Josh Butler is the entrepreneurial force behind Butler Benefits and the High Plains Health Plan. Josh shares his riveting journey from managing a country and western nightclub to revolutionizing healthcare in northern Texas. He reveals his innovative health plan that offers $0 deductibles and copays, challenging the status quo and addressing the financial inaccessibility plaguing the healthcare system.

Josh's story is a testament to leadership that inspires action and drives monumental change. His approach isn't just about altering healthcare logistics; it's about nurturing a community where accessible healthcare isn't just a privilege but a given. This episode isn't just an interview; it's a call to be part of a groundbreaking shift towards sustainable, fair, and transparent healthcare solutions.

Want to learn more about Josh's work? Check out their website at https://butler-benefits.com/.

Connect with Josh on LinkedIn at https://www.linkedin.com/in/josh-butler-benefits/.

Key Points with Timestamps:

• 00:00:00 – 00:02:21: Craig Andrews introduces the podcast and guest Josh Butler, highlighting the resilience of his team during his coma and the importance of leadership in challenging times.
• 00:02:21 – 00:08:44: Josh Butler discusses his background, from his Texan entrepreneurial roots to his transition into the healthcare industry, emphasizing innovation in healthcare solutions.
• 00:08:44 – 00:11:49: Exploration of the High Plains Health Plan, detailing its unique approach to $0 deductibles and its impact on healthcare affordability.
• 00:11:49 – 00:22:21: In-depth discussion on healthcare pricing, the inefficiencies in the system, and the strategies Butler Benefits employs to reduce healthcare costs.
• 00:22:21 – 00:34:17: Josh and Craig discuss the complexities of healthcare billing, insurance, and the potential for systemic change through transparent pricing and fair negotiation.
• 00:34:17 – 00:42:48: The benefits of a zero-deductible plan are outlined, focusing on hospital cost-reduction, patient satisfaction, and overall healthcare accessibility.

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;23;17
Craig Andrews
Today is an interview I've really been looking forward to. our guest is doing something important in the area of health care and whatever you're doing today, I hope you stop and listen to him, because this is an important and necessary change. Obviously, it's personal to me. from my experience with, you know, three months in the hospitals and, and all that, I've, I've witnessed some of the brokenness firsthand.

00;01;23;18 - 00;02;00;23
Craig Andrews
And I've looked at the stack of bills, literally two inch stack of bills sitting on my desk, and Josh Butler is it comes from a family of entrepreneurs. His family goes back deep in the history of Texas. His great great grandfather was a rancher. Its family got in the oil businesses. He's best Texan as they come. And you know, one of the things I think that means is finding new and better ways to doing things and doing them without letting people stop you.

00;02;00;25 - 00;02;21;02
Craig Andrews
And one of the quotes he gave me, he said, the greatest leader is not necessarily the one who does the greatest things. He's the one that gets people to do the greatest things. And this is a Herculean task to make these changes. And so I hope, I hope you'll become part of this change. And so I want to introduce Josh Butler.

00;02;21;02 - 00;02;36;20
Craig Andrews
He's owner of Butler Benefits and runs the High Plains Health Plan. That's health plan that covers northern Texas. a little bit of New Mexico and maybe, Oklahoma. But, Josh, welcome.

00;02;36;22 - 00;02;40;03
Josh Butler
Hey, Craig, thanks so much. Thanks for having me.

00;02;40;05 - 00;02;54;26
Craig Andrews
So, you know, we, you know, we've talked before and most of what we talked about was the, was what you're doing in health care. What you didn't tell me at that time was you met David Lee Roth.

00;02;54;28 - 00;03;00;02
Josh Butler
I did, I met David Lee Roth, once. Once upon a time, I did.

00;03;00;05 - 00;03;11;13
Craig Andrews
And so for the few people that don't know who David Lee Roth is, he was the original lead singer of Van Halen. And where did you meet David Lee Roth?

00;03;11;16 - 00;03;34;27
Josh Butler
Well, Craig, I guess we're just going to get right out of the gate and get into my skeletons in my closet. not a whole lot of people that I'm associated with today. Craig. no, my, my checkered past, I would say, before I got into, insurance and employee benefits and consulting, I worked for a country and western nightclub chain.

00;03;34;27 - 00;03;39;23
Josh Butler
They owned country western nightclubs all across the United States and socially.

00;03;39;25 - 00;03;50;01
Craig Andrews
So. Wait a minute. Wait, are you telling me that David Lee Roth is a closet country star? But he's not sporting the long hair and the tight leathers? He's. He's playing country.

00;03;50;07 - 00;04;12;21
Josh Butler
No, he was not playing country. And he was very much in his spandex and his long hair when we met, we met in Amarillo. we had a country western nightclub here, and it was a rather large, venue. And people that live around here know exactly the venue that I'm talking about. but, we did a cross-promotional deal with a local rock station, Rock 108.

00;04;12;24 - 00;04;31;04
Josh Butler
and they had gotten into inviting artists to stomp through Amarillo. Maybe they were passing from Dallas to Denver, you know, on their tour bus. And, we're able to get these folks to stop in Amarillo and play shows in smaller venues. And this was at the tail end of, you know, this is not at the heyday of Van Halen.

