Broken Healthcare

Hosted by Ray Kober

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103

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Jul 2026

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About the show

“Broken Healthcare” isn’t just another podcast exposing flaws in the healthcare system—it’s a movement. Hosted by the entertaining and knowledgeable Ray Kober, we pull back the curtain on the hidden forces driving up costs and making care confusing. Whether you’re an employer, an industry insider, or just someone tired of overpriced, low-quality care, we arm you with the insights to fight back. Get real stories, expert insights, and actionable solutions to take control of healthcare decisions—because better choices start with better information. Hosted on Acast. See acast.com/privacy for more information.

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July 27, 20261 hr 13 min

They Paid $600,000 for ONE Healthcare Claim. Could You Be Next? | Broken Healthcare #96

Todd Martin, Chief Sales Officer at NOVA Healthcare Administrators, joins Ray in-studio to break down what's really happening inside your health plan and why the arrangement most employers are in was never designed to protect them.Todd has 18 years in the TPA space and has seen it all. From a $600,000 radiation claim nobody caught, to a 1,200-employee company whose national broker never once mentioned reference-based pricing. He explains why a flat renewal means your carrier is making bank on your business, what private equity is doing to TPA service quality, and how an employer spending $10 million on healthcare could realistically save $2 million in year one.If you're an employer, CFO, HR Director or benefits consultant - this one's for you.📌 Subscribe for more conversations on fixing the broken healthcare system.🔗 NOVA Healthcare Administrators: novahealthcare.com📞 Todd Martin: tmartin@novahealthcare.com | 716-870-5916#BrokenHealthcare #SelfFundedHealthcare #TPA #EmployerHealthcare #CFO #HRLeaders #ReferencedBasedPricing #StopLoss #HealthcareCosts #HealthcareTransparency #NOVA #Podcast 0:00 Introduction & Welcome1:45 What Is a TPA and What Does NOVA Do?5:30 Why Large Employers Are Still Fully Insured8:00 Flat Renewals — Why Your Carrier Is Making Bank10:30 Level Funded vs Traditional Self Funded14:00 Minimum Group Sizes & Stop Loss Explained16:30 How NOVA Approaches Claims Management20:00 Reference Based Pricing — What It Is and Why It's Growing25:00 Realistic Savings Expectations — The $10M Example30:00 The $600,000 Radiation Claim Nobody Caught35:00 Pharmacy Costs — From 10% to Over 50% of Claims40:00 Why Big Box Brokers Won't Tell You About RBP45:00 The Boston Story — 1,200 Employees, Zero Options Presented50:00 Private Equity Buying TPAs — What It Means for Service55:00 The Crawl Walk Run Approach to Self Funding1:00:00 Saving $2M on Healthcare = $8M in New Sales1:05:00 How to Find a Quality TPA — Do Your Diligence1:09:00 How to Reach Todd Martin1:11:00 Final Thoughts Hosted on Acast. See acast.com/privacy for more information.

