[0:02] Nirav Chheda: or contractors. So then it's kind of like Uber.
[0:08] Nirav Chheda: Yeah. [laughter] Exactly. I mean, do you recommend that?
[0:13] Nirav Chheda: It's crazy. Crawford. Marc is the director of transportation and NEMT program leader at Swan Insurance, which specializes in providing insurance to NEMT businesses.
[0:42] Nirav Chheda: A unique thing about Marc and Swan is that they work with a lot of startup and new NEMT businesses that have as few as one to two vehicles.
[0:51] Nirav Chheda: Marc has consistently been at the NEMTAC conferences for the past four years.
[0:56] Nirav Chheda: Very involved in the NEMT community all over the place.
[1:00] Nirav Chheda: Marc, thanks so much for being with us.
[1:02] Nirav Chheda: How you doing, man? Hey, great to be here.
[1:04] Marc Crawford: I really appreciate the time. It's good to connect as always.
[1:07] Marc Crawford: Good to see you after a uh insightful uh trip down to NEMTAC and Jacksonville, Florida in which we got to see Bambi's launch live which was great to see.
[1:18] Marc Crawford: Appreciated seeing all my operators. So uh it's good to be here.
[1:21] Marc Crawford: Thanks for having me. For sure.
[1:24] Nirav Chheda: Um Marc, I'm going to let you give a quick background about yourself and how you got into the NEMT insurance Sure.
[1:34] Marc Crawford: So I have been a commercial transportation broker for 16 years all in transportation and normally we we do two types of transportation when one's for cargo and one's for people.
[1:46] Marc Crawford: So again people transportation is what we call livery.
[1:50] Marc Crawford: Um I got into um non-emergency medical transportation about five years ago.
[1:56] Marc Crawford: I saw there was a need for operators and finding them a solution for insurance.
[2:01] Marc Crawford: insurance is very tricky in that it's state specific as well as contract specific.
[2:06] Marc Crawford: So I saw there was a real need in the market for operators, specifically newer operators that weren't able to find or be able to pay for uh commercial auto insurance that met the requirements for So we migrated into
[2:24] Marc Crawford: non-emergency medical transportation and I built a program.
[2:27] Marc Crawford: Again, we are SWAN insurance. So it stands for sleep well at night.
[2:31] Marc Crawford: So we want you to sleep well at night while we cover your insurance.
[2:35] Marc Crawford: And from this we have built a book where we provide operators with the insurance coverage.
[2:41] Marc Crawford: We are now in 42 states.
[2:44] Marc Crawford: We have over a 100 operators that we work with directly.
[2:47] Marc Crawford: And again we have operators that started three four years ago with one one van and now we're at 50 60 units.
[2:56] Marc Crawford: We have others that are that are mom and pop that wanted two vehicles and have stayed with two vehicles and are very happy and are living the life they want to.
[3:04] Marc Crawford: So, we want to work with operators with TPS that that um that are comfortable in what they're doing and supporting our seniors, our individuals with disability.
[3:16] Marc Crawford: Um there's such a high demand and we are in the service industry.
[3:19] Marc Crawford: So, um, we're here to support you, uh, assist you and educate you when it comes to insurance in the NEMT market.
[3:27] Nirav Chheda: So, Marc, anyone who's in the NEMT world typically knows that insurance is one of the, if not the biggest cost to an NEMT business.
[3:39] Nirav Chheda: And especially for NEMT businesses that are newer starting out, um it's kind of difficult to figure out like what are the factors to consider in choosing, you know, to go after one insurance provider versus another?
[3:53] Nirav Chheda: Like can you just give us, you know, at the outset like a highlevel overview of what an NEMT business that's new to the game has to think about in figuring out how to get insurance?
[4:05] Marc Crawford: Great question. So, I'm going to start at a at a macro level, which is up here, which is that you're going to need three lines of insurance coverage to be compliant as a non-emergency medical transportation operator.
[4:20] Marc Crawford: Those are commercial auto that is a general liability policy, and the third is a professional liability, and actually that is called a SAM policy or a sexual abuse and molestation that was required by your ride broker or vendors.
