They Paid $600,000 for ONE Healthcare Claim. Could You Be Next? | Broken Healthcare #96
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They Paid $600,000 for ONE Healthcare Claim. Could You Be Next? | Broken Healthcare #96
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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
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