June 19, 20262 hr 8 min

Doctor Asked What The X-Ray Cost...The Answer Was Insane | Broken Healthcare #95

She billed me $902 for a two-second X-ray. The insurer pays $78. In this episode of Broken Healthcare, Ray Kober sits down with Dr. Dana Mincer DO - physician, Direct Primary Care founder, and certified yoga instructor - to break down what really happens when a doctor becomes a patient and gets the bill.Dana slipped on the ice on New Year's Eve, fractured her elbow, spent an hour in the ER, saw a PA for 7 minutes, and never met a physician. The bill? Over $3,300. She brought slides.In this episode:→ The itemized bill from Sentara Health - and what insurers actually pay for the same procedures→ Why a physician was billed who never walked into the room - and what happened when Dana called to dispute it→ How CPT billing codes work and why hospitals always bill at the highest possible level→ Why the chargemaster means the same procedure has hundreds of different prices at the same hospital→ Why most US hospital systems are for-profit organizations operating under nonprofit status→ How auto-adjudication works - and why insurance companies are blindly paying claims nobody is reviewing→ Why self-funded employers using United, Cigna or Aetna as their TPA are paying full retail. Always.→ What PREVENT Consent is and why you should know it before you ever need an ER→ How to cite EMTALA - and why it immediately changes the conversation with hospital administrators→ Why by 2035 healthcare premiums could exceed 50% of annual household income→ What Direct Primary Care actually looks like - same day appointments, your doctor's cell phone, no insurance billing→ Why Ray is now 3 months alcohol-free - and what Dana thinks about it as a physician who ran an addiction medicine centerPlus: less than 400 food additives are approved in Europe. The US has over 10,000. They get into that too.If you're an employer, a CFO, an HR Director, a patient, or just someone who has ever been shocked by a medical bill - this episode was made for you.🔗 Love Health DPC: LoveHealthDPC.com📱 Dana's Instagram: @drdanalovehealth🎙️ Subscribe to Broken Healthcare: youtube.com/@BrokenHealthcarePodcastTimestamps:0:00 Introduction & How Ray and Dana Met4:37 Ray's Magic Mushroom Experience & Sobriety9:06 Dana's Response as a Physician & Addiction Medicine13:56 The Vibroacoustic Table & Teaching the Body Calm22:06 Hospital Consolidation & Energy Medicine in Practice26:00 The Broker Problem & How Insurance Incentives Work30:11 Nonprofit Hospitals Masquerading as For-Profits33:00 Food Additives, Glyphosate & RFK Jr.50:35 Dana's New Year's Eve ER Visit - The Story Begins1:01:00 The Bill Arrives - What She Expected vs Reality1:07:00 CPT Codes Explained & How Hospitals Maximize Billing1:17:10 What Insurers Actually Pay vs What You're Billed1:23:01 The Sentara Numbers Revealed - The Real Data1:30:00 How Self-Funded Employers Pay Full Retail1:37:00 How to Challenge Your Bills & Independent Auditing1:44:00 PREVENT Consent, EMTALA & Your Patient Rights1:57:00 Direct Primary Care Explained - The Alternative2:03:50 Love Health DPC & How to Find Dana#BrokenHealthcare #DrDanaMincer #HospitalBills #HealthcareBilling #MedicalDebt #HealthcareTransparency #DirectPrimaryCare #DPC #HealthSharing #EMTALA #HealthcareCosts #CFO #EmployerHealthcare #NonprofitHospitals #PriceTransparency #Podcast Hosted on Acast. See acast.com/privacy for more information.

June 11, 202621 min

I Haven't Had a Drink in Over Two Months. Here's What Changed | Broken Healthcare Podcast #94

Yeah, this one's different.No guests. No healthcare policy. No claims data. Just me, sitting down and talking about something I've never talked about publicly before.For years, a couple of drinks at the end of the day was just part of life. Business dinners, networking, winding down. A few glasses of Don Julio. Nothing dramatic - just a quiet daily habit that, somewhere along the way, became more than I wanted it to be.A guided psilocybin journey changed that. And I haven't had a drink in over two months.I'm not a doctor. I'm not here to tell anyone what to do. This is just my story - and I'm sharing it because I think too many people, especially in business, are carrying things they don't talk about. The shame around that needs to stop.In this episode I talk about the months of preparation before the journey, what the experience actually felt like, the memories that surfaced - including seeing my dad, who passed away when I was two years old, and reliving the hardest conversation I ever had with my kids, but this time through their eyes. I talk about what changed after. The calm. The presence. The fact that I just... stopped thinking about drinking.I also talk about what my doctor said when I told him. That part stuck with me.This isn't a healthcare episode. It's a human one. If it helps one person feel less alone - that's why I recorded it.⚠️ Not medical advice. Psilocybin can be dangerous for people with certain mental health histories or on specific medications - please speak to a medical professional before considering anything like this, and check the legal status in your area.brokenhealthcarepodcast.com youtube.com/@BrokenHealthcarePodcast linkedin.com/in/raykober/#BrokenHealthcare #Psilocybin #MagicMushrooms #MentalHealth #PsychedelicTherapy #Sobriety #PersonalGrowth #RayKober #MensHealth #Healing Hosted on Acast. See acast.com/privacy for more information.

