Kimberly Carleson didn’t set out to become a leader in health care reform. Life forced her into it.

When her husband was diagnosed with stage four metastatic bladder cancer, Kimberly found herself navigating a health care system built for confusion, not care. Pregnant and raising a young daughter, she refused to accept the death sentence doctors gave her husband. Her advocacy, persistence, and leadership saved his life—and revealed a deeper calling.

That experience became the foundation for U.S. Beacon, the company she founded to fight bloated medical billing and protect employers from skyrocketing health costs. Kimberly’s team reviews claims for self-funded plans, finding and eliminating ineligible charges—often cutting 20–40% from monthly claims. Her work restores fairness and trust in a system where both are in short supply.

Her leadership isn’t just professional. It’s deeply personal. Kimberly speaks with clarity, strength, and purpose—because she’s lived what most only fear.

Want to learn more about Kimberly Carleson’s work? Check out their website at https://www-us-beacon.com.

Connect with Kimberly Carleson on LinkedIn at https://linkedin.com/in/kimberlycarleson.

Key Points with Timestamps

• 00:51 – Introduction to Kimberly Carleson and U.S. Beacon’s mission

• 02:24 – Kimberly’s husband diagnosed with stage 4 metastatic cancer

• 03:49 – Major hospitals refused surgery to protect their survival stats

• 05:00 – A board member doctor steps up; surgery saves his life

• 06:00 – Kimberly fights to maintain normalcy for her children during crisis

• 07:39 – She processes grief privately to lead with strength publicly

• 12:12 – Kimberly reflects on purpose and leadership through adversity

• 13:00 – From health care worker to patient advocate—an insider’s view of a broken system

• 14:29 – Kimberly sees financial ruin devastate families; her mission begins

• 18:39 – Overview of how U.S. Beacon reduces employer medical spend

• 19:33 – Explains the typical 20–40% ineligible charges per claim

• 24:22 – Most companies can save 10% annually on health claims

• 25:06 – Kimberly urges employers to stop blindly trusting health plan data

• 25:41 – How to contact Kimberly and work with U.S. Beacon

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 in 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 this show.

00;00;51;10 - 00;01;29;12
Craig Andrews
Today I want to welcome Kimberly Carleson She is the founder of U.S. Beacon. She leads a team that is focused on improving health care affordability. Their mission is to meticulously review and optimize medical bills, ensuring significant savings for employers and health care plans, while upholding strict compliance with laws and regulations. If you run a business and you provide health care for your employees, you've probably been noticing that your premiums are going up double digits year on year that will eventually ever take your revenue if it hasn't already.

00;01;29;13 - 00;01;38;28
Craig Andrews
So this is something you have to get in control if you're running a business, and if you want to retain good employees. Kimberly, welcome.

00;01;39;00 - 00;01;42;18
Kimberly Carleson
Thank you for having me, Craig. I really appreciate it.

00;01;42;20 - 00;02;05;15
Craig Andrews
I know I've been looking forward to this, and, you know, I think you and I both have, you know, one of the reasons I've invited a whole bunch of people like you on, on the podcast is my own personal journey. My three months in the hospital and all the aftermath after that, running up $2 million worth of health care bills.

00;02;05;17 - 00;02;24;23
Craig Andrews
I, I just saw incredible brokenness in the system and, you know, and I was like, we have to do something about it. And I think you you had something happen to your husband that kind of was your motivation.

00;02;24;25 - 00;02;31;18
Kimberly Carleson
That's right. Craig. So my husband was diagnosed with stage four cancer. It was metastatic.

00;02;31;18 - 00;02;32;02
Kimberly Carleson
It.

00;02;32;03 - 00;02;34;21
Craig Andrews
And let me pause. Metastatic means what?

00;02;34;23 - 00;02;39;17
Kimberly Carleson
It means it spread over his body. Yes. You can't make a bet.

00;02;39;19 - 00;02;40;22
Craig Andrews
No no no no, no. That's good.

