Healthcare costs continue to rise, but many employers don’t realize how little oversight exists within their health plans. In this episode of The Benefit Whisperer , Ralph Weber speaks with healthcare advocate and claims audit expert Kimberly Carleson about why employers should take a closer look ...

In this episode of The Benefit Whisperer , Ralph Weber examines Tennessee’s proposed legislation, SB 2040 and HB 1959, aimed at preventing pharmacy benefit managers (PBMs) from owning pharmacies. An audit from the Tennessee Department of Commerce & Insurance found instances where a major PBM a...

Healthcare claim denials are not rare administrative errors. They are systemic. In the United States, approximately 850 million insurance claims are denied every year , roughly 17% of all submitted claims. Yet appeal win rates can range from 70% to 90% , raising a critical question: Why are so m...