“Obtaining your coverage as early on in your schooling as possible is helpful. I get it, as a resident or fellow, budgets are tight compared to when you’re in practice. But you’re probably never going to be as young or as healthy as you are then.” -Anjali Singh

In today’s episode, we are thrilled to welcome back an expert in her field, Anjali Singh. Anjali is a Certified Financial Planner and Financial Advisor. In this episode she covers what you need to know about disability insurance. She covers the important differences between types of disability coverage, differences in rates, as well as some really important tips that you will be glad you know. Your future self will be glad you tuned in to this episode.   

Anjali is a Certified Financial Planner and Financial Advisor. She is a Trusted Resource of DocWorking. She specializes in disability, life, malpractice, commercial and workers comp plans. She has been working exclusively with healthcare providers since 2000. 

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Please find the full transcript of this episode below:

Anjali: Obtaining your coverage as early on in your schooling as possible is helpful. I get it, as a resident or as a fellow, budgets are tight compared to when you’re in practice, but you’re probably never going to be as young or as healthy as you are then.

 

Jen: Hi, I’m Dr. Jen Barna. Thank you for joining us today on DocWorking: The Whole Physician Podcast. Today, I have a special guest, Anjali Singh, of insurance services in California who is one of our trusted resources. If you go to our homepage and look at the bottom of the page, you’ll see some special trusted resources that we have formed a relationship with, and they are people who specialize in working with physicians, and people who we would trust to work with ourselves, and I’ve really enjoyed some interesting conversations with Anjali. Some of the stories she’s told me made me want to bring her onto the podcast, because I think they’re very relevant to us as physicians. Welcome, Anjali. 

 

Anjali: Hi, Jen. Thank you so much for having me. 

 

Jen: Well, thanks for being here with me today. We were talking recently about some situations that you’ve encountered as a specialist over the years. You have specialized in working with physicians and medical professionals since 2000. Is that right?

 

Anjali: That is correct. Yeah, I’ve been licensed 23 years. The last 21 years working with healthcare providers, largely with disability coverage. 

 

Jen: Okay. The disability coverage specifically is something that we were talking about recently, and you had some stories that you had encountered firsthand with some of your clients, and it sounded like they would be worth telling as a cautionary tale, to those of us who may not have heard of those situations or may not have thought of them prior to this point. I wonder if you could dive right in, and tell us about yourself and your practice and what you do, and then maybe let us know about some of the situations you’ve seen?

 

Anjali: Yeah, absolutely. I’ve been working with healthcare providers since 2000, and disability insurance, life insurance, professional liability, some other lines. Out of all the plans that are health based, disability is probably the hardest one to get. They do look at the entire medical history, and I think the thing that can be challenging for physicians and healthcare providers is that it’s looked through from a lens of actuary science and risk versus your actual medical condition. I don’t try to pretend I know more than a physician. I know I don’t, but sometimes there can be a condition that is not medically significant. It doesn’t need ongoing care, it doesn’t affect somebody’s daily life, but from a disability insurance perspective, can be challenging, or in some cases, not possible to ensure. Then, you and I had some conversations recently, where people had a health crisis of some form come up, and we’re trying to get coverage after the fact, and we’re surprised they couldn’t. I think doing some education and talking about the timing of when it’s good to get a plan can be helpful to people as well.

 

Jen: Great. Can you tell us some specifics about some of the situations you’ve seen over the years?

 

Anjali: Yeah, absolutely. I had somebody, they actually weren’t in the healthcare field, but they were wrapping up a short-term disability claim, and their benefits were running out, and their coverage payout was going to drop when they transition to long-term disability. It was through their employer, and they contacted me to find out if they could buy a plan. I like to equate it with if you’re trying to look for car insurance after the accident has happened, or you’re trying to shop for homeowner’s plan after the fire’s occurred, there’s no carriers that are equipped to do that, and it’s the same with disability. Once the event has happened, you really have to work with whatever you have or the lack thereof. I’d say the lesson to be learned there was that the person relied solely on work coverage, and they found that it didn’t quite work the way that they thought it would. 

 

I do see providers that finish their training– and I recognize that in healthcare you exit and enter practice with a large amount of debt. I completely get it. I’d say dental school tends to run a little more than medical school. I’ve seen new grads with debt as high as 500k to 750k depending on if they’re a specialist or not, which is pretty mind blowing. So, it can be very tempting as a new grad to defer or put off getting coverage. The same week that I had the conversation with the person that had the employee benefits that didn’t function the way they wanted, I had a business owner that had gotten some coverage as required by their bank. When you finance a healthcare office, oftentimes, banks will require you to get disability and life insurance on the loan. 