May 26, 20261 hr 3 min

$7.4 Million Found in 60 Days: How AI Is Exposing Hidden Claims Waste | Broken Healthcare #93

Your healthcare claims have an error rate of 8 to 12%. Most employers have no idea.In this episode of Broken Healthcare, Ray Kober sits down with Stephen Carrabba - CEO and Co-Founder of Claim Informatics - to break down what's really happening behind the scenes in healthcare claims, payment integrity, and fiduciary oversight.Stephen's team recently found $7.4 million in improperly paid claims for a single client. In two months. At a 10.9% error rate.And the fix isn't complicated. It just requires someone with no conflicts of interest to actually look.In this episode:→ Why 8-12% of healthcare claims are paid incorrectly→ The "sub $15,000" TPA story that should make every CFO furious→ Why the shared savings model creates perverse incentives and what Claim Informatics does differently→ How AI is being used to analyze 15,000 pages of contracts and find violations hiding in plain sight→ Why combining two clauses on page 1 and page 111 of your ASO can legally authorize spread pricing — and nobody catches it→ The fiduciary exposure every plan sponsor is carrying right now→ Why post-payment recovery gets harder over time and why prepayment is the smarter play→ What Marilyn Bartlett found when Montana finally just asked some simple questions ($113 million, as it turns out)→ Why "garbage in, garbage out" applies to AI - and why building a real system took 8 monthsIf you're an employer, CFO, HR leader, broker, TPA, or benefits consultant.. this episode will change how you think about every claim your plan has ever paid.🔗 Claim Informatics: claiminformatics.com📊 Independent assessment for employers: benefixa.com/#consult🎙️ Subscribe to Broken Healthcare: youtube.com/@BrokenHealthcarePodcastTimestamps:0:00 Why Healthcare Claims Feel Broken2:12 How Stephen Got Into the Space5:10 From Pharma Audits to Claim Informatics8:20 Why Medical Claims Are More Complex11:35 The Broker and TPA Problem14:20 What Changed After the CAA17:10 Why Data Access Matters20:20 How Claims Are Audited23:35 Prepayment vs Post-Payment27:00 Real Savings at Scale30:15 How Their Fee Model Works33:20 Why Shared Savings Creates Conflicts36:40 Independent Oversight and Fiduciary Risk40:05 Why Recovery Gets Harder Over Time43:10 How Much Money Gets Missed46:20 Why Contracts Matter49:30 The AI Layer53:05 What Employers Should Demand57:00 Final Thoughts#BrokenHealthcare #HealthcareClaims #ClaimInformatics #StephenCarrabba #PaymentIntegrity #ERISA #CAA #FiduciaryDuty #HealthcareTransparency #AIinHealthcare #EmployerBenefits #HealthcareCosts #TPA #SelfFundedHealthcare #Podcast Hosted on Acast. See acast.com/privacy for more information.

April 16, 20261 hr 34 min

From The Convent to The White House to Fixing Broken U.S. Healthcare | Broken Healthcare Podcast #92

Katy Talento joins the show in-studio to share her unique journey from religious life to advising on healthcare policy at the highest levels of government - and what she believes it will take to fix the U.S. healthcare system.With a background in epidemiology, public health, and federal policy, Katy brings rare insight shaped by her experience working in the U.S. Senate and advising on healthcare issues at the White House. Her career spans global public health work, infectious disease research, and shaping national healthcare policy that impacts employers, patients, and the broader healthcare system.In this conversation, Katy shares how her early desire to change the world led her into public health, policy, and ultimately into healthcare reform efforts in Washington. She explains how incentives inside the healthcare system influence decision-making, why meaningful reform can be difficult to achieve, and why healthcare costs continue to rise despite ongoing policy changes.We also discuss how employer-sponsored healthcare plays a central role in the U.S. system, why prevention-focused models such as Direct Primary Care (DPC) are gaining attention, and how transparency may help improve healthcare outcomes over time.Subscribe for more conversations focused on improving healthcare outcomes and fixing the broken healthcare system.#HealthcareReform #HealthPolicy #HealthcareCosts #DirectPrimaryCare #EmployerHealthcare #HealthcareInnovation #HealthcareLeadership #HealthInsurance #PublicHealth #HealthcareTransparency00:00 Intro00:23 Welcome Katy Talento01:30 Early life and desire to change the world04:30 Faith journey and decision to enter religious life08:00 Global public health work and infectious disease research12:30 Working internationally in public health16:00 Entering Washington health policy20:00 Writing healthcare legislation in the U.S. Senate24:00 How healthcare policy is shaped in Washington29:00 Speechwriting and political communications32:30 Industry influence in healthcare policy36:00 Why healthcare reform is difficult to achieve40:00 How incentives influence healthcare decisions45:00 Employer-sponsored healthcare and system complexity52:00 Insurance incentives and unintended consequences58:00 Why healthcare costs continue to rise1:05:00 Transparency and accountability in healthcare1:12:00 Direct Primary Care and prevention-focused models1:18:00 Where meaningful reform may come from1:25:00 The future of healthcare policy1:31:00 Final thoughts on fixing U.S. healthcare Hosted on Acast. See acast.com/privacy for more information.

