The Healthcare Hangover · 2024-12-24 · 28 min
Key moments - from our scoring
Substance score
50 / 100
Five dimensions, 20 points each
Emma Fox and David Contorno dissect a painful client loss that exposes a fundamental misalignment in how employers evaluate benefit consulting value. Their client of nearly three decades - a 3,000-person self-funded employer that had realized $85 million in documented savings through direct primary care, cost containment strategies, and alternative funding mechanisms - terminated the relationship to engage a major national brokerage firm offering broader HR services and brand recognition. The hosts unpack why perception of a recognizable carrier logo now trumps the actual financial performance and healthcare access improvements their consulting delivered. They explore how large brokers monetize relationships through undisclosed commission structures, stop-loss spreads, PEPM arrangements with TPAs, and volume bonuses tied to carrier placement - incentives misaligned with employer savings. David argues the industry has trained employers to value the "discount" and intermediary rather than the net healthcare cost and quality outcome, while Emma questions why employers want big-name insurance when the public is actively rejecting United Healthcare and major carriers post-Brian Thompson. The episode reveals how new C-suite leadership, private equity influence, and the illusion of free ancillary services drive employers toward traditional solutions despite documented alternatives saving millions.
Over six to seven years, the 3,000-person employer saved $85 million in actual (not projected) costs through their consulting firm's model, which included direct primary care, cost containment mechanisms, and alternative stop-loss funding strategies like aggregating specific provisions.
An aggregating specific is a risk bet that reduces stop-loss premium by allowing the employer to absorb claims up to a higher threshold, creating upside if claims stay low with no downside; brokers avoid it because the reduced premium directly cuts their commission-based compensation.
Large brokers earn through multiple channels: stop-loss commission, PBM spread pricing cuts, PEPM fees from TPAs or medical managers, and volume bonuses from insurers based on placing multiple groups - all of which increase when the employer spends more money.
Employers can request the broker provide a signed disclosure of all revenue sources under the No Surprises Act and Consolidation Appropriations Act requirements; if the large broker refuses to disclose, that refusal itself signals misaligned incentives.
New C-suite executives often bring existing relationships with large firms; employers believe a recognizable brand name on benefit materials will improve employee perception and satisfaction, prioritizing brand credibility over documented financial results.
Our reviewer’s read on each dimension, with quotes from the episode.
The episode contains a handful of genuinely useful operational insights - aggregating specific mechanics, how broker compensation scales with employer spend across stop-loss/PBM/TPA channels, and the disclosure law tactic - but they are heavily diluted by emotional venting, the UHC CEO tangent, and repetitive complaining. A smart benefits operator would extract maybe 6-7 minutes of real substance from 28.
every avenue has one thing in common. Or the employer spends. The more the broker makes.
6.05%, 6.05% denial rate in all of our plans across our book business that does not involve a health insurer
The legal tactic of demanding a signed executive disclosure form under the CAA is a genuinely actionable and underused insight, and the absurdist framing of hiring the fired advisor to supervise their replacement is a sharp rhetorical device. However, the broader thesis - big brokers are conflicted and self-funded transparency is better - is familiar doctrine inside the benefits consulting world, not a contrarian or first-principles argument.
You as a broker are not doing everything we need. So we're going to hire another broker. But then we're going to pay you on top of them. To make sure that they don't do what they've done.
the no Surprises act and the consolidation appropriations action requires you to disclose how much money you are making on us. And I want that signed off by an executive of your company.
There is no external guest; this is two co-hosts conducting an internal debrief. Both are credible practitioners - David Contorno is a recognized innovator in self-funded benefits with a 30-year client track record - but the format functions as a therapy session rather than an expert interview, limiting the depth of expertise surfaced.
David and I are benefit consultants. We run our own firm and we retain clients, usually employers in the mid to large markets, self funded.
David has helped for almost 30 straight years and I've certainly been involved for the last six.