00;04;31;04 - 00;04;49;11
Josh Butler
Obviously. I'm not that I'm not quite that old. but yeah, David Lee Roth was one of the artists that stopped, in Amarillo and played a show at the country and Western nightclub that I was the the general manager for. So, interesting, interesting guy.

00;04;49;13 - 00;05;00;19
Craig Andrews
I gotta say, I, I mean, I used to listen to I had a lot of Van Halen albums. I listen to a lot of Van Halen. Never before have I heard that David Lee Roth played in the country and Western bar.

00;05;00;21 - 00;05;02;08
Josh Butler
He certainly did.

00;05;02;11 - 00;05;09;01
Craig Andrews
Wow. And so you. So that's where you got your start. That's where you learn business.

00;05;09;03 - 00;05;26;10
Josh Butler
So it's where I learned a lot of business as a lot of young people that, you know, back when college was actually affordable, I didn't have the luxury of being on a any type of scholarship to go to school. And, my family did help, you know, pay for a little bit of my college, but a lot of it, you know, fell on me for the financial responsibility.

00;05;26;10 - 00;05;50;19
Josh Butler
So, I had to work, you know, like most, like a lot of college, people do have to do today. And so I, took a job at this country and western nightclub as a bartender. And ultimately, I can't work in there because I was able to work three nights a week and and pay my rent and make my truck payment and buy groceries and keep up with my my living expenses and have a little bit of playing around money.

00;05;50;19 - 00;06;09;11
Josh Butler
But, then as, as I got closer to, graduating college, I went to my boss and I just said, hey, man, you know, I guess I got to get out in the real world and get a real job. And that's when they made me an offer. And I said, hey, look, you. We think that you're a smart guy and you're definitely a hard worker, and we'd like to offer you a management position.

00;06;09;11 - 00;06;35;15
Josh Butler
And so I didn't have a whole lot going on, Craig. I mean, it's not like I was going to Goldman Sachs, right? so, I took it in, we went down south to San Antonio for, for a spell. Then I was in Houston for a little while, and then, just continued to graduate up and get promoted up through hard work and effort and, and things and, up until I became an operations manager, me managed a couple of hundred employees, and the rest is history.

00;06;35;15 - 00;06;39;23
Josh Butler
And Craig, that is way in the rearview mirror. Wow.

00;06;39;25 - 00;06;43;21
Craig Andrews
Well, so how did you go from that to insurance?

00;06;43;24 - 00;07;01;28
Josh Butler
Yeah. So, I mean, as you can imagine, I mean, the last time I was a single guy at the time, you know, not not club life is not very conducive to family life. And as I had worked for that organization for a number of years and kind of on their corporate ladder, I just I wanted to go do different things.

00;07;01;28 - 00;07;22;09
Josh Butler
And I had a friend who introduced me to a guy that was working in insurance, and, I'm a salesperson. Lucky. Like you mentioned, I come from a long line of entrepreneurs. I love the idea of being in sales because there was no cap on your on your income, potential. Right. And so, I jumped ship.

00;07;22;12 - 00;07;47;20
Josh Butler
I left the country and Western, not club industry got into insurance sales, and, I've been in it ever since. And then in 2015, my wife and I, started our own, consulting and brokerage firm. That's another benefits and consulting that you referenced off the top. And, we've been blessed and we've been successful. And, and then in 2022, we launched top Line Self-cleaning.

00;07;47;23 - 00;07;48;26
Craig Andrews
Okay.

00;07;48;28 - 00;07;51;25
Josh Butler
There it is out a 50,000ft level.

00;07;51;28 - 00;08;12;29
Craig Andrews
So. And just so people know where we're going, high plains health care. It's a health care plan where the it's for companies it's group plans and for the employees pay $0 deductibles. If they need to go to the doctor, they go to the doctor.

00;08;13;02 - 00;08;40;05
Josh Butler
So we do offer, a very unique plan that is, does provide $0 deductibles and $0 copays for thousands of medical services and procedures, including all generic medication is covered at 100%. It's a $0 copay for generic meds as well. And so yes, sir. that is the type of health plan that we have. that we've constructed and built and it is gaining traction.

00;08;40;07 - 00;08;44;03
Josh Butler
hopefully this will help promote them as well.

00;08;44;06 - 00;09;02;08
Craig Andrews
Well, and so we launched High Plains Health Plan and in 2022, what what was happening there? What was the impetus, what got that started? What was different from Butler benefits.

00;09;02;11 - 00;09;24;13
Josh Butler
Yeah. So Butler Benefits is more of, you know, a traditional brokerage firm. We're an independent brokerage firm. So that means that we can sell insurance plans for companies like Blue Cross Blue Shield, Cigna, Aetna, Humana, United Health Care, Guardian, Aflac, colonial, you name it. I mean, we're appointed with a lot of different insurance companies, but health care and health insurance are two different things.

00;09;24;13 - 00;09;52;22
Josh Butler
And so what we started to see predominantly more and more of is health insurance has gotten so damn expensive because health care is expensive. And if we're going to try to get control of health insurance costs, we have to address health care costs directly and specifically. And so that's what we started to do. We just first started with the question and, and thought, is it even possible to pay less for health care?

00;09;52;28 - 00;10;14;07
Josh Butler
And if it is, let's go figure out how to do that. And then, you know, just things start to evolve and things start to come together. And we realized that we had, access to all these solutions, whether we develop them internally or we collaborated with a different organization or what we call a point solution vendor partner to, that's what the work they were doing.

00;10;14;07 - 00;10;43;06
Josh Butler
We discovered this entire community of companies and organizations around the country that had the same mission, had the same purpose, is to lower the cost of health care and make it more accessible and more affordable for more people. But what we kept running into was, how does all of this work within a BlueCross BlueShield plan? And I don't mean to pick on Blue Cross Blue Shield or because it's not them specifically, but these types of solutions don't work in a traditional insurance environment.

00;10;43;06 - 00;11;07;11
Josh Butler
And there's a whole host of reasons why. And we could do five more podcast episodes and cover them all. And you, we still wouldn't cover them all. but we decided we're not going to be able to get the results that companies and employees are looking for because they all want the same thing, which is what to lower their costs without compromising the integrity and the quality of their benefits.

00;11;07;13 - 00;11;29;11
Josh Butler
If I put a $50,000 deductible in place, yeah, not lower your premium, but nobody can afford to use the plan, right? So it defeats the purpose. And so we decided the only way that we feel like are the most one of the most effective ways you can accomplish that is to build your own health plan. And we did that and we it was, it's been it's still a labor.

00;11;29;11 - 00;11;49;12
Josh Butler
It is a lot of hard work. but we launched it in 2022. We've got about 18 months of experience under our belts, and the plans are performing exceptionally well. And we knew that they would, because of the concepts and the strategies that were in place to drive down the cost of health care.

00;11;49;14 - 00;12;01;12
Craig Andrews
So when I when I hear the $0 deductible, I think expensive. I think the higher the deductible, the cheaper it is lower the deductible, the more expensive it is for sure.

00;12;01;14 - 00;12;22;25
Josh Butler
I mean, I'm happy to address that because. But let me back up for just a second and predicate my answer on this. And you're going to shake your head and you're going to say, you know what? You're right is if you think about all the things that we purchase in the American economy, I can only think of one thing that we all consume, and we all purchase before you ever know a price and before you ever know the quality of what you're buying.

00;12;23;00 - 00;12;49;09
Josh Butler
And it's called health care. Okay. So and then another thing is health insurance. The in the way insurance plans are designed. I'll give this example. If you have a $5,000 deductible, a maximum out of pocket, you really don't care what the total price tag is of your service. All you really care about is what comes out of your pocket and what your personal financial liability is for that service, which is only $5,000.

00;12;49;12 - 00;12;58;26
Josh Butler
People have lost sight of that, that they don't care what the ultimate sticker price is. But I use this analogy all the time. Okay, what does this?

00;12;58;29 - 00;12;59;29
Craig Andrews
It's a mobile phone.

00;13;00;03 - 00;13;03;02
Josh Butler
Would you give me $25,000 for this phone?

00;13;03;05 - 00;13;04;11
Craig Andrews
Oh absolutely not.

00;13;04;17 - 00;13;06;04
Josh Butler
Why not?

00;13;06;06 - 00;13;08;10
Craig Andrews
Because I can buy a pretty good one for 1000.

00;13;08;17 - 00;13;10;15
Josh Butler
How do you know that?

00;13;10;18 - 00;13;11;28
Craig Andrews
prices are listed.

00;13;12;00 - 00;13;28;07
Josh Butler
They're not listed in health care now, are that correct? So now you're getting to the you're getting down to why people don't know the price of what they're buying. And just on principle, I don't care. Do you think Warren Buffett would buy this cell phone from me for $25,000?

00;13;28;09 - 00;13;34;06
Craig Andrews
what I know about Warren Buffett, if it's a $1,000 phone, he's going to figure out how to buy it for $500.

00;13;34;12 - 00;14;03;10
Josh Butler
Thank you very much. And so that that begs the thing, it's not about if we have the resources to buy something at a certain price out of principle alone, Warren Buffett would not pay me $25,000 for this piece of technology. And so that's the thing. And that's why you're seeing all these legislative laws and things get done at the legislative level and states and even at the federal level, to give people like me and like you access and transparency into first pricing.

00;14;03;12 - 00;14;27;18
Josh Butler
And we use that kind of data to go negotiate better prices for our clients. So if a under, in another agreement somewhere, a knee surgery used to cost 50 grand and I don't negotiate it for 20 grand. And that's a real example, by the way, that's not a hyperbolic situation. That is a real situation that's very, very common.

