Healthcare reform champion, Justin Leader, is the founder of Benefits DNA. Leader, known for his relentless pursuit of transparency and equity in healthcare, shares his personal drive stemming from his Aunt Gwen's tragic healthcare journey. Despite facing America's healthcare challenges firsthand, including high deductibles and inaccessible treatments, Leader is on a mission to overhaul the system—one plan at a time. His approach focuses on compliance oversight, cost mitigation strategies, and advocating for patients' rights, aiming to dismantle the misaligned incentives plaguing the industry.

Justin's work is more than just business; it's a passion fueled by stories of injustice and a desire for reform. He underscores the necessity of understanding healthcare rights, advocating for legislative transparency, and educating both providers and recipients on navigating the complex system. The podcast illuminates the dark corners of the healthcare system, revealing a landscape rife with overcharging, lack of accountability, and a dire need for change. Leader's commitment to reform is evident in his fight against systemic inertia, advocating for patient-centric approaches that prioritize health over profit.

Want to learn more about Justin Leader's work? Check out their website at https://www.benefitsdna.com/.

Connect with Justin Leader on LinkedIn at https://www.linkedin.com/in/justindonaldleader/.

Key Points with Timestamps

• (00:01:57-00:04:03) Justin Leader's motivation driven by personal and observed injustices in healthcare.
• (00:04:03-00:06:12) The impactful story of Aunt Gwen, illustrating the flaws in healthcare.
• (00:06:12-00:08:43) Discussion on healthcare transparency, legislative action, and advocacy.
• (00:07:16-00:09:00) Craig Andrews recounts his experience with remdesivir and kidney failure.
• (00:08:43-00:10:03) Justin Leader on the misaligned incentives in healthcare.
• (00:10:03-00:10:31) Justin Leader emphasizes the disconnect between healthcare policy and public experience.
• (00:10:31-00:11:10) Discussion on direct marketing of pharmaceuticals and lack of price regulation.
• (00:11:10-00:13:10) Justin Leader shares his punk rock influences and how they relate to his mission in healthcare.
• (00:13:21-00:18:07) Exploration of misaligned incentives and transparency in healthcare with real-world examples.
• (00:18:07-00:19:09) Benefits DNA's approach to healthcare reform and transparency.
• (00:19:17-00:20:17) Craig Andrews and Justin Leader discuss the power dynamics in healthcare and pharmaceutical advertising.
• (00:20:28-00:21:39) A father's plea for help with his son's medical treatment highlights systemic flaws.
• (00:21:39-00:25:03) Justin Leader on the importance of questioning and improving healthcare systems.
• (00:25:34-00:29:47) Benefits of direct contracting and patient advocacy illustrated through personal stories.
• (00:28:34-00:29:47) The impact of legislative action on hospital transparency and healthcare costs.
• (00:29:47-00:31:15) Discussion on challenges and backlash faced by Benefits DNA in advocating for healthcare reform.
• (00:32:34-00:37:17) The critical role of Benefits DNA in educating employers and advocating for better healthcare plans.
• (00:37:17-00:39:57) Conclusion and how to connect with Justin Leader and Craig Andrews for further insights.

Transcript

00;00;00;00 - 00;00;30;20
Craig Andrews
I was in a coma for six weeks while the doctors told my wife I was going to die. When I woke up, she told me the most fantastic story. My team kept running the business without me. Freelancers reached out to my team and said, we will do whatever it takes. As long as Craig's in the hospital. I consider that the greatest accomplishment of my career.

00;00;30;23 - 00;00;51;10
Craig Andrews
My name is Craig Andrews and this is the Leaders and Legacies podcast where we talk to leaders creating an impact beyond themselves. At the end of today's interview, I'll tell you how you can be the next leader featured on the show.

00;00;51;10 - 00;01;22;09
Craig Andrews
Today I want to welcome Justin later. I've known Justin for several months now and been looking forward to this interview. And for those that know me, you know, I spent three months in the hospital and it was not a glowing experience. And I've discovered some. I challenged me once, last year and they said, Craig, you need to reach out and find some of the people that are doing the right things in health care.

00;01;22;11 - 00;01;57;03
Craig Andrews
They're out there and you need to find them. And Justin's one of the first people that I talked to. And he in 2014, he established benefits DNA. it's an objective independent health and welfare benefits. consulting firm a provide compliance oversight, actuarial services, cost mitigation strategies and traditional broker services to group health, plan sponsors. Now, that's a mouthful, but Justin is part of the solution.

00;01;57;06 - 00;02;12;25
Craig Andrews
And there's a handful of people around this country, and we're trying to interview them on leaders and legacy's. Justin is one of the ones that's being a part of the solution. So I want you to listen in because this will give you hope. Justin, welcome.

00;02;12;27 - 00;02;16;29
Justin Leader
Thank you. Thank you for having me. I'm honored to be here. Craig.

00;02;17;01 - 00;02;36;20
Craig Andrews
So, you know, we met through, mutual friend, Matt Zane. We both been on his podcast, and, and he introduced me to you, and then I discovered that, Kirsten, you're, you know, you're in her vestige group, and it's like, oh, my goodness is such a small world.