The episode punches above average on specificity for a conversational podcast: an audited $85M savings figure for a named company size, a precise 6.05% denial rate across a book of business, a six-figure aggregating specific, and two specific disclosure laws cited by name. However, many broker-compensation claims remain vague ('multiple avenues,' 'dirty') without dollar amounts or named firms.
over the last six, seven. Seven years, the difference in cost for a, what, 3,000 person company was $85 million saved. Like not projected, but actually saved.
6.05%, 6.05% denial rate in all of our plans across our book business that does not involve a health insurer
Emma's deliberate on-the-spot challenges ('What are the top three things an employer can expect?' and the broker-compensation follow-up) generate structured, useful answers and show some host craft. However, the episode is predominantly a mutual grievance session with no pushback, no challenging of each other's claims, and repeated agreement rather than productive disagreement.
What are the top three things that an employer can expect when they hire one of the big letterhouses?
Can you explain what are some of the most common ways a traditional or big letter broker house is getting paid that employers may or may not know about?
Computed from the transcript - who did the talking, and the words that came up most.
In this episode, Emma and David dive into the gut punch of losing a long-time client right before Thanksgiving. After saving them a jaw-dropping $85 million, the client still jumped ship, swayed by a new exec chasing the clout of a big-name broker. The conversation cuts into the disconnect between what employers think their employees want and what they actually need in healthcare. Emma and David don’t hold back their frustration with the industry’s obsession with flashy brands and so-called "free" services - distractions that mask skyrocketing costs and subpar care. Now stepping into a consulting role with the client, they hammer home the critical need for transparency and bold leadership from employer groups. The episode wraps with a direct challenge to employers: it’s time to rethink your health insurance strategy and the brokers you're trusting with it. TIMESTAMPS: [01:15] Losing a major client and reevaluating their decision-making process. [04:08] Concerns about the client transitioning to a traditional broker. [12:00] The compensation structure for traditional brokers. [20:04] The potential resistance from large brokerage firms toward greater transparency.
Transcribed and scored by The B2B Podcast Index.
Speaker A: Welcome to the Healthcare Hangover. I'm one of your hosts, David Contorno.
Speaker B: And I'm your other host, Emma Fox. This is a podcast about the headaches we've been encountering in the healthcare system that are leaving us feeling a little hungover.
Speaker A: Let's dive in.
Speaker B: All right. This week I've been hungover on this issue for a couple weeks now. So I just wanted to talk through what happened with one of our clients recently. And for the audience, you guys should know by now, unless you are brand new here, that David and I are benefit consultants. We run our own firm and we retain clients, usually employers in the mid to large markets, self funded. And one of our larger clients that we've helped now. Well, actually David has helped for almost 30 straight years and I've certainly been involved for the last six. They fired us about. What was it, like a couple days before Thanksgiving.
Speaker A: Mm.
Speaker B: And I want to talk through this because, you know, losses are hard in our business. I think any, any person who runs a business that has clientele, it's, it's always difficult to lose a client.
Speaker A: Right?
Speaker B: But this one was, uh, it was pretty unique.
Speaker A: Well, let me ask you this question. To your knowledge, do they plan on changing TPAs?
Speaker B: No.
Speaker A: Do they plan on changing direct primary care providers?
Speaker B: No.
Speaker A: Do they plan on changing pharmacy benefit managers?
Speaker B: No.
Speaker A: Stop Loss carriers?
Speaker B: Hm.
Speaker A: Cost containment mechanisms, International sourcing?
Speaker B: No.
Speaker A: No. There's one thing that they wanted to change and you know, you and I recently did a, uh, analysis and because they've been a client of ours for so long, we said, hey, listen, what, what would your costs have been if we didn't bring you to this model? And over the last six, seven. Seven years, the difference in cost for a, what, 3,000 person company was $85 million saved. Like not projected, but actually saved. But yet I feel like they're compelled by the free stuff, quote, free the large brokers are offering them by coming to them. And I just, you know, my question is, what's of the greater value, the $85 million or the couple hundred thousand dollars worth of free stuff you get every year?
