Month: June 2025

Why Insurers Profit from Complexity and you Pay the Price with Guest David Scheinker (Ep. 14)

Why Insurers Profit from Complexity and you Pay the Price with Guest David Scheinker (Ep. 14)

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🎧 Episode 14: Dr. David Scheinker on Why Healthcare’s Complexity Isn’t an Accident

This week on The Benefit Whisperer, Ralph Weber is joined by Stanford’s Dr. David Scheinker, a leading voice in healthcare engineering and reform, to break down the $1 trillion in administrative waste baked into the U.S. healthcare system.

From vague insurance denials to year-long billing delays, Dr. Scheinker explains why these inefficiencies aren’t glitches, they’re features of a system designed to protect profits, not patients.

🔍 In this episode:

  • Why it took a year to bill for a pre-approved procedure

  • How AI is being used to fight appeals and deny claims

  • What the mortgage industry can teach healthcare

  • The root cause of system-wide complexity—and who benefits from it

If you’ve ever wondered why fixing healthcare feels impossible, this conversation offers rare clarity—and hope.

For benefits plans that eliminate waste and put employers back in control, visit routethree.com
The PPO Shell Game: How Employers Get Trapped by Hidden Healthcare Costs (Ep. 13)

The PPO Shell Game: How Employers Get Trapped by Hidden Healthcare Costs (Ep. 13)

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Group health benefits are often sold as a shiny package, but beneath the surface lies a complex system that’s costing employers far more than they realize. 

In this eye-opening episode, Ralph Weber pulls back the curtain on PPO networks, revealing staggering price variances, like a CT scan that can cost anywhere from $635 to $19,830, depending on where you go and what you know.

Ralph unpacks the hidden mechanics behind cross-plan offsetting, opaque contracts, and the ways big insurance companies profit while businesses struggle with ballooning healthcare costs. 

But this isn’t just an exposé, it’s a guide. Ralph shares actionable strategies like self-funding, direct contracting with hospitals, and reference-based pricing to empower employers to take control of their plans, reduce expenses, and provide better care for their teams.

What to expect:

  • The shocking truth behind PPO pricing & why you’re paying more than you should
  • How cross-plan offsetting could be draining your bottom line
  • Why self-funded plans give you the data advantage
  • Smart solutions like reference-based pricing and direct contracting
  • And more!

Connect with Ralph Weber:

Podcast episode thumbnail for The Benefit Whisperer featuring Dr. Don Berwick. Text reads: "The $5 Trillion Lie: Why U.S. Healthcare Fails Us ALL – With Guest Dr. Don Berwick." Includes headshots of Dr. Berwick and host Ralph Weber with Route Three branding and a microphone.
The $5 Trillion Lie: Why U.S. Healthcare Fails Us All With Guest Dr. Don Berwick (Ep. 12)

The $5 Trillion Lie: Why U.S. Healthcare Fails Us All With Guest Dr. Don Berwick (Ep. 12)

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In this powerful episode of The Benefit Whisperer, host Ralph Weber is joined by legendary health policy expert Dr. Donald Berwick, former CMS administrator, Harvard-trained pediatrician, and co-founder of the Institute for Healthcare Improvement, for a candid and urgent conversation about what’s really broken in American healthcare.

Dr. Berwick pulls no punches as he exposes the systemic greed, institutional profiteering, and regulatory loopholes that continue to drive costs up while delivering subpar outcomes. From Medicare Advantage overpayments and PBM manipulation to private equity’s quiet takeover of hospitals and autism care, Berwick breaks down how a system designed to heal has become a $5 trillion machine that transfers wealth from the poor to the rich.

They also discuss the global models that prove a better way is possible, and why American employers, lawmakers, and voters must step up if we want real reform. If you’ve ever felt that our healthcare system isn’t working for you, this episode is essential listening.

Chapters

00:00 Introduction to Healthcare Reform

01:01 Dr. Berwick’s Journey in Healthcare

03:34 The Impact of Profit-Seeking in Healthcare

06:25 Defining Greed in Healthcare

10:27 Healthcare as a Human Right

14:28 The Role of Legislation and Public Activism

18:38 Aligning Incentives with Patient Outcomes

20:57 Employer Responsibility in Healthcare

22:48 Global Perspectives on Healthcare Systems

24:31 Myths About Choice in Healthcare

26:54 Urgent Changes Needed in Congress

28:09 The Role of AI in Healthcare

34:11 Reflections on Leadership Changes in Healthcare

Podcast title card for The Benefit Whisperer featuring guest Benjamin Jolley. Text reads: “The $11 Drug That Costs Employers $6,000. Guest Benjamin Jolley.” Includes images of Benjamin Jolley in a white pharmacy coat and host Ralph Weber speaking into a microphone. The Route Three Insurance & Financial Services logo appears in the top left, with “Episode 11” labeled in the top right.
The $11 Drug That Costs Employers $6,000 (Ep. 11)

The $11 Drug That Costs Employers $6,000 (Ep. 11)

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In this episode of The Benefit Whisperer, Ralph Weber and pharmacist Benjamin Jolley delve into the complexities of prescription drug costs, focusing on how employers can navigate pharmacy benefits management (PBM) to save money. They discuss the significant savings achieved by New Jersey, the impact of drug pricing strategies, and the legal implications for employers regarding PBM contracts. The conversation emphasizes the importance of employers being proactive in managing their pharmacy benefits to avoid costly pitfalls and ensure fair pricing for medications.

Chapters

00:00 Introduction to Prescription Drug Costs
03:25 Conclusion and Future Considerations