Tag: Health Insurance

Podcast title card featuring Adam Russo and Ralph Weber. Text reads: “Why ‘Good Discounts’ Are Costing You a Fortune – Inside a Smarter Healthcare Model: Reference-Based Pricing with Guest Adam Russo, Esq.” Episode 09 of The Benefit Whisperer. Logos and portraits of both speakers included.
Why “Good Discounts” Are Costing You a Fortune. Inside a Smarter Healthcare Model: Reference-Based Pricing with Adam Russo, Esq. (Ep. 09)

Why “Good Discounts” Are Costing You a Fortune. Inside a Smarter Healthcare Model: Reference-Based Pricing with Adam Russo, Esq. (Ep. 09)

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Is your PPO network actually saving you money—or just selling you a myth?

In this eye-opening episode of The Benefit Whisperer, host Ralph Weber sits down with Adam Russo, co-founder and CEO of The Phia Group, to expose the broken economics of traditional healthcare pricing. They dive deep into the real story behind Reference-Based Pricing (RBP), why most brokers avoid it, and how smart employers are slashing costs without cutting care.

✅ The truth about PPO “discounts”
✅ Why laziness—not logic—drives plan design
✅ How RBP protects patients from surprise billing
✅ What AI and price transparency mean for the future of healthcare

🎧 Whether you’re a CEO, benefits advisor, or just tired of rising deductibles and shrinking benefits, this episode will change how you think about cost, quality, and control in healthcare.

🔗 Learn more about Adam Russo and The Phia Group: https://phiagroup.com
📩 Contact Ralph: Ralph@thebenefitwhisperer.com
📞 Call: 832-924-3330

Chapters

00:00 Introduction to Healthcare Challenges

02:36 Understanding Reference-Based Pricing

06:40 The Necessity of Reference-Based Pricing

12:47 Consumerism in Healthcare

18:41 Addressing Balance Billing Concerns

22:22 The Power of Representation in Healthcare Billing

24:18 Understanding Healthcare Pricing Variance

26:40 The Importance of Patient Education

28:15 Challenges in Educating Employers and Employees

32:24 Implementing Reference-Based Pricing

34:54 Analyzing Healthcare Data for Cost Reduction

36:33 The Role of AI in Healthcare Transparency

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#healthcarecosts #RBP #benefitsstrategy #healthcaretransparency #thebenefitwhisperer #AdamRusso #employeebenefits #healthcarepodcast

Podcast title graphic for The Benefit Whisperer featuring Benjamin Jolley, discussing prescription drug pricing, PBM corruption, and spread pricing.
The Billion Dollar Drug Scam (ep. 8)

The Billion Dollar Drug Scam (ep. 8)

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Why Are Prescription Drugs So Expensive? The Truth About PBMs, Spread Pricing & What Employers Can Do

In this eye-opening episode of The Benefit Whisperer, host Ralph Weber sits down with pharmacist and reform advocate Benjamin Jolley to expose the hidden forces behind America’s skyrocketing prescription drug costs. 💊

From shocking stories of $1,800 bills for $140 drugs to the disturbing influence of pharmacy benefit managers (PBMs) and their spread pricing schemes, this conversation breaks down complex systems with clarity—and urgency.

🔥 Highlights include:

  • Why the U.S. pays more for drugs than almost any other nation
  • How a New Jersey benefits plan saved $1 BILLION just by rewriting its contract
  • The dangerous power of vertically integrated PBMs like CVS Caremark
  • The recent bipartisan push by 39 state Attorneys General to break up monopolies
  • How employers and CFOs can protect themselves from being held personally liable

If you’re an employer, benefits administrator, policymaker—or just someone wondering why your prescriptions are so expensive—this is a must-watch.

📌 Chapters:
 0:00 – Welcome + Prescription Drug Teaser
 0:41 – Meet Benjamin Jolley
 1:00 – Why Prescription Costs Are So High
 4:00 – What Is Spread Pricing? (Shocking Example)
 8:00 – Silencing Critics: Non-Disparagement and Audits
 13:00 – What Should Employers Be Paying Per Member?
 17:40 – 39 Attorneys General Demand PBM Reform
 21:00 – New Jersey’s $1B Savings by Rewriting a PBM Contract
 25:00 – Closing Thoughts + How to Reach Benjamin
Medical Debt Is Bankrupting Americans (Ep. 6)

Medical Debt Is Bankrupting Americans (Ep. 6)

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What if the greatest threat to your financial security isn’t a market crash, but a medical bill?

In this eye-opening episode, Ralph Weber uncovers the hidden costs of America’s broken healthcare system. Every minute, a family files for bankruptcy due to medical expenses, and employers are spending over $16,000 per employee each year, often more than they invest in their own core business.

Ralph breaks down why this system is unsustainable and what you can do about it. He shares practical, forward-thinking solutions — from customized level-funded health plans to smarter prescription drug formularies, that could dramatically cut costs and protect your bottom line.

If you’re a business owner, HR leader, or simply someone trying to make sense of rising healthcare costs, this conversation is a must-listen.

Key discussion points include:

  • The alarming rise of medical bankruptcies [00:01:04]
  • How medical debt impacts both employees and employers [00:03:00]
  • Innovative healthcare solutions to manage and reduce costs [00:10:11]
  • The role of self-insured plans and level funding [00:10:48]
  • Real-world examples of healthcare financial struggles [00:06:42]
  • Legal implications for employers not managing health costs effectively [00:17:07]
  • And more!

Resources:

Connect with Ralph Weber:
How the Affordable Care Act Changed Health Insurance Forever (Ep. 5)

How the Affordable Care Act Changed Health Insurance Forever (Ep. 5)

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What does optimizing your group benefits really mean for your business?

This week, Ralph Weber discusses the intricacies of healthcare benefits, focusing on the Affordable Care Act’s impact on health insurance and the workplace. Ralph aims to demystify complex regulations and unveil strategies to help you cut healthcare costs. 

Key discussion points in this week’s episode include:

  • The intent and outcomes of the Affordable Care Act [01:12]
  • Understanding employer and individual mandates [02:37]
  • Navigating participation requirements and minimum contribution [08:14]
  • Differences between self-insured and fully insured plans [22:33]
  • Innovative strategies like health reimbursement arrangements (HRA) [24:43]
  • And more!

Connect with Ralph Weber: