Tag: Self-funded health plans

The Dallas Health Plan, Part 3: Take Back Control of the Money | Mark Cuban, Chris Deacon, Marilyn Bartlett (Ep. 57 – Part 3 of 3)

The Dallas Health Plan, Part 3: Take Back Control of the Money | Mark Cuban, Chris Deacon, Marilyn Bartlett (Ep. 57 – Part 3 of 3)

Subscribe to my YouTube channel for a lot more: https://www.youtube.com/@BenefitWhisperer

After examining claims visibility and the contract itself, Part 3 asks the most important question: Who should actually be responsible for managing the money?

In the final installment of our three-part series on the City of Dallas health plan, Ralph Weber is joined by Mark Cuban, Chris Deacon, and Marilyn Bartlett to move from diagnosis to possible solutions.

The discussion focuses on what active health-plan management could look like for Dallas and for other employers and public entities funding their own healthcare plans.

Mark Cuban argues that organizations need dedicated expertise capable of reviewing healthcare spending as it happens – rather than relying primarily on audits after the fact. Chris Deacon raises a broader question about how much administration and control public plans should outsource. Marilyn Bartlett brings the conversation back to a fundamental accounting principle: if an employer funds a claim, it should be able to reconcile that funding to what was actually paid.

In this episode:

  • Why healthcare spending should be treated as a major financial responsibility, not simply an HR function
  • Why Mark believes employers need dedicated health-plan expertise
  • Why managing large claims in real time may be more valuable than discovering problems later through an audit
  • The importance of preserving data, RFP, and contractual rights before claims are paid
  • Whether public employers should consider retaining more administrative capability and control
  • How AI and better technology may help – and why expertise still matters
  • Why “disruption” should not automatically be treated as a negative in healthcare
  • The basic accounting question every self-funded employer should be able to answer: Can you reconcile what you funded to what was actually paid?
  • Why long-term healthcare contracts need to account for changing requirements
  • What Mark says employers can gain by taking a more active role in managing healthcare

This is Part 3 of 3 in The Dallas Health Plan: Who’s Watching the Money?

Part 1 – Visibility: What can Dallas actually see?

Part 2 – Contracts & Incentives: What does the fine print actually permit?

Part 3 – Control: What should Dallas and other employers do about it?

Guests:

Mark Cuban – Entrepreneur and Co-Founder of Mark Cuban Cost Plus Drug Company

Chris Deacon – Healthcare attorney and former Director of the New Jersey Division of Pensions & Benefits

Marilyn Bartlett, CPA – Nationally recognized healthcare cost-containment leader and former administrator of the Montana Employee Health Plan

Host:

Ralph Weber | The Benefit Whisperer | Route Three

 

If this series has changed the way you think about healthcare purchasing, share it with a CEO, CFO, HR leader, benefits professional, public official, or anyone responsible for managing a self-funded health plan. Subscribe to my YouTube Channel as we address more in the healthcare world! https://www.youtube.com/@BenefitWhisperer/

Subscribe to my Substack: https://substack.com/@thebenefitwhisperer

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

Music licensed through Soundstripe.

Code: YTA6TLJZGWC58KTH

The Dallas Health Plan, Part 2: What’s Hiding in the Contract? | Mark Cuban, Chris Deacon, Marilyn Bartlett (Ep. 57 – Part 2 of 3)

The Dallas Health Plan, Part 2: What’s Hiding in the Contract? | Mark Cuban, Chris Deacon, Marilyn Bartlett (Ep. 57 – Part 2 of 3)

Subscribe to my YouTube Channel for a lot more:  http://www.youtube.com/@BenefitWhisperer

The headline fee is not always the whole deal. The contract determines what the employer actually agreed to.

In Part 2 of our three-part series on the City of Dallas health plan, Ralph Weber is joined by Mark Cuban, Chris Deacon, and Marilyn Bartlett to examine the contract structures, payment arrangements, fees, and incentives that employers and public plans need to understand before signing an agreement.

The discussion begins with Chris Deacon explaining why the most important provisions may not be found where an employer expects them – and why reading the fine print matters. From there, the conversation moves into large-claim management, hospital payment arrangements, PBM and ASO compensation, procurement practices, and the importance of understanding who is being paid, how they are being paid, and what authority the plan sponsor has retained.