00;02;36;23 - 00;02;49;12
Justin Leader
Oh my gosh. Yeah, yeah. And I love the time on Matt's podcast. And Kirsten has helped me so much personally, professionally the last few years and working with her. I'm eternally grateful if you will.

00;02;49;14 - 00;03;11;14
Craig Andrews
Yeah, well, she's also been on Leaders and Legacies. Matt's been on Leaders and Legacies, but part of the reason that I really wanted to talk to you is you, you know, obviously you're passionate about fixing things and. Yeah. And I read a little bit from your bio and it has, you know, some of that, some of that is just kind of gobbledygook.

00;03;11;16 - 00;03;26;09
Craig Andrews
what's the that you had an experience that really resonates when you show up for work? There's a, there's a name and there's a face that that drives you.

00;03;26;11 - 00;03;44;25
Justin Leader
Well, you know, a lot of folks have heard me talk about my Aunt Gwen. but it's a culmination of a couple of different phases, right? I, I shared with you my experience of being adopted by my grandfather, my great grandmother. One of the things that they echoed in my head as an early age was do the right thing.

00;03;44;28 - 00;04;03;16
Justin Leader
And so, you know, we fast forward years later, I'm working in this industry. There's a lot of things that I see wrong with it. It's part of the reason why I couldn't stay in the pharmaceutical business or working for a big bank at this thing with ethics and justice, and if I see an injustice, like I want to fix it.

00;04;03;19 - 00;04;26;05
Justin Leader
but my Aunt Gwen is sweetest lady in the world. she worked, off the Bedford Turnpike interchange in Pennsylvania at a Denny's. She raised her kids on, you know, waitress tips and working her tail off, and, then, you know, took care of her grandkids, too. But like many Americans, she has this issue with, her health plan.

00;04;26;08 - 00;04;49;09
Justin Leader
And what do I mean by that? Well, employers in this uniquely American scenario offer this thing called health and welfare benefits. And it's the second largest overhead expense that they have, second largest line item on the panel. And they get really, really bad advice and we can get into all that. But my Aunt Gwen, she falls victim to what most of Americans, have happened to them.

00;04;49;09 - 00;05;10;03
Justin Leader
They can't afford time off work, and they can't afford their out-of-pocket expenses because she was on a high deductible health plan. She had a high deductible health plan. Why? Because the premiums are low. She needs all that money in her paycheck, so she ignores a bunch of symptoms for a period of time. She collapses at work. She goes to the hospital and gets diagnosed with stage four cervical cancer.

00;05;10;05 - 00;05;30;19
Justin Leader
She picks up the phone, calls me and says, Judd, that's what my family calls me. Judd. not how can I beat this? She asks me, how can I afford this? And therein lies the problem. We live in one of the greatest countries, one of the greatest developed nations on the planet. But we spend $4.5 trillion on health care.

00;05;30;22 - 00;05;49;29
Justin Leader
Our quality outcomes are ranked somewhere in the mid 30s for developed nations. Like that's a problem. So we pay a lot for really crappy value. And unfortunately, my aunt didn't know what her rights were when it came to even accessing not for profit facilities that are required to provide care to people in her demographic. And it's not just her demographic.

00;05;49;29 - 00;06;12;07
Justin Leader
It's like 70% of America are eligible for programs that these hospitals are required to provide because they don't pay any taxes so long and long and short, as she died a few years later from that cancer. And I have to question, could we have prevented it? Could she be in a scenario where she could see a doctor and be able to afford time off work?

00;06;12;09 - 00;06;41;18
Justin Leader
And that's what we're trying to fix? You know, one plan at a time across this country, and then take it a step further and educate other people on how to do the same thing, even if they're a competitor of ours, and go down to DC and champion this legislation that furthers the issue of transparency. So yeah, I to sum it up, I'm very passionate and I think about those people that have been impacted and some, I would argue, possibly killed by the system.

00;06;41;20 - 00;06;43;16
Justin Leader
And you're you're familiar with that.

00;06;43;19 - 00;07;16;23
Craig Andrews
Yeah. Yeah. it's, my wife and I have been really clear. We believe it's nothing short of a miracle that I'm alive, you know? And and you talk about, you know, you talk about justice. One of the things that just enrages me and and this, you know, and this is where I have a high skepticism of government, because when we passed the CARES act, we gave the doctors broad, sweeping immunity.

00;07;16;25 - 00;07;56;23
Craig Andrews
and they did a number of things that, in my mind were criminal, at least criminally negligent. You know, for instance, there was a drug they gave me. It's remdesivir, and they gave it to me on August 10th, 2021. That was when I got my first dose. At that point, almost, over a year earlier, The Lancet had released a study showing that remdesivir was ineffective in the treatment of Covid ten months before they gave me that dose, the World Health Organization came out and said that remdesivir was ineffective in the treatment of Covid, so don't use it because it has risks.

00;07;56;25 - 00;08;22;00
Craig Andrews
Multiple studies showed that the risk where it would damage your kidneys. And so they gave me a drug that had multiple states and it was ineffective in the treatment. Covid. Multiple studies have shown that would damage the kidneys. They never told me that. And from what I can tell, the only redeeming trait of that drug was on that day, August 10th, 2021.

00;08;22;07 - 00;08;33;21
Craig Andrews
It was one of three drugs that the that cms.gov. The government website listed there for doctor prescribed that for the treatment of Covid they would give the doctor a 20% bonus.

00;08;33;23 - 00;08;43;04
Justin Leader
you talk about misaligned incentives. Our health care system chock full of them uncover them every day. But that was your life, man.

00;08;43;06 - 00;08;59;28
Craig Andrews
It put me in. Within ten days of my final dose. I was in kidney failure. I was on dialysis while. It's a miracle that I lived.

00;09;00;03 - 00;09;40;05
Craig Andrews
And when we passed the CARES act, we gave doctors broad sweeping immunity because I actually reached out to some attorneys because not because I was looking for a payday, but I was like, we have to stop this. And you know what the attorneys told me? We're not going to take your case. It's a hard case to prosecute. And you lived, still have kidney issues, but that's that justice that I appreciate when I start seeing you and I see and some of the people that you hang out with is you're passionate about fixing these things.

00;09;40;08 - 00;10;02;05
Justin Leader
and just to go back to your earlier comment, I think one, the government is too conflicted. And a lot of this there's a lot of money, you know, there's a lot of wam walk around money, right? Funding. And then too, I don't think they understand how bad it is.

00;10;02;08 - 00;10;03;01
Craig Andrews
Interesting.

00;10;03;03 - 00;10;30;27
Justin Leader
Explain that there's a disconnect. You think about congressmen, senators, they live a very different life than John. Q public you know, I grew up as a chip kid. I was on Medicaid. Yeah, thankful for that program. Right. Otherwise I wouldn't have had health care. So you think about those folks not to say they're in an ivory tower, regardless if you're on one side or the other, but there is a disconnect.

00;10;31;00 - 00;10;46;08
Justin Leader
And then there's a lot of misinformation. You know, you drive down the highway, you see billboards about the best care in this region. And you turn on the TV. We're one of the only developed nations that allows direct marketing of pharmaceuticals to patients.

00;10;46;12 - 00;10;48;17
Craig Andrews
One of two, one of two.

00;10;48;19 - 00;11;09;21
Justin Leader
The other ones, I think New Zealand. Yep. Right. We also have no pricing constraints on what can reasonably be charged for any medication or service. So now you have the tickler law that passed hospital transparency law that passed the Consolidated Appropriations Act. But where is the accountability? You know, I grew up, I grew up listening to a lot of punk rock.

00;11;10;05 - 00;11;12;24
Craig Andrews
So what punk rock groups did you like?

00;11;12;26 - 00;11;31;25
Justin Leader
Yeah, so I like I like the Sex Pistols. These are actually the first three albums that I had in middle school sex pistols, rancid and No Effects. And the Sex Pistols was, never mind the ballocks. Rancid was an outcome. The Wolves, that album and then No Effects was punk and black, and then it just went downhill from there.

00;11;31;26 - 00;11;33;13
Justin Leader
Like I was obsessed.

00;11;33;15 - 00;11;45;09
Craig Andrews
Wow. Yeah. And you know, Johnny Rotten still making the rounds. You see him pop up and make a comment here and there. He's not as bright as you used to be, but he's still he's still out there.

00;11;45;14 - 00;11;56;22
Justin Leader
No, no, they're, they're all aging, you know, some better than others. But, you think about that like hell. It's amazing that the guys from the Rolling Stones are still alive.

00;11;56;24 - 00;12;03;27
Craig Andrews
Yeah, yeah, yeah, yeah, they they're they're like the worst anti-drug use commercial ever.

00;12;03;29 - 00;12;07;06
Justin Leader
Yes, yes. But.

00;12;07;08 - 00;12;29;06
Craig Andrews
So I love the, I love offspring. And the thing that blows me away about offspring is when I listen to their lyrics, I'd be like, I want my kids listening to this because they all of a sudden speak, become punk. To have a job and live a responsible life and have self-esteem.

00;12;29;09 - 00;12;56;26
Justin Leader
Yeah, 100%. And that's what I mean. I think what I love most about music in general, and I listen to everything, man. I mean, I was cheering for JellyRoll last night at the CMT, Country Music Awards is it's storytelling and it's heart and passion, and I can get enthralled in those lyrics and understand and why they're passionate about, you know, any number of topics and, that that goes across all genres of music.

00;12;56;26 - 00;13;10;00
Justin Leader
But for punk rock, they were really, you know, fighting something. They were fighting the status quo in the system. And for me, it was kind of lost, as a youth trying to figure things out. you know, I felt that.

00;13;10;03 - 00;13;21;14
Craig Andrews
Yeah. So now, you know, you're kind of living out that you're fighting the status quo, right? Because let's be honest, health care is a behemoth.

00;13;21;16 - 00;13;56;10
Justin Leader
it's exhausting. Not just a behemoth. That's a $4.5 trillion behemoth. And there's a lot of, misaligned incentives. And we're trying to do things aboveboard and transparent and the right way. And I understand, why people don't enter into this business and the way that we have. Because there's a lot of status in the status quo. A good, good attorney friend of mine, Karen Hahndorf, partners with Julissa Lesniak, and Risa, she, she came out and said that I'm like, Karen, you're right, you're right.