00;14;27;20 - 00;14;59;07
Josh Butler
I just generated $30,000 worth of savings through that negotiation. Well, if I can save $30,000 on a surgery, Craig, I can well afford to cover your $5,000 deductible out of pocket and still net save $25,000 on the procedure. Everybody wins. But you have to have a mechanism where all of that is easy enough for the patient that when they walk in somewhere, all I gotta do is hand them that I.D. card and they got insurance, and everything gets set in motion to accomplish that.

00;14;59;09 - 00;15;22;14
Craig Andrews
Now, one thing that I think is a mystery, in addition to how how things are priced, I think one thing that's a mystery to people is how Blue Cross Blue Shield, you know, gets built by, you know, let's say a hospital. And if I understand it correctly, it's it's a multiple of Medicare.

00;15;22;16 - 00;15;47;28
Josh Butler
a lot of newer contracts and updated contracts can be a multiple of Medicare, but some of the old legacy contracts can even be a discount off billed charges. So that's typically why you see a hospital bill. And people think, oh my gosh, look at this bill. They charged $58 for a single tablet of Tylenol. Well, yes, they charged $58, but nobody got paid $58, right?

00;15;47;28 - 00;16;19;26
Josh Butler
Nobody. None of the payers, none of the insurance companies actually pay those list build charges. It's some discount off of that. So there's two different methodologies that you just brought up though. There is a discount off of a list price or there is a markup over of Medicare allowed. And we think that the latter the markup over what Medicare allows for services is more in line with what we would deem a fair price than a discount off of a $58 charge for a single tablet of aspirin.

00;16;20;03 - 00;16;37;24
Josh Butler
Because most insurance discounts are in the neighborhood of between 50 and 60%. So let me ask the final question. If I gave you a 50% discount on a single tablet of aspirin or Tylenol priced at $58, are you getting a good deal or a bad.

00;16;37;27 - 00;16;40;02
Craig Andrews
Yeah. Yeah, exactly. I mean.

00;16;40;02 - 00;17;01;18
Josh Butler
And that's what happens in health care, thousands and thousands and thousands of times every minute in this country. And that's how health care is bought and paid for. And people don't understand it. People don't even know it. And they wonder. And they sit around and they ask questions like, why is my health insurance so expensive? Why are my premiums keep going up year over year over year?

00;17;01;21 - 00;17;03;16
Josh Butler
Now, you know?

00;17;03;18 - 00;17;26;15
Craig Andrews
Well, let me give a couple of examples from my journey of things. I have consumed a lot of my time and and I'm the outlier. I'm, you know, I'm a little bit of a I'm a little bit of a bulldog on some things. And and one was a case of, fraud. and just for the lawyers are listening, this is alleged fraud.

00;17;26;16 - 00;18;09;28
Craig Andrews
The person, the company that committed it has admitted nothing. But I will tell you, there's a company out there called World Tech Health Care that supplies oxygen. And in 2018, they paid the DOJ $10 million for knowingly defrauding, Medicare patients. that is a factual statement in the public record. But anyway, I had a a company that was providing claim to be providing me oxygen, and they build me and my insurance company for oxygen for two years and first started when I was in the hospital in the ICU on the ventilator and all they provided was portable oxygen.

00;18;09;28 - 00;18;42;27
Craig Andrews
So obviously I wasn't using portable oxygen was on the ventilator. So that's when it started and they continuously billed me for a year. And a year. And three months after I returned the oxygen to the company that was actually providing me the oxygen. And so my insurance company got billed and they actually paid out benefits to two different oxygen suppliers, overlapping the same time.

00;18;43;00 - 00;18;53;09
Craig Andrews
And I ended up having to spend $1,500 to get a lawyer to make all this go away, because they were they were threatening me with, with payment.

00;18;53;12 - 00;18;54;25
Josh Butler
Yeah. Collections. Yep.

00;18;54;28 - 00;19;07;13
Craig Andrews
And, but when I look at that, that's an example of an inefficiency. My, my insurance company paid them a lot of money for oxygen. They never delivered. Right.

00;19;07;15 - 00;19;26;07
Josh Butler
And so my question gets asked, why would an insurance not kit and company not catch that. And there's a lot of stories and reports and there's a lot of investigative journalists that have done this work. And they there's I mean, what it's not their money that they're paying the vast majority of insurance claims with. I'll get back to that in just a second.

00;19;26;09 - 00;19;47;20
Josh Butler
Where's the incentive to catch this fraud? Where's the incentive to catch these billing errors? Where's the incentive to lower the price of health care? There's a whole lot of, you know, misaligned incentives in health care that are counterintuitive to most people. Most people think the insurance company wants to absolutely pay the very least amount they have to pay, not necessarily, not necessarily.

00;19;47;20 - 00;20;31;15
Josh Butler
And there's a whole provision in the Affordable Care Act that kind of set that in motion way back in in 2012. It's called the medical loss ratio of the Affordable Care Act. Again, a whole nother episode of your podcast. But the thing is, it's counterintuitive to people is that it's like taxes. When we try to say that the government, they don't, they first must extract money from the citizens through taxes before anything ever gets paid, ever before any road gets built, before any thing that gets bought and paid for, gets bought and paid for, they first must extract from the electorate, from the citizens of this country who pay taxes in order to to make

00;20;31;15 - 00;20;59;11
Josh Butler
those payments. Insurance companies are the same way. They first must extract funds from fully insured employers through the form of premiums before they can ever pay a claim. So if you want to know what your premium is, It's because they're given a 50% discount on a 58 tab, $58 tablet of aspirin. You're getting ripped off. It's a everybody says, oh, look how great of a discount we offer.