In this episode:

  • Why contract exhibits and negotiated provisions matter
  • Why large claims should be reviewed in real time
  • The difference between an aggregate discount guarantee and what may happen on an individual high-cost claim
  • Why employers should focus on the actual price paid – not simply the percentage discount
  • How PBM and ASO compensation can affect incentives
  • What Chris Deacon learned from New Jersey’s procurement approach
  • Why Mark Cuban believes vendors should be paid for the services they actually provide
  • How RFP design can shape the outcome before negotiations even begin
  • Why employers should understand prior authorization, denials, related entities, and potential conflicts
  • Why Marilyn Bartlett says plan sponsors cannot simply sign the contract and walk away

The episode closes with a basic but powerful reminder:

It’s your money.

If an employer or public entity is funding the health plan, it should understand the contract, the incentives, the payment flows, and the rights it has retained.

This is Part 2 of 3:

Part 1 – Visibility: What can Dallas actually see?
Part 2 – Contracts & Incentives: What does the fine print actually permit?
Part 3 – Control: What should Dallas and other employers do about it?

Guests:
Mark Cuban – Entrepreneur and Co-Founder of Mark Cuban Cost Plus Drug Company
Chris Deacon – Healthcare attorney and former Director of the New Jersey Division of Pensions & Benefits
Marilyn Bartlett, CPA – Nationally recognized healthcare cost-containment leader and former administrator of the Montana Employee Health Plan

Host: Ralph Weber | The Benefit Whisperer | Route Three

Subscribe for Part 3, where the conversation turns from identifying the problems to what Dallas – and other employers – can actually do differently.
Subscribe to my YouTube Channel:  http://www.youtube.com/@BenefitWhisperer

Music licensed through Soundstripe.
Code: YTA6TLJZGWC58KTH

The Dallas Health Plan, Part 1: 99% Accurate – – But 99% of What? | Mark Cuban, Chris Deacon, Marilyn Bartlett (Ep. 57 – Part 1 of 3)

The Dallas Health Plan, Part 1: 99% Accurate – – But 99% of What? | Mark Cuban, Chris Deacon, Marilyn Bartlett (Ep. 57 – Part 1 of 3)


Subscribe to my YouTube Channel for a lot more: http://www.youtube.com/@BenefitWhisperer

The City of Dallas is facing rising healthcare costs and the possibility of higher costs or reduced benefits for employees. 
But before making those decisions, there’s a more fundamental question: 

Can the people paying the bills actually see and verify what they’re paying for? 

In Part 1 of this special three-part series of The Benefit Whisperer, Ralph Weber is joined by Mark Cuban, Chris Deacon, and Marilyn Bartlett 
to examine the City of Dallas health plan through the lens of claims visibility, audit rights, contract accountability, and active health-plan management. 

The conversation explores: 

• What does a “99% claims accuracy rate” actually measure? 
• Why claim-count accuracy and claim-dollar accuracy are very different 
• What Mark Cuban found after obtaining and reviewing the Dallas health-plan contract 
• Whether limiting an audit to a small number of claims gives a plan meaningful oversight 
• Why employers need access to their underlying claims data 
• How Marilyn Bartlett approached claims, banking, and large-case management in Montana 
• Why Chris Deacon believes employers must look beyond headline administrative fees and examine the actual contract terms 
• Why Mark argues healthcare needs to be managed like any other major business expense 

One of the central questions in this episode is simple: 

Before asking employees to pay more, shouldn’t the organization funding the health plan know exactly where the money is going? 

This is Part 1 of 3. 
Part 1: What Dallas Can’t See - and Why That Matters 
Part 2: What’s Buried in the Contract and Incentives 
Part 3: How Dallas - and Other Employers - Take Back Control 

Subscribe for Parts 2 and 3: Subscribe to my YouTube Channel and watch the video podcast!

