Cutting-Edge Benefits Podcast · 2026-07-02 · 12 min
Key moments - from our scoring
Substance score
37 / 100
Five dimensions, 20 points each
Tom Quigley, founder of Claim Links, draws on three books written over two decades to challenge how employers purchase health insurance. The core problem he identifies: companies operate blind, lacking access to claims data needed to make informed purchasing decisions. By running a MERP (Medical Expense Reimbursement Plan) analysis, employers gain visibility into inpatient stays, outpatient procedures, and drug utilization - intelligence that enables strategic plan design and cost control. Quigley argues the ACA, despite restrictions on carve-outs and pre-existing conditions, still allows employers to explore non-traditional pathways: spousal coverage options, military benefits, parent and college plans, and marketplace alternatives for employees earning under certain thresholds. He positions Section 105 plans (legal since 1954) as black-and-white, DOL and IRS-vetted solutions, dismissing 'gray area' terminology as scare tactics pushed by insurance agents and brokers protecting commission structures. For CFOs and business owners tired of annual 10-20% premium increases with no visibility into claims drivers, his first directive: get C-suite buy-in and remove decision-making from HR departments, which he views as implementing rather than strategizing.
Companies operate without access to claims data, making decisions blindly while insurers cite high claims but show no documentation; a MERP analysis reveals inpatient stays, outpatient surgeries, and drug usage to enable informed purchasing.
The ACA eliminated pre-existing condition exclusions and mandatory maternity carve-outs but still allows employers to explore non-traditional pathways like spousal coverage, military benefits, college plans, and marketplace coverage for employees under income thresholds.
Section 105 plans have operated legally since 1954 and carry DOL and IRS validation letters; 'gray area' language is a scare tactic used by insurance brokers and attorneys tied to insurance companies who benefit from traditional models.
Secure buy-in from owners, presidents, CFOs, and CEOs to align leadership, then remove decision-making authority from HR departments and shift to active, data-driven purchasing strategy.
Employees earning under certain thresholds (e.g., bartenders making $20,000-$22,000) may qualify for no-cost health insurance with no deductible through spousal plans, military options, parent plans, or ACA marketplace coverage.
Our reviewer’s read on each dimension, with quotes from the episode.
The episode contains some substantive points about healthcare cost management - notably the importance of accessing claims data through MERPs and the distinction between fully insured vs. self-funded structures - but these insights are buried in lengthy tangents, rambling explanations, and repetitive positioning. The guest spends considerable time on philosophical arguments about 'gray areas' and self-promotional book references rather than unpacking actionable mechanics.
when you do a merp, you know all your, you get all your data. So you know how many inpatient stays you had, how many outpatient surgeries, you know all of it. Whereas before you know you, you're going blind.
They need to get the buy in of the owners, presidents, CFO, CEOs. They all have to be on the same page and they need to take it out of the HR department's hands. HR should only be implementing, they shouldn't be making decisions.
The core argument - that employers should demand data transparency and move away from passive insurance buying - is sensible but not novel in the benefits consulting space. The Section 105 health reimbursement plan discussion and the 'don't trust HR' framing are recycled talking points. The guest resorts to strawman arguments (e.g., comparing compliance concerns to scaring people with 401k excise taxes) rather than offering fresh frameworks or contrarian reasoning.
There's a better way to purchase uh, your health insurance as a company and as an individual.
Section 105 has been around since 1954.
Tom Quigley appears to be an operator in the benefits consulting space with some track record (three books, references to DOL/IRS letters), but the transcript provides almost no credible markers of at-scale execution, specific client wins, or quantified impact. He positions himself as an expert but relies heavily on book sales and accusatory rhetoric toward HR and insurance agents rather than demonstrating deep operational authority. The lack of named client examples or measurable outcomes is a significant gap.
We've written three. First one came out 2004 I believe and the last uh, one I think was 19 or 20.
Uh, ours has been looked at by the DOL and the irs. We have a two page letter from the DOL proving that our ideas are not only legit, they work.
The episode is largely devoid of concrete data, named examples, or quantified outcomes. The guest mentions 'people under 40 getting under $100 a month' in the past and references a bartender earning '$20,000 or $22,000' on a W2, but these are abstract illustrative figures, not case studies or measured results. There are no named companies, no comparative savings figures, no claims data examples, and no specific program structures explained in implementable detail.
people under 40, I was getting them under $100 a month health insurance costs
a job bartending and making 20,000 W2 or 22,000 that are eligible for no cost health insurance and no deductible
The host asks reasonable opening questions but fails to press for specifics or challenge vague claims. When the guest makes broad accusations (e.g., 'HR makes terrible decisions,' insurance agents use 'gray area buzzwords to scare people'), the host offers no pushback or request for evidence. The guest is also allowed to ramble into extended tangents (the bird-flying-into-window metaphor) without redirection. The conversation reads as a book-promotional platform rather than a rigorous exploration of the topic.