00;13;56;10 - 00;14;15;08
Justin Leader
We can make a lot more money if we did things like everybody else and had all these fees and commissions, but it doesn't help fix the underlying root of the problem, which is transparency. we're not in a capitalistic system because we have no idea what the hell we're paying for. There's no way for us to understand and create a competitive market the way it is now.

00;14;15;10 - 00;14;17;15
Justin Leader
But we're trying.

00;14;17;18 - 00;14;38;18
Craig Andrews
Well. And perfect capitalistic system is that you can go in and you can ask for things that are reasonable. And so I actually have recordings of my family asking the doctors to put me on vitamins. When I was on the ventilator. And no kidding, the doctors said, well, if we give him vitamins, we'd have to give everybody else vitamins.

00;14;38;21 - 00;15;05;07
Craig Andrews
Yeah, right. And vitamin D was one of the most effective treatments against Covid. But from what I can tell and and I don't have 100% confirmation, but I have pretty close. They had a protocol. They had an FDA protocol that they had to follow. As long as they followed that protocol, they got 20% bonuses on everything they did.

00;15;05;09 - 00;15;20;07
Craig Andrews
And if they departed from that protocol, as far as I can tell, I don't think I won't be very careful. I don't have 100% confirmation on this, but from what I can tell, if they departed from that protocol, they lost their bonus.

00;15;20;09 - 00;15;48;22
Justin Leader
I'm not surprised. Right? There are so many programs out there that drive, bonus structure. on performance and, that don't have a lot of basis from patient to patient health. We're name benefits DNA because every single plan that we touch has its own unique DNA. Yeah. What works for one patient might not work for another patient, you know, but unfortunately, that's how people are incentivized.

00;15;48;22 - 00;16;13;20
Justin Leader
Take a look at the hospital systems that have purchased primary care practices. You know, PCP is are going the way of the dinosaur. The independents. Why? Because, well, primary care physicians, they're ground zero to be able to refer upstream for unnecessary tests, you know, MRIs, x rays, bloodwork that really has little to no value, in some of these situations.

00;16;13;20 - 00;16;29;03
Justin Leader
But it's a big revenue driver for a hospital. I get an argument with a local hospital CFO once. He's like, yeah, I know I could charge a couple hundred bucks for an MRI, but if I can get ten grand from a plan, I'm going to get ten grand. Oh, yeah. Right. That's just it's wild to think about that.

00;16;29;05 - 00;16;37;18
Craig Andrews
Well, and so let's talk about this transparency. The where the costs get hidden everywhere.

00;16;37;21 - 00;16;58;28
Justin Leader
And I hate to say that, but if you look at if okay let's let's talk about a claim in general I go seek care. Right. Providers are taught classes on how to up code in charge for maximizing reimbursement. So I go in for preventative care. If I happen to mention that my elbows sore, boom, game on. It's no longer preventative.

00;16;59;03 - 00;17;21;21
Justin Leader
We're going to code it for something else. And then as that claim makes its way through the food, through the, up the ladder, you know, there's a number of things that can happen before it's paid, but ultimately, plans are paying exorbitant amount for little to no value. The whole idea of a discounted network, has been proven time and time again that it's just a bunch of malarkey.

00;17;21;23 - 00;17;40;07
Justin Leader
The only way for. Let's take a let's take an insurance carrier network, for instance. What is it? it's a discounted contractual network. That's why we're going in. We're supposedly getting a better deal. But if we don't know the starting price, we don't know that we're getting a good deal. It's like me saying, I'm going to sell you a new car.

00;17;40;09 - 00;18;07;01
Justin Leader
you're going to get 50% off. And, maybe the starting price is $1 million for, $100,000 car. Is that really a good deal? You're overpaying by 400 K in that scenario. so, case in point, when we hire an insurance carrier, an administrator, they should be adjudicating claims, and you should be getting a discount. The issue in what has come out of the Consolidated Appropriations Act is now, as a plan sponsor.

00;18;07;08 - 00;18;27;29
Justin Leader
If we enter into any contract that contains verbiage that prevents me from understanding cost, quality and utilization, that's known as a gag clause. And all of these carriers and vendors are saying, Mr. and Mrs.. Plan sponsor, we got you. We're going to test on your behalf that there's no gag clauses in our contract. And the Dol allows that because of knuckleheads.

00;18;28;01 - 00;18;45;06
Justin Leader
And they should be going after these people for a testing on things that are not true. Because as soon as I come in representing my client or my client runs in the right to demand letter to these entities asking for information, even though they sign these forms saying there's no gag clauses. You know what they say, Greg? What?

00;18;45;08 - 00;19;09;00
Justin Leader
No go bounce. And that's proprietary information. But when we get data, we can prove time and time again. There's up coding. There's unbundling exorbitant charges. We're not getting that discount that you're reporting that we're getting. Right. So it's all a facade and it's built on a house of cards, but we're exposing it little by little. But it's not without a fight.