Speaker B: Well, it goes a little farther than that. And you know, this, this, the assassination of the United Healthcare CEO sort of brought this to light, but there's this disconnect of what employers think that their employees want and what they actually need. And in this case, it's my belief that, you know, they, they hired a new C suite executive. And every time that happens, I think most business owners are like, oh, crap, okay, let's tighten up this ship. Right. Because those people come into that job with relationships that they've, they've used in the past. So it's always sort of uh, an uphill climb. But they decided that as they were growing they needed brand name brokerage that that would make their employees feel better, supported. And I couldn't disagree with that more if I tried. And I won't waste the entire episode going on a tangent as to why that is just so absurd. But I want to always make our clients feel like they can come back to us. And so we work really hard to put our emotions aside because a lot of these long term clients have become friends. You know, like we've met each other's families after a period of time or we've dined with them or we've gone through some really, uh, in a lot of cases, some really serious healthcare issues with them since we managed their health plans. And so I want to make their transition as smooth as possible. And what happened was I had a, almost two hour phone call with the executive team and you know, we were just going through what are the outstanding items, what are things to look out for? And I said, listen, you know, I, I just want to, you know, voice some concerns about where you're going because to your point, they do have things like direct primary care, they have cost containment measures, they have a lot of complexity in these plans that we've built over several years. And I, I have concerns that ah, a traditional brokerage does not know how to manage those components that they don't plan on changing. And so had this really, really, really long phone call. We had great open dialogue about, you know, here's what you need to look out for. And there were a lot of things and at the end of the call, our client, our client who is firing us, uh, asked is there any way that you can stay on as an independent consultant to audit and basically keep an eye on our new big house broker to make sure that they don't do all the things that you think they're going to do.
Speaker A: So let me, let me get this straight. I need to understand this.
Speaker B: You heard me right.
Speaker A: Yeah. You as a broker are not doing everything we need. So we're going to hire another broker.
Speaker B: Yeah.
Speaker A: But then we're going to pay you on top of them.
Speaker B: Mhm.
Speaker A: To make sure that they don't do what they've done.
Speaker B: Expect them to do. Right.
Speaker A: I mean think about that like in a legal perspective. Imagine if you said, listen, you are a crappy lawyer, I'm Going to fire you as a lawyer, but I'm going to hire you to watch the new lawyer. To make sure the new lawyer is doing what the new lawyer should do.
Speaker B: Yeah.
Speaker A: Where else would that ever occur? But here's the thing. This is, this is the problem. And I am part, um, of the problem. And at least had been. We have convinced employers that our value is not on what we can do to control health care costs. Our value is on all the things that we put around that. The HR compliance, the technology, all the things that we claim are, quote, free, which aren't free.
Speaker B: Right.
Speaker A: And um, listen, I'll admit, and I think you'll, you'll admit too, that the large brokerage houses can offer a lot more of that free stuff than you and I can. Right. That's not our business. Our business is to take your largest spend and reduce it.
Speaker B: Mhm. Substantially by the way.
Speaker A: Substantially. And get people access to better care at a lower cost. That is our role. And when you do that, you free up so many funds to do all the other, quote, free stuff. But people love free. People would rather pay 30% off of $10,000 than pay $7,000 for whatever a car they would rather like. That's, that's the American culture. And health insurance has played into that. Right? Every EOB you get says, hey, they charge this, but because of Cigna, you're going to pay this and you pay this part and the insurance pays that part. And we've led them to believe that that discount is the important piece, which really it's not. It's the end price that's really the important piece.
Speaker B: Well, and let me tell you, I, uh, think we're going to be talking about this for a while, but since the UHC CEO assassination, we've heard Americans that are sick of insurance, they're, they're sick and tired of dealing with this rat race that is insurance. And I've been trying really hard to reconcile that because one of the issues at this client in particular was people feeling like they couldn't just use their insurance, quote, right? Like they couldn't just pull out an ID card that had this big recognizable logo on it and just walk on into the hospital with no issues. But then when you give them that, they don't like that either.
Speaker A: Right?
Speaker B: And so sometimes it just feels like, what in the world do you want us to do? Like, what is it that you want us to do? You want us to reduce your healthcare spend? We did that. We did that with flying freaking colors. We should have gotten Award for that every damn year that we saved that company money.
