. And then, every once in a while, you'll get an absolute curve ball of well, we'd like to start sending this out to people and we'll watch them on a Zoom cam. So there's all kinds of permeations that have occurred under this. But it is again another place where I think insureds and agents can get quite upset with a litany of questions coming at them after the submission process.
Scott Scheiblin:I personally find it easier to give a lot of these questions up front, having worked multiples of these accounts and an awareness of what markets will and will not do. We can give that to you. So, again, you can qualify it up front, you can get the necessary information, you can make an insured aware like, hey, you don't have X, y and Z. This is going to be a real tough slog to find something, but it is part of an emerging side of mental health. That is not slog to find something, but it's. You know it is part of an emerging side of mental health that is not going to go away. You know, holistic, alternative therapies are only going to likely become more and more commonplace and carriers are figuring out the right way to evaluate those risks right now.
Amanda Knight:And I feel like I've actually seen as a person in the public, I guess I'll say I've seen, you know, a ketamine clinic.
Amanda Knight:Pop up down the street and be there a few months and then it's gone, right, it disappears, but then, I've had, you know, friends be treated with for that drug resistant major depression via ketamine in a very well know, well-respected setting and have phenomenal results from that. So I'm sure that there is a wide spectrum of just like with any risk, right, You've got a wide spectrum when it comes to ketamine, clinics of you know quality, what they're doing, how they're doing it. So working with a qualified wholesaler makes a difference, you know, depending especially on the risk.
Scott Scheiblin:It makes a big difference, I think, to be able to articulate the ways in which the risks are looked differently by different carriers, and I think having some working with a wholesaler that doesn know or at least has seen many of the risks can be incredibly beneficial. Even if it can be tedious to the insured, it can be incredibly beneficial long term.
Amanda Knight:Well, I mean, I feel like our team is really good at in all things. We may not be able to tell you exactly what your insured wants to hear, but we will tell you the truth and we will tell you what they need to hear for the best outcome in the long run, right, which is ultimately the best thing for everyone. I think that applies to the sectors we've talked about so far, and then this next one that we're going to talk about, which is med spas and anti-aging treatments. I think every third ad I see on social media or television or you know any sort of media, is this new sort of anti-aging or med spa or some amalgamation of all the things. I know that's exploding in popularity, but that also has to bring some new risks to light. So what are some of the biggest concerns when we're approaching, you know, med spas or anti-aging clinics from an insurance standpoint?
Scott Scheiblin:Yeah, well, you nailed it. Med spas, let's say 10 years ago, just to use a number, it was Botox, it was like Juvederm, it was some laser hair removal. You know it was pretty standard stuff that you would expect out of a med spa and they were pretty consistent, like every med spa kind of did it. The most challenging, pressing thing back then was the Botox parties, where they wanted to do it at a house and serve some champagne. That was the hardest thing.
Scott Scheiblin:What med spas have figured out is is pivoting or or or bringing in more of what what I would term anti-aging. Um, these are processes that are still aesthetic a lot of times in in in their composition or in their goal, but these are not traditional med spa procedures. So you have things like the usage of exosomes and stem cells, both in an IV treatment or even on a facial kind of thing. You have, well, obviously there's the GLPs, the weight loss medications, all of those sorts of things. Um, you have more laser based stuff, that that are more higher level cosmetic like IV treatments and stuff too right.
Scott Scheiblin:Yeah, higher level cosmetic, Like IV treatments and stuff too, right, yeah, IV vitamins, peptides, all kinds of things aimed at not just, you know, reducing a wrinkle, but this idea of feeling being younger, all of that. There's a lot of questions within that about where are you getting this stuff? You know stem cells can be harvested from you or they can be brought by a third party. Uh, exosomes are, are sort of a derivative of stem cells, the the kind of the bubbles that come up, Um, and and how are you utilizing them? Uh, what's your training? What promises are you making with this kind of thing? You know they have the potential, I'm sure, for good and they also have the potential for some negative, bad results.
