Shows
ClaimTalkThe Search for a Good TPA — Part 2 | Ep. 21Selecting 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 compe...
2026-01-2940 minClaimTalkThe Search for a Good TPA — Part 1 | Ep. 20Building 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...
2025-12-1238 min
CLEARly Beneficial PodcastEp. 6 Mike Trent: Beyond Self-Insured, Energizing Your Health Plan Funding with RBPBeyond Self-Funding: Why Reference-Based Pricing Is the Solution Hiding in Plain SightMike Trent, VP of Business Development at ClaimDOC, reveals why self-funding alone doesn't solve healthcare costs—and how RBP can save employers $150,000 per 100 employees annually.Vincent (Vinny) and Mike discuss reference-based pricing (RBP) as an alternative to traditional PPO networks for self-funded employers. Mike shares how his wife's $67,000 hospital bill became a $7,000 claim through RBP—with no balance billing to employees. They explore the reality that most self-funded employers still pay PPO prices (250% of Medicare) without realizing it, while RBP typically reimburses at 150% of M...
2025-10-2934 minClaimTalkWhy RBP Success Starts With HR | Ep. 19In 2022, Featherlite Trailers partnered with ClaimDOC to begin implementing a new reference-based pricing health plan for its employees. It's no secret that moving to an RBP plan can come with friction but, with Shannon Westin, SHRM-SCP leading its human resources department, Featherlite didn't just endure the change, they owned it. Westin joins Danielle Young and Amy Hansen on ClaimTalk this month to share how taking the time to truly understand the plan and being proactive in resolving potential issues caused watercooler talk to shift from uncertainty to appreciation.
2025-10-2331 minClaimTalkVetting Your Vendors' Cyber Vulnerability | Ep. 18If your organization sponsors a self-funded health plan and cybersecurity isn’t part of your vendor evaluation criteria, it’s time to reassess. Protecting your own infrastructure is essential, but it’s not enough. Every vendor with access to your data must meet rigorous cybersecurity standards. Otherwise, you're not just accepting risk, you're creating it.In this episode of ClaimTalk, Andrew Smith and Jeremy Schuller share with Danielle Young some of the threat tactics that cybercriminals are using today and discuss best practices in evaluating vendors to ensure your data will be secure.
2025-09-1940 minClaimTalkMaking Sense of Cash Pay | Ep. 17Paying cash for healthcare services is not a new concept, but it's also an option that is not widely used. The reason for that is because many providers prefer to accept reimbursement from insurance. But cash pay does have its advantages.On this episode of ClaimTalk, Danielle Young visits with Amy Pellegrin and Leah DeBartolo about the pros and cons of cash pay, how health plans can create service around cash pay, and what stands in the way of cash becoming a more popular payment option for healthcare.
2025-08-2943 min
The Business of Benefits Podcast56. The Truth About Reference-Based Pricing: What Employees Really Experience with Danielle YoungWelcome back to The Business of Benefits Podcast! In Part 2 of our deep dive with Danielle Young of ClaimDoc, we shift focus from theory to reality — what actually happens when employees engage with a reference-based pricing (RBP) plan?We break down:The truth about provider accessHow ClaimDoc achieves a 96%+ acceptance rateFear-based tactics vs real-world outcomesHow to handle balance bills — and prevent themWhy communication before open enrollment is keyThe co-fiduciary model that protects employees and employersWhat brokers should be doing (and what to look out for)Building a proactive communication strategy that WORKSThis episode is a must-listen for HR l...
2025-07-2434 minClaimTalkAdapt or Fall Behind: Making Nontraditional Plans Thrive | Ep. 16For nontraditional health plans to work — whether they use reference-based pricing or another strategy — they often require customized solutions. As health plans evolve, vendors can't ignore new methods to give plan members what they need.In this episode of ClaimTalk, Amy Pellegrin and Stephanie Mohr visit with Sharla Mallett, a member of our direct primary care team. They discuss how the DPC team works to give members a more personalized health plan experience and why making adjustments to health plans is crucial to providing a positive member experience.
2025-07-1723 minThe Business of Benefits Podcast55. Stop Overpaying for Health Benefits (RBP) for Employers with Guest Danielle YoungWelcome to The Business of Benefits Podcast — the no BS, no sales guide to transforming your health benefits. In this explosive Part 1 of our two-part series, Chelsea Ryckis sits down with Danielle Young of ClaimDoc and host of Claim Talk to unpack one of the most misunderstood and feared concepts in healthcare: reference-based pricing (RBP). What is RBP? How does it really work?And is it as scary as traditional brokers and carriers make it seem? Danielle breaks it down with real-world examples, industry insights, and straight talk on what’s broken in the system and how employers can...
