Take Two: EP433: The Mystery of the Weekly Claims Wire, With Justin Leader

An episode of the Relentless Health Value podcast, hosted by Stacey Richter, titled "Take Two: EP433: The Mystery of the Weekly Claims Wire, With Justin Leader" was published on June 5, 2025 and runs 38 minutes.

June 5, 2025 ·38m · Relentless Health Value

0:00 / 0:00

Episode Description

Stacey Richter has a second take on the original episode 433 since it is so relevant right now. Stacey engages in a compelling conversation with Justin Leader, CEO of BenefitsDNA, about the opaque practices of third-party administrators (TPAs) and their impact on healthcare costs.

They discuss the hidden fees tucked into weekly claims wires, including shared savings fees, prior authorization fees, prepayment integrity fees, pay and chase fees, and TPA adjudication fees.

The episode emphasizes the need for transparency, understanding hidden costs, and ensuring fiduciary responsibility for self-funded employers. Additionally, Leader shares insights from a Health Affairs article and mentions ongoing legal cases that highlight the financial discrepancies in TPA practices.

=== LINKS ===

🔗 Show Notes with all mentioned links:

https://relentlesshealthvalue.com/episodes

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter:

https://relentlesshealthvalue.com/join-the-relentless-tribe

🫙 Support the podcast with a small donation to the Tip Jar:

https://relentlesshealthvalue.com/join-the-relentless-tribe

🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b

📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue

=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/

✭ Threads https://www.threads.net/@relentlesshealthvalue/

✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social

✭ X https://twitter.com/relentleshealth/

06:32 EP457 with Cynthia Fisher.

06:56 How is the claims wire typically explained to a plan sponsor?

10:49 What is the whole point of self-funding?

10:58 Why is it so vital to understand what you're paying for?

11:53 What are the five "buried" items that wind up in these claims wires?

12:12 What is a shared savings fee?

16:14 "Rates are important, but so are your rights."

20:13 What's going on with prior auth fees?

22:44 What is prepayment integrity?

27:29 What is pay and chase?

28:46 EP428 with Julie Selesnick.

30:58 What is a TPA claim review?

33:21 EP285 with Dawn Cornelis.

34:16 EP379 with AJ Loiacono.

34:45 Is there medical claim spread pricing?

Share this episode

Similar Episodes

Act Like an Overcomer

Apr 11, 2026 ·37m

Inclusion and Fear of Rejection

Apr 4, 2026 ·42m

We Can Experience Renewal

Mar 28, 2026 ·48m

Dr. Sarah Gothard Discusses AI

Mar 21, 2026 ·64m

Is God Punishing Us When We Suffer

Mar 14, 2026 ·44m

Relentless Truth Extra-2-The Gospel Explained in Clear Terms

Mar 10, 2026 ·16m

Similar Podcasts

Heart Mending Mentor Bold Brave TV “There was a whole different world outside of the bubble I grew up in! Thank goodness I found it!” ~Calynda TriffoEveryone has a story...Calynda was raised in a large family, excelled in school, started in the corporate world in her early twenties and became a single mom of two. Being responsible for two children meant she had to do double duty... it eventually caught up to her. Battling debilitating anxiety disorder and panic attacks became a daily reality. Searching relentlessly for solutions only led her to medication that made her feel numb. At 36, life looked bleak, with little hope.In 2009, everything went wrong. Deaths, failing career, declining health, lost relationships, accidents and depreciating finances were all challenges she was facing in addition to her diagnosis. Her insides felt like they were going to explode with her digestive system not working properly. Funerals were the new family gathering and she finally collapsed after losing Relentless Truth with John Warren John Warren John extracts the truth from a wide range of topics revealing who God is, who we are and how we relate to each other. For the Culture Relentless Love For the Culture is a podcast brought to you by Relentless Love where we discuss Black history, Black life and Black liberation. If you’re looking for resources for the movement, or how to better understand how lessons from the past can shape our future, this show is for you! Erosion Lon S. Cohen In this podiobook: Canyon Park is bowed down under a relentless torrent of rain. The fields are flooded, the bridges crumble and the increasingly isolated town is host to a serial killer with a grudge against the wealthy Lollo family. Slipping between a small cast of characters; the killer, the tortured policeman hiding a dark secret, the returning son, the inquisitive librarian, the boy caught between cultures.... each of these marred, struggling humans a part of the threadbare fabric of the town. Throughout the story, secrets and motivations are slowly revealed, people continue to die, and it continues to rain. - Emily from POD PeopleThe story is about a Native American, driven to madness by his experience growing up in the small upstate New York town of Canyon Park being discriminated, molested and ostracized. In his mind, various characters of his tribe's mythology and American popular culture vie for his soul. He terrorizes the residents of Canyon Park, murdering those he judges g

URL copied to clipboard!