Don't let your HR department deter you from a good story. Um, take advantage of everything. Um, you know the old adage. Don't let your money get in the way of a good, good story unless you're. Your ass is on the line.
Why did the bird just fly into my window and kill itself? Really just happened.
Computed from the transcript - who did the talking, and the words that came up most.
Healthcare costs continue to rise, but Tom Quigley believes the real problem is not just the price of insurance - it is the way businesses buy it. In this episode of The Cutting Edge Benefits Podcast , Tom Quigley of ClaimLinx joins Neil Haley to discuss the ideas behind his book How to Beat the High Cost of Healthcare and why its core message remains just as relevant today as when he first began writing about healthcare reform and employer benefits strategy. Tom explains that one of the biggest misconceptions in corporate health insurance is that employers believe they understand how their plans are being used. In reality, most companies receive limited data, vague renewal explanations, and little transparency into what is actually driving their costs. According to Tom, Medical Expense Reimbursement Plans, or MERPs, give employers better visibility into healthcare usage and allow them to make more informed financial decisions. The conversation explores how businesses can shift from being passive insurance buyers to active healthcare consumers.
Transcribed and scored by The B2B Podcast Index.
Speaker A: Hi everyone and welcome to special simulcast the Neil Haley show and the Cutting Edge benefits podcast with our host Tom Quigley of Claim Links. And our topic today is unpacking how to beat the high cost of healthcare. Uh, basically this is uh, based on Tom's book and Christie's book. Tom, talk about when you wrote this book and how important this is for small business owners.
Speaker B: Oh, it spin out. We've written three. First one came out 2004 I believe and the last uh, one I think was 19 or 20. Um, but you know, if people read the books, they quickly realized that there's a better way to purchase uh, your health insurance as a company and as an individual.
Speaker A: So when you both sat down to write the book how to beat the high cost of health Care, what was the biggest sing, biggest uh, misconception or myth about corporate health insurance that you felt absolutely compelled to uh, compelled to bust?
Speaker B: That people just don't use it like they think and all the data is hidden from them to make informed decisions by using a medical expense plan.
Speaker A: You're on mute. Tom, you're mute. Tommy, you're mute.
Speaker B: Am I bet off?
Speaker A: You're bet.
Speaker B: You're back.
Speaker A: Now you're back now you went mute. Now you're back. You're good.
Speaker B: I'm back.
Speaker A: Okay, keep going with that question. Go.
Speaker B: So uh, what happened was uh, is you, you know, when you do a merp, you know all your, you get all your data. So you know how many inpatient stays you had, how many outpatient surgeries, you know all of it. Whereas before you know you, you're going blind. You know they, they're saying, oh, you had a lot of insurance claims yet they pro show you no data. And same with the drugs. You know how you know how much drug usage and all those items, it's just night and day. So you can make informed decisions on how you purchase or programs you put in to entice people to take other options. But unfortunately, so that that was the biggest thing I wanted to tell companies and even the self funded companies don't get a lot of data. Mhm.
Speaker A: The book outlines a framework for pushing back against escalating health expenses. Looking at the landscape today, which core principles from the book have remained entirely unchanged and which parts have to adapt to most modern regulations.
Speaker B: Quite frankly, uh, the, the book uh, itself, the frames intact, there's some cosmetic, uh, things that have happened such as ACA laws that allow for there's no more pre existing and you can't carve out maternity. Um, there's no limits anymore. So pretty much what they've passed has helped businesses build their house nicer.
Speaker A: Mhm.
Speaker B: Whereas before they were uh, restricted by a few things. The HIPAA laws helped, but the ACA laws weren't there yet when we first started. But you know, some of the nice things back then was you could carve off maternity, uh, for guys and young ladies and the healthy folks, you could get real good rates. I mean like people under 40, I was getting them under $100 a month health insurance costs and they got rid of that M and because of the aca, that's what they need to do is go back to where you have options like that but keep some of the ACA requirements. No limits, no pre existing but still get reward people for being some of the items. Yeah, yeah.
Speaker A: For help being healthy. A major theme in your writing is shifting the employer's mindset from a passive buyer of insurance to an active strategic consumer. What is the first, very first step a company needs to take to make that mental shift?
Speaker B: They need to get the buy in of the owners, presidents, CFO, CEOs. They all have to be on the same page and they need to take it out of the HR department's hands. HR should only be implementing, they shouldn't be making decisions. They're making terrible decisions out there.
