In this eye-opening episode, Emma Fox and David Contorno dive deep into the often-overlooked mechanisms that drive healthcare costs higher year after year. Emma shares her viral LinkedIn post about being "anti-BUCA" (Blue Cross, United, Cigna, Aetna) and the heated debate that followed. The conversation unveils the truth behind medical loss ratios, pre-certification practices, and the intricate systems that benefit insurers at the expense of employers and employees. Tune in to understand why challenging the status quo is essential for creating fair and transparent health plans.

TIMESTAMPS

[01.22] The anti-BUCA (Blue Cross, United, Cigna, Aetna) stance

[04.42] David explains how pre-certification is used to control care and ensure claims go up

[10.36] Discussed an article about Aetna's former medical director ignoring patient records

[11.15] Correlation between premium increases and carrier stock prices

[16.43] Higher standards their plans are held to compared to traditional carriers

[19.19] History and purpose of pre-certification in healthcare

[24.27]Story of a physician-owned hospital system preferring non-BUCA payers

[28.47 The role of doctors in current healthcare system

QUOTES:

• "None of this is by accident. When I meet with employers and we talk about how we build health plans, we talk about medical management... the initial decisions are made by largely non-clinical administrative people who are following a series of checkboxes." -Emma Fox
• "You know, carriers put out messages that they provide great care, that they want costs to be lower, that they want to control costs, but that's not how they operate." -David Contorno
• "I feel like when I come in with the plan that I have demonstrated is higher quality going to lower out of pocket, it's going to save the money. I'm held to a much higher standard than Blue Cross and United is." -David Contorno

SOCIAL MEDIA LINKS

David Contorno

LinkedIn: https://www.linkedin.com/in/dcontorno/

Emma Fox

LinkedIn: https://www.linkedin.com/in/emmamariefox/

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

Mixed & Edited by Next Day Podcast

info@nextdaypodcast.com