Category: Finance

What If Your Most Valuable Health Plan Asset Is the Data You’ve Never Seen? (Ep. 36)

What If Your Most Valuable Health Plan Asset Is the Data You’ve Never Seen? (Ep. 36)

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Welcome to The Benefit Whisperer, where we decode the nonsense in healthcare.

In this episode, Ralph Weber is joined by Chris Condeluci, one of the nation’s leading ERISA and healthcare transparency attorneys. Chris argues that pricing data and claims information aren’t just useful, they’re plan assets under ERISA. And if that’s true, carriers, TPAs, and PBMs may be fiduciaries… whether they like it or not.

This episode unpacks:

  • Why plan sponsors can’t meet fiduciary duty without full data access
  • How compensation disclosure rules are tightening around PBMs and TPAs
  • What’s coming in “Transparency 2.0” and routine audits
  • Why regulators may soon force carriers to open the books — or face liability

If you’re an employer, consultant, or HR leader tired of flying blind, this is the episode you can’t afford to skip.

Schedule a FREE CONSULTATION with Ralph: bit.ly/3Y5Gkhu

Learn more: https://fixmybenefitsnow.com
Contact Ralph: ralph@thebenefitwhisperer.com

The Rebate Racket: Why Employers Are Still Getting Fleeced (Ep. 35)

The Rebate Racket: Why Employers Are Still Getting Fleeced (Ep. 35)

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Ralph Weber is joined again by PBM insider Rachel Strauss to deconstruct how rebate programs have evolved into hidden commissions and cost traps. Learn how to avoid rebate mirages, leverage 340B strategies, and spot the telltale signs your PBM is profiting more than they should.

00:00 Introduction to Pharmacy Benefits and Rebates

02:39 The Evolution of Rebates in Healthcare

07:08 Understanding How Rebates Work

10:12 The Importance of Net Cost Tracking

15:28 Exploring Alternative PBM Models

18:17 Understanding Fiduciary Responsibility in PBM Contracts

19:01 The Role of Prior Authorization and Step Therapy

24:48 Navigating Pharmaceutical Pricing and Transparency

26:53 Quick Wins for Employers in Pharmacy Benefits Management

Guest: Rachel Strauss | rachelmstrauss.com | LinkedIn: linkedin.com/in/rachelmstrauss | Email: rachel@rachelmstrauss.com

Host: Ralph Weber | ralph@thebenefitwhisperer.com | Phone: (832) 924-3330 | Website: fixmybenefitsnow.com | Schedule a FREE consultation with Ralph: bit.ly/4i8Zpsw

From Bankrupt to Bulletproof: Why Critical Illness Coverage Matters Now (Ep. 34)

From Bankrupt to Bulletproof: Why Critical Illness Coverage Matters Now (Ep. 34)

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In this episode, Ralph sits down with longtime friend and insurance strategist Mark Halpern, founder of IllnessProtection.com and WealthInsurance.com.

Mark shares how his father’s untimely death shaped his mission to make critical illness insurance and philanthropic estate planning a household conversation. From stark differences between Canadian and U.S. insurance markets, to overlooked strategies like return-of-premium riders and tax-neutral giving, this episode breaks it all down.

You’ll hear real stories, like the donor who guaranteed $50K/year to his favorite charity—forever. Plus, how both Ralph and Mark have used personal tragedies to fuel purpose-driven work in legacy planning.

🎯 If you’re a financial advisor, a business owner, or just someone who wants to leave more behind for family and causes you care about—this one’s for you.

Schedule a FREE consultation with Ralph: bit.ly/3LpYc3U

🔗 Learn more at: fixmybenefitsnow.com

$1 Trillion in WasteHealthcare Contracts and Digital Legos (Ep. 33)

$1 Trillion in WasteHealthcare Contracts and Digital Legos (Ep. 33)

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Ralph Weber welcomes back Dr. David Scheinker, Executive Director at Stanford Children’s Health and founder of SURF Stanford Medicine. Together, they tackle the inefficiencies buried in hospital-payer contracts and how lack of standardization drives up costs. Dr. Scheinker shares how his team uses operations research and optimization modeling to streamline care, reduce waste, and protect patients financially. Topics range from pediatric ICU efficiency to lessons from aviation and finance. Plus, why AI and LLMs could revolutionize hospital systems—if used wisely.