[4:34] Marc Crawford: So with these three lines of coverage, you will be compliant not only in the states that you transact business but also which the um you will be able to obtain the ride vendor contract which examples are Modivcare,
[4:50] Marc Crawford: Verida, MTM, Access2Care etc.
[4:56] Marc Crawford: and or work with a uh medical group, which the simplest way to think of a medical group is you're working with a dialysis clinic specifically um or a operation for uh non-urgent care services.
[5:11] Marc Crawford: So, they are all going to require similar levels of insurance, but those three um levels again are commercial auto, general liability, and professional liability, which is called sexual abuse and molestation.
[5:24] Marc Crawford: So, those are the three that you're going to need.
[5:26] Marc Crawford: Again, what we like to do is we like to take you to a program that has all three lines under one policy.
[5:34] Marc Crawford: So, you're paying one payment, one monthly cost, and you can plan that into your budget.
[5:40] Marc Crawford: So, you know what your fixed cost of insurance is.
[5:43] Marc Crawford: There are no variables. You're going to be compliant.
[5:46] Marc Crawford: And again, at the end of the day, it's making sure that you're able to get on the road and get as many rides as you want or you're able to obtain and not have to have to be concerned
[5:57] Marc Crawford: with, you know, what your cost of insurance is because it's structured, it's planned, and you know what that is um for the policy period.
[6:05] Nirav Chheda: Okay, thanks for that high level.
[6:07] Nirav Chheda: So, can you do this for me, Marc?
[6:09] Nirav Chheda: Let's walk through a journey of a new NEMT business, right?
[6:13] Nirav Chheda: They're just starting up. Maybe they haven't, you know, they're just getting their first vehicle in place, they're about to start doing trips.
[6:20] Nirav Chheda: You know, when in the life cycle of starting the NEMT business do they reach out, get insurance, and you know, what are the factors to consider in what kind of, you know, you're saying like you package all three
[6:34] Nirav Chheda: into one? Like in that one package even, you know, what are the things to consider in when I should get these?
[6:41] Nirav Chheda: You know, what level of insurance I should get?
[6:44] Nirav Chheda: Does that depend on where I am?
[6:46] Nirav Chheda: Like, walk me through the journey.
[6:48] Marc Crawford: Okay, that great question and good for your new operators because you're going to get a lot of information thrown at you and it's good to be able to have a road map to get to completion so you can
[6:59] Marc Crawford: actually get on the road. So, what I would say is first and foremost, you're going to have a vehicle and you're going to have a driver.
[7:06] Marc Crawford: From there, you're looking at getting compliant within the state in which you are domiciled, in which you work.
[7:12] Marc Crawford: So, your state limits are going to be through your um through the state and those are going to vary.
[7:19] Marc Crawford: The difference between Florida, which requires three 300,000, and Connecticut that requires 1.5 million, commercial auto are very different.
[7:27] Marc Crawford: But you are not going to match your limits to the state.
[7:31] Marc Crawford: You're going to match them to the contract that you are focused on obtaining or private pay limits.
[7:37] Marc Crawford: So, we'll take a step back.
[7:39] Marc Crawford: You have your vehicles registered and licensed.
[7:41] Marc Crawford: you are going to be required to um provide the state the department of uh motor vehicles with your coverage.
[7:49] Marc Crawford: Um normally we need uh uh form E in certain states which shows that you have the limits of liability to transact livery which all that means is that you're transporting people.
[8:01] Marc Crawford: So, you need to make sure that your limits are in line with the state limits, but also that you are going to be able to match the contract.
[8:08] Marc Crawford: And let's say you're going after Modivcare, that you're going to need a million dollar commercial auto limits.
[8:13] Marc Crawford: You're going to need a $1 million general liability, and you're going to need $500,000 in SAM coverage.
[8:19] Marc Crawford: So, what we do is we make sure that it meets both the state and the um ride vendor contracts.
[8:26] Marc Crawford: Now, you normally have about a two week period to do this.
