Health Insurance Is a Mess; How’d We Get Here? – Part 1 | Ep. 24

Health Insurance Is a Mess; How’d We Get Here? – Part 1 | Ep. 24

Purchasing healthcare didn’t become this complicated overnight. So how did we get here? Our industry experts — CEO Ben Krambeck, Vice President of Provider Relations Brad Hansen and Vice President of Audit Services Cynthia Swanson — join Danielle Young on a new ClaimTalk to trace the policy decisions, reimbursement shifts and billing changes that helped create today’s health insurance mess. From the Affordable Care Act to questionable billing practices to the coding complexity still driving costs and confusion, their conversation breaks down how the system changed — and how understanding that history can lead to better decisions for employer health plans.

How Dual Option Turned an RBP Skeptic Into an Advocate | Ep. 23

Convincing consultants to bring reference‑based pricing to clients isn’t easy. Paul Saunders, executive vice president at Saunders & Company, knows firsthand as someone who once was "totally opposed" to RBP. That changed when he saw how a dual‑option approach could work: pairing a traditional health plan with a lower‑cost RBP option and letting members choose what fits them best. In this month's episode of ClaimTalk, Saunders joins ClaimDOC’s Omar Arif and Stephanie Mohr to explore how dual‑option plans help brokers address rising renewal costs without forcing employers into an all‑or‑nothing decision. They explore why offering choice may be the most practical path to affordability, client confidence and long‑term satisfaction.

Good TPAs – They Do Exist | Ep. 22

Who's a good third-party administrator? There are many to choose from, but far fewer that consistently deliver when it matters. And the difference between a good TPA and a mediocre one often determines whether a health plan works exceptionally well or frustrates everyone it touches. Our last two episodes of ClaimTalk weren't kind to TPAs. While much of that criticism was earned, the reality is that TPAs operate in a landscape that is complex, constrained and often misunderstood. On this episode, Luke Schafer of BRMS joins Danielle Young, Shay Butler and Dallas Lovell to discuss why the strongest TPAs are the ones that stay in their lanes and are laser-focused on their primary responsibility — paying claims.

The Search for a Good TPA — Part 2 | Ep. 21

Selecting the right vendors for a reference-based pricing health plan isn’t an exact science. At the end of the day, it often comes down to experience, discernment, and the ability to read the signals vendors give off long before the contract is signed. In this episode of ClaimTalk, Emma Fox, CHVA joins Danielle Young, Bruce Hansen and Stephanie Mohr to continue their unapologetically candid examination of vendor dynamics to offer pointed insights on evaluating partners that can make or break a self-funded strategy. They break down what truly constitutes “good” and “bad” vendor vibes, define what real competency actually looks like, and outline how to identify red flags before they turn into costly mistakes. If you’re serious about elevating your self-funded health plan performance, this conversation cuts through the noise and shows you what to look for, because not every vendor deserves a seat at your table.

The Search for a Good TPA — Part 1 | Ep. 20

Building a successful self-funded health plan demands skilled and efficient vendor partners that have the expertise to deliver on their promises. Identifying the best vendors can be challenging, and settling for substandard partners can lead to less-than-desirable outcomes. But how do you find the best partners? On this episode of ClaimTalk, Emma Fox, CHVA gets brutally honest during the first half of a two-part conversation with Danielle Young, Bruce Hansen and Stephanie Mohr on the struggles that can arise with vendors. While a good portion of the discussion centers on the issues they've experienced with third-party administrators, they also discuss why it can be difficult to find the right partners, the strategies they use to identify dependable vendors, and why some of the most unreliable vendors continue to survive in the industry.