One X-Ray. Two seconds. $902. Insurer pays $78. Dr.Dana brought the receipts | Broken Healthcare #95

One X-Ray. Two seconds. $902. Insurer pays $78. Dr.Dana brought the receipts | Broken Healthcare #95

She billed me $902 for a two-second X-ray. The insurer pays $78. In this episode of Broken Healthcare, Ray Kober sits down with Dr. Dana Mincer DO - physician, Direct Primary Care founder, and certified yoga instructor - to break down what really happens when a doctor becomes a patient and gets the bill. Dana slipped on the ice on New Year's Eve, fractured her elbow, spent an hour in the ER, saw a PA for 7 minutes, and never met a physician. The bill? Over $3,300. She brought slides. In this episode: → The itemized bill from Sentara Health - and what insurers actually pay for the same procedures → Why a physician was billed who never walked into the room - and what happened when Dana called to dispute it → How CPT billing codes work and why hospitals always bill at the highest possible level → Why the chargemaster means the same procedure has hundreds of different prices at the same hospital → Why most US hospital systems are for-profit organizations operating under nonprofit status → How auto-adjudication works - and why insurance companies are blindly paying claims nobody is reviewing → Why self-funded employers using United, Cigna or Aetna as their TPA are paying full retail. Always. → What PREVENT Consent is and why you should know it before you ever need an ER → How to cite EMTALA - and why it immediately changes the conversation with hospital administrators → Why by 2035 healthcare premiums could exceed 50% of annual household income → What Direct Primary Care actually looks like - same day appointments, your doctor's cell phone, no insurance billing → Why Ray is now 3 months alcohol-free - and what Dana thinks about it as a physician who ran an addiction medicine center Plus: less than 400 food additives are approved in Europe. The US has over 10,000. They get into that too. If you're an employer, a CFO, an HR Director, a patient, or just someone who has ever been shocked by a medical bill - this episode was made for you. 🔗 Love Health DPC: LoveHealthDPC.com 📱 Dana's Instagram: @drdanalovehealth 🎙️ Subscribe to Broken Healthcare: youtube.com/@BrokenHealthcarePodcast Timestamps: 0:00 Introduction & How Ray and Dana Met 4:37 Ray's Magic Mushroom Experience & Sobriety 9:06 Dana's Response as a Physician & Addiction Medicine 13:56 The Vibroacoustic Table & Teaching the Body Calm 22:06 Hospital Consolidation & Energy Medicine in Practice 26:00 The Broker Problem & How Insurance Incentives Work 30:11 Nonprofit Hospitals Masquerading as For-Profits 33:00 Food Additives, Glyphosate & RFK Jr. 50:35 Dana's New Year's Eve ER Visit - The Story Begins 1:01:00 The Bill Arrives - What She Expected vs Reality 1:07:00 CPT Codes Explained & How Hospitals Maximize Billing 1:17:10 What Insurers Actually Pay vs What You're Billed 1:23:01 The Sentara Numbers Revealed - The Real Data 1:30:00 How Self-Funded Employers Pay Full Retail 1:37:00 How to Challenge Your Bills & Independent Auditing 1:44:00 PREVENT Consent, EMTALA & Your Patient Rights 1:57:00 Direct Primary Care Explained - The Alternative 2:03:50 Love Health DPC & How to Find Dana #BrokenHealthcare #DrDanaMincer #HospitalBills #HealthcareBilling #MedicalDebt #HealthcareTransparency #DirectPrimaryCare #DPC #HealthSharing #EMTALA #HealthcareCosts #CFO #EmployerHealthcare #NonprofitHospitals #PriceTransparency #Podcast ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

I Haven't Had a Drink in Over Two Months. Here's What Changed | Broken Healthcare Podcast #94

