ClaimTalk

Reference-based pricing has come a long way from its early days. While eye-popping savings got employers interested, RBP created enough disruption to make you wonder if the savings were worth the headaches. Then the model grew up. Jeff Kweder, president of Shepherd Insurance, and Shepherd Advisor Steven D. Goodin join Danielle Young on this episode of ClaimTalk to trace RBP’s evolution over the years. They provide firsthand insight into how it transformed from a desperate last resort into a s...

Roughly one in five medical claims is denied, yet only a fraction of patients ever appeal. Denials aren't just an administrative headache. They're becoming a barrier to necessary care in a system that makes it confusing for people to challenge the decision. On this episode of ClaimTalk, Claimable, Inc. Co-Founder and Chief AI Officer Zach Veigulis and Head of Engineering Ben Goerdt join host Danielle Young to explain how Claimable uses AI to give patients a fighting chance in a process that o...

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 ...

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, co...

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 c...