00;19;09;01 - 00;19;17;00
Justin Leader
I mean, I have people that start my car now in the morning just, because we're bucking the system, and I'm joking, but, you know, it's that I think about.

00;19;17;03 - 00;19;40;22
Craig Andrews
I believe that. I mean, I believe that the forces, you know, the forces behind it are just insanely powerful. And I think the number when you were talking about how the United States and New Zealand are the only two kind of I think they're the only two countries in the world, not just developed countries. I think they're the only two countries in the world that allow pharmaceutical advertising on TV.

00;19;40;25 - 00;19;49;21
Craig Andrews
It's the, if I remember correctly, 72% of advertising revenue comes from pharmaceuticals.

00;19;49;23 - 00;20;17;19
Justin Leader
It's it's some asinine number like that. I mean, it's it's just wild. When I sold, blood pressure medication is a $2 billion drug. We had like, six competitors in the same class, and it was like the third or fourth therapy that you should be trying to control your hypertension. And I'm like, man, this is insane. But we are handing out free coupons like candy to make the co-pay that at the equivalent of a generic for the consumer.

00;20;17;21 - 00;20;26;23
Justin Leader
But what do you think it was charged in the health plan on a monthly basis, on back end? A couple hundred bucks when the front line generic alternative was like pennies on the dollar?

00;20;26;26 - 00;20;28;03
Craig Andrews
Yeah.

00;20;28;05 - 00;20;51;14
Justin Leader
So I'm not I'm not trying to listen. I'm a science guy. My undergrad was biology, chemistry, pre-med. Like I appreciate science and advancement. But let me tell you a story. I get a call the other week. Somebody gave this guy my contact information, not a client. He's not one of the members on a health plan I represent. But he called me and he said, hey, I heard you might be able to help my, my, my, my four year old son just got diagnosed with two canes.

00;20;51;14 - 00;21;09;22
Justin Leader
Muscular dystrophy. And the drug they want to put him on is $7,000 a month. And the genetic therapy that could help prolong and extend his life, which is approved for his age, is $3.2 million. And I don't know where to start.

00;21;09;24 - 00;21;11;14
Craig Andrews
Oh my goodness.

00;21;11;16 - 00;21;39;07
Justin Leader
So father to father, I got two boys at home. Yeah. Heartbreaking that is to think about that. You know your kid just gets handed essentially a terminal illness right. And your only hope to keep him alive is $3.2 million A7KA month. Now, there's organizations out there, there's charities, there's all this other crap. But like, you think we would invest more in helping people understand how to navigate the system.

00;21;39;10 - 00;21;59;24
Justin Leader
But it's not just that case. I mean, we have instances where we help somebody, you know, save $80 a month on a prescription drugs or a couple drugs that they're taking. And that woman cried because if you annualize that $80 a month for her when she's just struggling to put food on the table and pay her rent and take care of her kids, that's a lot of that's a lot of money.

00;21;59;27 - 00;22;02;18
Craig Andrews
That's a significant part of our income.

00;22;02;20 - 00;22;07;22
Justin Leader
When you're barely making, you know, 25 grand a year, 30 Grant. Hell yeah. It is.

00;22;07;24 - 00;22;31;26
Craig Andrews
Yeah. Wow. You know, something I ran into? And I think maybe this ties into what you're talking about. so I have a sensitivity to developing chelation, which is basically a big bump on the eyelid. And when you when you see one, you know, anybody that that knows what they are, knows exactly what it is. They're like, hey, it's a lazy arm.

00;22;31;26 - 00;22;55;08
Craig Andrews
We need to lancet, drain it and you'll be good. I have one. And so I, I'm we're high deductible plan. And so I called I called three different clinics and the first one called, I said how much? And they're like, well, you know, you first need to come in for a, you know, for a consult. I'm like, you're kidding.

00;22;55;08 - 00;23;18;07
Craig Andrews
It's a chelation. This is your business. When you see it, you're going to say it's it's lazy on lay back. We're going to Lancet. You're going to be good. And and they eventually came back. They said, hey, it'd be $350. I call another place. I could never get a quote of them. They were. And they were even more rigid.

00;23;18;09 - 00;23;38;08
Craig Andrews
they wanted me to come in. They wanted to do all these things. And I said the same thing. They're like, now we can't do that. But when I started questioning them, I got in my head that probably going to them would cost about $800. And so finally I called the third place. And they also say you need to come in for a consult.

00;23;38;08 - 00;23;55;28
Craig Andrews
And I'm like, come on, give me a break. You know, like, okay, come on, em, we'll do it. I got a half hour with a nurse. I got 45 minutes with the surgeon, and I got a follow up visit with the surgeon for it was like, $250.

00;23;56;00 - 00;23;57;14
Justin Leader
Amazing.

00;23;57;16 - 00;24;08;24
Craig Andrews
And when I thought back to it that that one place I think was around $800, I realized they've built a machine to melt the insurance companies, that they're an insurance extraction machine.

00;24;08;26 - 00;24;12;25
Justin Leader
It's called maximizing reimbursements. My friend.

