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Self-Funded
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เข้าร่วมเมื่อ 24 มี.ค. 2020
Self-Fund or Die
Episode 150 - Talking RBP with ClaimDOC, Live From Des Moines!
“If you're going to be the fiduciary, you have to protect the members, you have to protect the plan, and you need to defend that allowable to make sure that you're covering all of your bases." - Amy Pellegrin
We made it to episode 150! A huge thank you to every guest we’ve had on the show so far, and obviously to you, the listeners, for making the show what it is today.
For this special episode, we traveled to Des Moines, Iowa to meet with ClaimDOC, one of our sponsors, in early March and I hosted a panel podcast with Bruce Hansen, Amy Pellegrin, and Brad Hansen.
We talked about how each of them made their way to ClaimDOC, why it’s so important that ClaimDOC is a co-fiduciary with it’s clients, and why human customer support is especially welcome in the healthcare space. We also talked about the reference based pricing world at large and what ClaimDOC does to help its clients deal with balanced bills.
Join us for the 150th time this week on Self-Funded with Spencer as we talk all things RBP!
Chapters:
00:00:00 Welcome to Episode 150!
00:02:53 Member-Centric Healthcare Pricing
00:17:49 Navigating Healthcare Billing and Coding for Fair Charges
00:20:50 Claimdoc's Co-Fiduciary Role in Healthcare Operations
00:25:43 Better Healthcare Experiences Through Member Advocates00:37:22 Navigating Balance Billing With An Advocate
Key Links for Social:
claim-doc.com/
@SelfFunded on TH-cam for video versions of the podcast and much more - www.youtube.com/@SelfFunded
Listen on Spotify - open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02
Listen on Apple Podcasts - podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286
Follow Spencer on LinkedIn - www.linkedin.com/in/spencer-smith-self-funded/
Follow Spencer on Instagram - selffundedwithspencer
Key Words:
#ReferenceBasedPricing #HealthcareBilling #FiduciaryResponsibilities #MemberAdvocacy #VendorRelationships #NetworkFreeOptions #BalancedBilling #ProviderRelationships #MemberAdvocates #HealthcareTools #HealthcareInnovation #selffunded #podcast
Reference Based Pricing, Healthcare Billing, Fiduciary Responsibilities, Member Advocacy, Vendor Relationships, Network Free Options, Balanced Billing, Provider Relationships, Member Advocates, Healthcare Tools, Healthcare Innovation, self funded, podcast
We made it to episode 150! A huge thank you to every guest we’ve had on the show so far, and obviously to you, the listeners, for making the show what it is today.
For this special episode, we traveled to Des Moines, Iowa to meet with ClaimDOC, one of our sponsors, in early March and I hosted a panel podcast with Bruce Hansen, Amy Pellegrin, and Brad Hansen.
We talked about how each of them made their way to ClaimDOC, why it’s so important that ClaimDOC is a co-fiduciary with it’s clients, and why human customer support is especially welcome in the healthcare space. We also talked about the reference based pricing world at large and what ClaimDOC does to help its clients deal with balanced bills.
Join us for the 150th time this week on Self-Funded with Spencer as we talk all things RBP!
Chapters:
00:00:00 Welcome to Episode 150!
00:02:53 Member-Centric Healthcare Pricing
00:17:49 Navigating Healthcare Billing and Coding for Fair Charges
00:20:50 Claimdoc's Co-Fiduciary Role in Healthcare Operations
00:25:43 Better Healthcare Experiences Through Member Advocates00:37:22 Navigating Balance Billing With An Advocate
Key Links for Social:
claim-doc.com/
@SelfFunded on TH-cam for video versions of the podcast and much more - www.youtube.com/@SelfFunded
Listen on Spotify - open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02
Listen on Apple Podcasts - podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286
Follow Spencer on LinkedIn - www.linkedin.com/in/spencer-smith-self-funded/
Follow Spencer on Instagram - selffundedwithspencer
Key Words:
#ReferenceBasedPricing #HealthcareBilling #FiduciaryResponsibilities #MemberAdvocacy #VendorRelationships #NetworkFreeOptions #BalancedBilling #ProviderRelationships #MemberAdvocates #HealthcareTools #HealthcareInnovation #selffunded #podcast
Reference Based Pricing, Healthcare Billing, Fiduciary Responsibilities, Member Advocacy, Vendor Relationships, Network Free Options, Balanced Billing, Provider Relationships, Member Advocates, Healthcare Tools, Healthcare Innovation, self funded, podcast
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I am from india i have an complete acl Tera how to regrow it
Home ready is the program u want . Dont listen to these guys its almost always a bad idea to buy a home with a non loved one.
much better option is to use Border income to qualify fannie mae allows it now thru their guidelines take your roomate tenant with u but keep all the ownership
Thank you for your insight
Being a real estate guy I don’t ever think I’ve been more excited to listen to this podcast. 👏👏👏
Awesome. Thanks Marty!!!