00;20;59;14 - 00;21;23;00
Josh Butler
But nobody ever stops to ask a discount off. What a discount of $58 for a single Tylenol is still a bad deal. And we. And so that's why we have in our industry a lot of people use this. You know, this, this, this comment and this this quote. And it goes back to this phone. I'll give you a 99% discount on this phone.

00;21;23;00 - 00;22;00;18
Josh Butler
Craig. Under one condition. As long as I get to set the price, I'll give you any kind of discount. And that's what we have historically seen in health care is the prices are inflated 400, 500, 800, 1000 1317 hundred and 2,000%. And then they turn around and offer you a 50 to 60% discount. And so the thing is, more and more people need to understand the finance mechanisms of health care and how health care actually gets paid for is what's messed up in this country.

00;22;00;21 - 00;22;21;08
Craig Andrews
Yeah it's it unfortunately, it's been an expensive lesson for me and it's been painful lesson. Yeah. In watching it, I mean it's, you know and to your point, my hospital stay came in somewhere around the two, $2 million built. And you told me before you said the insurance company paid nowhere near that.

00;22;21;11 - 00;22;39;05
Josh Butler
No, they might have paid a million. No, on a $2 million bill. I mean, if you if you just look at the statistical, average discounts through PPO networks, I don't know if you're on a PPO plan or an HMO plan to say it was a PPO network plan, and let's say it was with United Health Care. It doesn't matter.

00;22;39;05 - 00;23;04;09
Josh Butler
You can pick either. They're all going to be in the same, similar vicinity as one another on a $2 billion bill. What if they got a 50% discount? That's still $1 million in care, but was that was that was that still egregiously overpriced at the end of the day? I mean, that's what we the type of analysis that we do for companies and we say, yeah, you got a 50% discount on 2 million bucks.

00;23;04;12 - 00;23;33;25
Josh Butler
But under deals that we negotiate, you would have gotten a 76% discount. And so that's how we're driving down the unit cost of care for services, hospital stays, prescription drugs, diagnostic imaging, things like MRI, CT scans, sonograms, Pet scans, hip replacements, you name it, I mean, it all kinds of things that we're able to impact the unit price of and what the plans actually have to pay out in the form of a claim.

00;23;33;27 - 00;23;55;28
Josh Butler
And when you lower that, then naturally, health insurance premiums are going to come down with it. And that's our that's our belief. That's what we're setting out to prove in this country is that there are solutions, in this realm. And we don't need a government to swoop in and take it over if we just don't.

00;23;56;00 - 00;24;21;19
Craig Andrews
You know, I used to say, you know, I used to tell people, I said, you know, we have the best health care in the world. I've, you know, I've lived in multiple first world nations and experienced health care abroad. And I was like, what we have is better. And I got to say, after my experience going through the hospital, I don't say that anymore.

00;24;21;22 - 00;24;37;14
Craig Andrews
you know, but the one thing I say is where I've experienced government run health care, what I, what I experienced, I don't want that. I don't want that. But I'm also not defending what we have because what we have seems really, really broken.

00;24;37;16 - 00;24;55;11
Josh Butler
Well, especially, you know, when Covid 19 came around and I know that, I don't know anybody that was this severe. I know I had some friends and some people that we knew that, passed away from Covid 19. But you had you obviously had a very, very severe case. I had a severe case, but nothing like you.

00;24;55;11 - 00;25;17;22
Josh Butler
I double pneumonia as well. I was down for about 40 days, nowhere near three months, but, but I can tell you, I think that Covid, really kind of exposed our health care system on not being prepared for those types of pandemics situations. And it really kind of exposed the quality, issues that are existent in our health care system.

00;25;17;24 - 00;25;39;21
Josh Butler
Now, I do not have a clinical background. I'm not a physician. I'm not a nurse. I'm not, you know, a, pharmacist or anything like that. But I work with a lot of those types of people and so they they expressed the same concerns that you, that you just shared is that, you know, where are we buying our ingredients for our prescription drugs?

00;25;39;23 - 00;26;03;17
Josh Butler
How are we, reliant on countries that don't like us very much? and that it's all tied to our, you tied to our healthcare system right now? I mean, the the SEC allowed a merger to happen between the largest insurance company in the world, UnitedHealth Group, and one of their subsidiary companies, Optum. They bought another company, and they allowed that merger to happen.

00;26;03;21 - 00;26;11;16
Josh Butler
Well, this other company is a switch operator for 20 tens of thousands of pharmacies. And they just got hacked last week. I don't know if you saw that story.

00;26;11;21 - 00;26;12;20
Craig Andrews
I did not.