 

I had brought up personal coverage a number of times, they had opted not to do anything, mainly for cost reasons. Then, when the event happened, they were disappointed that they didn’t have any personal income coming in. The coverage they had was all payable to their bank, and met that requirement, but they didn’t have any actual coverage payable to them, and unfortunately, it was a cancer claim. The added challenge is that when they beat the cancer, which obviously I hope they do, most carriers, unfortunately, will not offer coverage within five years of the tail end of cancer treatments, because they’re worried about recurrence. They want to make sure that the person stays in remission.

 

Jen: Mm-hmm, right. With the first case, when you said that the person was changing jobs, and they realized that they had a situation where their coverage wasn’t what they expected, can you tell us a little bit about what it was that they thought that the coverage had that the coverage did not have, and perhaps, if you’re advising someone now, what would they specifically ask for to be sure to cover what this person wished that they had had covered?

 

Anjali: Well, I think there are two things. Short-term disability is designed for short-term situations, and it usually can pay out 100% for those that are lucky enough to have it. When you reach the long-term disability stage, the coverage amount often drops from 100% down to 60%, or about 50%. When it’s employer paid, the added challenge is that can sometimes be taxable. This person specific issue was that they wanted to work on the side to keep busy and generate some income, while their employer coverage did not permit them to work outside of their regular job. So, if they chose to do that, they would be disqualified. In the disability world, that type of coverage is called own occupation. If you get disabled, and you can’t do what you are doing at the time of claim, if you have an own occupation policy, you can typically go elsewhere, make a side income, and not disqualify yourself. 

 

The thing I’ve run into working with healthcare providers is that to get through medical school, residency fellowship, what have you. You have to be very, very driven, and often those type of people don’t do well sitting at home. They want to be functional and contributing and doing things. So, when you have a non-own occupation policy that does put you in a position where if you work somewhere else, it can reduce benefits or sometimes eliminate them altogether.

 

Jen: Is there a big difference in the cost of the two types of policies?

 

Anjali: Yeah. It’s a matter of you get what you pay for. This person was relying only on employer coverage. Frankly, they weren’t paying anything, because they had it through their job. But when things happened, it wasn’t what they wanted, or really what they felt like they needed. Then, separate from that, and this is true for healthcare providers as well as not, for long-term disability plans, they have a waiting period. That’s how long you have to be disabled before they start paying out. Most long-term plans have a 90-day waiting period. Mechanistically, let’s say you get hurt January 1st. You have to be disabled all of January, all of February, all of March, and then your payout would start April 1st moving forward. You have to be disabled for the month, and then at the end of the month, it’ll pay you back for that month, in this case, April. So, from a planning standpoint, it’s advisable to have emergency funds so that way, you can cover those couple of months and not run out of cash while you’re waiting for the policy to kick in.

 

Jen: I see. Sure. 

 

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Jen: Are there other tips that you would recommend for healthcare workers?

 

Anjali: Yeah, I’d say obtaining your coverage as early on in your schooling as possible is helpful. I get it, as a resident or as a fellow, budgets are tight compared to when you’re in practice, but you’re probably never going to be as young or as healthy as you are. Then, for female providers, the added thing I’ve run into in the last couple of years is that, if you go the fertility road, and that can be true, whether it’s the female physician that is being evaluated, or they go in as a couple within the male partner has an issue, once you’ve had a fertility consult, and something is found where the doctor indicates that they might need to do an IUI, or IVF, or what have you, that is considered a preexisting condition, and pregnancy can be excluded. 

 

When I tell people, “Hey, if you’re thinking about or you’re getting married, and that’s not happening now, but it’s going to happen in two, three, four, five years, get your coverage before. So, if the unfortunate happens, you need to go the fertility road. You don’t have to worry about a pregnancy exclusion.” With a lot of not just healthcare providers, but other people opting to have children later and later in life, we do see that. Pregnancy in my office is the leading cause of disability just complications, pregnancy carpal tunnel, gestational diabetes, and then, unfortunately, I’ve had a couple of claims where the delivery was challenging and the recovery took longer. Those things happen.

 

Jen: Such an interesting point of view. It’s very helpful to hear that, because people can ensure earlier if they know to do that, and I’m sure as you say, it’s not at the forefront of people’s minds, before those things come up, and the best thing to do is to be insured prior to that.

 

Anjali: Talking about fertility, it can be a very sensitive topic, and I aim to be respectful. But it’s something to think about if that’s a possibility. As healthcare providers, it’s not uncommon for somebody to go get checked to see what is their egg reserve look like, or how are their hormone levels? There’s more male infertility. Those checks come into play, and it’s unfortunate that the female provider, if their male partner has a low sperm count or what have you, because the fertility specialist knows they’re going to have to do IVF or IUI, they will place the exclusion on the female practitioner’s policy. So, even though it’s a male issue, it still comes up.

 

Jen: Oh, I see. Wow. That is an insight that is helpful to know. If someone is interested in starting disability policy when they’re in residency or fellowship, that physical exam and the workup necessary to obtain the policy, how long would that last? Would that last indefinitely as long as they maintain the policy?