I would spend my entire day at an expanded lifetime
Same
I need more of these videos in my life! So funny
Thank you! We have a few in the Tom Broker playlist
Capitalism is not the answer to anything that is a requirement to healthful living.
So capitalism doesn’t help feed people? Capitalism doesn’t create gyms for people to work out in? Capitalism doesn’t create the shoes you go for a walk in or the headphones you have in your ears while you do? Capitalism isn’t the boogey man
To solve healthcare, you need to remove the non-medical administrative “leadership”staff and make it a nonprofit service.
I’m not sure that is totally the answer. I agree that admin staffs have been completely bloated and top heavy, but some are still necessary. We shouldn’t expect the surgeon to also be the CEO and CFO as well. Every business needs some admin leadership to make the business more efficient, and I highly doubt tasking a surgeon with also managing payroll would make healthcare better.
Really inspiring podcast, I work on an R&D team for a company that builds products for payers around payments. This really gave me a bunch of ideas.
That’s awesome to hear Steven! Thanks for sharing 🙏🏼
This is a great interview, and it appears a wave of companies making the move into the ICHRA world is growing. The traditional models aren't sustainable long term.
Zero reason to bother with health insurance unless its really good and no deductible. Most peopple cant afford that type
Yes and no. If you’re not getting it through an employer, then a cheaper high deductible plan is OK, but I would put direct primary care underneath it so all of your routine care was coming from a fixed cost model. Not ideal, but then you would have insurance on top for catastrophic care
@@SelfFunded great points! So essentially bankruptcy insurance then right? I don't know the number of hand but I do know most Americans are tied to their insurance via their job
Nobody is asking for a perfect system. We're asking for a proven and tested system, even a flawed one like most other countries have, to be adopted here. Atleast in part. Let's not act like these are impossible standards when they have been tried and used in dozens of other systems. Our system IS broken. We aren't even making corrections to the current structure.
Great advice, push through the fear.
👊🏼🙏🏼
What a topo Chico? Top boy?
Sparkling/fizzy water
This isn't even my bill and I'm anxious about paying it! We NEED universal healthcare ASAP!
Martin Skrelli (however his last name is spelled) was put in jail for jacking up the price of medication his company controlled. I don't see how that was illegal but hospitals can charge thousands for an MRI scan etc. They should determine the cost to make a drug/the cost to operate equipment etc and say they can charge X amount more at most. Right now it costs $10 for something and the medical industry charges $10k or more. They should get to make a profit, not rob people blind
This is the number 1 reason people are scared to move to the USA, Im looking at escaping Canada and the USA is not my best or first option because of this,
When the politicians are paid off ridiculous things like this are allowed to thrive. Curruption plain and simple
With insurance you have max OOP though so we’re saying the carrier picked up 90% of this?
I still can't imagine paying that much though!
$70K
Its a scam .... the scam is so big, it's blatantly obvious to anyone willing to discuss it
Real socialized medicine like in Germany, won’t work here. Like in Venezuela, the government is too corrupt here.
Fascism really. The government is working with these private companies to steal from and oppress the American citizens. It’s crazy to say that America has devolved into a Fascist country.
It’s criminal.
Thanks for sharing, Spencer!
That's good code billing. Dayam.
Somebody knew what they’re doing…
Sounds like BS.
That scream makes a lot of sense now
It has lost 35 pounds in 2 months
Healthcare shouldn’t be a for-profit industry. It should be a government agency that controls all hospitals and medical professionals.
That's communism and it always fails. Look up stuff on Canada or the UK free healthcare
She is wrong, there is no such thing as traditional health care setting. In all commercial transportations, buying groceries, getting a haircut, buying a car, going out to dinner, the list is endless. The consumer knows what the proposed payment for the goods or services is. There is no surprise at 7-11 or Dunkin donuts, you see what you are paying. In healthcare there is an intentional disconnect from what things cost and who, how the bill got paid and the final amount. Americans don't know anything, start to finish. Don't know what the procedure is supposed to cost, what they paid, and who paid it. Many people pay @$3-700 bucks a month and a single procedure is more than that, week after week or month after month and somehow the system continues. The patient, the consumer, the customer, you need to know how much everything costs, every time and need a bill before leaving the office and you should need to a knowledge how much it costs
Same could be said about an oil change, or anything else
Great episode!
This episode is truly an eye-opener, thank you for bringing us such insightful content.
Thank the government
I pay cash for my prescriptions. Otherwise, with insurance my copay would cost me more than out of pocket. Insane!
This is a very common phenomenon with paying cash. It’s routinely less than using insurance for everything from prescriptions to ER visits. Kudos to you for being smart!