00;26;12;22 - 00;26;51;10
Josh Butler
But it affects and then they just completely shut down their systems. And now this is affecting over 70,000 pharmacies from coast to coast, that these pharmacies and these doctors are not able to submit their claims and get their payments because of this consolidated. And that's one of the fears and why the SEC gets involved on mergers and acquisitions is like if you allow these two major companies to form into one, and that one company gets a cyber attack, like what just happened in the last two weeks with Change health care, it can disrupt the entire healthcare system, and that's another risk in another direction.

00;26;51;10 - 00;27;16;10
Josh Butler
I see our healthcare industry going and I think poses a real threat and a real danger to the safety and security of not just our country, but and companies, but of all citizens. When you can basically shut down our claims processing companies and people can't get paid and people can't get prescriptions filled, that's a major, major disruption. And I'm pretty fearful.

00;27;16;10 - 00;27;25;08
Josh Butler
I don't trust the government to guide us in the right direction in almost any facet of of this, of what we're doing in healthcare now.

00;27;25;10 - 00;27;47;27
Craig Andrews
Well, let me bring up another situation from my journey, because I think you may have something to say about this as well. So, what I've discovered is, you know, when you get the service, you know, let's say I'll use an example, an anesthesiologist, because I had a few of those, right after they deliver the services, they deliver a bill.

00;27;48;00 - 00;28;14;23
Craig Andrews
And, you know, most companies will continue to bill on a monthly basis until you pay your bill. Well, I found in health care they quit billing, they got silent. And then the next thing you see is, is you're in collections. That's the next notice is you're in collections, like a year later. Well, on September 11th, 2021, I was in surgery having a treat put in.

00;28;14;26 - 00;28;43;10
Craig Andrews
And obviously when you're in surgery, there's an anesthesiologist there and they put out a bill for $2,400 for that. but they never submit it to insurance. And, you know, most likely if they'd submit to insurance, insurance would knocked it down to about $1,000, but insurance would pay 100% of that because if it was, you know, I'd already met my deductible while they never submitted it.

00;28;43;15 - 00;29;10;18
Craig Andrews
And then, then one point last year, I get this notice from a law firm that's trying to collect that, actually, a law firm up in North Texas, up in Sherman and trying to collect data on that. And I wrote back to them. I said, hey, you guys never filed this with insurance. Go back and file it with insurance.

00;29;10;21 - 00;29;15;29
Craig Andrews
and it turns out I found out they missed the deadline.

00;29;16;02 - 00;29;17;08
Josh Butler
Timely filing.

00;29;17;10 - 00;29;41;18
Craig Andrews
Timely filing. So anyway, there's a sense these geologists out there that should have been paid. I mean, his job was keep me alive during surgery. I'm still alive. He should have gotten paid, but he never got paid. And, And because he doesn't get paid, part of his business model says, I'm going to charge more for all these services to cover.

00;29;41;20 - 00;29;52;19
Craig Andrews
You know, what I know will be a certain amount of loss. How does what you're doing address, unclaimed bills or unpaid bills?

00;29;52;21 - 00;30;25;15
Josh Butler
Well, there's a couple of things. I think that the No Surprises Act, NSA has addressed this particular issue with using an in-network facility. I'm assuming the hospital you were in and you received this training in this procedure was an in-network hospital. Yeah. Okay. So now no surprises. Act has some consumer protections built into it that if you're you in at an an in network facility, but you received services from an out-of-network provider like this anesthesiologist because many anesthesiology groups are not in network with anybody.

00;30;25;18 - 00;30;50;13
Josh Butler
And so if they if they were, then they are contractually obligated to submit that claim in a timely manner, to the insurance company for adjudication, processing and payment of that claim. So I'm not saying this is what happened in your case, but I have seen this in other cases that I've got involved with is that that anesthesia company knows if I submit this over to insurance, this bill is going to be discounted.

00;30;50;13 - 00;31;13;14
Josh Butler
Let's stay with the same percentage we've been using on the other stories. 50% $2,000 bill. I'm going to get paid a thousand. But is there a chance that if I send Craig Andrews a $2,000 bill and keep hounding him and hounding him to pay the full 2000, and he'll just pay me out of his pocket, assuming that he owes it, because I think that most people, when they receive a bill.

00;31;13;16 - 00;31;34;09
Josh Butler
To your point, a second ago, they provided the service they deserve to get paid. Well, when I get a bill for $2,000, I guess I owe it. If that's the bill, I guess I got to paid. And that is that is a very understandable perception and understanding that if because like if you get the electric bill, you know, you owe it, right?

00;31;34;16 - 00;31;54;08
Josh Butler
And you're assuming that the electric company has done an accurate job of reading your meter and assessing you the right rates and charging you the right rates, and you don't even think to question the bill. You just pay it. Like most Americans, they get bills, we pay them. So that's the hope, is that I don't want to get paid $1,000 if Craig will pay me 2000.

00;31;54;12 - 00;32;20;20
Josh Butler
So just send him the bill and don't send it to insurance. And then if they don't send it the insurance, we'll send him to collections and we'll see what we can get out of it. Now, a lot of I wouldn't say a lot, but I have seen out-of-network provider groups behave in this way. And what this is why educating the public through things like podcast and things like, you know, open enrollment meetings and town hall meetings, this is why these venues are so important.