00;02;41;00 - 00;03;01;26
Kimberly Carleson
Sure. Okay, so. So he was diagnosed with stage four metastatic bladder cancer. Metastatic, meaning it spread into his lymph nodes. And typically when it spread into your lymph nodes, they give you two years to live. All they did with this particular cancer. So when we realized we had cancer, it just infiltrated every single bit of our lives.

00;03;01;26 - 00;03;04;10
Kimberly Carleson
You have doctors?

00;03;04;13 - 00;03;06;29
Kimberly Carleson
Doctors visits, hospital stays.

00;03;06;29 - 00;03;26;17
Kimberly Carleson
You're constantly just. Nothing is ever normal when you're got a cancer patient. When you're living with a cancer patient. So when we were told he had two years to live, I just couldn't accept that. I knew we were in the biggest fight for our life. Luckily, we had a friend that was an oncologist that said, hey, you've got a death sentence.

00;03;26;20 - 00;03;49;11
Kimberly Carleson
If you do not have someone do a surgery on you, you will die. You've got to go in and take everything out. And what he was meaning when he said everything, he meant his bladder, his prostate and his lymph nodes that could have been affected by the cancer. So we went to all the major institutions, and none of them were touching because it would hurt their statistics.

00;03;49;11 - 00;04;04;01
Kimberly Carleson
So luckily, he was on the board. Oh, whoa, whoa. Yeah. What we called all those institutions that say they'll cure cancer. But when I told them it was stage four, they said we can't take him in.

00;04;04;03 - 00;04;06;12
Craig Andrews
It would hurt their numbers.

00;04;06;14 - 00;04;13;14
Kimberly Carleson
Absolutely. Because he was going to die in most doctors as he was supposed to die.

00;04;13;16 - 00;04;15;19
Craig Andrews
This is the honorable profession.

00;04;15;22 - 00;04;17;14
Kimberly Carleson
Right?

00;04;17;17 - 00;04;24;06
Craig Andrews
We're talking about the honor profession that won't try to save someone's life because it would hurt their record.

00;04;24;07 - 00;04;29;03
Kimberly Carleson
This was our experience. This was our experience. I don't know if it's everyone's that.

00;04;29;03 - 00;04;37;28
Kimberly Carleson
When he was that far gone, they thought I should just chemo him and let him go. That's what I was told. Can you need to just chemo him?

00;04;38;00 - 00;04;40;06
Craig Andrews
Which is a miserable life in itself.

00;04;40;08 - 00;04;45;23
Kimberly Carleson
Right. Right. And I was pregnant at the time with our son. So,

00;04;45;23 - 00;05;00;14
Kimberly Carleson
And I had a four year old daughter, so, we fired that doctor, and we found a doctor. That. And I'm not downing doctors by any means that many are has saved my husband's life. So,

00;05;00;14 - 00;05;12;05
Kimberly Carleson
the odds were stacked against us. But by the grace we found a doctor that said, I will do the surgery because he was on the board of a cancer center, and he told us he would do the surgery.

00;05;12;07 - 00;05;22;18
Kimberly Carleson
But it's a Hail Mary, is what he told me. And I said, I don't care. I want you to go in and do everything you can to save my husband. So they went and did the surgery.

00;05;22;18 - 00;05;27;17
Kimberly Carleson
I watched advocate for every aspect of his care,

00;05;27;17 - 00;05;32;17
Kimberly Carleson
from his chemo to his meds to what every single thing they did.

00;05;32;17 - 00;05;39;13
Kimberly Carleson
I was in there watching, making sure it was all done right. And by the grace of God, he's here with us today.

00;05;39;15 - 00;05;42;17
Craig Andrews
Now, how many years ago was how many years ago was this diagnosis?

00;05;42;19 - 00;05;52;06
Kimberly Carleson
So? So, Craig I know it was. My son is 18 and I was four months pregnant. We had just found out we had a boy. So we're talking 19 years ago.

00;05;52;08 - 00;05;56;26
Craig Andrews
He was giving me a two tier, two year death sentence. And here he is.