Scott Scheiblin:So, and there's the expansion of more and more of even just the aesthetic ones, like vampire facials, for instance, or things like that, which use PRP and you know, or I mean it's kind of self-explanatory they they're puncturing and with the needle. Uh, you know, I think the most, uh, probably well-known, hellacious med spot claim is is somebody doing something like that didn't clean the needles, and I believe it was somewhere in the neighborhood of six people contracted hiv out in, I think I believe it was new mexico. So it's a combo of a lot of different stuff. It's more emerging procedures, more catered towards anti-aging, that are bringing in different things, as you said, like IV hydrations, peptides, GLPs, stem cells, all those types of things, and then also aesthetics that have gotten even further along the line than just Botox. Now you're talking about more laser-based cold lipo, all kinds of different things.
Scott Scheiblin:So when the markets are looking at that, they want to have an understanding of the training for the various people that are there. What's the level of services there is going to be provided, things like where are the stem cells harvested from? What are the specific promises, uses and reasons for it? You know, I think, that sometimes you just have insureds say, well, we're going to use stem cells, but for what? Right, Like you would put it on cereal, Like what are you going to?
Amanda Knight:There's some things happening. Be specific, yeah.
Scott Scheiblin:What's it going to be? So I mean, that's an entrepreneurial spirit that the med spas have expanded. It's very good for them because it is cash-based, or I should say at least it's not insurance reimbursable, and so they're expanding it out further and further. You are moving away from sort of very predictable aesthetic claims. You knew what a laser hair removal was going to be, you knew what it was going to do, you knew how much you were going to pay, you knew what a nuisance claim was going to be all that kind of stuff to claims that have a higher chance for severity. So you have to amend how you're going to underwrite it, what you're going to price it for and how focused you're going to be on various things to see whether or not the risk is possibly doing what it can to mitigate the liabilities, mitigate the liabilities, and so it's a real expansion of that whole side of the business.
Amanda Knight:And I don't see that slowing down. I think it's only going to keep going.
Scott Scheiblin:No, not at all. If there's one truth that is universal, it's that everybody wants to look younger and that industry is part of the beauty industry. And I, what is that? How many billions? At this point, I mean, yeah, so, and and I think, uh, you know, once glp's really hit it, expanded it out even further. Oh, sure for sure because those aren't everywhere yeah, well, it's going to be interesting.
Scott Scheiblin:The glp ones are very, very interesting. I think it's one of those pieces where, over the next couple months, it's going to actually be incredibly beneficial for people to utilize their wholesaler for glp risks, because I think we're approximately two months away from the idea of those compounding ones using smaglutut and terazapatide not the FDA saying that the shortage is over and it can be met and therefore the compounding is not going to be needed any longer or allowed. Ooh, I can only guess the amount of twists and turns we're going to have over the next couple of months because you know, keeping abreast of both what's happening from the regulatory side and then how carriers are going to respond to it, this is going to be a time where I think it's going to be incredibly beneficial to be utilizing a broker who has the relationships and awareness in that realm, because I think some stuff could turn on a dime very quickly.
Amanda Knight:Absolutely.
Scott Gordon:Yeah, we talked about that before. Anything that comes out of the gate this hot, everything else, including insurance, has to kind of catch up with it. Yeah, 100%, it's catching up. Multi-state operations are yet another layer of complexity that's been added to this, especially when it comes to PCFs or patient compensation funds. So what do agents need to know about this Patient?
Scott Scheiblin:compensation funds. I think they can affect in any realm of business. They are I'm trying to say it politely the bane of many people's existence.
Amanda Knight:Fair.
Scott Scheiblin:Yeah, I mean, it's like it's like trying to read how to do your taxes, you know, or put together your stereo. It's in English but it's a specific way of writing that English Right, but in all seriousness, they are. There are mandatory and there are voluntary ones. There are places where, as businesses expand and you see more and more expansion, both from a tele perspective and from just a geographical perspective, as insurers want to do that, from just a geographical perspective, as insurers want to do that when you move into certain of these states, especially the mandatory, you are faced with the proposition of having to be in some of these pcfs or, for a portion of your risk, having to. Um, it is always going to be the responsibility of the insured and and the specific doctor generally to make sure they're compliant with the fund. But the bottom line is, if you get into those states, you have to be aware of it and you want to be working with a wholesaler who also knows how to find the right carrier partner, because in some cases the carrier has to do this, and so you could take it out to 20 markets, but there's only three that are the right ones.