00;32;20;20 - 00;32;47;05
Josh Butler
And these discussions are important is because people need to understand what types of protections they have under the law, what types of protections they have under their insurance contracts. Because when you purchase an insurance policy, you are entering into a contract. And if those providers of care are also in the network, they are in a contractual, relationship with yourself, with the all the doc and everybody else that are in the network.

00;32;47;07 - 00;33;09;23
Josh Butler
And so just people that this is not their area of expertise. But now there are some protections built in for things like NSA. But we we advise people a lot of times from, we will reach directly out to those out-of-network providers and say, hey, listen, you're out of network. And here's what the plan provision is. Craig's already met his deductible.

00;33;09;28 - 00;33;35;25
Josh Butler
And if you submit your claim over to us, here's what we're going to pay you. And if they're out of network, they can balance bill. They can send you a bill for the balance. But oftentimes we're a we're very successful at getting those balance bills to go away because there's more legal protections coming through. Things like independent dispute resolution where you say that's not a reasonable amount, I'm not paying you 2000.

00;33;35;28 - 00;33;55;23
Josh Butler
My insurance company paid you a thousand, and that is deemed reasonable and customary. Leave me alone. And we're pretty successful in that arena. There's other companies out there that do similar work. But yeah, we we get involved with our clients and we roll up our sleeves and we're advocates and we try to help people avoid those types of situations.

00;33;55;25 - 00;34;17;06
Josh Butler
Yeah. But for Tom, let me finish it up with this timely filing. I think it is a reasonable expectation if someone came to your house to mow your yard. Okay, I use the lawn care analogy quite a bit. If someone came to your yard, our house to mow your yard, you would expect to get a bill correct. If they say, hey, here's my process, I'm going to bill you later.

00;34;17;08 - 00;34;44;13
Josh Butler
Craig. I'm going to bill you later. Right. And somebody came back to you two years down the road and said, hey, man, I just turned you over to collections because you never paid me for my for mowing my yard. And you're like, well, you didn't send me a bill and you know, you wouldn't pay the bill. I mean, you might I mean, because you actually think, well, if the price was fair, but what if the guy sent you a bill for five grand and he's like, oh, well, you know, I forgot to send you my bill two years ago.

00;34;44;13 - 00;34;59;14
Josh Butler
Here's a bill for $5,000. Are you going to pay it? Of course you're not going to pay it. So I think it's still there's an aspect that still comes into the scenario in the conversation about what is reasonable, what is equitable, what is fair, not just bill charges.

00;34;59;16 - 00;35;28;02
Craig Andrews
Yeah. So let's let's talk about that in the context of deductible. So if somebody has a $5,000 deductible and they go into the hospital and they, they you know, they obviously they pay the first 5000 out of pocket, the remainders picked up by insurance. What's the advantage of going with a plan like yours where there is no deductible?

00;35;28;02 - 00;35;30;24
Craig Andrews
What's the advantage to the hospital?

00;35;30;26 - 00;35;53;08
Josh Butler
Yeah, cost to collect. you know, I had a conversation with a CFO of a hospital once, and I asked that question. I said, how many, $5,000 deductibles are you actually collecting from patients? And he actually had an answer, and he said it's about 17%. And didn't follow up on the ask a follow up question. How many $5,000 deductibles do you collect from patients within 30 days of service?

00;35;53;10 - 00;36;12;17
Josh Butler
And he laughed. And he said, I don't know, but I guarantee it. Eight, 17% I said, yeah, so you're having there's a cost to collect from that patient. Five grand. We take that away. They do not have to chase debt. They don't have to turn their, patients into collections. They don't have to set people up on payment plans.

00;36;12;20 - 00;36;35;01
Josh Butler
And, you know, it's kind of like when you're selling your home, you don't want to own or finance it, like, right? Because you want the equity in your in your pocket. Right then. So, you know, put a down payment on a new house. Right. Hospitals don't operate much different. They want cash flow. And so this is a solution that we're also improving accounts receivable, improving that metric which is cost to collect from the patient.

00;36;35;01 - 00;36;57;15
Josh Butler
Because that is a real metric that hospitals are very, very sensitive to. And if our plan steers volume to the to their hospital versus the competing hospital across the street, and we improve their accounts receivables and we make them a little bit more equitable on, you know, and they don't have to chase patients to collect deductibles and co-insurance.

00;36;57;17 - 00;37;16;27
Josh Butler
All of those things carry value to that hospital. And that's why they give me a lower rate. That's why they give me a better discount. That's why they negotiate a better contract. So that's what's in it for them. Increased volume, reduced cost to collect that better patient satisfaction scores. People actually like to come to their hospital now, you know.

00;37;16;28 - 00;37;40;05
Josh Butler
So, it does help. It's not 100% of the solution. But think about it. You're probably being a little bit better mood. Craig, when you left the hospital knowing you didn't, you had a $0 deductible, an out-of-pocket max versus whatever it was 5000, 6000, 8000. that's their that's their skin in the game.