Guests: 
Mark Cuban - Entrepreneur and Co-Founder of Mark Cuban Cost Plus Drug Company 
Chris Deacon - Healthcare attorney and former Director of the New Jersey Division of Pensions & Benefits 
Marilyn Bartlett, CPA - Nationally recognized healthcare cost-containment leader and former administrator of the Montana Employee Health Plan 

Host: 
Ralph Weber | The Benefit Whisperer | Route Three
AI: Faster MISTAKES, Faster INFLATION (Ep. 51)

AI: Faster MISTAKES, Faster INFLATION (Ep. 51)

Healthcare isn’t broken, it’s optimized to extract.

In this episode of The Benefit Whisperer, Ralph Weber sits down with Dave Chase to expose what’s really happening behind employer-sponsored healthcare.

From hidden contract clauses to billion-dollar middlemen, this conversation pulls back the curtain on a system that rewards complexity, not outcomes.

They cover:

  • Why AI could accelerate bad decisions in healthcare
  • How billing games turn millions into tens of millions
  • The role of middlemen—and why they keep winning
  • What employer-led models could look like instead

If you’re an employer, CFO, or HR leader, this isn’t theoretical. This is your money.

Subscribe for more conversations that challenge how healthcare actually works.

Ralph Weber Host, The Benefit Whisperer: Schedule a FREE Consultation

🌐 https://mybenefitssuck.com

📧ralph@thebenefitwhisperer.com

Special Guest: Dave Chase

https://www.linkedin.com/in/chasedave/

“This Should Be Illegal,” Mark Cuban on U.S. Healthcare (Ep. 49)

“This Should Be Illegal,” Mark Cuban on U.S. Healthcare (Ep. 49)

Episode Overview

In this episode of The Benefit Whisperer, Ralph Weber sits down with Mark Cuban, David Scheinker, and Dr. Kevin Schulman to expose how healthcare pricing really works in the United States.

This is not theory.

It’s a direct look at:

  • Facility fees
  • 340B program dynamics
  • Insurance-driven pricing
  • And why patients and employers rarely know what they’ll pay

At one point, Cuban compares healthcare billing to:

Charging $3 for a beer… and $5,000 for the cup.

Key Topics 

Healthcare Pricing & Transparency

  • Why medical pricing is often unknown until after care
  • How contracts define process, not actual payment amounts

Insurance & Incentives

  • How insurers and intermediaries profit from complexity
  • Why delays, denials, and negotiations are built into the system

Hospital Revenue Models

  • The role of facility fees in cost inflation
  • How programs like 340B influence pricing behavior

Employer Impact

  • Why employers are funding the system, but lack visibility and control
  • The disconnect between plan design and actual outcomes

Potential Solutions

  • Direct contracting models
  • Transparent pricing strategies
  • Simplified, digitally defined agreements

Key Takeaway 

The U.S. healthcare system is not unpredictable by accident. It’s structured in a way where complexity and lack of transparency directly support revenue generation.

Guests & Contact Information

Ralph Weber
Host, The Benefit Whisperer
🌐 https://mybenefitssuck.com

📧ralph@thebenefitwhisperer.com

Mark Cuban
Founder, Cost Plus Drugs
📧 mark@costplusdrugs.com

Dr. David Scheinker
Executive Director of Systems Design and Collaborative Research, Stanford Lucile Packard Children’s Hospital
Founder & Director, SURF (Stanford Medicine)
🌐www.surf.stanford.edu

📧 www.linkedin.com/in/david-scheinker/

Kevin Schulman
Professor of Medicine and Health Policy, Stanford University
Faculty Director, Stanford Clinical Excellence Research Center
📧 kevin.schulman@stanford.edu

Produced by Kathrine Mowrey (Content & Distribution)

The “OpenTable for Doctors” That’s Breaking Healthcare (Ep. 47)

The “OpenTable for Doctors” That’s Breaking Healthcare (Ep. 47)

Dr. Paula Muto, founder of UberDoc, joins Ralph Weber to discuss how direct-pay healthcare is transforming specialist access. By removing insurance barriers, patients gain faster access to care with transparent pricing. This episode explores how employers can reduce costs, improve access, and rethink traditional benefits strategies through models like the Direct Pay Option (DPO).

If you’re an employer, broker, or advisor tired of the PPO hamster wheel, this conversation will challenge how you think about healthcare delivery.