00;05;56;28 - 00;06;19;12
Kimberly Carleson
Here he is. Because we stood up, we were a voice. He had a voice. And also we found someone where we were not just a number, we were a name. And I think that means a lot in a system, a big system. You don't go in if you're just that number that's called out, like next in line. You're not seen as much as if you are a name and a person and they're taking care of you.

00;06;19;14 - 00;06;23;18
Craig Andrews
You know, when, when I was in, in my come,

00;06;23;18 - 00;06;30;09
Craig Andrews
you know, and then later presumably going to die from Covid, my wife told me about she met some,

00;06;30;09 - 00;06;45;19
Craig Andrews
some of the other families, and she told me about one family. It was pregnant. The wife was pregnant, had a bunch of kids, and she just felt horrible. I just can't imagine the terror you went through of, oh, my.

00;06;45;26 - 00;06;53;19
Craig Andrews
I mean, just all the things that you had to process. You're about to lose your husband. You're about to raise a baby by yourself.

00;06;53;21 - 00;07;04;17
Kimberly Carleson
Now, it it you you really cannot fathom until you go through it about every picture you take, every you just think about. This could be the last.

00;07;04;17 - 00;07;19;24
Kimberly Carleson
I tried to not let my mind go there, but the I. Because I wanted my daughter to see. I didn't want her to know as much. They gave us a video to show her, but I wasn't going to approach that with her yet because we weren't there.

00;07;19;27 - 00;07;39;16
Kimberly Carleson
And in my mind, I was going to save him or not save him. The doctors were, but we were going to try everything we had. So I had to keep my mind focused on the present. But at the time that I would go down the path of really breaking down would be in the shower. So the only time I had alone, you know, and so that's when I would really,

00;07;39;16 - 00;07;49;21
Kimberly Carleson
be able to get all the fear and sadness out and then have to go back and present myself, because my daughter had started kindergarten and I had to be the mom that was, you know,

00;07;49;21 - 00;07;52;01
Kimberly Carleson
the parent that comes up to the school

00;07;52;01 - 00;08;06;22
Kimberly Carleson
and does everything for their kids because I wanted to be that role and I wanted to be the advocate role. I wanted to be everything. So it was a difficult time. But I learned so much through it, so I wouldn't change it for anything.

00;08;06;25 - 00;08;08;00
Craig Andrews
And I think that's,

00;08;08;00 - 00;08;11;26
Craig Andrews
True.

00;08;11;26 - 00;08;19;02
Craig Andrews
Sorry. I'm, it's I mean, that just hit me emotionally.

00;08;19;02 - 00;08;27;16
Craig Andrews
Because it's so hard to keep that good face for your daughter.

00;08;27;16 - 00;08;38;05
Craig Andrews
You know, my wife, one day in her journal, it was the day they finally transferred me out of the ICU. And she said how she had always tried.

00;08;38;08 - 00;08;55;15
Craig Andrews
She talked to me through my whole come and I heard her and she told me about, you know, how she had always try to keep it positive when she was in the room and the day they transferred me out of the ICU and she's looking at my weathered body, she said, I just couldn't hold back anymore and just broke out crying.

00;08;55;17 - 00;09;00;02
Craig Andrews
I know how he held it together.

00;09;00;04 - 00;09;06;14
Kimberly Carleson
It's hard. It was hard. I'm getting emotional. I'll tell you. Yeah.

00;09;06;14 - 00;09;08;00
Kimberly Carleson
That it

00;09;08;00 - 00;09;12;01
Kimberly Carleson
it was difficult.

00;09;12;04 - 00;09;16;23
Craig Andrews
Yeah I bet. Oh my goodness that's terrifying.