Speaker A: Did get.
Speaker B: We did, we did. That's the sad part. This is one of our flagship clients that a lot of our clients get recognized and we're very, very grateful for that. But this one in particular has been on stages around the country talking about
Speaker A: how they're pioneering for their HR to come to these conferences to speak about the successes.
Speaker B: Yep. And now they're, they've decided, you know what, we need a big name on, on our, I don't know, benefit booklet. I guess.
Speaker A: I think the thing that changed was private equity because again, it became profit above everything else, which is the real, that's why Brian Thompson was assassinated. Profit above everything else. Right. That's, you know, listen, I, I am not adverse to profit driven companies. I'm not adverse to capitalism. I really am not. But when it rises to the point of, uh, hurting people, that's when you need to really say, okay, let me dial this down a little bit. And I don't think most people do that.
Speaker B: Well, you know, I, I gotta be honest with you. I don't see the big broker houses being all that different than the insurance carriers. I think they perform the same way, they, they garner the exact same results and they are driven by the exact same motives that insurance carriers are. And so, you know, what's been really confusing about this client is, uh, first of all, I've never been fired and then been asked to stay on and make sure that the person they're replacing me with is not going to completely screw them over. And I've got news for you guys, they're going to screw you over. Like I would, I would do this freaking job for free just, just on the bet that they're going to be screwed over. Because here's the thing, uh, and if you're a layperson listening, uh, I apologize. These terms might escape you, but our client has an aggregating specific provision in their stop loss plan.
Speaker A: I guarantee six figure.
Speaker B: A six figure aggregating specific. And it's, it's basically a bet on risk. Right. But it reduces premium by the same amount as the aggregating specific. If you're following along and we basically roll the dice and we say we're either going to spend it or we don't. But if we don't, great. If we do, nothing lost. Right.
Speaker A: It's similar to being at the casino and saying, Listen, I have $100,000 to bet and I am going to say that I can lose this money in an even bet. But if I win the money, I have the upside. And so there's no downside to an aggregating specific. None is only upside down.
Speaker B: I'm going to challenge you on that. No, no, no. There is a downside. Okay, not for the employer.
Speaker A: Right, true. For the insurance company and the broker. Right, I agree.
Speaker B: Yeah, there is a downside. There's a downside to putting in an aggregating specific because that reduces premium, stop loss premium, which is great for the employer, but it is not great for brokers who get their payment from commission because that reduces their commission.
Speaker A: It does reduce premium, but it also it to the employer, it says, listen, we're going to reduce our premium by $100,000. We're going to increase our potential liability by $100,000. And so if we are right, we win 100,000. And if we are wrong, we're break even. Like, where is the downside in that except for the broker who's getting commission?
Speaker B: Well, I said yes to staying on and now I am, I'm sort of curious because, you know, they have to now shop Stop Loss with me overseeing everything that they're quoting, everything that they're
Speaker A: asking, a lot of, a lot of privileges that we have earned with the Stop Loss.
Speaker B: Yeah. So I, you know, I've never done this, I've done this lots of times before, but I've never done it for a current slash former client. And it just, just strikes me as so bizarre that you, it, what it taught me, what it told me this last week was that the perception of having a brand name really is more important than the value of, of not right. And, and truly, if you are paying attention to the American public's reaction to the shooting of Brian Thompson, you'll hear that the American public don't want big health insurance. They do not. They've, they've been traumatized by it, they've been harmed by it, their family members have been lost to it, They've been financially devastated by it. That's not what they want. And so I've been trying to reconcile in my, in my mind, like, okay, this client thinks that, you know, if they bring in a big, big letter house, we call them letter houses or the vanity houses. If they bring in one of those, it'll be a more recognizable name and people will feel better. Well, how does that compute when we have half of America screening right now over UnitedHealthcare and we have to really
Speaker A: dial in to what it is that we want? Because let's, let's try to put Ourselves in the shoes of a household in which, you know, you're barely getting by and you need to buy a new car. Okay, so you have a car, it's no longer good. You have to buy a new car. What is most important in that buying process? Is it the quality of the insurance? Is it the quality of the broker of that insurance? Or is it the quality of the actual car?