Yeah, this one's different. No guests. No healthcare policy. No claims data. Just me, sitting down and talking about something I've never talked about publicly before. For years, a couple of drinks at the end of the day was just part of life. Business dinners, networking, winding down. A few glasses of Don Julio. Nothing dramatic - just a quiet daily habit that, somewhere along the way, became more than I wanted it to be. A guided psilocybin journey changed that. And I haven't had a drink in over two months. I'm not a doctor. I'm not here to tell anyone what to do. This is just my story - and I'm sharing it because I think too many people, especially in business, are carrying things they don't talk about. The shame around that needs to stop. In this episode I talk about the months of preparation before the journey, what the experience actually felt like, the memories that surfaced - including seeing my dad, who passed away when I was two years old, and reliving the hardest conversation I ever had with my kids, but this time through their eyes. I talk about what changed after. The calm. The presence. The fact that I just... stopped thinking about drinking. I also talk about what my doctor said when I told him. That part stuck with me. This isn't a healthcare episode. It's a human one. If it helps one person feel less alone - that's why I recorded it. ⚠️ Not medical advice. Psilocybin can be dangerous for people with certain mental health histories or on specific medications - please speak to a medical professional before considering anything like this, and check the legal status in your area. brokenhealthcarepodcast.com youtube.com/@BrokenHealthcarePodcast linkedin.com/in/raykober/ #BrokenHealthcare #Psilocybin #MagicMushrooms #MentalHealth #PsychedelicTherapy #Sobriety #PersonalGrowth #RayKober #MensHealth #Healing ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

$7.4 Million Found in 60 Days: How AI Is Exposing Hidden Claims Waste | Broken Healthcare #93

Your healthcare claims have an error rate of 8 to 12%. Most employers have no idea. In this episode of Broken Healthcare, Ray Kober sits down with Stephen Carrabba - CEO and Co-Founder of Claim Informatics - to break down what's really happening behind the scenes in healthcare claims, payment integrity, and fiduciary oversight. Stephen's team recently found $7.4 million in improperly paid claims for a single client. In two months. At a 10.9% error rate. And the fix isn't complicated. It just requires someone with no conflicts of interest to actually look. In this episode: → Why 8-12% of healthcare claims are paid incorrectly → The "sub $15,000" TPA story that should make every CFO furious → Why the shared savings model creates perverse incentives and what Claim Informatics does differently → How AI is being used to analyze 15,000 pages of contracts and find violations hiding in plain sight → Why combining two clauses on page 1 and page 111 of your ASO can legally authorize spread pricing — and nobody catches it → The fiduciary exposure every plan sponsor is carrying right now → Why post-payment recovery gets harder over time and why prepayment is the smarter play → What Marilyn Bartlett found when Montana finally just asked some simple questions ($113 million, as it turns out) → Why "garbage in, garbage out" applies to AI - and why building a real system took 8 months If you're an employer, CFO, HR leader, broker, TPA, or benefits consultant.. this episode will change how you think about every claim your plan has ever paid. 🔗 Claim Informatics: claiminformatics.com 📊 Independent assessment for employers: benefixa.com/#consult 🎙️ Subscribe to Broken Healthcare: youtube.com/@BrokenHealthcarePodcast Timestamps: 0:00 Why Healthcare Claims Feel Broken 2:12 How Stephen Got Into the Space 5:10 From Pharma Audits to Claim Informatics 8:20 Why Medical Claims Are More Complex 11:35 The Broker and TPA Problem 14:20 What Changed After the CAA 17:10 Why Data Access Matters 20:20 How Claims Are Audited 23:35 Prepayment vs Post-Payment 27:00 Real Savings at Scale 30:15 How Their Fee Model Works 33:20 Why Shared Savings Creates Conflicts 36:40 Independent Oversight and Fiduciary Risk 40:05 Why Recovery Gets Harder Over Time 43:10 How Much Money Gets Missed 46:20 Why Contracts Matter 49:30 The AI Layer 53:05 What Employers Should Demand 57:00 Final Thoughts #BrokenHealthcare #HealthcareClaims #ClaimInformatics #StephenCarrabba #PaymentIntegrity #ERISA #CAA #FiduciaryDuty #HealthcareTransparency #AIinHealthcare #EmployerBenefits #HealthcareCosts #TPA #SelfFundedHealthcare #Podcast ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

From The Convent to The White House to Fixing Broken U.S. Healthcare | Broken Healthcare Podcast #92

