ClaimTalk

Hosted by ClaimDOC

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Episodes

Latest episode

Jul 2026

Language

EN-US

About the show

Welcome to ClaimTalk, the official ClaimDOC podcast, where we dive deep into the complex world of unbundled health plans. Together with industry experts, we'll pull back the curtain on a wide variety of cost containment topics. We'll provide listeners with a lot of information with a few shenanigans along the way.

Listen to episodes

28 recent

July 31, 202640 min

Claimable: Taking on the Confusing World of Denials | Ep. 26

Medical claim denials are necessary to protect plan dollars from abuse, but for patients they can mean delayed treatment, financial hardship and life-altering uncertainty. On Episode 26 of ClaimTalk, we welcome Zach Veigulis, co-founder and Chief AI Officer of Claimable, an AI-powered medical claims appeal platform. Zach visits with ClaimDOC President Bruce Hansen, SVP and Chief Legal Officer Amy Pelligren, and host Danielle Young about why most denied claims go unchallenged, how the appeals process stacks the deck against patients and what happens when people are left to fight the system alone. The discussion examines common denial practices and highlights the growing need for transparency, accountability and member advocacy in health insurance.

June 26, 202627 min

Health Insurance Is a Mess; How'd We Get Here? – Part 2 | Ep. 25

Can the problems with health insurance actually be fixed? In Part 2 of this ClaimTalk conversation, CEO Ben Krambeck, Vice President of Provider Relations Brad Hansen and Vice President of Audit Services Cynthia Swanson continue unpacking how we got here — and what it will take to change course. Building on Part 1, they explore with host Danielle Young how well-intentioned innovation, shifting demographics and policy decisions have combined to create a system that’s increasingly expensive, complex and unsustainable for employer health plans. More importantly, they move beyond diagnosis to discuss what a path forward could look like. They address the unexpected negative impact of consumer transparency rules, the role of legislation and skyrocketing pharmacy costs.

May 29, 202633 min

Health Insurance Is a Mess; How’d We Get Here? – Part 1 | Ep. 24

Purchasing healthcare didn’t become this complicated overnight. So how did we get here? Our industry experts — CEO Ben Krambeck, Vice President of Provider Relations Brad Hansen and Vice President of Audit Services Cynthia Swanson — join Danielle Young on a new ClaimTalk to trace the policy decisions, reimbursement shifts and billing changes that helped create today’s health insurance mess. From the Affordable Care Act to questionable billing practices to the coding complexity still driving costs and confusion, their conversation breaks down how the system changed — and how understanding that history can lead to better decisions for employer health plans.

April 17, 202623 min

How Dual Option Turned an RBP Skeptic Into an Advocate | Ep. 23

Convincing consultants to bring reference‑based pricing to clients isn’t easy. Paul Saunders, executive vice president at Saunders & Company, knows firsthand as someone who once was "totally opposed" to RBP. That changed when he saw how a dual‑option approach could work: pairing a traditional health plan with a lower‑cost RBP option and letting members choose what fits them best. In this month's episode of ClaimTalk, Saunders joins ClaimDOC’s Omar Arif and Stephanie Mohr to explore how dual‑option plans help brokers address rising renewal costs without forcing employers into an all‑or‑nothing decision. They explore why offering choice may be the most practical path to affordability, client confidence and long‑term satisfaction.

March 6, 202637 min

Good TPAs – They Do Exist | Ep. 22

Who's a good third-party administrator? There are many to choose from, but far fewer that consistently deliver when it matters. And the difference between a good TPA and a mediocre one often determines whether a health plan works exceptionally well or frustrates everyone it touches. Our last two episodes of ClaimTalk weren't kind to TPAs. While much of that criticism was earned, the reality is that TPAs operate in a landscape that is complex, constrained and often misunderstood. On this episode, Luke Schafer of BRMS joins Danielle Young, Shay Butler and Dallas Lovell to discuss why the strongest TPAs are the ones that stay in their lanes and are laser-focused on their primary responsibility — paying claims.

January 29, 202640 min

The Search for a Good TPA — Part 2 | Ep. 21

Selecting the right vendors for a reference-based pricing health plan isn’t an exact science. At the end of the day, it often comes down to experience, discernment, and the ability to read the signals vendors give off long before the contract is signed. In this episode of ClaimTalk, Emma Fox, CHVA joins Danielle Young, Bruce Hansen and Stephanie Mohr to continue their unapologetically candid examination of vendor dynamics to offer pointed insights on evaluating partners that can make or break a self-funded strategy. They break down what truly constitutes “good” and “bad” vendor vibes, define what real competency actually looks like, and outline how to identify red flags before they turn into costly mistakes. If you’re serious about elevating your self-funded health plan performance, this conversation cuts through the noise and shows you what to look for, because not every vendor deserves a seat at your table.

December 12, 202538 min

The Search for a Good TPA — Part 1 | Ep. 20

Building a successful self-funded health plan demands skilled and efficient vendor partners that have the expertise to deliver on their promises. Identifying the best vendors can be challenging, and settling for substandard partners can lead to less-than-desirable outcomes. But how do you find the best partners? On this episode of ClaimTalk, Emma Fox, CHVA gets brutally honest during the first half of a two-part conversation with Danielle Young, Bruce Hansen and Stephanie Mohr on the struggles that can arise with vendors. While a good portion of the discussion centers on the issues they've experienced with third-party administrators, they also discuss why it can be difficult to find the right partners, the strategies they use to identify dependable vendors, and why some of the most unreliable vendors continue to survive in the industry.

October 23, 202531 min

Why RBP Success Starts With HR | Ep. 19

In 2022, Featherlite Trailers partnered with ClaimDOC to begin implementing a new reference-based pricing health plan for its employees. It's no secret that moving to an RBP plan can come with friction but, with Shannon Westin, SHRM-SCP leading its human resources department, Featherlite didn't just endure the change, they owned it. Westin joins Danielle Young and Amy Hansen on ClaimTalk this month to share how taking the time to truly understand the plan and being proactive in resolving potential issues caused watercooler talk to shift from uncertainty to appreciation.

September 19, 202540 min

Vetting Your Vendors' Cyber Vulnerability | Ep. 18

If your organization sponsors a self-funded health plan and cybersecurity isn’t part of your vendor evaluation criteria, it’s time to reassess. Protecting your own infrastructure is essential, but it’s not enough. Every vendor with access to your data must meet rigorous cybersecurity standards. Otherwise, you're not just accepting risk, you're creating it. In this episode of ClaimTalk, Andrew Smith and Jeremy Schuller share with Danielle Young some of the threat tactics that cybercriminals are using today and discuss best practices in evaluating vendors to ensure your data will be secure.

August 29, 202543 min

Making Sense of Cash Pay | Ep. 17

Paying cash for healthcare services is not a new concept, but it's also an option that is not widely used. The reason for that is because many providers prefer to accept reimbursement from insurance. But cash pay does have its advantages. On this episode of ClaimTalk, Danielle Young visits with Amy Pellegrin and Leah DeBartolo about the pros and cons of cash pay, how health plans can create service around cash pay, and what stands in the way of cash becoming a more popular payment option for healthcare.