[8:29] Marc Crawford: So, what I say is once you have your vehicles registered, you know, you've got your LLC set up, you have your vehicle, you have your drivers, you understand that you're going after, and you've submitted the primary paperwork for
[8:41] Marc Crawford: ride uh vendor contracts. Let's say you're going after Modivcare, you're going after MTM or Verida, you've submitted, they're going to come back.
[8:49] Marc Crawford: Um, you've got your approval with the state.
[8:52] Marc Crawford: Um, at that point, you're going to have to have the insurance bound.
[8:56] Marc Crawford: And then you've got about a two-week period in which you can get the first contract.
[9:00] Marc Crawford: Again, you want to make sure you also have a good partnership with routing software that you have um someone like Bambi in place for you to make sure that you can you can manage these rides.
[9:11] Marc Crawford: So, there are a lot of moving parts.
[9:12] Marc Crawford: We normally we normally sit down with our operators and make sure that they are aware of each um each point each base first, second, third, fourth, fifth and that we can get you there in the right timeline because
[9:25] Marc Crawford: we have to work off the timeline of the ride vendor contract and we have to make sure that you have everything in place to be able to pick up the rides once that contract's inked.
[9:37] Nirav Chheda: Okay. Thank you. That's know how to do it the right way.
[9:42] Nirav Chheda: Um, Marc, now I want you to tell me how people do it the wrong way.
[9:47] Nirav Chheda: So, like there's a lot of NEMT businesses out there that I'm sure you've come across where you're like, man, like I see these mistakes made all the time.
[9:58] Nirav Chheda: Like, what are those mistakes? What do people need to do to avoid them?
[10:02] Marc Crawford: Great, great question. And I think you could probably learn more from the mistakes and the people that follow the road map because it's what not to do which is going to get you in trouble and really push back
[10:14] Marc Crawford: your ability to work in the industry and make money and at the end of the day it's getting enough rides getting the right rides and generating revenue from those rides on a repeated basis.
[10:23] Marc Crawford: So what you don't want to do you don't want to go and you don't have to come and work with us.
[10:29] Marc Crawford: I mean, I like that we are a specialized brokerage and we have a program for NEMT, but you don't have to come work with us.
[10:37] Marc Crawford: Problem is, if you go with another broker that doesn't understand NEMT, you're going to spend weeks, if not months, getting placed with the wrong insurance, it's not going to be compliant with the state or with the contract that
[10:49] Marc Crawford: you're going after for the ride vendor.
[10:51] Marc Crawford: And then you're going to end up having to come back to us and we're going to have to fix it.
[10:55] Marc Crawford: So rather than you go through the process of making a mistake or a broker that doesn't really understand that you need loading and unloading and they give you a policy that excludes that, the contract will look at that
[11:08] Marc Crawford: and say this is excluded. You're declined.
[11:11] Marc Crawford: You can't get the ride. So those are mistakes.
[11:13] Marc Crawford: That is an insurance mistake. Oftent times people wait too long to submit for their insurance.
[11:21] Marc Crawford: So I'm going after ride broker.
[11:24] Marc Crawford: they open the window and say we have this requirement that you have to have insurance.
[11:28] Marc Crawford: Well, then you start looking for insurance.
[11:31] Marc Crawford: It's not a quick process. I will say our program takes minimum 7 to 10 business days from when you get me all the information to get this submitted and approved.
[11:41] Marc Crawford: As a new venture, again, we have a lot of flexibility.
[11:45] Marc Crawford: Um, but I need to know what's your bio, what's your background, do you have health service um experience, do you have transportation experience?
[11:52] Marc Crawford: So things that are important for us to know.
[11:55] Marc Crawford: Um another pitfall is not planning for drivers.
[12:00] Marc Crawford: You know, you may think, okay, it's just going to be myself, my husband, my wife, and then you put two vehicles on and you need another driver.
[12:08] Marc Crawford: Well, you haven't you haven't done any of the pre-work.
[12:10] Marc Crawford: You haven't done um background. You haven't done you haven't run NVR.
[12:15] Marc Crawford: So, things of that nature. You do not want to get into a position where you have vehicles, you have potential rides coming through, but you don't have drivers.
[12:22] Marc Crawford: So, things to think about. Um, and I've seen them all.
