Care Beyond Code

In this episode of Care Beyond Code, we're joined by Alberta Manga and Miranda Buder from Custom Design Benefits. They discuss how their unique in-house medical management and patient advocacy teams use data to predict and prevent high-risk hospital admissions.Listen as they share two high-impact stories of real people navigating difficult diagnoses. Learn how Custom Design Benefits secured a single case agreement for out-of-network cancer care in just three hours to avoid surprise billing. Then, hear how they guided a patient through post-discharge financial anxiety by securing community resources and setting up a hospital payment plan.What you will learn:-- How in-house case management eliminates lagging data transfers to assist members immediately.-- Why looking at the social determinants of health is crucial for a successful patient recovery.-- How three-way calls can help laymen navigate complex hospital financial conversations.00:00 Welcome to Care Beyond Code00:46 Introduction to Custom Design Benefits01:45 The Advantage of In-House Medical Management03:21 Predicting and Preventing Future Health Crises05:04 Addressing Social Determinants of Health06:44 Story 1: A Testicular Cancer Diagnosis08:28 Securing an Out-of-Network Single Case Agreement11:15 Resolving Patient Frustration in Just Three Hours15:04 Building Long-Term Trust with Patients16:25 Story 2: Recovering from a Ruptured Appendix17:27 Providing Community Resources for Financial Anxiety20:44 Navigating Hospital Payment Plans via Three-Way Calls22:24 The Importance of Compassionate Healthcare Learn more about VBA's solutions for TPAs and health plans at vbasoftware.com. Don't forget to subscribe for more insights into the future of healthcare tech.

In this episode of Care Beyond Code, we sit down with Todd Archer, President of Concierge TPA (CTPA), to discuss how technology is injecting more humanity into healthcare administration. We explore how his team leverages hospital bill reviews and the 501(r) tax code to assist vulnerable members on limited benefit plans.What you’ll learn:-- How a life-changing wrist surgery bill was successfully reduced to zero.-- The unique financial challenges faced by workers with limited or no benefits.-- How modern technology connects electronic medical records to hidden financial assistance.-- The future of on-demand communication and AI in the health insurance space.If you found this story inspiring, be sure to subscribe to our channel for more examples of care above and beyond the code!00:00 Introduction to Care Beyond Code01:19 Meet Todd Archer and Concierge02:10 Serving the Underserved04:08 Traditional TPA Practices06:26 Setting the Stage for an $80k Bill08:20 Understanding Hospital Bill Reviews09:15 The Power of Section 501(r)11:54 Erasing an $80,000 Debt13:08 Automating Patient Outreach15:27 Leveraging Electronic Medical Records19:08 The Human Impact of Zero Debt20:56 Navigating Hospital Relationships23:51 The Future of AI in Insurance26:07 Keeping the Human TouchLearn more about VBA's solutions for TPAs and health plans at vbasoftware.com. Don't forget to subscribe for more insights into the future of healthcare tech.

What happens when a pharmacy system denies a prescription for a sick patient? Or when a member battling a serious illness is buried under a mountain of confusing medical bills? In healthcare administration, code and software can only do so much. Sometimes, you just need a human to pick up the phone.In this episode of Care Beyond Code, we sit down with Mike Castleberry, CRO of Consociate Health, to discuss the critical balance between operational efficiency and human empathy. Mike shares two powerful stories from the front lines of benefits administration that prove why the "old school" method of personal advocacy is still the most effective way to solve complex member problems.In this episode, we cover:The Pharmacy Glitch: Why simple prescriptions get denied and the manual intervention required to fix it.The "Big Stuff": How TPAs can relieve the administrative burden for members facing catastrophic health events.Balance Billing: The specific steps administrators take to reconcile provider bills so members don't pay what they don't owe.AI vs. Humans: Why technology should handle eligibility, but humans must handle the care.00:00 Introduction: The Spectrum of Life00:53 Meet Mike Castleberry & Consociate01:49 Story 1: The Prescription Problem07:11 Why the System Breaks at the Pharmacy Counter10:04 The Value of "Old School" Communication12:08 Story 2: When Medical Bills Stack Up17:43 Resolving Balance Billing Issues20:59 The Future of AI in Benefits Administration24:52 Conclusion: Instituting Care Beyond CodeLearn more about VBA's solutions for TPAs and health plans at vbasoftware.com. Don't forget to subscribe for more insights into the future of healthcare tech.

The TPA world is moving faster than ever. What happens when legacy systems can no longer keep up with the demand for real-time data, complex integrations, and AI?In this episode of Care Beyond Code: VBA's SVP of Engineering Matt Salerno, and Allegiance President & CEO Stephen Tahta, pull back the curtain on the massive tech modernization happening right now. They break down the critical shift from on-prem "Old Faithful" systems to scalable, resilient, and secure cloud platforms that are ready for the future.What you'll learn:-- What is an API? Plus, an "airport" analogy for healthcare data.-- Why APIs are the "connective tissue" for real-time care.-- How AI is actually being used (Hint: It's not replacing humans).-- A look at VBA's new AI tools: Project Oscar & Project Stormbreaker.00:00 Introduction01:15 The Modern TPA Landscape03:56 Stephen's "Airport" Analogy06:48 The Challenge of "Old Faithful"08:06 The Drivers for Modernization09:52 Why Move to the Cloud?12:14 The Real Speed of the Cloud15:43 What is an API? (The Restaurant Analogy)18:42 APIs as "Connective Tissue"21:51 How VBA Approaches AI25:30 VBA's AI Projects: Oscar & Stormbreaker27:12 AI Frees Humans for Human Work29:51 Predictive Insights with AI31:50 Conclusion: Complexity vs. InnovationLearn more about VBA's solutions for TPAs and health plans at vbasoftware.com. Don't forget to subscribe for more insights into the future of healthcare tech.#HealthcareTechnology #TPA #DigitalTransformation

Can a health insurance denial actually save a life? In this powerful episode of Care Beyond Code, that's exactly what happened.Jessica Vander Zanden, SVP of Operations and Member Experience at Network Health , shares the incredible true story of how a "mission moment" and a culture of human-centric care transformed a routine denial into a life-saving diagnosis. She explains how Network Health's physician-owned foundation empowers its case managers to become true member advocates, going far beyond the transactional lines of code .In this episode, you'll learn:-- The unforgettable story of a denial that led to a critical cancer diagnosis.-- How to operationally scale empathy and achieve high employee retention .-- How Network Health balances AI and new technology with a human-first member experience .-- What the future of best-in-class member experience will look like.00:00 Welcome to Care Beyond Code00:47 Network Health's Mission Moments01:53 Why Focus on the Human Side?03:02 A Leader Says "Healthcare Sucks"05:20 Getting the Real Stories Out06:38 The Story: A Life-Saving Denial09:24 How Denials Are Usually Handled10:45 Coaching the Member to Advocate12:48 The Diagnosis: Metastatic Cancer14:21 Staying Connected Through Treatment15:54 The Member's Thank You Letter19:22 How to Scale Human Empathy22:43 Marrying Data and AI with Humans26:11 Future of Member Experience28:18 Making Healthcare "Suck Less"VBA helps payers, TPAs, and health plans build the flexible solutions needed to create their own moments of "Care Beyond Code." Learn more at vbasoftware.com.#CareBeyondCode #MemberExperience #HealthTech