00;09;16;26 - 00;09;18;09
Kimberly Carleson
I wanted to be

00;09;18;09 - 00;09;21;29
Kimberly Carleson
there for my daughter though. I didn't want her life to change,

00;09;21;29 - 00;09;24;16
Kimberly Carleson
because she was so young. And that could have really,

00;09;26;18 - 00;09;44;09
Kimberly Carleson
Put a, It just kind of hurt her emotionally. Really bad at that young of an age. You know, they say your kids personalities form in those younger years, and I didn't want her to see me as a sad mom. You know? I wanted her to be grounded in faith and also to,

00;09;44;09 - 00;09;46;07
Kimberly Carleson
feel security.

00;09;46;09 - 00;09;47;06
Craig Andrews
Yeah.

00;09;47;09 - 00;09;48;12
Kimberly Carleson
It was difficult.

00;09;48;14 - 00;09;59;18
Craig Andrews
Oh, well, good for you. I mean, I just, I, I've never been in in those shoes. I just can't imagine it.

00;09;59;20 - 00;10;03;20
Kimberly Carleson
Yeah. When we, when we when I had my son, it was,

00;10;03;20 - 00;10;17;21
Kimberly Carleson
I husband was bald at the time because he had been doing chemo, but, I looked over at him and he was holding my hand, but I looked at him, and that's the first time I've looked at him, and he really looked like a cancer patient.

00;10;17;21 - 00;10;31;10
Kimberly Carleson
And when I say that in the utmost respect for cancer patients because nobody knows what they're going through. Yeah, but they have no eyelashes. They're kind of yellowish and bald headed and,

00;10;31;10 - 00;10;38;25
Kimberly Carleson
very frail. But to see that moment of him holding my son was just amazing.

00;10;38;28 - 00;10;41;15
Craig Andrews
Oh, wow. Wow.

00;10;41;20 - 00;10;42;14
Kimberly Carleson
To be there.

00;10;42;15 - 00;10;45;03
Craig Andrews
So I bet that's a treasure trove.

00;10;45;06 - 00;10;50;00
Kimberly Carleson
I might get through this, but yeah, Craig was bringing me back to,

00;10;50;00 - 00;10;52;23
Craig Andrews
I bet that's a treasured photo of you holding him.

00;10;52;23 - 00;11;05;09
Kimberly Carleson
Holding on it, is it? But you know, when I see it, I see you bringing that photo back. I see all it brings up, all the fear I was going through at the time. Because he's

00;11;05;09 - 00;11;14;25
Kimberly Carleson
headed and he's. But he's holding my son. But it's a lot of fear that will come back. It's almost like a post-traumatic stress, you know, that I see in that picture.

00;11;14;25 - 00;11;17;17
Kimberly Carleson
So sometimes it's hard for me to look at it.

00;11;17;19 - 00;11;44;08
Craig Andrews
Yeah. No, I get that. It's it's. I think it's hard for people to people that haven't been through that kind of trauma. It's hard to understand where it just sneaks up on you. And I mean, for me, my my sister in law posted a picture of a train riding down tracks next to a mountain next to a lake.

00;11;44;10 - 00;11;49;14
Craig Andrews
And when I saw that photo, it immediately took me back to my coma. And just it was like,

00;11;49;14 - 00;11;57;21
Craig Andrews
it was PTSD. It was a dream I had in my coma. And it's wild how those things just come out of the blue and they hit you.

00;11;57;23 - 00;12;00;18
Kimberly Carleson
It really is. It can be a certain smell.

00;12;00;18 - 00;12;05;14
Kimberly Carleson
There's so much you remember when you're going through that moment at that time that,

00;12;05;14 - 00;12;10;22
Kimberly Carleson
it can definitely bring you back and give you that feeling that just kind of get you, you know?

00;12;10;24 - 00;12;11;28
Craig Andrews
Yeah.

00;12;12;00 - 00;12;29;20
Kimberly Carleson
But it also gives you a feeling of so much thankfulness and just why eyes why did you allow eyes. And then you realize you've got purpose. Meaning to be here and to be able to tell your story like you have your, you know, such purpose in telling your story.

00;12;29;22 - 00;12;43;17
Craig Andrews
Yeah. No. And I think, I mean, kind of speaking of that, it's so in the process of doing that, you kind of became an expert in the medical system.