[12:26] Marc Crawford: I've seen I've seen people that put four vehicles on, have no drivers, have the wrong insurance.
[12:32] Marc Crawford: Um, they haven't gone to a professional.
[12:34] Marc Crawford: So, in this business, not like auto insurance where you can just go out and, you know, your local agent on the corner can ride it.
[12:42] Marc Crawford: you need to be very careful that you go with a specialist that knows what they're doing.
[12:47] Marc Crawford: Not only because um it will protect, you know, or allow you to get the contract.
[12:52] Marc Crawford: It protects you as the owner from liability.
[12:55] Marc Crawford: You you know, you're handling a very precious cargo, probably the most precious cargo, and that's that's our seniors.
[13:02] Marc Crawford: That's what I think of my grandmother going going from her house to her doctor's appointment.
[13:07] Marc Crawford: So, people people hold you at a higher standard.
[13:09] Marc Crawford: So, make sure that you work with professionals, you partner with professionals in this business so you can become a Well said.
[13:19] Nirav Chheda: Thank you. I [clears throat] like that line.
[13:23] Marc Crawford: You can borrow that bad boy.
[13:25] Nirav Chheda: I will. I will. Right on.
[13:28] Nirav Chheda: Um, it's story time. Marc, tell me a story of um a new NEMT business, maybe one, two vehicles that you've worked with where things may have gone the wrong way, but they were righted.
[13:43] Marc Crawford: Okay. Good opportunity to have and and we'll we'll admit the name, but I'm sure they wouldn't mind if we said it.
[13:50] Marc Crawford: They're out of LA, actually, out of Orange County.
[13:53] Marc Crawford: They came in had a good transportation background.
[13:58] Marc Crawford: They put on vehicles. Um, and what they wanted was both ambulatory and non-ambulatory, meaning that, you know, they were fine with people that had full mobility.
[14:10] Marc Crawford: Um, but they also wanted wheelchair and gurney.
[14:13] Marc Crawford: Well, they put the vehicles on without the sufficient training.
[14:17] Marc Crawford: So they were able to put the vehicles on, but they had drivers pull up and they gave [snorts] assistance to the wheelchair, you know, off the curb and then had no awareness of how to procure that individual within
[14:32] Marc Crawford: in the van. So I had a call from one of the owners saying, "Hey, we've got drivers." They went through basic basic training.
[14:41] Marc Crawford: So they were they were transportation specialists, but they didn't have wheelchair procurement.
[14:45] Marc Crawford: Well, that's huge in this business because you need to understand that how to secure someone in a wheelchair.
[14:51] Marc Crawford: I'm glad they called me. We walked them through it and then I went through the next day and we did a full training for all their drivers, even those that were just doing um able-bodied individuals that could walk
[15:03] Marc Crawford: to their wheelchairs and their that and then they've gone on to Gurnie.
[15:07] Marc Crawford: So that was something that they missed in that process because they they were assuming that because they had a lift or a ramp that it was the same as helping somebody that was on a walker or on a
[15:20] Marc Crawford: stick where it's completely different in how you secure someone in a wheelchair.
[15:25] Marc Crawford: Um that is you know these guys are good.
[15:30] Marc Crawford: They're they're quick learners and they understood that there was a deficiency in their in their operation.
[15:36] Marc Crawford: So, we corrected that quickly. Uh, the ride went smoothly and now they're fully compliant.
[15:42] Marc Crawford: All their guys know how to secure wheelchairs.
[15:45] Marc Crawford: So, uh, and they've put on six new units.
[15:49] Marc Crawford: So, they're they're now just under 10 units strong and continuing to grow.
[15:56] Nirav Chheda: Everybody loves an underdog story. There we go.
[15:58] Nirav Chheda: Kind of like Bambi the deer.
[16:00] Marc Crawford: There we go. Yep. [laughter] Run.
[16:03] Nirav Chheda: Actually a good segue, Marc, to the patch that's on your arm right now.
[16:07] Nirav Chheda: Um, we were just talking about this earlier, but can you tell everyone what that is and why you're wearing it?
[16:13] Marc Crawford: Yeah. Yeah, I'm happy to. So, this is for the certified transport specialist.