Scott Scheiblin:I've had quite a few insureds decide this isn't necessary at this juncture of my business to expand into this venue. That's going to create this problem and this extra cost. I'd rather focus in on other states and and they save themselves a lot of hassle and they save themselves a lot of frustration by knowing upfront where was going to be difficult and where wasn't going to be difficult. So I that's another way that I think a wholesaler may, may you know they're not going to dictate your business, they're not going to say anything absolutely particular, but can at least help you have conversations with your insureds Because, again, the goal is always to make it as easy as possible for everyone, um and and try to present the knowledge so that you, you can have that be as easy as possible.
Scott Gordon:We've got the roadmap.
Scott Scheiblin:Yeah.
Scott Gordon:Yeah, or we've got the. We've got the map legend yeah. Whether or not you go down it, crc can tell you which states are hot and which states are not.
Scott Scheiblin:If you want to go, you go, but at least you know up front.
Amanda Knight:Right, that's another one of those. We may not be able to tell you what you want, but we can tell you what you need, kind of thing. Yeah, exactly. Well, before we wrap up, Scott, it's time for everyone's favorite segment. Let's be honest Rapid fire. It's here, scott Gordon, take it away.
Scott Gordon:Yeah, this is whatever comes off the top of your head, you know the rules Okay. So question number one if you had to swap jobs with any famous person for a week, who would it be, and what's the first thing you'd do?
Scott Scheiblin:this is one of those questions that that feels like it should I have to have like 8 000 follow-ups. But um, I mean, the obvious answer is jeff bezos and I and I would have him cut a check to scott schaiblin for about six billion dollars. I mean that, that's, that's the obvious. Uh, yeah, if I stay away from any of the third rails of politics and all the rest, what I would say? I've never dunked a basketball, so, being LeBron, that could be fun. Yeah, the first thing I would do is dunk a basketball. I'd be dunking basketballs on everybody.
Amanda Knight:For the whole week.
Scott Scheiblin:I'd just be dunking yeah, I'd be dunking on the concierge at the hotel. All the rest, either either that or uh I don't know any names, but it would be pretty cool to be like a very uh skilled and famous chef, because I would love to know what it feels like to uh cook well and actually enjoy cooking.
Scott Gordon:there you go, yeah and know what things are. That's the thing. Yeah, like, what is this? Um, that's awesome. Um, yeah, you need to go find one of those, uh, little lowered basketball goals I've done those all the time. My pride keeps me from it. Go up, show those kids who's boss or who's you know older. Um, all right, our second question what's one completely useless talent or skill that you have that you're oddly proud of?
Scott Scheiblin:oh, guys I have so many niche hobbies, so many hobbies I mean there. There's a thousand things I could list. I would, if not for the fact that it would be inappropriate, plug my literal an aquarium and I hard scaped it with like expanding foam and rocks and moss and all kinds of stuff, and then I layered the tubing through it and created an actual fountain. I don't think anyone I don't think anyone is ever going to be on a plane saying like quick, is there a man who can create a fountain? Maybe? If so, I'm there. I got quite a few. There's at least another podcast worth of things that I could say for this.
Amanda Knight:We'll have to ask this question again and require a different answer every time.
Scott Scheiblin:I'll have at least 100.
Amanda Knight:Well, thank you, scott, for joining us today and sharing your insights and being a good sport. Having you on is always a lot of fun and also very informative. So thanks for joining us and to our listeners. If you need help placing these challenging risks, reach out to your local CRC Group producer. Thanks for tuning in Once again to your local CRC Group producer. Thanks for tuning in. Once again Scott thanks for joining us, thanks for having me, and we'll see you all next time. On Placing you First,