Speaker B: Mhm.
Speaker A: Right. Like I would rather like if I had $5,000 to buy a new car or a used car and that's all I had. The quality of the car I buy is going to be far more important than the insurance or the broker I use to get the insurance. Right. But why is it in health insurance we prioritize the insurance and the broker that we get the insurance through more so than the, than the healthcare itself? That's the problem. I really think that's the problem.
Speaker B: I got a challenge for you.
Speaker A: Go.
Speaker B: And I'm putting you on the spot. And I do this a lot.
Speaker A: Even in our personal life, you do it all the time. Go.
Speaker B: It's my favorite pick. But you're so good at this and you're better at it when I put you on the spot. But here's what I want to ask you. What are the top three things that an employer can expect when they hire one of the big letterhouses?
Speaker A: Well, they can expect for the traditional solutions to be brought in. The blue crosses, the United, the cignas, the Aetna's. Number one, that's the number one thing. Number two, it's going to be things that they claim are cost containment but actually are not. And number three is going to be all the ancillary services that the broker attaches on, whether it's HR compliance, all the stuff that brokers kind of put around it. Those are the three things that wasn't a test.
Speaker B: So it, uh. Because there's like probably 12 or 15 things. I was just asking your top three and I'll follow up with asking you. Can you explain to. Let's just pretend an employer is listening right now. Can you explain what are some of the most common ways a traditional or big letter broker house is getting paid that employers may or may not know about?
Speaker A: Okay, let's talk about that in two venues. Fully insured and self funded. Fully insured. It's two ways, number one, commission. The more your rates go up, the more they make. And number two is bonus. The more business they funnel with a particular carrier, the more money they make. So if they keep you with Blue Cross and Blue Shield or United or Cigna, they make more money. Self funded, however, is a lot more intricate because.
Speaker B: Oh, it's dirty.
Speaker A: Oh, uh, oh my gosh. There are multiple avenues for that broker to get paid. And I will tell you that every avenue has one thing in common. Or the employer spends. The more the broker makes.
Speaker B: Mhm.
Speaker A: Whether it is commission on stop loss, whether it is part of the spread pricing from the pbm, whether it is a PEPM from the TPA or the medical manager, the more the client spends, the more the broker makes. And that is the problem.
Speaker B: So let's take it a step farther. Let's say you're an employer listening to this and all of a sudden a light bulb's gone off and you're like, I don't know what my broker's making. Right. What steps would they take? Where would they go? I would say they would start with the TPA because it's most likely that. And, and I mean it when I say the self funded market is dirty. And I'm telling you that as uh, somebody who has been in this market for the majority of my career, I've always worked in ASO or self funding. And I don't think it's the little guys you have to watch out for. I think it's the big guys in the self funded markets that can nickel and dime every single contract and they don't have to report half of it. So I would say they would start with the tpa. But, but how? As an employer, if you go to your broker, if you're, let's say you're like a Mercer broker and I go to you and uh, I'd be like, how much money you making? You're going to tell me the fee that I'm paying you, but I want to know, where's the rest?
Speaker A: It's actually very easy. So there were a couple of laws passed over the last few years that require brokers to disclose how much money they make. And there is an actual form about broker compensation. And if you're with one of the big houses, I would say, here's this form. I want you to disclose every source of revenue that you're getting on us and I want it signed off by some sort of authority within your large brokerage firm. They will not do it. They will not do it. They promise you they will not do it. And that is the most telling answer that you could possibly get. Yeah, within our business we are, we don't even have to comply with those disclosures because we are automatically complying with them. In our agreements with our clients, we need to disclose anything more than we've already disclosed. But if you want to know where your broker is making money, say, hey, the no Surprises act and the consolidation appropriations action requires you to disclose how much money you are making on us. And I want that signed off by an executive of your company.
