Ralph Weber returns with Part 2 of the Healthcare History Series: The Price is WTP. This episode exposes how hospital pricing got so wildly inflated, starting with the 1929 Baylor teacher’s plan and exploding with the Medicare DRG system.
Ralph and Bill Tucker explain:
What the Chargemaster really is
Why PPO discounts are misleading
The administrative waste that’s costing $1 trillion+
Real-world data showing CT scans ranging from $635 to $19,800
💥 This is a must-listen for employers, brokers, and CFOs who want to stop feeding a system that’s rigged against them.
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
Most employers have no idea what’s really driving their skyrocketing healthcare costs, and it’s not just medical inflation. It’s the contracts they’ve already signed.
In this episode of The Benefit Whisperer, Ralph Weber sits down with Dave Chase, founder of Health Rosetta, to uncover the hidden clauses and incentives that enrich insurers, PBMs, and hospital systems at the expense of your people and your bottom line.
You’ll learn:
How one employer paid $4 million on a bill originally priced at $996,000, all because of contract loopholes
Why anti-steerage clauses prevent you from guiding employees to safer, higher-value care
How access to your own data is the single biggest predictor of plan performance
The dirty truth behind PBM rebates, offshore GPOs, and the 50+ revenue streams you never see
What it takes to cut your per employee costs by 35%, without compromising care
If you’re a CEO, CFO, HR leader, or benefits advisor ready to stop feeding a system that’s rigged against you, this is the episode to hear.
🎧 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)
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
In this must-watch episode of The Benefit Whisperer, Ralph Weber sits down with ERISA attorney Julie Selesnick to unpack one of the biggest legal stories in employee benefits: the JP Morgan healthcare lawsuit—and why it should matter to every employer and plan sponsor.
Julie brings 25+ years of legal experience and explains: ✅ What the JP Morgan case is really about ✅ Why PBMs (Pharmacy Benefit Managers) are under bipartisan fire ✅ How employers unknowingly violate fiduciary duties ✅ Why your broker might be working against your best interests ✅ What you must do now to protect your business and employees
This episode is essential for:
CFOs, HR Leaders, and Benefit Managers
Business owners with self-funded health plans
Anyone responsible for healthcare plan compliance
🎯 Learn how to safeguard your company from costly lawsuits and build a benefits plan that actually works.
🔔 Subscribe now for insider insights, unfiltered truths, and actionable strategies to reduce healthcare costs and improve employee benefits.