April 9, 20261 hr 5 min

Broken Healthcare Costs, Self-Funding, Anti-BUCA & Real Reform | Broken Healthcare Podcast #91

Emma Fox joins the show in-studio to explain why healthcare costs keep rising and how incentives inside the traditional health insurance system often work against employers and patients.Drawing on her experience inside the industry, Emma breaks down how compensation structures, carrier incentives, and consolidation influence employer-sponsored healthcare decisions. She explains why more organizations are exploring self-funded health plans, independent TPAs, direct primary care, and reference-based pricing as alternatives to traditional insurance models.We also discuss how collaboration between employers, advisors, and physicians can help create more transparent healthcare strategies, and why education initiatives like Symposium are helping drive innovation across the healthcare ecosystem.If you are an employer, advisor, HR leader, or healthcare professional trying to better understand rising healthcare costs, this conversation offers practical insight into how the system works and where change may happen.Subscribe for more conversations focused on improving healthcare outcomes.#HealthcareCosts #SelfFundedHealthPlans #HealthInsurance #EmployerBenefits #HealthcareInnovation #HealthcareTransparency #DirectPrimaryCare #ReferenceBasedPricing #BenefitsStrategy #HealthcareReform #TPA #HealthcareEconomics #HealthcareLeadership #BUCAIncentives 00:00 Intro 01:10 Emma’s journey from the UK to U.S. healthcare03:00 Starting in life insurance and entering the insurance industry08:30 Understanding health insurance incentives12:00 Ethical conflicts inside traditional insurance models15:00 Advisor compensation structures and industry challenges18:00 Capitalism and healthcare economics21:00 Government influence and healthcare policy realities23:00 The employer’s role in fixing healthcare27:00 The origin of Symposium30:00 Bringing employers, advisors, vendors, and physicians together32:00 Why physicians must be part of the healthcare conversation35:00 Private equity and healthcare delivery challenges38:00 Collaboration between doctors and advisors42:00 Purpose-driven advisory models45:00 Vision for improving the healthcare system52:00 Advice for employers evaluating healthcare strategies58:00 Industry collaboration and future outlook1:04:20 How to connect with Emma Fox Hosted on Acast. See acast.com/privacy for more information.

March 26, 20261 hr 21 min

Functional Medicine, Longevity & Why Doctors Are Leaving The System | Broken Healthcare Podcast #90