Schedule a FREE consultation with Ralph: bit.ly/47JjX6b

Guest: Dr. David Scheinker | LinkedIn: https://www.linkedin.com/in/david-scheinker/

Host: Ralph Weber CEO of Route Three and host of The Benefit Whisperer podcast | Website: FixMyBenefitsNow.com | Email: Ralph@TheBenefitWhisperer.com LinkedIn: https://www.linkedin.com/in/ralphweber

 

Are PPO’s the Problem? Here’s What They Don’t Want You to Know. (Ep. 32)

Are PPO’s the Problem? Here’s What They Don’t Want You to Know. (Ep. 32)

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In this episode, Ralph Weber is joined once again by compliance strategist Ann Lewandowski to dive deep into the unseen world of healthcare data, who owns it, who profits from it, and what most employer contracts don’t actually protect.

They break down the illusion of “transparency” in benefit plans, the legal blind spots of HIPAA, and the skyrocketing value of employee data in today’s AI-driven ecosystem. Ann shares how contracts that don’t explicitly restrict de-identified data sales could cost employers millions, and why plan sponsors must learn to read between the lines.

You’ll also hear how new privacy laws (like the California Consumer Privacy Act) could impact your plan, whether you realize it or not. If you’re an HR leader, CFO, or benefits broker still trusting your vendors without verifying what’s under the hood… this episode is your wake-up call.

00:00 Data-Driven Decision Making in Healthcare
04:03 Understanding Healthcare Data Management
04:47 The Role of AI in Healthcare
06:21 Navigating Healthcare Regulations and Privacy
07:13 Contracting with Third-Party Vendors
08:14 The Value of Data in Healthcare
11:02 The Limitations of HIPAA
12:49 Contract Clauses and Data Protection
15:47 The Importance of Data Breach Language
18:16 The Need for Independent Healthcare Consulting
19:50 Understanding Pharmacy Benefit Managers (PBMs) and Rebates
23:08 Transparency in Healthcare Contracts

Host:
Ralph Weber
📧 ralph@thebenefitwhisperer.com
📞 (832) 924-3330
🔗 fixmybenefitsnow.com

Guest:
Ann Lewandowski
Founder, Healthcare Rebel Alliance
📧 ann@hcrebelalliance.com
🔗 hcrebelalliance.com
🔗 linkedin.com/in/annlewandowski

 

Trust, But Verify: Why Your TPA May Be Selling Your Employees’ Data (Ep. 31)

Trust, But Verify: Why Your TPA May Be Selling Your Employees’ Data (Ep. 31)

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Ralph Weber welcomes back Ann Lewandowski to unpack one of the most overlooked threats in benefits: your data. This episode exposes how TPAs and PBMs can legally profit from “de-identified” plan data, why HIPAA offers false comfort, and what transparency should mean in 2025. If you’re a plan sponsor, this is essential listening.

00:00 The Importance of Trust in Benefits

02:35 Understanding Healthcare Operations and Compliance

05:12 Evaluating Individual vs. Group Health Plans

08:10 The Role of Fiduciaries in Employee Benefits

10:45 Identifying Misaligned Incentives

13:18 Trust but Verify: The Need for Transparency

16:08 Employee Trust and Data Privacy

18:56 Wellness Programs and Legal Risks

21:32 The Future of Wellness Litigation

24:16 Data-Driven Decision Making in Healthcare

Guest: Ann Lewandowski

Website: hcrebelalliance.com

Email: ann@hcrebelalliance.com

LinkedIn: linkedin.com/in/annlewandowski

 

Host: Ralph Weber

Website: FixMyBenefitsNow.com

Free Consultation: bit.ly/3WiO5zY

Email: Ralph@thebenefitwhisperer.com

LinkedIn: https://www.linkedin.com/in/ralphweber/

 

The PBM Princess: From Rebate Myths to Deception, How PBMs Hide True Rx Costs (Ep. 30)

The PBM Princess: From Rebate Myths to Deception, How PBMs Hide True Rx Costs (Ep. 30)

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On this episode of The Benefit Whisperer, Ralph Weber interviews Rachel Strauss, the “PBM Princess,” to expose how pharmacy benefit managers manipulate contracts, rebates, and definitions to extract margin from employers. They break down contract landmines, phony transparency language, weak audit clauses, and the real story behind “100% pass-through.”