00;37;40;08 - 00;37;54;26
Craig Andrews
Now, people listening are I mean, this is sounding really, really interesting. And I imagine there's number of people listening. I'm even interested. if I came to you, would you be able to provide health plan? Who do you cover? Who do you not.

00;37;54;28 - 00;38;14;13
Josh Butler
Yeah, it's a great question. So right now, because everything is private, you have to get the actual true payer. And when we talk about payers I'm not you know, I can't take credit for this statement. I can't remember who it was that very first said it. But it's like calling H&R block or calling, Blue Cross, Blue Shield or a signal or an Aetna.

00;38;14;20 - 00;38;33;04
Josh Butler
The payers of health care is like calling H&R block a pair of your taxes. H&R block doesn't pay my taxes or your taxes or anybody else's time. Now, they may help administer and do the filings and get the forms all prepared and get your ducks in a row so that they can, and they may also submit it over to the IRS on your behalf.

00;38;33;09 - 00;38;52;16
Josh Butler
But the bill comes to Josh Butler and the bill comes to Craig Andrews. You pay, you're responsible for your taxes. So calling these big insurance companies payers is not accurate. So we work with the true payers who we believe are the true payers, which are employers and employees. Because think about how all health care is funded in this country.

00;38;52;16 - 00;39;14;04
Josh Butler
If you're privately insured, you're funding health care through premiums or you work at a company that is self-insured or self-funded, paying those claims directly, if it's Medicare, that is through taxation, if it's Medicaid, that's through taxation, if it's all the so all the taxpayers and the workers in the companies are the ones funding health care in this country.

00;39;14;04 - 00;39;31;10
Josh Butler
So we go work directly with payers. Our plan is a self-funded plan. And you can't be a self-funded individual, right? I mean, it's just and I mean, you can be if you're Warren Buffett, if you're a, you know, if you're independently wealthy, you don't need insurance. You just pay your medical bills as they come, as they come up, you pay cash for them.

00;39;31;12 - 00;40;03;24
Josh Butler
But the vast majority of Americans, as a matter of fact, 65% of this country still enters and accesses our health care system through an employer sponsored health insurance plan. And so that's why our target audience is employers that either are large enough or have the ability to be self-funded. And that's what High Plains Health Plan targets are those types of companies, and doesn't mean that we're not working to bring those solutions to smaller organizations.

00;40;03;27 - 00;40;27;28
Josh Butler
but it is not a fully insured product. It's a self-funded product, because first you need to be in a vehicle. I tell this people, this all time self-funding is just a vehicle. It's a vehicle that allows you to be in more control over what you spend in health care, and then you have to go take the opportunity of that flexibility and control, and you got to go negotiate better prices.

00;40;28;00 - 00;40;53;10
Josh Butler
And that's what we do for companies. And we show them ways to do it, from primary care to acute care, all the way down to generic medication across the entire health care spectrum. And if we're able to impact, the more we're able to impact every episode of care, the more we can save and the more that we can put back into benefits like zero our deductibles and co-pays, co-insurance and things of that nature.

00;40;53;12 - 00;40;58;18
Craig Andrews
Very cool. Well, how how should people reach you?

00;40;58;20 - 00;41;15;29
Josh Butler
I'm all over LinkedIn. you know, I've got a nice following there, and, I can get a little controversial at times, but that, I mean, we all have our opinions and we all have our, ways that we see things and view the world, and especially this industry because it impacts so many people. LinkedIn. I'm I'm in there.

00;41;15;29 - 00;41;38;13
Josh Butler
You can find me. our, our our website is butler-benefits.com. That's our firm's website. but we also have a dedicated website for High Plains Health Plan which is HP Health plan.com. And there you can see we have a directory of people that we direct contract with. that searchable just like any other, provider directory would be.

00;41;38;15 - 00;42;01;29
Josh Butler
It gives some case studies there from some of our clients. And it really has a great call to action because we believe, Craig, that what we're doing here in the Texas Panhandle, we know this. We don't just believe this because there are people, just like me and much more talented than I am all over the United States that are doing similar and same things in pockets of the country, in the hope, in in the hope.

00;42;01;29 - 00;42;29;04
Josh Butler
And the mission is that that this, that this spreads far and wide from market to market, city to city. Because health care, it's cliche to say it, but health care is local. And when you can bring local and regional employers together with local and regional health care providers, directly and just negotiate terms directly with one another, you can really make a difference in the communities and lower cost for employees.

00;42;29;06 - 00;42;41;29
Craig Andrews
Well, excellent. Well, I, I wish you well in your mission. I think I think I think we need what you're doing. We need more people like you. And thank you for telling the story. leaders and legacies.

00;42;42;02 - 00;42;48;03
Josh Butler
Craig. Man, it's been a pleasure to meet you. I hope you're doing well. My friend Liz. Stay in touch.

00;42;48;03 - 00;43;17;01
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;43;17;03 - 00;43;40;13
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;43;40;15 - 00;45;50;29
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.