Speaker B: Yeah, it's not going to happen. Sorry guys. It's just not going to happen. Because they also need to calculate in, you know, how much of their bonus is tied to you in your group. Because volume bonuses are a thing, right? Like I have a history of working at insurance carriers. I repent every single day. But you know, I can tell you that if a broker put 10 or more cases with me, 20 or more cases with me, that they would end up getting a big fat bonus check at the end of the year. And you know, listen, uh, I, I, uh, don't, I, I don't dismiss the fact that we all have families, we all have bills, we all have needs, right? And so if someone said to me, well, if you do this, it's like a coffee punch card is what it is. You go to the coffee drive through and they give you a punch card and after you buy 10 coffees, you get the 11th coffee free. It's exactly how it works in the health insurance carrier world. You write 10 groups with me, I give you this much. You write 20 groups with me, I give you this much. And that works in the self funded market, it works in the fully insured market. And so you have to think about how those financial incentives are, are driving the decisions that your broker is making. Because again, they have bills to pay. And I've said this for the majority of my career and David and I have, you know, we, we argue sometimes, but I maintain that brokers have been put into a system that, that uh, puts them kind of in an impossible situation. Because if you're new, you're just coming into the business and you need to feed your family, you're going to do what you got to do, right? The problem is it's just so perverse, the entire system is so perverse that you get stuck having to do more and more and more. It's like being in an abusive relationship, honestly. Like, you end up having to appease this and appease that and appease that just to make sure that it keeps coming in. And I know that sounds very dramatic, but that's exactly how it works. And so now we have this client, we've, we've lost, you know, a Big client of ours that's been both an emotional and, uh, physical loss of ours, and being asked to stay on to make sure that their new broker that they've selected, it's almost insulting. I mean, listen, I feel. I feel complimented in that they believe that I am so trustworthy that I will take care of them. But, yeah, you're right. I also feel like, well, what the
Speaker A: are we doing here taking care of you, like, and you're firing us? Uh, only to.
Speaker B: I know, I know. And you know what? I got to be honest with you. This is one of those clients that did not embrace education. They did not embrace communication strategies. They didn't do the stuff they needed to do. And I maintain this as hot take as it is. If you are an employer and you don't have strong, courageous leadership at the helm, don't talk to me. Don't talk to me. Because you have to be. You truly have to be a leader. And I'm tired of people at employer groups who pretend that they're these. They're these leaders. They're project managers.
Speaker A: I take on hard things.
Speaker B: Oh, my God. It's like, are you serious? They. They, like, bow under the pressure of the first healthcare instance where access might be an issue. And I just want to be like, grow a there. What are we doing?
Speaker A: And oftentimes, it's the. The. The executives that are. Their spouses are the ones that are complaining m. The loudest and.
Speaker B: And yet always the damn wife.
Speaker A: Well, it could be husband, but yes,
Speaker B: it's always the wife at her gynecologist. Come on.
Speaker A: Always.
Speaker B: Always.
Speaker A: I know. I'm trying to be more opportunistic. I think the.
Speaker B: The.
Speaker A: The reality is that. That they think the employees know what they want.
Speaker B: Right.
Speaker A: And when it relates to healthcare and health insurance, they simply don't because they don't understand the system enough. It's not their fault, but they. They. They think they want something other than what they want. They actually think they want the very thing that's been harming them for decades. And they want to keep just. It's like Stockholm syndrome, which I've said many times. They want to just keep being hurt by the very people that are hurting them.
Speaker B: Yeah. And I. This. This loss was particularly profound just because I can see all the ways in which this could have gone better. And we received such pushback from the leadership at the group. And actually, the most disappointing thing was this new C suite executive that they brought on. I love her. She's so tenacious. She's like. She's got it locked in, you know what I mean? Like, she gets it, she's concise, she's, she makes decisions, she like seeks to understand. And I just look at her and I think, God, I wish you were here two years ago when I was trying to put out a communication strategy, when I was trying to do educational meetings year round when I got pushback. Well, we can't fit that in. We just don't have the bandwidth for it.
Speaker A: It's not a priority right now.