Katy Talento joins the show in-studio to share her unique journey from religious life to advising on healthcare policy at the highest levels of government - and what she believes it will take to fix the U.S. healthcare system. With a background in epidemiology, public health, and federal policy, Katy brings rare insight shaped by her experience working in the U.S. Senate and advising on healthcare issues at the White House. Her career spans global public health work, infectious disease research, and shaping national healthcare policy that impacts employers, patients, and the broader healthcare system. In this conversation, Katy shares how her early desire to change the world led her into public health, policy, and ultimately into healthcare reform efforts in Washington. She explains how incentives inside the healthcare system influence decision-making, why meaningful reform can be difficult to achieve, and why healthcare costs continue to rise despite ongoing policy changes. We also discuss how employer-sponsored healthcare plays a central role in the U.S. system, why prevention-focused models such as Direct Primary Care (DPC) are gaining attention, and how transparency may help improve healthcare outcomes over time. Subscribe for more conversations focused on improving healthcare outcomes and fixing the broken healthcare system. #HealthcareReform #HealthPolicy #HealthcareCosts #DirectPrimaryCare #EmployerHealthcare #HealthcareInnovation #HealthcareLeadership #HealthInsurance #PublicHealth #HealthcareTransparency 00:00 Intro 00:23 Welcome Katy Talento 01:30 Early life and desire to change the world 04:30 Faith journey and decision to enter religious life 08:00 Global public health work and infectious disease research 12:30 Working internationally in public health 16:00 Entering Washington health policy 20:00 Writing healthcare legislation in the U.S. Senate 24:00 How healthcare policy is shaped in Washington 29:00 Speechwriting and political communications 32:30 Industry influence in healthcare policy 36:00 Why healthcare reform is difficult to achieve 40:00 How incentives influence healthcare decisions 45:00 Employer-sponsored healthcare and system complexity 52:00 Insurance incentives and unintended consequences 58:00 Why healthcare costs continue to rise 1:05:00 Transparency and accountability in healthcare 1:12:00 Direct Primary Care and prevention-focused models 1:18:00 Where meaningful reform may come from 1:25:00 The future of healthcare policy 1:31:00 Final thoughts on fixing U.S. healthcare ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

Broken Healthcare Costs, Self-Funding, Anti-BUCA & Real Reform | Broken Healthcare Podcast #91

Emma Fox joins the show in-studio to explain why healthcare costs keep rising and how incentives inside the traditional health insurance system often work against employers and patients. Drawing on her experience inside the industry, Emma breaks down how compensation structures, carrier incentives, and consolidation influence employer-sponsored healthcare decisions. She explains why more organizations are exploring self-funded health plans, independent TPAs, direct primary care, and reference-based pricing as alternatives to traditional insurance models. We also discuss how collaboration between employers, advisors, and physicians can help create more transparent healthcare strategies, and why education initiatives like Symposium are helping drive innovation across the healthcare ecosystem. If you are an employer, advisor, HR leader, or healthcare professional trying to better understand rising healthcare costs, this conversation offers practical insight into how the system works and where change may happen. Subscribe for more conversations focused on improving healthcare outcomes. #HealthcareCosts #SelfFundedHealthPlans #HealthInsurance #EmployerBenefits #HealthcareInnovation #HealthcareTransparency #DirectPrimaryCare #ReferenceBasedPricing #BenefitsStrategy #HealthcareReform #TPA #HealthcareEconomics #HealthcareLeadership #BUCAIncentives 00:00 Intro 01:10 Emma’s journey from the UK to U.S. healthcare 03:00 Starting in life insurance and entering the insurance industry 08:30 Understanding health insurance incentives 12:00 Ethical conflicts inside traditional insurance models 15:00 Advisor compensation structures and industry challenges 18:00 Capitalism and healthcare economics 21:00 Government influence and healthcare policy realities 23:00 The employer’s role in fixing healthcare 27:00 The origin of Symposium 30:00 Bringing employers, advisors, vendors, and physicians together 32:00 Why physicians must be part of the healthcare conversation 35:00 Private equity and healthcare delivery challenges 38:00 Collaboration between doctors and advisors 42:00 Purpose-driven advisory models 45:00 Vision for improving the healthcare system 52:00 Advice for employers evaluating healthcare strategies 58:00 Industry collaboration and future outlook 1:04:20 How to connect with Emma Fox ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.