00;24;12;27 - 00;24;22;06
Craig Andrews
All right. So what's. Yeah. So what does that and what how come we don't see this more often? How do or don't recognize that what's happening?

00;24;22;09 - 00;24;43;19
Justin Leader
Because it's what we're used to. We're used to having a card in our pocket that has one of maybe four logos Blues, United, Cigna, that, the bill goes and we go in and we fall victim to what we, what we think the system is or how it operates. It's crazy. It's like a form of Stockholm syndrome. We just accept it and take it on the chin.

00;24;43;22 - 00;25;03;27
Justin Leader
I think we're reaching a boiling point where people are getting pissed off and they're they're demanding more, especially post Covid. But if you grow up inside a box, you don't know that there's a box. Once you step outside of the box. You know, I say this all the time. If you're a Ted Lasso fan, the psychiatrist has a great line in that that show, she says, Ted, the truth will set you free, but first it'll piss you off.

00;25;03;29 - 00;25;33;28
Justin Leader
It really pissed off when you realize how things could be. So you see, direct primary care, you know, practices booming up, or concierge medicine where you can go in and actually talk to a physician for 30 minutes. You can have an actual consult, like, that's the way it should be. But, you know, in order for a lot of these folks to survive five and to get paid, you know, they have to see so many patients, they have to do so many procedures, services, blah, blah, blah, blah, blah, blah, blah.

00;25;34;01 - 00;26;03;20
Justin Leader
And it creates this like this just massive feeder, but a problem really for for care and compassion for the patient. And I think that's why I didn't go into medicine. I lived abundantly above a doctor's office in, in college. And she she told me she's like, listen, she's like, unless you really, really, really, really, really want to do this every day and help people and, and incur a ton of debt like, we don't get to practice medicine the way that we used to.

00;26;03;23 - 00;26;37;21
Justin Leader
And that was 2006, 2005. Sorry. you know, but I look at it this way, like, there are a lot of great clinicians out there. There are I think the administration I think we have a problem there and how they're operating these facilities and these big institutions. And I don't know who their customers are. At the end of the day, maybe it's their board, maybe it's their shareholders, but I think they've really lost touch with the patient themselves.

00;26;37;21 - 00;26;46;23
Justin Leader
And much like that chapter in your book. Yeah, that CEO right from a hospital that said, thank you for your business, or something like that. It's just it's wild.

00;26;46;26 - 00;27;17;12
Craig Andrews
Yeah. I was a senior executive and, the, Yeah, it's a I've, I've talked to them, about things and one thing, you know, you know, I live in Texas. And so one of our conversations was about the cost of antivenom. If you get bitten by a snake, which happens in Texas. it's $5,000 per mile if you drive, if you leave Austin, go 250 miles south and cross the border, it's like $250.

00;27;17;12 - 00;27;51;27
Craig Andrews
About a mile. And so it's 20 times more expensive on this side of the Mexican border than it is the other side of the Mexican border. And we're not talking about some guy in a shack with rusty needles, you know, injecting you, you know, with things. We're just talking about the raw antivenom and and the one thing that's abundantly clear in talking with this fella, what the senior executive is, he has no, he has no intention.

00;27;51;27 - 00;28;07;16
Craig Andrews
He has no motivation to reduce cost. He's all about increasing the multiple, working with carriers to increase his multiple of Medicare. They gets reimbursed for, by, you know, Blue Cross or whoever.

00;28;07;18 - 00;28;34;06
Justin Leader
It's, it's extremely problematic. So over, over my shoulder, you'll see a poster. there we go. it's patient, right? Advocate. Patient rights advocate. they had a concert recently with the Foo Fighters. Dave Grohl was supporting their event. and all about transparency. So it's like 2016 going in 2017. I get a call from this lady named Cynthia Fisher who is running patient rights, and she's like, I'm working with the current administration.

00;28;34;08 - 00;28;59;09
Justin Leader
Donald Trump's a friend of mine. I'm I'm I'm working towards a hospital transparency rule. And I heard you guys are doing this thing called direct contracting. And ultimately, what we uncovered was, and it's really no surprise you could go to an orthopedic surgical center and run it through insurance and maybe pay 50, 60 grand. Or you could do a direct arrangement between the employer and the facility.

00;28;59;09 - 00;29;25;18
Justin Leader
And like all in still to this day, a knee replacement maybe 2021 Grant. Right. And in that we waive the deductible for the member, we give them a cash bonus, maybe for making, you know, a, you know, a purchasing decision. But anyway, she flew down and met with us. And then a short time after one of our clients she brought down to DC and was there the signing of the hospital transparency law.

00;29;25;21 - 00;29;47;18
Justin Leader
So I'm a big fan of of patient rights advocate and what they do, and continue to do and we'll support them. And it's cool to have played like a little part in trying to push, you know, the envelope in the system to this day, like 6,070% of hospitals are still non-compliant with posting the pricing. which is unfortunate, but slowly we're improving.

00;29;47;25 - 00;30;15;07
Justin Leader
I tell you this because not only were we doing that with surgeries, but we were doing it with prescription drugs as well. Hence your story where we were finding different sources to save a buttload of money. And I won't name the entities, but because we were promoting this, we got a cease and desist not only from a major Blue Cross Blue shield, but also from a pharmaceutical company, a threat essentially saying, you guys need to stop doing this.