2025-07-1030 minClaimTalkDirect Contracts & Healthcare Pricing Complexities – Part 2 | Ep. 15Whether you're using a reference-based pricing strategy or some other alternative, there are many challenges in creating an effective direct contract. Much of the time, they boil down to the complexities of healthcare pricing in one way or another. Whether it's compliance with regulations, plan design or services billed by a third party, creating an effective direct contract requires a partner with the expertise to help you maneuver through all elements of the agreement.This month, Jay Kempton, Shane Cerone and Brad Hansen return to ClaimTalk for the second half of an in-depth discussion on direct contracts...
2025-06-2031 minClaimTalkDirect Contracts & Healthcare Pricing Complexities – Part 1 | Ep. 14Healthcare access can be the biggest hurdle to successfully implementing a reference-based pricing plan. Sometimes it requires creating an agreement called a direct contract between a health plan and a provider to ensure access to that provider. Direct contracts are an effective tool for RBP health plans, but they can be more complicated than they sound. On this month's ClaimTalk, experts Jay Kempton, Shane Cerone and Brad Hansen discuss the complexities of direct contracts and their impact on the rising cost of healthcare.
2025-05-2230 minClaimTalkClaim Denials: Their Rippling Effect on Health Plans | Ep. 13Claim denials are a complex piece of the healthcare system, and they can cause frustration for patients and providers alike. There are many reasons claims can be denied, whether it's due to technical errors, subrogation or if it's deemed not medically necessary.Experts Alex Arnet, Colton Casonand Carrie Kennedy join this month's edition of ClaimTalk to peel back all the layers of claim denials and share their insights on how its time to rethink this process.
2025-04-2439 minClaimTalkBalance Bill Protection: Often Promised, Rarely Executed | Ep. 12A strong balance bill defense is essential to a successful reference-based pricing health plan. But what does that look like? And how do you know what you're being offered isn't just lip service? The answer is fiduciary responsibility.ClaimDOC Balance Bill Manager Alex Deeter and Chief Legal Officer Amy Pellegrin join this month's edition of ClaimTalk to discuss why it's important to choose a partner that sees balance bill defense as an obligation rather than a service.
2025-03-2726 min
Dysrupt Healthcare PodcastUnlocking Healthcare Savings with Reference-Based Pricing: Insights from Omar ArifIn this episode of Impact Healthcare, host Lester Morales dives deep into the world of Reference-Based Pricing (RBP) with Omar Arif, Senior Vice President of Growth at Claim DOC. Together, they explore how RBP is disrupting the health benefits industry by replacing traditional PPO networks with a more transparent, cost-effective approach.Omar shares real-life examples of how organizations can save millions while improving access to care, debunking myths surrounding RBP and addressing common challenges. Whether you’re an employer, benefits consultant, or healthcare professional, this episode provides actionable insights to rethink your healthcare strategy....
2025-03-0550 minClaimTalkPBMs: Are You Getting Good Advice – Part 2 | Ep. 11In the second half of a two-part episode on PBMs, experts Marc A. Sweeney, Trevor Daer and Mike Kroupa return to discuss some of the intricacies of the pharmaceutical industry. They tackle complex topics like international drug sourcing, specialty drugs, GLP-1s and more.
2025-02-2033 minClaimTalkPBMs: Are You Getting Good Advice? – Part 1 | Ep. 10There are several key vendor decisions brokers and plan sponsors must make when unbundling a self-funded health plan, including pharmacy benefit management. On a new episode of ClaimTalk, self-funding experts Marc Sweeney, Trevor Daer and Mike Kroupa will help you evaluate if you're making the best decision on your drug spend.
2025-01-1626 minClaimTalkWhen the 'Easy' Plan Isn't Member-Friendly | Ep. 9BUCAs may seem like the easy, all-inclusive choice, but they don’t offer the personal, one-on-one assistance most health plan members actually prefer. Plus, no plan sponsor should accept inferior member service — whether big network or reference-based pricing. In this month’s episode of ClaimTalk, Michelle Henaman and Heidi Martinez share the gaps in service you need to DEMAND get filled for your clients.