00;12;43;20 - 00;12;55;05
Kimberly Carleson
Well, I became I've got my degree in radiologic technology, so I've already been in the system quite a bit,

00;12;55;05 - 00;13;00;27
Kimberly Carleson
because I worked at a hospital. But then when we became the patient on the other side,

00;13;00;27 - 00;13;10;07
Kimberly Carleson
it was a different level of being in the system. And, yes, I, had to watch every single thing. Not not that you have to.

00;13;10;08 - 00;13;17;09
Kimberly Carleson
I don't want to say that, but as a patient, you have to make sure you're advocating for yourself.

00;13;17;11 - 00;13;22;24
Craig Andrews
100%. I don't think people realize that.

00;13;22;26 - 00;13;24;02
Kimberly Carleson
I do not get skipped.

00;13;24;02 - 00;13;30;21
Craig Andrews
I almost missed a blood transfusion. If my wife hadn't been there I would've never gotten that transfusion.

00;13;32;24 - 00;13;34;20
Craig Andrews
I don't think people appreciate that.

00;13;34;22 - 00;14;01;13
Kimberly Carleson
They do not, they don't realize because nobody knows you better than your wife or your spouse, whomever your kids, they know if something is off. And so you know when something needs to be done because you're the one watching the charts, watching everything that goes in their mouth, watching, you know, so you have to kind of be that annoying that it goes and let them know I get down here and take care of, you know, my husband.

00;14;01;13 - 00;14;05;23
Kimberly Carleson
So I did that all, all the way through. And I was,

00;14;05;23 - 00;14;10;22
Kimberly Carleson
I eight months well, now but he was in hospital several times, but,

00;14;10;22 - 00;14;15;19
Kimberly Carleson
I was told down to get up at the time, so,

00;14;15;22 - 00;14;18;03
Craig Andrews
So what was what was kind of the big.

00;14;18;03 - 00;14;29;04
Craig Andrews
You know, so you, you started, you know, you were in radiology before as a provider and now you're on the patient side. What were, what were the kind of big ahas for you at that moment?

00;14;29;07 - 00;14;30;02
Kimberly Carleson
I think that,

00;14;30;02 - 00;14;34;24
Kimberly Carleson
seeing so many families going through what we went through and,

00;14;34;24 - 00;14;52;10
Kimberly Carleson
being in a waiting room and knowing that we were my husband was with Merrill Lynch. She was senior vice president over the institutional side. So he was diversified or our financials were diversified, but there were a lot that weren't. And I talked to them and,

00;14;52;10 - 00;14;53;24
Kimberly Carleson
I was with them.

00;14;53;24 - 00;15;04;08
Kimberly Carleson
You're you can't, you know, who's going to be at chemo that day or who's in the hospital beside you because you're in it for a year, basically. So, you know, everybody,

00;15;04;08 - 00;15;17;24
Kimberly Carleson
there lot weren't a lot lost their family members and a lot couldn't afford to continue on with their treatment. So it started making sense to me that I might could do something.

00;15;17;24 - 00;15;36;08
Kimberly Carleson
There is purpose. Why he is here. There is purpose. Why? And I don't know why anyone survived, but I'm a believer in Jesus and there's purpose in it. Now how can I use that purpose? And the purpose is for me to be able to help others navigate the system.

00;15;36;10 - 00;15;41;14
Craig Andrews
Which is so incredibly confusing.

00;15;41;17 - 00;16;05;19
Kimberly Carleson
It is so confusing, and it's built to make you feel like you're failing the system. So you have to have. I think it is important for people to find someone that knows what they're doing and to help them, because a lot of people will just if I would have just listened to that, those major hospitals that we see advertising, I don't want to know name, but they're very well known hospitals.

00;16;05;26 - 00;16;14;14
Kimberly Carleson
If I were to just listen to them and hung up the phone and said, okay, you just have two years to live, I wouldn't have a husband and my kids wouldn't have a father.

00;16;14;17 - 00;16;19;04
Craig Andrews
Well, the.