Speaker B: Um, it's not a priority. Yeah. And at the same time, and the other fist fielding these issues where members just weren't understanding the plan and it's just like this insanity and I don't know, I wanted to talk about it to get it off my chest, but I, this is the first time I'm doing this for a current slash former client and I'm, you know, I'm ready to name and shame. I think I want to go through this process. I want to see what they're doing because it's not projection. This is actually happening to a lot of employers that just don't know any better. And with light of recent events, I think it's time that we all brought transparency outside of the health insurance system and into the general public, which I'm, I'm grateful to be seeing.
Speaker A: And I think the other thing too that we need to recognize, especially in how we do plans, is that generally speaking, the ones that are encountering problems are the huge minority.
Speaker B: Mhm. Right.
Speaker A: And how much is this working for, for so many other people that you're going to yank this away from, in which they're finally getting care that they can afford, that that is good for them, that is keeping them healthy, that is keeping their diabetes under control or their weight under control, their mental health under control. But when you go and encounter health care and get what you expected to get, no one says anything. Even though, uh, that's the minority, actually I would argue. But when it doesn't go the way they expect, they are so loud and so vocal.
Speaker B: Well, let's take that one step farther, right, because let's compare what we do to a traditional plan which they're about to probably end up in at some point. And again, look at the public outrage over the UHC thing. Denials, denials, denials with a very limited overturn rate in the appeal process is what we found out in our plans. We do not use any health insurance carrier. In fact, we, we, we shut them out entirely. What that means though, is that if and when someone. And, uh, what did you say our denial rate was? 6% or something like that? 6.05%, 6.05% denial rate in all of our plans across our book business that does not involve a health insurer. Right. However, out of that 6% of denials, we have the ability, the employer has the ability to go and say, you know what? I think this is necessary and I need to overturn this decision. So our overturn rate is a lot higher if you are with UnitedHealthcare, Blue Cross, Aetna, uh, Cigna. You ain't getting that. You. You denied. Good luck. You're denied.
Speaker A: Done. You're done.
Speaker B: Like, I don't. I just don't get it, David. Like, they're giving up the transparency, the control, the flexibility. Just like. Oh. Because we always wanna make our employees happy. But apparently, according to the latest public outrage, it doesn't make people happy. Make it make freaking sense.
Speaker A: It doesn't make sense. It is nonsensical in healthcare. And that's what I really want to bring is, like, some sort of sense to healthcare and health insurance. The same sense we have to everything else we buy and everything else we insure.
Speaker B: I know. Well, listen, thanks for listening to me on my tangents. I think we can probably move on to the next hangover. I'm sure there will be many, but I will keep you guys informed of how I am. Um. What did I say? Um, I'm. I'm now the fox watching my old hen house. So this will be interesting to see how they behave and whether or not it's different because they know that I'm keeping an eye on it. But I'll be sure to report back.
Speaker A: Looks all we're doing.
Speaker B: Thanks so much for tuning in. Be sure to subscribe and leave a review. And remember, there's always a hangover with healthcare.
Speaker A: Until next time.
Other episodes covering the same guests and topics, from across The B2B Podcast Index.
EP 544 Healthcare Costs Keep Rising Because Prices Stay Invisible - with Katy TalentoThe ShiftShapers Podcast · on Direct Primary Care91 / 100
Stop-Loss DemystifiedThe Generous Benefits Podcast · on Self-funded health plans87 / 100
Episode 17: From Pebble Beach to Astrid - Samir Qamar on 25 Years of Reinventing Primary CareThe Root Cause · on Direct Primary Care86 / 100
How Private Equity Is Rolling Up Emergency Room StaffingPrivate Equity Conversations with Fexingo · on No Surprises Act78 / 100
How Do You Explain the Difference Between an ASO Vendor and a TPA? With Claire Brockbank. Episode 518Relentless Health Value · on Direct Primary Care75 / 100
Innovating Radiology Access: OneImaging’s Blueprint for Healthcare SavingsHealthcare on the Rocks · on TPAs (Third Party Administrators)74 / 100