2024-12-2043 minClaimTalkADVISORS UNLEASHED - Part 2 | Ep. 8In this month's episode of ClaimTalk, brokers and industry experts Craig Gottwals and Mike Kerns are back for ADVISORS UNLEASHED — Part 2. They go even deeper into the benefits consulting industry, offering more brutally honest insights you won't hear anywhere else.
2024-11-1326 minClaimTalkADVISORS UNLEASHED - Part 1 | Ep. 7This month's edition of ClaimTalk is the first half of a two-part discussion with brokers and industry experts Craig Gottwals and Mike Kerns. They provide an inside look at the benefits consulting industry in a no-holds-barred conversation you won't want to miss.
2024-10-1737 minClaimTalkGot a Provider Access Fire? Call in a Fixer | Ep. 6Access will always be an obstacle with RBP medical plans. At ClaimDOC, we believe obstacles can be overcome. Our first wave of attack is proactive provider education through Pave the Way. When that’s not working, we turn to Austin Miller and our team of fixers. Learn more about Austin's journey at ClaimDOC and how our provider relations team uses data and relationships to ensure access in a new episode of ClaimTalk.
2024-09-1924 minClaimTalkKeeping Claims Honest — The Role of a Fiduciary | Ep. 5As a fiduciary, you are responsible for ensuring medical claims are billed accurately. If your plan administrator is prevented from auditing claims due to the network contracts, who is fulfilling this duty? Cynthia Swanson and Amy Pellegrin join this month's episode of ClaimTalk to discuss egregious billing practices and what it is required to be a compliant fiduciary.
2024-08-2232 minClaimTalkHow Do You Measure Great Member Experience? With Baby Pictures | Ep. 4How do you silence RBP noise? In this month's episode of ClaimTalk, we interview rock star member advocate Amanda Ogg, and our training manager, Lori Van Groningen, about how they approach the challenges facing our members. There would be no headache-free direct access to care or cute baby pictures without their efforts.
2024-07-1815 min
Self-FundedEpisode 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...
2024-06-2559 minClaimTalkWinning the RBP Access War, With or Without Contracts | Ep. 3Direct contracts are very different from direct access. In our latest episode of ClaimTalk —Winning the RBP Access War, With or Without Contracts — two of our legal experts share how we interact with providers to make sure DirectAccess+ members can receive medical care when they need it and from whom they want to receive it.
2024-06-1925 minClaimTalkRBP From the Front Lines: It’s As Personal As Healthcare Gets | Ep. 2Is the member experience too challenging with reference-based pricing programs? Listen to Bruce and Stephanie discuss the challenges our member advocates face each day as they help members navigate their medical plans. And hear about the successes they achieve directly from one of our member advocates.
2024-05-1026 minClaimTalkNSA Claims - Surprise Billing and the Shocking Mistakes that Cost Plans Money | Ep. 1No Surprise, the No Surprises Act has unintended consequences when administrative errors are costing plans money. Join us and we'll share some horror stories from open negotiations and tips for making sure your clients aren't just compliant, they are protected. #ClaimTalk #Transparency #NSA
2024-04-0935 min
Gott's Gulch - Craig’s Substack PodcastHealthcare Pricing on Trial: The Case for Reference-Based PricingDive headfirst into the wild world of Reference-Based Pricing, the game-changing strategy that's revolutionizing health plan cost containment like nothing else in the past two decades of employee benefits. Imagine stripping away the cumbersome layers of national carriers and their bloated PPO network fees, paving the way for a bold, new pricing model beyond the tangled web of the Government-Healthcare matrix.But here's the twist: without a pre-agreed pricing framework between healthcare providers and patients (or their health plans), how do we navigate the murky waters of billing disputes? Picture a scenario where, post-emergency service, a bill...
2024-04-091h 17ClaimTalkWelcome to ClaimTalkGet ready for a podcast that explains the complexities of cost containment and shares industry insights! Our team of experts will share their passion with the world in our new podcast, ClaimTalk. Subscribe now!
2024-04-0800 minClaimTalkClaimTalk by ClaimDOCClaimDOC is jumping into podcasting by launching ClaimTalk. Each month, you can look forward to a new episode filmed directly from our headquarters in Des Moines, Iowa. We won't be turning anyone into a benefits celebrity, but we will be hitting on issues we feel don't typically get expressed to audiences in ways that will make them better consumers. Stay tuned for the release of our first episode on April 10th, where we discuss the No Surprises Act, some open negotiation horror stories, and more. Subscribe now so you never miss an episode. #Cla...