[16:18] Marc Crawford: Um, I recommend that all operators go through a course in which they become aware of what's really required both on ambulatory and non-ambulatory um, in the NEMT space.
[16:32] Marc Crawford: Meaning again you're assisting people that are fully mobile.
[16:36] Marc Crawford: They can walk on their own ambulatory and or those that are in a wheelchair.
[16:40] Marc Crawford: Um I say on a stick which just means using a walking stick or on a walker.
[16:45] Marc Crawford: And this is a good opportunity for you to really understand um not only on what's the difference of um being a transportation specialist with someone that has limited ability capacity to move.
[17:02] Marc Crawford: um you know limited cognition. Uh all these things are covered under the transportation specialist portal um training and then there's also wheel wheelchair securement which um is another uh good module to go through.
[17:17] Marc Crawford: Uh these are both offered through NEMTAC um which is an op option that you can go you can send your drivers but strongly uh recommend that you go through a training program so you're aware of really how to
[17:37] Marc Crawford: support seniors in transportation or Americans with disability in with transportation.
[17:43] Marc Crawford: So, yep. This is I wear this proudly.
[17:45] Marc Crawford: Um, and I recommend that all the drivers do as well.
[17:49] Marc Crawford: You know, it's it's it'll take you a couple days on the course, but then you can wear this.
[17:54] Marc Crawford: You also get a decal that you can put in your vehicles, so it shows that you are those drivers um that are driving those vehicles are compliant.
[18:03] Marc Crawford: So, it's a little bit of um another layer of protection for individuals or or let's say the kids of parents that are traveling.
[18:13] Marc Crawford: They they like to see the sticker knowing that your drivers are compliant.
[18:18] Marc Crawford: So, something something to think about if you're a new operator.
[18:21] Marc Crawford: Um, always good to be aware and stay current on on how to handle and transport uh seniors and uh uh anyone that has disability that needs Wearing it proudly.
[18:36] Nirav Chheda: There we go. Thanks for sharing One thing I want to touch on.
[18:42] Nirav Chheda: So the actual dollar amounts, right?
[18:45] Nirav Chheda: When you're thinking about, okay, I'm starting this business.
[18:48] Nirav Chheda: I have my costs. here's what I project my revenue to be.
[18:54] Nirav Chheda: a lot of people don't have even a rough sense of what the dollar costs actually are.
[19:02] Nirav Chheda: And I know it's, you know, hard to give exact numbers.
[19:04] Nirav Chheda: There's a lot of factors that weigh into it, but would you be able to share like, you know, when people are starting out one vehicle, like what cost numbers are they actually looking at?
[19:17] Marc Crawford: It's a that's a good question and what I advise um a new operator to do is almost do a P&L but I have a simple you know one pager that I can send out that you can look at
[19:29] Marc Crawford: and say okay what's my fixed cost and what are my variable costs and you look at things like okay if I have a vehicle um let's say I have a Honda Odyssey ramped Odyssey you know what's my monthly
[19:42] Marc Crawford: on that you know and then cycle everything down as you said earlier in our conversation, one of your largest fixed expenses is insurance.
[19:51] Marc Crawford: So that is a line item, but that's a fixed expense.
[19:54] Marc Crawford: You know, you know, if you have that one vehicle, the Honda Odyssey, you have the one driver at that time.
[20:00] Marc Crawford: You know, oftentimes if you're a new venture, it's just you driving.
[20:03] Marc Crawford: So again, you want to pay yourself, but beyond that, there are, you know, there's about six fixed expenses that you can look to look to come out of pocket.
[20:13] Marc Crawford: um your front end frontend expenses like you know your um getting your getting you um through the DMV your registration things of that are going to be a one-off cost but really what you need to look at is
[20:27] Marc Crawford: a controlled expenses like your cost of insurance the lease on that vehicle um if you're going to hire staff what software packages you're using how do I control those I like to manage expenses and know what the fixed
[20:42] Marc Crawford: cost is so stay away from variables, variable cost as much as possible.
[20:46] Marc Crawford: Um, on this I would say it it varies greatly.
