Why Your Healthcare Sucks
Why Your Healthcare Sucks
How can layoffs lead to new opportunities?
After 19 years in corporate America, the company decided it didn't need me anymore. I got laid off. Like many of you, I've experienced that, and it was the best thing that ever happened to me. I’m about to turn 57, and 58 would have been my retirement age, allowing me full retirement benefits. I cannot imagine how miserable I would have been if I had stayed because I was paid just enough with decent benefits to not leave. I had to be told, "We don't need you anymore."
When it happened, it was like a wake-up call about how corrupt these companies are. If you’re working for an insurance company, especially one of the "BUCAs" (Blue Cross, UnitedHealthcare, Cigna, and Aetna), know they are not your friends. Even if your company has a self-funded plan with one of these insurers, you’re likely not getting the benefits you think. There are lawsuits against them for not managing plans properly. They're for-profit, but they’re not just making profits—they're profiteering.
My journey taught me this and made me passionate about helping people differently. It was an unconventional path, and I didn't intend to end up in the insurance industry. It was an accident. But it's been a wonderful experience of growth, figuring out what's really happening, and helping people access the healthcare they deserve.
What are the hidden problems with health insurance?
I had to recognize a problem with how things work now, or how they worked in the past, to understand there was a real issue. This realization didn’t come from my own experience alone. I helped hundreds, if not thousands, of people get health insurance, and I listened to them. The problems were often severe and financially overwhelming. Medical debt is still the number one cause of bankruptcy in the U.S., and about 80% of those people have health insurance. Clearly, there's a fundamental problem.
This confusion comes from conflating "healthcare" with "health insurance." For example, healthcare.gov is the federal website for health insurance, but you can't actually buy healthcare there. In fact, insurance can often prevent you from getting the care you need. You might be denied the right to see a specific doctor because they’re not in-network, or you may need a procedure that the insurance company decides isn't necessary, even if it’s potentially life-saving.
There are countless stories of people being denied coverage for things as simple as an MRI. Often, insurance companies require alternatives, like physical therapy, even when an MRI is needed to determine the right course of action. This lack of proper diagnostics can lead to more harm. Similarly, if someone is injured and unconscious, like in a car accident, and is airlifted by helicopter, insurance companies can deny the claim, saying it wasn’t necessary—even though the person couldn’t consent to the transport. This can leave people with massive bills, like $80,000, with no control over the decision.
In many cases, AI now makes decisions on whether claims are approved, which can be problematic. Even when claims are reviewed by doctors, they may not have the right expertise. For instance, a pediatrician reviewing a cancer treatment for an adult patient might deny the treatment, not based on oncology expertise, but on saving the insurance company money. This kind of decision-making can have fatal consequences.
What are better alternatives to traditional health insurance?
It’s a fundamental question that traditional insurance brokers don’t usually ask. When they ask, "What do you want?" they mean, "Do you want Blue Cross or Aetna this year? Do you want a high or low deductible?" They’re focused on plan options, not what you actually want to take care of.
Let’s talk about options beyond traditional insurance. There’s medical cost sharing, custom health plans, and care navigation. Care navigation gives your employees a true advocate for their healthcare. For example, if a doctor recommends an MRI, the plan could cover it with zero out-of-pocket costs if employees follow the recommended pathway. This might include no cost for doctor visits, specialist consultations, MRIs, or even surgeries. And all of this care is provided at high-quality centers of excellence, where patients are more likely to avoid low-quality care or complications.
You might say, "I’m not a healthcare expert; what don’t I know?" There’s a lot, and that’s why it’s important to have a conversation. This way, we can build a plan tailored to your needs. If you're a group of 50 or more, you have regulatory requirements to meet, or you risk huge fines. We handle all of that—compliance with ACA and ERISA guidelines is crucial. You don’t have to choose between compliance and a good health plan; you can have both. With a compliant plan that feels different from traditional ones, you finally have true healthcare for you and your employees, without the limitations of standard insurance.
How can staying true to yourself shape your entrepreneurial journey?
Stay true to yourself. I say this because I was recently asked what advice I would give my younger, high school self about the journey to take. My answer was to take the same exact journey. The experiences I’ve had—from corporate America to becoming an entrepreneur and identifying industry problems—shaped who I am today. All of it was necessary.
I had to stay true to myself and allow myself to become the entrepreneur and spokesperson I was meant to be. I never imagined doing this. There was almost no chance I'd end up in this role, but here I am. This was never my dream. I never thought, "I want to be an insurance guy who changes things." Who dreams of that? But staying true to yourself means doing what you're really here to do and not letting anything get in the way.
*This interview has been edited and condensed for clarity.*