Speaker A: In the book you challenge the traditional fully insured premium model for ex. For an executive listening who is currently locked into a standard high premium plan. How do you visually map out the financial waste that your book exposes?
Speaker B: Well, you got different scenarios that they may be eligible for. They may be eligible for Medicare or spouses plans or they may have military options or they may have parents plans, they may have college plans for some of their kids. The kids may not be uh, wise to be on their tax return because they, they're living on their own and they're, they got a job bartending and making 20,000 W2 or 22,000 that are eligible for no cost health insurance and no deductible. So there's all kinds of ways that you can navigate through the uh, process that the ACA has brought to them but no one's doing it. They're all, they're all thinking that traditional thought and you got a non traditional law and you're trying to use traditional thoughts. You know, you just throw your hands up.
Speaker A: Many business owners think innovative health plans or self funded structures are a temporary fix or a legal gray area. How does the long term track record of strategies in your book prove that this is sustainable? Decades long business strategy.
Speaker B: I honestly believe the way that most agents are selling it is gray. Compare, I mean their traditional health plans the way they do it. Um, there's no, I don't believe there is any black or white ways. I uh, believe our ways more black and white than what people are doing. Uh, ours has been looked at by the DOL and the irs. We have a two page letter from the DOL proving that our ideas are not only legit, they work. Uh, but the problem is the
Speaker A: uh,
Speaker B: gray areas is buzzwords used by attorneys or accountants or uh, who usually work for the insurance agents or agencies or insurance companies because they want, they don't want any solution that's black and white because it's not good for who they work for.
Speaker A: Right.
Speaker B: So you use gray areas. Just like you could say a 401k is a gray area because the, the biggest gray part is this excise tax that they try to scare people with. You know, a hundred dollars a day per person that it's not. But the uh, HR, the uh, 401ks have the same rules under ERISA. And it's really funny because you could be they use buzzwords that are, you know, scare the average person. But the people that get it go, like myself. I simply say to them, you could say that about any 401k. It's, you know, it's could be gray, it could be, you could be exposed. Well, why can you do this? Well, uh, the 401ks don't have as long of longevity as the Section 105. Section 105 has been around since 1954. So I'm sorry guys.
Speaker A: Good.
Speaker B: Um, try the business owners that ah, fall for that, get what they deserve. Higher premiums, worse benefits.
Speaker A: So if you're a business owner finishing listening to this episode and want to implement the ultimate takeaway from your book to protect their bottom line this quarter, what directive or analysis should they assign to their leadership team tomorrow?
Speaker B: The last 30 pages is revenue after revenue and private letter rulings that in laws that support everything we're doing. So for the attorneys here, this is why you can do this. They haven't changed because of the aca. That's a misnomer. That's just the, and you know, agents trying to scare people, the HR, the CFOs, those folks should be looking at the first 30 pages which explain how you should design your benefit plans. Um, the legalese is the last 30. Anyone who does that will listen to me. Those who, you know, pay the 995 and get our book. Listen, uh, to us. I personally, uh, am looking for people that are fed up, that are sick and tired of the same old, uh, our rates go up 10, 20% every year. Then we get no reasons why other than you had claims. Yeah, but what claims can't tell you. You know, it's just so funny to me, the whole thing. It's like, you know, you're. Why can't you do this? Why can't you do that? I, um, don't know. Why did the bird just fly into my window and kill itself? Really just happened. Um, I don't. I don't know what to tell you. Uh, I don't know why, but, you know, why are you getting ripped off? I. I, uh. Because you've chosen not to do something. That's proactive. I guess if I didn't have windows, that bird would have flown right through. But, you know, it is what it is. So the bottom line to what I tell everyone is you can continue down the same path and it makes no sense, but, you know, you. You. It. It's longer. It's not as, uh, nice. Or you can create your own path. That is awesome. No threats, and you get to know, uh, everything. Um, but that, you know, that's your choice. Um, don't let your HR department deter you from a good story. Um, take advantage of everything. Um, you know the old adage. Don't let the. Don't let your money get in the way of a good, good story unless you're. Your ass is on the line. And. Got it. Whose asses are on the line? Um, well, that's pretty easy. Uh, that's. The insurance agents could be the HR department. It could be whoever's made these terrible decisions. So, you know, let the truth prevail. The truth prevails. You win.
Speaker A: All right. Appreciate it. Go to claim links.com schedule a call Tom today. Appreciate, Tom.
Speaker B: Thank you.
Speaker A: That was a special sim cast Neil Haley show on the Cutting Edge Benefits podcast. Guys, take care.
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