[20:51] Marc Crawford: So, you know, the cost of an operator to run in Southern California is going to be very different than in, you know, central Tennessee, for example.
[21:03] Marc Crawford: Um, but that being said, you should plan, um, you know, let's say if you're a one-off operator, you should probably plan for the insurance expense, you know, to be 800 to a,000 a month on all lines of of
[21:24] Marc Crawford: coverage. If you are getting a a tier ride vendor contract, um that is that's an average across all all states.
[21:36] Marc Crawford: But um it it's a gauge to start with if you're just looking at insurance.
[21:42] Marc Crawford: But beyond that, I mean, there are a lot of variables that go into that depending on, you know, do you have a marketing budget?
[21:48] Marc Crawford: Oftent times it's just word of mouth when you start.
[21:51] Marc Crawford: I can't put enough weight into talking about your business.
[21:56] Marc Crawford: Um, you know, even something as simple and as cheap as wrapping your vehicle.
[22:02] Marc Crawford: Um, brand brand. Um, a lot of people are visual.
[22:07] Marc Crawford: They're going to see your company.
[22:09] Marc Crawford: Um, you can start with one or two dialysis patients if they if you're doing private um those dialysis uh visits are normally scheduled three months in advance.
[22:22] Marc Crawford: So you know what your revenue is going to be for the following three months on each one of those patients.
[22:27] Marc Crawford: So it's a calculable um revenue stream for you because one thing I want to make sure and people aware of is from the vendor contract you are uh for no better word at their mercy a little bit.
[22:42] Marc Crawford: So you are dependent on them sending you rides.
[22:44] Marc Crawford: You might have high volume weeks, you might have low volume weeks.
[22:47] Marc Crawford: So, you want to manage that out.
[22:49] Marc Crawford: If you can have a mix of uh ride broker rides and private pay, then that you can manage that a lot better.
[22:58] Marc Crawford: But again, after the initial, you know, I'd say um on the startup cost, then you can manage those on a monthly basis and control your expenses.
[23:10] Marc Crawford: Um and again, I'm happy to share.
[23:13] Marc Crawford: We have a very simple one-pager to calculate your initial costs and then your operating costs for your first year.
[23:21] Marc Crawford: Um, you know, they makes it makes certain assumptions, but it can be beneficial for someone just thinking if I want to get in this business, hey, how what's it really going to cost me?
[23:30] Marc Crawford: So, I hope that answered the question.
[23:31] Marc Crawford: It's again there's I'm making a lot of assumptions because it's very different depending where you are in the US.
[23:39] Nirav Chheda: Yeah. Yeah, I know. But no, thanks for making the assumptions and giving us a okay rough estimate.
[23:46] Nirav Chheda: Yeah, for everyone watching, I'm putting Marc's contact info in the description of this video.
[23:53] Nirav Chheda: Um, Swan Insurance. Marc, you've dropped a lot of gems over this talk.
[23:59] Nirav Chheda: Is there any sort of one final large or even, you know, niche takeaway that you want to leave the viewers with?
[24:07] Marc Crawford: I think for a new operator, we can simplify your process and there's a huge opportunity.
[24:14] Marc Crawford: We project about uh 63% growth in this market in the next 5 years.
[24:21] Marc Crawford: So, what that is is we're we're not looking at, you know, 5 10% growth.
[24:26] Marc Crawford: We are looking at a massive increase in the demand for rides.
[24:31] Marc Crawford: So, I want these operators. I want new operators.
[24:34] Marc Crawford: there there's enough opportunity here. It's just do it the right way.
[24:39] Marc Crawford: Put in the time. Make make it your business and make it make it something you really want to do.
[24:45] Marc Crawford: And if you're happy, if you like transportation, if you like uh elder care, health care, and you can blend those together, I think it's a great opportunity for a business.
[24:57] Marc Crawford: So, I I'm very bullish on on the NEMT industry, and I think there's going to be a significant upside.
[25:06] Marc Crawford: I just want to make sure you uh you partner with the the right people and they support you and assist you in a successful journey.
[25:17] Nirav Chheda: Right on, Marc. Run, Bambi, run.
[25:20] Marc Crawford: [laughter]