Tim Organ, CEO of the Health Business Growth Collective, joins the show in-studio to discuss why the traditional healthcare system focuses on symptoms instead of root cause - and how functional medicine is changing the future of patient care.Tim shares his personal health transformation, including reducing body fat, optimising metabolic health, increasing protein intake, and improving longevity through lifestyle changes. He explains how functional medicine identifies underlying causes of illness, why regenerative therapies may reduce the need for surgery, and how practitioners are building independent health businesses outside the insurance model.We also explore AI-driven healthcare tools, preventative testing, and why the future of medicine may be more personalised, data-driven, and focused on long-term health outcomes.📌 Subscribe for more conversations on fixing the broken healthcare system.#FunctionalMedicine #Longevity #RootCause #MetabolicHealth #PreventativeHealth #RegenerativeMedicine #HealthcareInnovation #Biohacking #HealthOptimization #FutureOfHealthcare #Wellness #AIHealthcare 01:00 Tim Organ & Health Business Growth Collective 04:20 Personal health transformation & body composition changes 07:00 Protein intake, diet tracking & metabolic health 10:00 Lifestyle habits & fitness discipline 13:30 Longevity fundamentals: exercise, diet & sleep 16:30 Functional medicine vs symptom-based healthcare 20:00 Finding the root cause of chronic illness 23:00 Tim’s healthcare career journey 27:00 Digital healthcare systems & medical technology 29:30 Why practitioners are leaving insurance-based models 33:00 Challenges doctors face inside traditional healthcare 36:00 Regenerative medicine vs surgery 41:00 Why many orthopaedic procedures may be avoidable 45:00 AI in healthcare & interpreting lab data 48:30 Expanding access to functional medicine 51:00 Food systems, nutrition & chronic disease 54:00 Personal responsibility & preventative health 57:00 The future of personalised medicine 1:02:00 Business models for modern practitioners 1:07:00 Technology & data-driven health insights 1:12:00 Longevity mindset & maintaining muscle as we age 1:17:00 Final thoughts on fixing broken healthcare Hosted on Acast. See acast.com/privacy for more information.

March 11, 20261 hr 13 min

Healthcare Is Breaking — Here’s How Angle Health Plans to Fix It | Broken Healthcare Podcast #89

David Slepak & Caleb Parker (Angle Health) on fixing the broken U.S. healthcare system.Why do healthcare costs keep rising? Why do employers feel stuck? And what would it actually take to fix the experience?In this episode of Broken Healthcare, we break down what’s really driving costs, what most plans get wrong, and how smarter design + technology could reshape employer healthcare.#BrokenHealthcare #AngleHealth #HealthInsurance #EmployerBenefits #HealthcareCosts #HealthcareInnovation #AIinHealthcare #Podcast #BenefitsConsulting #HealthcareLeadership0:00 Why Healthcare Feels Broken1:02 From State Farm to Fixing Healthcare5:02 What Makes Angle Health Different7:02 Bad Benefits vs Bad Experiences11:00 The Tech + AI Advantage16:00 Why Speed Wins in Healthcare21:00 Palantir Roots & Data Strategy24:30 Why Costs Keep Exploding30:00 The Insurance Card Problem34:30 Fixing Friction in Healthcare40:00 Guiding Patients to Better Care44:00 Why Legacy Carriers Struggle49:00 Incentives That Actually Work57:00 The Truth About Pharmacy Spend59:30 Final Thoughts Hosted on Acast. See acast.com/privacy for more information.

March 6, 20261 hr 5 min

IRS Compliance Made Easy: Avoid IRS Penalties in 2-Minutes | Broken Healthcare Podcast #88

Sanju Sriram on fixing one of the most overlooked problems in business: IRS compliance.Why do so many companies miss required filings? Why are IRS forms so difficult to understand? And what would it take to simplify a system that frustrates even experienced professionals?In this episode of Broken Healthcare, Ray sits down with Sanju — CEO of Simple Tax Suite — to talk about her journey from Silicon Valley gaming engineer to building an IRS-authorised platform that has processed more than 5 million filings.🔗 Learn more: https://simple720.com/ - Use code BROKEN for 10% off#BrokenHealthcare #TaxCompliance #IRS #Fintech #HealthcareCompliance #EmployerBenefits #CFO #BusinessFinance #Startup #Podcast 0:00 Intro + Why IRS Compliance Confuses Businesses 2:05 Sanju’s Background (Gaming + Engineering Journey) 5:10 How She Got Into Tax Technology 7:15 The Moment IRS Forms Didn’t Make Sense 10:05 Partnering With the IRS 13:10 Identifying the Compliance Gap 16:00 What Businesses Get Wrong About Reporting 19:30 What Is PCORI (Explained Simply) 23:15 Who Needs to File + Deadlines 27:00 Why Companies Miss Required Filings 30:10 Paper Filing vs Electronic Reality 33:20 Avoiding Penalties & Getting It Right 37:10 Forms Explained (720, ACA, 5500, 5330) 41:45 Working With Brokers, TPAs & Employers 46:30 Small Businesses vs Enterprise Clients 50:10 AI + Automation in Compliance 54:30 The Future of Tax Compliance 58:20 Final Thoughts Hosted on Acast. See acast.com/privacy for more information.