If you’re an employer, broker, or benefits leader struggling to contain pharmacy costs, this episode is your roadmap to fighting back.

00:00 Understanding Pharmacy Benefits and PBMs

01:17 Contract Landmines and Definitions

03:58 Rebates and Their Implications

06:24 Guarantees and Risk in PBM Contracts

09:56 Audit Rights and Transparency

15:37 The Illusion of Pass-Through Pricing

18:39 Prior Authorization and Cost Management

23:06 Navigating High Deductible Health Plans

26:46 The Need for Transparency in Healthcare Pricing

Guest:
Rachel Strauss • rachelmstrauss.com
LinkedIn: linkedin.com/in/rachelmstrauss
Email: rachel@rachelmstrauss.com

Host:
Ralph Weber • ralph@thebenefitwhisperer.com
Phone: (832) 924-3330
Website: fixmybenefitsnow.com

Schedule a FREE consultation with Ralph: https://calendly.com/ralph-weber-routethree?utm_source=blubrry&utm_medium=emails&utm_campaign=ep30&utm_id=podcast
What If You Could Pay the Hospital with a QR Code? (Ep. 29)

What If You Could Pay the Hospital with a QR Code? (Ep. 29)

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A trillion dollars.

That’s how much the U.S. loses every single year, not on doctors or medicine, but on the billing chaos of healthcare.

In this episode, Ralph Weber unveils something quietly revolutionary: Noverasys. It’s not just a payment system, it’s a reset button for healthcare costs. One where hospitals get paid instantly, patients stop drowning in surprise bills, and employers finally get transparency and control.

You’ll hear how a $240 prescription became $46 in seconds…why hospitals secretly love cash… and what happens when the patient, not the insurer, becomes the payer. This isn’t theory. It’s happening. And it could change everything.

What you’ll discover in this episode:

  • Why traditional insurance payment rails waste billions, and how Noverasys eliminates that inefficiency
  • Real-world examples of instant-pay models saving employers and employees thousands of dollars
  • How QR-code payment systems make healthcare transactions faster, cheaper, and cyber-secure
  • The hidden opportunity for employers to give employees lower costs and more choice while protecting their bottom line
  • And more!

Resources:

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Fiduciary Failures & The Great American Healthcare Heist: How Employers Are Being Played (Ep. 28)

Fiduciary Failures & The Great American Healthcare Heist: How Employers Are Being Played (Ep. 28)

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Employers are footing the bill, but locked out of the details.

In this episode of The Benefit Whisperer, Ralph Weber pulls back the curtain on how PPO contracts, TPAs, and PBMs are rigged to benefit everyone except the plan sponsor. Featuring insights from public-sector reformer and author Chris Deacon, this conversation breaks down:

  • Why “discounted” claims may still be wildly overpaid

  • How common gag clauses block your access to vital claims data

  • What fiduciary duty actually requires — and how most plans are falling short

  • A real-life example where $678K was billed… and $2.1M was paid

  • Red flags in benefit contracts that should stop any employer cold

Whether you’re preparing for open enrollment or just trying to regain control of your health plan, this episode is your roadmap to asking smarter questions, and avoiding a costly healthcare heist.

🎧 Listen now
📘 Buy the book: The Great American Healthcare Heist
📨 Learn more at fixmybenefitsnow.com

Schedule a free consultation with Ralph: https://calendly.com/ralph-weber-routethree?utm_source=emails&utm_medium=blubrry&utm_campaign=ep28&utm_id=podcast