Guest: Dr. Paula Muto LinkedIn: linkedin.com/in/paulamutomd/

Host: Ralph Weber • ralph@thebenefitwhisperer.com

Phone: (832) 924-3330

Website: fixmybenefitsnow.com

Schedule a FREE consultation with Ralph: bit.ly/4i93SLR

 

Blind Trust in Healthcare Is Costing Employers Millions (Ep. 45)

Blind Trust in Healthcare Is Costing Employers Millions (Ep. 45)

Healthcare costs continue to rise, but many employers don’t realize how little oversight exists within their health plans.

In this episode of The Benefit Whisperer, Ralph Weber speaks with healthcare advocate and claims audit expert Kimberly Carleson about why employers should take a closer look at their healthcare claims.

Kimberly’s journey into healthcare advocacy began when her husband was diagnosed with stage-four metastatic bladder cancer. Doctors told her he had two years to live. Instead of accepting that prognosis, she sought second opinions and pushed for treatment.

Nineteen years later, her husband is still alive.

That experience opened her eyes to deeper problems in the healthcare system.

Today Kimberly works with employers to audit claims, uncover billing errors, and help plans regain control of their healthcare spending.

In this episode they discuss:

  • Why most healthcare claims go unchecked
    • The billing patterns that appear again and again
    • Why employers often don’t control their own data
    • How contracts can prevent oversight
    • What employers can do to regain control

This conversation highlights an uncomfortable truth: oversight in healthcare plans is often missing.

And employers are the ones paying the price.

​​​​​Ralph Weber
The Benefit Whisperer
www.thebenefitwhisperer.com
ralph@thebenefitwhisperer.com
(832) 924-3330

Schedule a FREE Consultation

How to Appeal the 850 Million Claims that are Rejected Every Year and Win 70 to 90% of the Time (Ep. 44)

How to Appeal the 850 Million Claims that are Rejected Every Year and Win 70 to 90% of the Time (Ep. 44)

Healthcare claim denials are not rare administrative errors. They are systemic.

In the United States, approximately 850 million insurance claims are denied every year, roughly 17% of all submitted claims. Yet appeal win rates can range from 70% to 90%, raising a critical question:

Why are so many claims denied in the first place?

In this episode, Ralph Weber speaks with physician and Claimable co-founder Warris Bokhari about:

  • The economics behind insurance claim denials
  • The “98% of eligible claims” narrative, and what it leaves out
  • AI-driven denial systems and automated claim edits
  • Employer liability under ERISA for denied claims
  • Transplant, oncology, and specialty drug denial cases
  • The impact of 200–600 day payment delays on hospitals
  • How patients and employers can respond effectively

They discuss how insurance denials affect patients, employers, providers, and the broader healthcare system, and why appeals succeed at such a high rate when properly constructed.

For employers sponsoring self-funded health plans, this episode is a critical reminder: you are legally responsible for the decisions made on behalf of your plan.

For patients, it offers practical insight into how to push back, and win.

Ralph Weber, The Benefit Whisperer
Share with a colleague. Email ralph@thebenefitwhisperer.com · (832) 924-3330 · fixmybenefitsnow.com · Schedule a free 15 minute consultation

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)

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

 

Chris Deacon: $2B Scam Broker Kickbacks & PBM Profits Fiduciary Duties Exposed (Ep. 27)

Chris Deacon: $2B Scam Broker Kickbacks & PBM Profits Fiduciary Duties Exposed (Ep. 27)

Guest: Chris Deacon, author of The Great American Healthcare Heist and former Director of Health Benefits, State of New Jersey.

Chris joins Ralph Weber to reveal how her team saved $2 billion, including $400M annually on pharmacy spend, by exposing PBM shell games, fixing contracts, and enforcing fiduciary duty.

📌 Topics:

  • How much waste is really in your health plan (30–40%)
  • Reverse auctions and pass-through PBMs explained
  • Why discount guarantees are often a scam
  • Contract terms every plan sponsor should demand

🎧 Listen now to understand how to stop paying for other people’s profits.

📘 Buy the book: The Great American Healthcare Heist

 🔗 Connect with Chris:https://www.linkedin.com/in/cdeaconc/

📬 Questions? ralph@thebenefitwhisperer.com · fixmybenefitsnow.com