Tag: self funded insurance

Healthcare’s Black Box and a Look Inside It (Ep. 53)

Healthcare’s Black Box and a Look Inside It (Ep. 53)

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Employers are funding more of healthcare every year, but many still have limited visibility into what is actually happening inside their health plan.

In this episode of The Benefit Whisperer, Ralph Weber speaks with Dr. Hemant Gupta, a physician executive with experience in hospital medicine, physician advisory work, utilization review, informatics, and medical management.

The conversation focuses on what employers should understand about medical management, prior authorization, denials, appeals, clinical alignment, and fiduciary responsibility.

Ralph and Dr. Gupta discuss why healthcare decisions need both clear clinical logic and honest economic logic. They also explore why self-funded employers should expect greater transparency when care is delayed, denied, redirected, or appealed.

This episode is especially relevant for CEOs, CFOs, HR leaders, benefits advisors, and employers responsible for managing healthcare spend.

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

Are Captives Too Complex? Phil Holowka Says You’re Asking the WRONG Question

Are Captives Too Complex? Phil Holowka Says You’re Asking the WRONG Question

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Are captives really too complex, or are brokers just afraid you’ll start asking the right questions?

In this new episode of The Benefit Whisperer, host Ralph Weber sits down with Phil Holowka, COO of Complete Captive Management Services, to unpack the truth about group vs. single parent captives, and why most advisors aren’t telling their clients the full story.

From hidden expense loads to the illusion of control in traditional insurance arrangements, this conversation reveals how smart employers are reclaiming their healthcare spend, building their own insurance companies, and finally breaking free of the PPO hamster wheel.

🎯 Ideal for CFOs, CEOs, and benefits advisors who:

  • Want to cut waste without compromising care

  • Are tired of fully insured traps and half-baked “self-funded” solutions

  • Are ready to explore how single parent captives work, even with just 20 lives

💡 What you’ll learn:

  • The difference between governance and true control

  • Why most group captives offer limited transparency

  • How expense loads quietly drain 30–45% of your premium

  • What questions you must ask when evaluating a captive strategy

🔗 Learn more at FixMyBenefitsNow.com
📧 Ralph Weber: Ralph@thebenefitwhisperer.com | 📞 832-924-3330
🎙️ Guest: Phil Holowka | CompleteCaptive.com

Credits
Hosted by: Ralph Weber
Special Guest: Phil Holowka
Produced & Edited by: Kathrine Mowrey | GSD Consultants, LLC
Marketing & Distribution: GSD Consultants, LLC