February 18, 20261 hr 48 min

Hospital Took Payment - Then Asked for More: The Consent Court Case | Broken Healthcare Podcast #87

There is a healthcare court case unfolding right now that could have massive implications for patients, employers, and how hospital consent is interpreted across the entire system.In this critical episode of Broken Healthcare, host Ray Kober sits down with healthcare outcomes expert and Validation Institute founder Al Lewis to break down a real case involving OhioHealth, a 29-hospital system in Ohio, that is now testing how consent and payment agreements actually work in practice.In this case, treatment was provided and accepted without objection. Payment was then sent via check clearly marked as payment in full for the agreed-upon amount. The check was cashed.But the story didn’t end there.After accepting and cashing the payment, additional demands for thousands more followed — raising serious questions about how consent, financial responsibility, and patient agreements are enforced in healthcare.This case is now becoming a powerful test of how consent is used — and why patients and employers need to understand exactly what they are agreeing to.One of the most important takeaways Al shares is simple but critical:Always ask for a printed copy of anything you sign in a healthcare setting.Because consent forms often contain language that can have long-term legal and financial consequences most people never fully realize.In this episode, you’ll learn:• The OhioHealth court case and why it could impact healthcare nationwide• How hospital consent forms actually work in practice• Why accepting treatment can sometimes be interpreted as accepting consent• Why requesting printed copies of consent forms is essential• How employers may unknowingly expose themselves to significant financial risk• The mission behind Quizzify and how it helps people make smarter healthcare decisions• How the Validation Institute independently verifies healthcare solutionsMost people assume healthcare is straightforward.But the reality is far more complex.This conversation exposes how the system actually works — and why awareness is one of the most important protections you have.⚠️ This episode is essential viewing for:• Employers and benefits leaders• Healthcare executives and advisors• HR professionals• Anyone who has signed hospital paperwork• Anyone who wants to understand their rights and risks in healthcareBecause what you sign — and what you don’t question — can matter more than you think.👤 About Al LewisAl Lewis is founder of the Validation Institute and Quizzify, and one of the most respected and outspoken healthcare outcomes experts in the country. His work focuses on bringing transparency, accountability, and evidence-based validation to healthcare.🎙 About Broken HealthcareHosted by Ray Kober, Broken Healthcare explores the real drivers of healthcare costs, consent, incentives, and accountability — and brings clarity to leaders navigating one of the most complex systems in the world.No spin. Just reality.🔔 Subscribe to Broken HealthcareIf you want to understand how healthcare really works — and how to protect yourself and your organization — subscribe and turn on notifications.💬 Join the conversationHave you ever signed healthcare paperwork without fully understanding it? Hosted on Acast. See acast.com/privacy for more information.

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Broken Healthcare

About the show

Listen to episodes

They Paid $600,000 for ONE Healthcare Claim. Could You Be Next? | Broken Healthcare #96

Doctor Asked What The X-Ray Cost...The Answer Was Insane | Broken Healthcare #95

I Haven't Had a Drink in Over Two Months. Here's What Changed | Broken Healthcare Podcast #94

$7.4 Million Found in 60 Days: How AI Is Exposing Hidden Claims Waste | Broken Healthcare #93

From The Convent to The White House to Fixing Broken U.S. Healthcare | Broken Healthcare Podcast #92

Broken Healthcare Costs, Self-Funding, Anti-BUCA & Real Reform | Broken Healthcare Podcast #91

Functional Medicine, Longevity & Why Doctors Are Leaving The System | Broken Healthcare Podcast #90

Healthcare Is Breaking — Here’s How Angle Health Plans to Fix It | Broken Healthcare Podcast #89

IRS Compliance Made Easy: Avoid IRS Penalties in 2-Minutes | Broken Healthcare Podcast #88

Hospital Took Payment - Then Asked for More: The Consent Court Case | Broken Healthcare Podcast #87

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