00;30;15;09 - 00;30;34;17
Justin Leader
And in the case of the blue, they actually pulled our appointment at the time to be able to do any business with them and represent our clients as a penalty and then educated the local competition, that we were bad, that we were somehow, you know, bucking the norm and putting patients in danger like it was the most asinine.

00;30;34;17 - 00;30;54;16
Justin Leader
12 months. And then finally they hired somebody over there that gave us our appointment back at the time. But this is the problem. I said, there's a lot of status in the status quo. You know, it's nothing for them to walk into an advisor and give $1 million bonus check at the end of the year, because you've kept all the business with a certain insurance carrier.

00;30;54;18 - 00;31;15;08
Justin Leader
That to me is problematic. That tells me that you're conflicted and you can't even act as a co fiduciary, let alone call yourself an advisor if you're given that bullshit type of advice. Am I a capitalist? Absolutely. Do I want to make money? Take care of my family? Kids? Yeah. But I want to be able to look at myself in the mirror every day and say, I'm doing the best that I possibly can to impact people's lives by virtue of doing good.

00;31;15;11 - 00;31;20;12
Justin Leader
We're going to do damn well and continue up. So I hate to get all passionate soapbox.

00;31;20;13 - 00;31;21;05
Craig Andrews
No, no, no.

00;31;21;08 - 00;31;23;24
Justin Leader
But this is what gets me up in the morning.

00;31;23;26 - 00;31;37;09
Craig Andrews
Well, the example that you gave where if you go through the system, a knee replacement is 60 grand, but you can directly go get for 20 grand. That gives you 40 grand to do all sorts of things with.

00;31;37;11 - 00;31;57;22
Justin Leader
Oh my God, think about how much money the system could save if you just negotiated directly and didn't rely on these other entities to give you this, like facade of a deal that you can't even prove with the data that they give you because they won't give you the data. So all that being said, you know, it. It just people need to start questioning what they're being told.

00;31;57;24 - 00;32;30;11
Justin Leader
They need to be open to listening to a different story. The problem is it's hard. It's easy to be complacent. Continuous improvement. It's a little bit more challenging, especially in this topic where people have these blinders on. but I tell you on the other side, there's so much opportunity now, the doll, because the doll loves air people and loves employers, has thrown all these responsibilities, not on the vendors, to be honest, for the employers to take fiduciary duty and responsibility seriously.

00;32;30;13 - 00;32;34;05
Craig Andrews
But and this is where this is where Benford's DNA comes in.

00;32;34;07 - 00;32;53;23
Justin Leader
We do, we do. We educate employers, we do the audits, from a compliance perspective and help them avoid what's going on with, like, Johnson and Johnson right now, employee has sued them for fiduciary breach. And now the Mayo Clinic as of this past week has been sued for breach of fiduciary duty and how they're managing their plans.

00;32;53;29 - 00;33;14;10
Justin Leader
And in that case, there's actually charges of Rico. Well, racketeering like crazy to think about. But if you control markets right. And you're breaking a number of consumer protections, you know, rules and laws, like how is it not Rico.

00;33;14;12 - 00;33;15;13
Craig Andrews
Yeah.

00;33;15;15 - 00;33;20;12
Justin Leader
Not for me to decide. We'll leave that up to the judge and the jury.

00;33;20;15 - 00;34;00;19
Craig Andrews
Well, at the end of the day, it's what's been being done has to be broken up in the in the story that you told about Blue Cross Blue Shield coming in and, you know, pulling your access and then, and then what sounds like slandering you, that that's just insane. And and it's, It's it's disappointing. I mean, I and I'll tell you right now, blue cross, blue shield, I alerted them to straight up fraud in my health care.

00;34;00;22 - 00;34;33;29
Craig Andrews
Somebody that never provided me oxygen charged Blue Cross Blue Shield for oxygen for two years, and I had to pay. I had to hire a lawyer to get them. Got to go away. I kept trying to call them and say, hey, I've never been a patient of yours. Blue Cross, Blue Shield. They they've happily been paying. And as far as I can tell, my best guess is there was some rule changes during Covid and and I, I my best guess is they had an insider.

00;34;34;05 - 00;34;53;00
Craig Andrews
They had an inside agent in the hospital that faked a prescription that, you know, for oxygen for portable oxygen. When I was getting ready to go on the ventilator and, and at that time, the rule that require that I sign for the equipment, and so they.

00;34;53;00 - 00;34;54;05
Justin Leader
Built it through.

00;34;54;07 - 00;34;59;14
Craig Andrews
They build me and my insurance company for two years for oxygen that I never received.

00;34;59;16 - 00;35;26;29
Justin Leader
You know, it. It's it's wild how much FDA fraud, waste and abuse goes on. and, I'm on another podcast coming up, Stacey Richter's podcast Relentless Health Value, where we talk about what's hidden in the claims wire that happens every week. And it's just asinine. You know, one of the newest members of my team, Paula Siegel, she she has a deep knowledge not only of advocacy but also coding.