00;16;19;06 - 00;16;48;09
Craig Andrews
I mean, the one of my big lessons was I had to go and question everything. I mean, when I was, when the bills started coming through, I was just crazy. One of the things, one of the things that they tried to charge me. Hey, present is not covered by insurance. Was when I was in the hospital, and I forget which surgery it was, you know, so I had a few, at least two surgeries.

00;16;48;12 - 00;17;03;29
Craig Andrews
One was to put my break in, and the other was to put my feeding tube in my stomach. One of those they didn't want pay the nurse these geologists because the as these geologist was our network. I'm like, I didn't I was in the hospital, which was the same place.

00;17;03;29 - 00;17;06;10
Kimberly Carleson
Right.

00;17;06;12 - 00;17;10;22
Craig Andrews
And I was like, I didn't make that choice.

00;17;10;25 - 00;17;15;23
Kimberly Carleson
Yeah. And most people don't know how to look at that and to question it right.

00;17;15;26 - 00;17;20;20
Craig Andrews
Yeah. Well, and and then there was, there was a claim that the,

00;17;20;20 - 00;17;34;02
Craig Andrews
and so these geologists never filed with my insurance. They've sold that debt twice and sent bill collectors after me to get that. And they never filed it with the insurance.

00;17;34;05 - 00;17;35;13
Kimberly Carleson
Wow.

00;17;35;15 - 00;17;54;12
Craig Andrews
And, you know, for those that don't know, the law says they have to they have to file it with your insurance by the first day of the 11th month after your treatment, or they never get to come after you for it. But they're still they've sold it to two different debt collectors to try to get money on me.

00;17;54;14 - 00;17;59;07
Kimberly Carleson
Have you? What do you do about what are you doing about that?

00;17;59;10 - 00;18;04;29
Craig Andrews
So in the process, I had to figure out how to become an expert in and radical law.

00;18;05;01 - 00;18;06;08
Kimberly Carleson
Right.

00;18;06;10 - 00;18;20;24
Craig Andrews
Thank goodness we live in the era of ChatGPT. Because I can say, please write a letter in accordance to with this code to respond. And ChatGPT will draft a letter that sounds reasonably professional and,

00;18;20;24 - 00;18;27;28
Craig Andrews
well, but you have to know how to direct ChatGPT. You have to know about the law. You have to know about these things.

00;18;28;01 - 00;18;39;29
Craig Andrews
And, and it's it's just crazy. But so that's so kind of coming back to you. You're helping folks navigate all this. You're helping the employers navigate.

00;18;39;29 - 00;18;45;22
Kimberly Carleson
We are we're helping self-funded plans. And is what we do is we review medical claims,

00;18;45;22 - 00;18;54;02
Kimberly Carleson
we find ineligible charges. Those are the charges that are typically unbundled from a certain CPT code, which is,

00;18;54;02 - 00;18;58;29
Kimberly Carleson
code on a bill that when they're charging or when they're,

00;18;58;29 - 00;19;04;12
Kimberly Carleson
putting your bill together, they're going to have to have CPT codes on it that are just going to explain the procedure.

00;19;04;12 - 00;19;13;22
Kimberly Carleson
It's a procedure code. So we go in, we take those procedure codes off that should not be there. Those are ones that

00;19;13;22 - 00;19;21;25
Kimberly Carleson
let's say that you've already paid for your surgery, but they add and sterilization or they add in a warming blanket, or they add in,

00;19;21;25 - 00;19;25;05
Kimberly Carleson
pill cutter, you know, things like that. That shouldn't be on the bill.

00;19;25;05 - 00;19;33;01
Kimberly Carleson
We take it out and typically we find around 20 to 40% of ineligible charges on every claim we review for in network and on

00;19;33;01 - 00;19;48;15
Kimberly Carleson
a network, we can go up to 70% and above. That's how much extra is on there. That should not be on the claim. And if you think about that, that adds up to a whole lot of dollars, especially by the end of the year.