2024-04-0100 min
Healthcare Uncut and UnfilteredUCUF #11 - Omar Arif - ClaimDOC and RBPThis episode's guest is Omar Arif. Omar is a 15 year veteran of the healthcare benefit space and most recently with ClaimDOC paving the way for reference based pricing. We talk family, work, international baseball and a little bit of bourbon.https://claim-doc.com/take-control-of-your-healthcare-spend/
2023-10-311h 04
Gott's Gulch - Craig’s Substack PodcastHealthcare's Final Frontier: Navigating the Wild West of RBP with Industry RenegadesEver imagine healthcare could feel like the Wild West? Welcome to the untamed lands of Reference-Based Pricing (RBP), the sizzling frontier where a select few employers unleash radical savings while giving the traditional PPO system a stiff arm.Unveil a world where only 3-4% of employers dare to tread, but where jaw-dropping 30-40% savings rain like gold and concierge-level service is the sheriff in town.Curious about RBP's magic? This isn't just healthcare. It's "Health-FAIR!" Here, employers "price-match" medical costs against benchmark prices, slicing their claims in half compared to big insurers. Projections sa...
2023-09-131h 48
Self-FundedUnlocking Cost Savings with Reference Based Pricing (RBP) - ClaimDOC - Omar ArifUnlocking Cost Savings with Reference Based Pricing (RBP) - ClaimDOC - Omar Arif
This week I sit down with Omar Arif, SVP of Growth with ClaimDoc to answer the question, "What is Reference Based Pricing, aka "RBP"?"
Omar Arif, the SVP of Growth for Claim Doc, a cost containment vendor, was sold on RBP when he discovered it. Claim Doc provides a balanced approach to RBP, combining both "pay and defend" and "negotiate and settle strategies".
Omar states that their network replacement is the...
2023-07-1859 min
Midway Business PodcastAnalyzing Risk with Daniel Wells at ClaimDoc | Zemar PodcastDaniel Wells from ClaimDoc joined us in the studio for this episode. Daniel shares his experience in risk modeling, known drivers when it comes to the industry, and improving outcomes.
In this episode, Daniel walked us through his experience in the industry leading up to ClaimDoc. Cost savings and better outcomes are the main objectives and healthcare trends you need to know.
Listen to the case study of huge savings for the employee at claim time.
Reach out to Daniel on LinkedIn. You can visit ClaimDoc on their website for more information.
F...
2023-03-3035 min
Benefits Executive RoundtableS4E12 - Examining Reference Based Pricing in Self-Funded Plans Featuring ClaimDOCIn this week’s episode, Host Dorothy Cociu interviews Mike Sigal, VP of Sales Development and Omar Arif, Senior VO of Growth from ClaimDOC, a Reference Based Pricing vendor. As we continue to examine cost containment in self-funded health plans, we take a look into ClaimDOC and how they differ from other vendors, the effectiveness of single case agreements, ways to deal with Balance Billing, and how ClaimDOC takes on the role of a Co-Fiduciary in the self-funded health plan. Join us for this informative podcast!
Podcast Website
https://advancedbenefitconsulting.com/s4e12-examining-reference-based-pricing-in-self-funded-plans
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2023-01-2459 min
The Ovation Show w/ Dan LabroadPatrick Martell and Reference Based PricingIn this episode, Dan LaBroad speaks to Patrick Martell about ClaimDoc and Reference Based Pricing. Patrick is the Vice President of Business Development at ClaimDoc with 13 years of experience in Employee Group Benefits. He is also a subject matter expert in the field of Reference Based Pricing (RBP) / Value-Based Payments (VBP) as well as an analytical and industrious senior sales professional with a track record of maximizing relationships and resources, building trust, and influencing positive outcomes.Useful Links:ClaimDOC: https://claim-doc.com/Patrick Martell: https://www.linkedin.com/in/martellpatrick
2021-09-0947 min
Self-FundedEpisode 13 - Patrick MartellThis episode features Patrick Martell of ClaimDOC. Patrick came on the show to discuss one of my favorite topics - Reference Based Pricing (RBP)! I love the potential of RBP to reduce plan spend, but I am no expert, so I asked Patrick to come to tell us the who, what, why, when, where, and how of moving your self-funded plan to this type of claims payment methodology.
2021-07-0247 min
Healthy Conversations with Matt MageeBruce Hansen: EVP at ClaimDoc - #24Tired of paying too much for your employees healthcare costs? Bruce breaks down how they audit self-funded health plans to keep costs in check.
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https://claim-doc.com/
2019-10-2835 min