The problem is that because health insurance is structured the way it is, hospitals can get away with charging more to make as much money as possible and most of the cost is supposed to come from insurance company. The problem comes in if your insurance isn’t that good, are denied, or you simply don’t have any than you are screwed, unless you are lucky enough to be at one the hospitals that offers a special program that forgives most if not all of your bill so long as you are below a certain income.
We all pay for the doctors education.. #studentloan
If roofers billed like doctors, they would be arrested .
Billed like insurance, but yeah
Have a brain tumor thats cancerous. 1 week in hospital Already costing me a fortune. Have a full year of treatments coming and lots more bills from the ladt few weeks
I work in the hospital lab. LET ME TELL YOU. Doctors order tests that are useless to the patient ALL THE TIME. We laugh about it in the lab sometimes... patient came in for food pain related to a broken toe... now we're testing their urine for a UTI when though their urine analysis doesn't indicate infection. Ask to see every test the doctor orders for you.
Change country.
Get a naturopath.
@ZarifaMEl-lf3zr do i can die in 6 months? Lol glioblastoma without surgery and with out chemo radation your lucky to get 6 months. With surgery and chemo radation have a 5% chance of making it 5-10 years. Only 1% more then 10. If
That cap was not medically necessary
🤣🤣🤣
Fair is not the right word to use.. it’s not unfair. That’s ridiculous. Word to use unfair what the hell who said healthcare has to be fair what needs to happen? Is it a proper business transaction I pay for service they give me that service with no funny business. You’re talking about getting rid of the funny business has nothing to do with being fair has to do with them what you’ve been charged for go to 7-Eleven you buy Slurpee they give you a Slurpee. They don’t call you three days later and by the way you gotta pay for the straw.
There should never be out of pocket in health care. You pay premiums and the insurance company pays the bill, 100% of it.
Pretty good vid. Been OMAD + Paleo 3 years extended fasting regularly reversed all my disease.
Thank you for the compliment and glad you were able to reverse your disease states with diet. Congrats to thriving!
Typical spin from an insurance representative. A balance bill occurs when the insurer or HMO does not pay 100% of their portion which typically orrurs when a provider is not contracted with the insurer or HMO or non-participating.
She’s a director of HR, not an “insurance representative”. This discussion also centers around her experience implementing Reference Based Pricing for her health plan, which is a network replacement solution that sometimes results in balance bills. In this situation, the “insurer” is the employer because they are self-insured. Thanks for commenting but your suggestion that this is “spin” is off base.
WHo's this guy
Just a guy
At least your govt has several billion to send overseas in military aid to multiple countries.
Yes they have and we don’t get a say in it at all. So many systems seek to extract wealth from American taxpayers and spend our money everywhere but here on Americans who need it
why is the us like this
Too difficult to answer in the comments. The best way to start answering the question is to follow the money and see how deep and dark the rabbit hole goes
I've seen policy after policy across many industries enacted that do little more than push potential customers away rather than pull in more revenue as intended. At some point, these decision-makers have to realize that you WILL get more flies with honey than you will with vinegar.
Yes direct contracting, reference based pricing or just pure cash are all preferred to the top-down of fake discounts off of already fake and insanely high billed charges. The entire payment model is smoke and mirrors designed to extract as much revenue out of the system until people revolt or we go bankrupt as a country
In a traditional healthcare setting we don’t get charged, its in our taxes 😂
What country are you in?
@@SelfFunded not USA that’s for sure
@@drew2626 SelfFunded describes employer groups that pay the medical expenses for their members instead of the insurer or HMO when monthly premiums are paid. SelfFunded groups are governed by ERISA. FullyInsured (monthly premiums) are governed by the state in which the policy is sold.
If half as many folks were pissed that Hospitals are companies that get away with more BS than Nestle while getting tax exemptions nearly as decent as churchs, as there were folks pissed about something happening on the other side of the world, we'd be a much better place.
I’m with you. This is a big reason my podcast exists, which is to expose the dark secrets of our healthcare system. Most people are unaware how bad it is, and if they were made aware, would be angry.
@@SelfFunded Whatever else someone might have to say about Trump, I was a big fan of the fact that he was trying to shine a spotlight on how loads of issues most folks just offhandedly blame on generic "insurance" or "pharma" (notwithstanding both of those are in fact pretty bad) are actually on the hospitals themselves. Everyone sees these massive medical bills and flips out and talks about how we "cant afford medical care because we need to have insurance to pay for this"...few of them even know to ask for an itemized receipt and suddenly see a vast amounts of that bill suddenly disappear, or telling the staff you dont have insurance and watch like magic as the costs go down... I was really looking forward to hospitals being treated like every other essential business and having to be held to business practice standards like the rest. The idea of knowing ahead of time what the cost for a procedure is up front on a website menu, that would be nice.