00;19;48;15 - 00;19;56;00
Kimberly Carleson
And then the premiums rise. People just don't understand the trickle down effect that that has with their employers.

00;19;56;02 - 00;20;07;10
Craig Andrews
Yeah, yeah. Because there's a I forgot there's one of those ratios that if you exceed it, your your next year's premiums are just going to go up a stupid amount.

00;20;07;12 - 00;20;12;14
Kimberly Carleson
Right. Like that. We've seen this year happen with premiums.

00;20;12;16 - 00;20;13;01
Craig Andrews
Yeah.

00;20;13;07 - 00;20;25;26
Kimberly Carleson
Ridiculous like going up. So I go on to read it a lot. I don't know if you ever go on there, but I read just personal stories because I like to see where people are. And I like to know how to meet people where they are. And so,

00;20;25;26 - 00;20;32;06
Kimberly Carleson
they're just talking about how they're not even able to afford insurance this year because it's going up so much or they can't do a family plan.

00;20;32;06 - 00;20;35;17
Kimberly Carleson
They've got to just do an individual budget.

00;20;35;17 - 00;20;39;14
Craig Andrews
And then that doesn't that suck? Okay, who are we going to insure?

00;20;39;16 - 00;20;44;04
Kimberly Carleson
Right. Exactly.

00;20;44;06 - 00;20;53;06
Craig Andrews
But so how is it how is it that you work with companies to get this under control?

00;20;53;09 - 00;20;56;29
Kimberly Carleson
Right. So we go to self-funded plans were typically

00;20;56;29 - 00;20;57;18
Kimberly Carleson
with,

00;20;57;18 - 00;20;59;19
Kimberly Carleson
we do municipal leagues, we do,

00;20;59;19 - 00;21;04;19
Kimberly Carleson
any self-funded plan, school districts, unions. We

00;21;04;19 - 00;21;20;11
Kimberly Carleson
go in pre or post payment and we audit their claims. A lot of times the networks are because CPAs will not let us go and prepayments. So if that occurs we go in post payment and we go collect the overpayments.

00;21;20;14 - 00;21;42;03
Kimberly Carleson
We have been doing this for a long time. We have found one claim claim. And when I say claim, that means there were no errors. But the claim did have a $5 charge on it. But I call that claim an extra charge so that that's claim to me. So, we our appeals rate is less than 1%. We've never lost an appeal.

00;21;42;03 - 00;21;50;15
Kimberly Carleson
So it's just a lot of times, intentional or not, it happens. Coding departments get busy, they throw on codes on appeal, it gets sent out. And,

00;21;50;15 - 00;22;07;14
Kimberly Carleson
it's typically pay. Your carrier's probably going to tell you they have a review party already in place like ours. But, if it's owned by them, I would say you should have an independent to be nice.

00;22;07;17 - 00;22;10;05
Craig Andrews
Well, I mean, here's an example from my journey.

00;22;10;05 - 00;22;30;22
Craig Andrews
There's a company I won't say their name on there, but they are a criminal organization. And the reason I say that criminal organization is in 2018, they pay. They settled a lawsuit with the DOJ. They paid the DOJ $10 million, and they admitted to knowingly billing people for equipment that they never delivered.

00;22;30;24 - 00;22;31;14
Kimberly Carleson
Yeah.

00;22;31;17 - 00;22;40;28
Craig Andrews
They're a criminal organization. They charged me for oxygen for two years. I was never their customer. I got oxygen from someone else.

00;22;41;01 - 00;22;41;20
Kimberly Carleson
Wow.

00;22;41;28 - 00;22;51;06
Craig Andrews
And I was off oxygen for well over a year while they were still billing me for oxygen that they never provided in the first place.

00;22;51;08 - 00;23;03;08
Kimberly Carleson
That happens all the time, too. Yeah, that was sickening. Yeah. And you're right, there's a lot of those criminal organizations in health care. Unfortunately.