00;35;27;01 - 00;35;47;28
Justin Leader
So we were joking. I was going to create a system called Paula Patient Assistance Up Coding and Legal Analysis, because she's reviewing claims now. And like 50% of claims have an issue with them. Or there's questions that should be asked. But the way it's set up now, it's just claims had a system in most cases auto adjudicate without any real oversight.

00;35;48;00 - 00;36;02;18
Craig Andrews
You know that's crazy. Well, hey, you know what? We could talk forever on this. but we kind of got to wrap up the, Do you help individuals or do you only work with businesses?

00;36;02;20 - 00;36;32;13
Justin Leader
So we work with businesses. We work with plan sponsors, both, employers and Taft-Hartley funds, you know, nonfederal government plans. And then we do, you know, a lot of work with, I'd say stakeholders, different vendors and things like that on some niche work. But by virtue of working with them, we're maximizing impact because typically those organizations represent hundreds sometimes thousands, tens of thousands of lives.

00;36;32;15 - 00;36;48;09
Justin Leader
so that's really our goal at the end of the day. But if somebody picks up the phone and calls me, just just my nature and the team that I've hired, we try to help them like that gentleman with his, with his kiddo that got that DMD, you know, diagnosis.

00;36;48;12 - 00;36;56;23
Craig Andrews
Yeah. So for a business that's listening to this, that has a group plan, why should they reach out to you?

00;36;56;26 - 00;37;17;20
Justin Leader
I have a conversation. As I look at it this way, if I can help educate somebody to ask better questions. Right. That's a trickle down effect. That's a rock in a pond. That's a ripple that could potentially expand if we get their business. Awesome. You know, I'm not owned by private equity. There's no venture capital. We self-funded the whole thing.

00;37;17;23 - 00;37;31;14
Justin Leader
There's nobody beating on my door saying, you need to generate an ROI from your clients and go out and beat down people's doors. I want to help people. And if you're one of those people that's like, maybe I should dig a little bit deeper, we're here.

00;37;31;16 - 00;37;44;27
Craig Andrews
And and so some of the benefits are one, you may end up saving a money. Two, you can keep them out of lawsuits for violations of fiduciary responsibilities. Is there a what else.

00;37;44;29 - 00;37;47;01
Justin Leader
You can feel good about your plan?

00;37;47;03 - 00;37;47;21
Craig Andrews
I think that's what.

00;37;47;21 - 00;38;11;21
Justin Leader
People miss in this whole equation. Benefits should benefit people. Why offer a plan if it doesn't benefit anybody? It's not going to help you attract and retain folks. So if we could save money, keep you compliant and make the benefits actually enjoyable, that's a win. We have a cool program with a couple of our clients, or just by engaging with a maternal fetal medicine expert one time a month for 30 minutes over the course of the pregnancy.

00;38;11;23 - 00;38;36;19
Justin Leader
At the end of that, and when that baby's delivered, we give you free wipes for a year. I'm sorry, free diapers for a year. So somebody that wiped a two year old's tushy first thing this morning. Free. Free diapers is a big deal. And there's a reason why we offer this program regarding high risk pregnancy and how hospitals jack up Nicki rates and get huge reimbursements because, well, nobody questions.

00;38;36;21 - 00;38;46;27
Justin Leader
Nicki claims they should, we have $1 million one that we're working through right now. but ultimately, those are the three things. If I was going to summarize, Craig.

00;38;47;00 - 00;38;50;04
Craig Andrews
Okay. And how did people reach you?

00;38;50;07 - 00;38;59;01
Justin Leader
you could go to we fix your health care.com, or you can go to benefits dna.com or just look on LinkedIn. I'm in a lot of places.

00;38;59;04 - 00;39;21;08
Craig Andrews
Yeah, well, Justin, thank you for your mission. Thank you for. It's a broken system that needs people like you fixing it. And what we're doing. The bottom line is what we're doing is not sustainable. It will break. If we could argue it's already broken. And thank you for being part of the solution. Thank you for telling that. On leaders and legacies.

00;39;21;10 - 00;39;28;08
Justin Leader
Thank you for giving us a platform to talk about the issue. I appreciate it, Craig.

00;39;28;08 - 00;39;57;04
Craig Andrews
This is Craig Andrews. I want to thank you for listening to the Leaders and Legacies podcast. We're looking for leaders to share how they're making the impact beyond themselves. If that's you, please go to Alize for me.com/guest and sign up there. If you got something out of this interview, we would love you to share this episode on social media.

00;39;57;06 - 00;40;20;16
Craig Andrews
Just do a quick screenshot with your phone and text it to a friend, or posted on the socials. If you know someone who would be a great guest, tag them on social media and let them know about the show, including the hashtag leaders and legacies. I love seeing your posts and suggestions. We are regularly putting out new episodes and content to make sure you don't miss anything.

00;40;20;18 - 00;42;31;02
Craig Andrews
Please go ahead and subscribe your thumbs up! Ratings and reviews go a long way to help promote the show. It means a lot to me. It means a lot to my team. If you want to know more, please go to Alize for me.com. or follow me on LinkedIn. Thanks for listening. We'll see you next time.