He told a $30 billion hospital system's CFO "sue me" - and won. David Silverstein, founder of Amaze Health and former U.S. Navy submarine officer, joins Ray in-studio to break down what's really broken in self-funded employer health plans and how one standoff over a $20,000 ER bill turned into a career fixing them.

David's daughter racked up three ER visits and $20,000 in bills her freshman year of college. He escalated the fight all the way to the C-suite, and when the hospital's CFO asked what he actually wanted, David told him to sue him. The CFO refused, not realizing his own hospital system was already a client of David's consulting firm. That standoff became "the denial of payment system," and it eventually pulled David into Washington, where he helped shape federal price transparency rules and the "right to self-pay" buried in the No Surprises Act - a right most patients don't even know they have.

David also breaks down the "grand bargain": pay a hospital in 3 days instead of 90, and they'll knock 25-30% off the bill, no negotiation required.. even on a $2 million NICU stay. He explains why employers have had the legal power to fix their health plans since ERISA passed in 1974, and why big broker and consultant firms have misaligned incentives with the clients they're supposed to serve.

If you're an employer, CFO, HR Director or benefits consultant - this one's for you.

📌 Subscribe for more conversations on fixing the broken healthcare system.

🔗 Amaze Health: amazehealth.com

📖 David's book: "The Lean Health Plan" — search his name on Amazon

🔗 David Silverstein on LinkedIn: https://www.linkedin.com/in/dsilverstein/

#BrokenHealthcare #SelfFundedHealthcare #EmployerHealthcare #CFO #HRLeaders #ReferenceBasedPricing #HealthcareCosts #HealthcareTransparency #AmazeHealth #ERISA #Podcast

0:00 Introduction & Welcome

0:45 Growing Up in Brooklyn

2:00 Life as a Navy Submarine Officer

6:30 Founding a Six Sigma Consulting Firm

9:00 The $12,000 ER Bill and the "Revenue Enhancement Specialist" Letter

14:00 "I Want You to Sue Me" — The $30 Billion Hospital Standoff

16:00 Building Amaze Health (2018–2020)

20:00 Writing Input for the State of the Union

24:40 The Call From the White House

27:00 The Gas Station Story That Convinced the Economists

30:00 Why Only the Free Market Can Fix Healthcare

36:00 The Transparency Rules Already on the Books

38:11 Sponsor Break

43:45 The Right to Self-Pay Nobody Uses

46:00 The "Grand Bargain" — Pay in 3 Days, Save 30%

48:00 Why Reference-Based Pricing Alone Isn't the Answer

51:00 The Lean Health Plan & How Employers Lost Control of Risk

53:00 The McKinsey Report: 30% of Employers Reconsidering

54:00 The $2,000,000 NICU Baby Story

56:32 How Amaze Predicts a Hospital Visit Before It Happens

1:00:53 PBMs, Rebates, and Formulary Control

1:01:09 Employers Have Had This Power Since 1974 (ERISA)

1:02:00 Why CEOs Tolerate It: Taxes, Complexity, Groupthink

1:06:00 AI, Up-Coding, and the Next Wave of Cost Inflation

1:08:24 The Employer Health Plan Maturity Curve

1:12:28 Direct Contracts and How Amaze Actually Works

1:13:59 The $4M Spend Example — Where's the Opportunity?

1:15:24 Hitting the Reset Button — A 30-40% Correction

1:16:12 Brokers' Private Jets and Masters Tickets — Who's Paying?

1:18:49 The Coming Litigation Bubble Over the $6 Trillion Question

1:20:26 Final Thoughts

Hosted on Acast. See acast.com/privacy for more information.

Todd Martin, Chief Sales Officer at NOVA Healthcare Administrators, joins Ray in-studio to break down what's really happening inside your health plan and why the arrangement most employers are in was never designed to protect them.

Todd has 18 years in the TPA space and has seen it all. From a $600,000 radiation claim nobody caught, to a 1,200-employee company whose national broker never once mentioned reference-based pricing. He explains why a flat renewal means your carrier is making bank on your business, what private equity is doing to TPA service quality, and how an employer spending $10 million on healthcare could realistically save $2 million in year one.

If you're an employer, CFO, HR Director or benefits consultant - this one's for you.

📌 Subscribe for more conversations on fixing the broken healthcare system.

🔗 NOVA Healthcare Administrators: novahealthcare.com

📞 Todd Martin: tmartin@novahealthcare.com | 716-870-5916

#BrokenHealthcare #SelfFundedHealthcare #TPA #EmployerHealthcare #CFO #HRLeaders #ReferencedBasedPricing #StopLoss #HealthcareCosts #HealthcareTransparency #NOVA #Podcast

0:00 Introduction & Welcome

1:45 What Is a TPA and What Does NOVA Do?

5:30 Why Large Employers Are Still Fully Insured

8:00 Flat Renewals — Why Your Carrier Is Making Bank

10:30 Level Funded vs Traditional Self Funded

14:00 Minimum Group Sizes & Stop Loss Explained

16:30 How NOVA Approaches Claims Management

20:00 Reference Based Pricing — What It Is and Why It's Growing

25:00 Realistic Savings Expectations — The $10M Example

30:00 The $600,000 Radiation Claim Nobody Caught

35:00 Pharmacy Costs — From 10% to Over 50% of Claims

40:00 Why Big Box Brokers Won't Tell You About RBP

45:00 The Boston Story — 1,200 Employees, Zero Options Presented

50:00 Private Equity Buying TPAs — What It Means for Service

55:00 The Crawl Walk Run Approach to Self Funding

1:00:00 Saving $2M on Healthcare = $8M in New Sales

1:05:00 How to Find a Quality TPA — Do Your Diligence

1:09:00 How to Reach Todd Martin

1:11:00 Final Thoughts

Hosted on Acast. See acast.com/privacy for more information.

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 for more information.