00;23;03;11 - 00;23;04;21
Craig Andrews
Well, I can think of,

00;23;04;21 - 00;23;14;02
Craig Andrews
I can think of one pharmaceutical company that has been convicted of so many felonies that if they were a person, they'd be spending life in jail.

00;23;14;05 - 00;23;33;27
Kimberly Carleson
I have to agree with you. There's several pharmaceutical companies that I've definitely been, had the lawsuits, but, you know, you don't hear about some of them as much because they go to arbitration and, you know, they settle it under the table. So they have those arbitration clauses in their agreements.

00;23;33;29 - 00;23;42;08
Craig Andrews
Yeah. So what does it so let's say I have a company that's let's say doing ten, 10 million in revenue. And I'm providing employee,

00;23;42;08 - 00;23;54;18
Craig Andrews
health care for my employees. How much how much money? If I brought you on, how much money on average would you bring back to my $10 million company?

00;23;54;20 - 00;23;58;07
Kimberly Carleson
So let's say you spent 10 million in,

00;23;58;07 - 00;24;22;06
Kimberly Carleson
claims. So we're only going to review 30% of that because 30% is going to be your 10,000 and above. And typically if you go below 10,000, it's really just kind of your contractual doctor's visits or something like that. And you're not going to find as much savings. But we would typically at the end of the year, it would be 10% of overall spend.

00;24;22;08 - 00;24;28;00
Kimberly Carleson
That would be very conservative. So you would save 10% of your overall spend.

00;24;28;02 - 00;24;29;16
Craig Andrews
That's pretty big.

00;24;29;18 - 00;24;31;05
Kimberly Carleson
Yeah. It can,

00;24;31;05 - 00;24;46;27
Kimberly Carleson
end up being hit every month like we bill monthly, let's say, to a lot of our clients every month when we give the percentage of what we say, it's typically between 20 and 40% for the month.

00;24;46;29 - 00;24;49;18
Craig Andrews
Well, and when we think about how,

00;24;49;18 - 00;25;06;07
Craig Andrews
health plans are quickly becoming the second or maybe third line item in the budget, in any company's budget to be able to tackle that. And not only that, but a budget item that's probably rising faster than revenue.

00;25;06;10 - 00;25;24;16
Kimberly Carleson
Right? Right. Yeah. Every plan should be looking at, you know, they look at every pencil, every piece of paper. They account for everything in the business, but they do not account for the health plan dollars. They don't look over them because they just trust.

00;25;24;18 - 00;25;25;24
Craig Andrews
Wow.

00;25;27;20 - 00;25;41;16
Craig Andrews
Well come away. This is just I mean, obviously, you know, you and I have talked to were both passionate about this. I think people need to reach out to and at least have a conversation. How can they reach you?

00;25;41;18 - 00;25;47;02
Kimberly Carleson
They can reach me on LinkedIn or go to our website. Us speaking.com.

00;25;47;05 - 00;25;48;05
Craig Andrews
Okay.

00;25;48;07 - 00;25;54;26
Kimberly Carleson
So we have an info button on there. And if they email that, we get back to them pretty quickly.

00;25;54;29 - 00;26;00;10
Craig Andrews
Well I'm I'm so thankful you were there for your husband. I'm so thankful for what you're doing.

00;26;00;10 - 00;26;02;20
Craig Andrews
Thank you for coming on Layers and Legacies.

00;26;02;22 - 00;26;12;15
Kimberly Carleson
Thank you so much for having me up, I appreciate it. I think you and I both share something in common, and we have a passion because of what we've been through, so I appreciate it.

00;26;14;15 - 00;26;41;09
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 Ally's for me.com/guest and sign up there. If you got something out of this interview, we would love you to share this

00;26;41;09 - 00;26;43;04
Craig Andrews
episode on social media.

00;26;43;06 - 00;27;06;18
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;27;06;20 - 00;27;14;25
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.

00;27;14;25 - 00;29;17;00
Craig Andrews
It means a lot to my team. If you want to know more, please go to Ally's for me.com. Or follow me on LinkedIn. Thanks for listening. We'll see you next time.