 

Anjali: Oh, yes, yes, yes. When you sign up for a policy and you pass the screening, if you get an individual policy, then, your screening is frozen in time, and whatever develops after can’t be held against you. That’s why it makes sense to incur the cost while you’re in residency. In fellowship, or early years of practice as you start to explore those things, they can’t come back and say, “Oh, well, now you’ve seen an IVF doctor. We want to not cover pregnancy.” The visit to the fertility specialist came after the policy was purchased if it’s designed right. The good news is at least right now, and we’re in 2021, a lot of the carriers in response to COVID for clients under anywhere between ages 40 to 45, they’re not doing the normal health screening. 

 

Back in the pre-COVID days, and when I heard somebody referred to it as BC, Before COVID, [giggles] we used to send technicians out, and they would do a blood draw, a urine sample, height-weight measurement, not the most fun experience. Because of COVID safety concerns, a lot of the carriers have opted to not actually do those anymore to keep their customers safe. As we’re recording this now in June 2021, you can get a solid disability policy without even doing blood and urine work if you’re the right age and you qualify with those carriers that have opted to not do those exams anymore. 

 

Jen: Very interesting. Wow. Well, some terrific tips. Can you give us a quick summary of the tips that you’ve discussed, because I think that’s really useful? Thank you.

 

Anjali: Absolutely. Just to summarize, you want to get your coverage earlier in your career versus later. You don’t want to solely rely on your employer coverage or if you do, you need to really understand how it works. For those that are female doctors, you want to try to get your coverage before any kind of fertility consults down the line, because that can make it challenging to get pregnancy covered. The distinction there, pregnancy means there’s some kind of complication or medical reason you don’t work, maternity coverage, which is bonding with the baby, there’s no carrier that covers that. I want to make sure that’s clear, because I get a lot of questions around that as well.

 

Jen: Sure, that does make sense, because that’s not a disability. 

 

Anjali: Exactly. [giggles] 

 

Jen: Yeah, absolutely. It’s such an interesting point that a partner’s problem can affect the insured’s ability to be covered on a certain medical issue.

 

Anjali: It’s not fair, but that’s how it works. So, it’s important to understand that so you can act accordingly and avoid it if you can.

 

Jen: If you get insured early on an individual policy, does the rate lock in, or does that change with age?

 

Anjali: No. There are plans that go up with age, but it’s a set progression, so you know what to expect. Then, there are plans that are fixed or locked, where it starts at X, and it stays at X over your career. I tend to advise younger providers to actually go with the graduated one to leave room in their budget for other things, but some people come out of training, and they just want the fixed rate, and they don’t want to worry about it, and oftentimes there’s a choice for that.

 

Jen: Okay. Wow, that’s really helpful. Thank you. You’re a mom yourself. So, I think some of the issues that we’re talking about that was the other thing that you and I found in common when we were talking in previous conversations, just the common struggles that parents face while trying to have a busy career, and it sounds like that’s something that you share with your clients, and it’s nice to be able to work with someone who understands firsthand [laughs] some of the challenges that we all face in the workplace.

 

Anjali: Yeah, absolutely, and especially with work from home, my kids are currently almost four and two. Yeah, the toddler life is [laughs] definitely never dull. It’s fortunately nap time now. So, you won’t hear anybody in the background. 

 

Jen: Yeah.

 

Anjali: But yeah, I like to draw on personal experience to help clients, and I also think that confidentially and appropriately sharing the experiences of people that say, “I wish I would have known this,” or, “If I go back in time I would do that,” I think can be helpful to doctors as they’re trying to figure this all out.

 

Jen: Absolutely. I think in some future conversations, we’ll be back to talk about some other things that you’ve witnessed that have to do with debt and insuring appropriately just situations where people are making decisions based on their personal circumstances that might be uncommon, but common enough that I think some of our listeners would relate. We’ll leave that hanging out for a future episode, but thank you again for coming on today, and I look forward to talking with you again soon.

 

Anjali: Absolutely. It’s always a pleasure to talk to you and thank you so much for creating this platform for people to learn. I think it’s amazing.

 

Jen: Thank you for being here and being part of it.

 

Jill: Thanks all of you for tuning in to listen to this edition of DocWorking: The Whole Physician Podcast. We have something new and exciting to tell you about. So, I want you to hop over to docworking.com. DocWorking THRIVE is getting ready to launch in a very short time, and what that is, is a subscription service for physicians. It includes an excellent self-paced course called STAT that is all about quick wins for living well. It is group coaching. It is a Facebook group where you have a chance to connect to other physicians and coaches to ask questions about things that are happening in your life. It also includes weekly video tips to come and give you advice on important things in your life. We’re really excited about this. The price is almost too good to be true. It’s so good, and I really think it’s going to be a fabulous support network for physicians. So, we hope you’ll hop on over. Check out DocWorking THRIVE today, and until next time, we’ll see you on DocWorking: The Whole Physician Podcast.

 

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