He told a $30 billion hospital system's CFO \"sue me\" - and won. David Silverstein, founder of Amaze Health and former U.S. Navy submarine officer, joins Ray in-studio to break down what's really broken in self-funded employer health plans and how one standoff over a $20,000 ER bill turned into a career fixing them.
David's daughter racked up three ER visits and $20,000 in bills her freshman year of college. He escalated the fight all the way to the C-suite, and when the hospital's CFO asked what he actually wanted, David told him to sue him. The CFO refused, not realizing his own hospital system was already a client of David's consulting firm. That standoff became \"the denial of payment system,\" and it eventually pulled David into Washington, where he helped shape federal price transparency rules and the \"right to self-pay\" buried in the No Surprises Act - a right most patients don't even know they have.
David also breaks down the \"grand bargain\": pay a hospital in 3 days instead of 90, and they'll knock 25-30% off the bill, no negotiation required.. even on a $2 million NICU stay. He explains why employers have had the legal power to fix their health plans since ERISA passed in 1974, and why big broker and consultant firms have misaligned incentives with the clients they're supposed to serve.
If you're an employer, CFO, HR Director or benefits consultant - this one's for you.
📌 Subscribe for more conversations on fixing the broken healthcare system.
🔗 Amaze Health: amazehealth.com
📖 David's book: \"The Lean Health Plan\" — search his name on Amazon
🔗 David Silverstein on LinkedIn: https://www.linkedin.com/in/dsilverstein/
#BrokenHealthcare #SelfFundedHealthcare #EmployerHealthcare #CFO #HRLeaders #ReferenceBasedPricing #HealthcareCosts #HealthcareTransparency #AmazeHealth #ERISA #Podcast
0:00 Introduction & Welcome
0:45 Growing Up in Brooklyn
2:00 Life as a Navy Submarine Officer
6:30 Founding a Six Sigma Consulting Firm
9:00 The $12,000 ER Bill and the \"Revenue Enhancement Specialist\" Letter
14:00 \"I Want You to Sue Me\" — The $30 Billion Hospital Standoff
16:00 Building Amaze Health (2018–2020)
20:00 Writing Input for the State of the Union
24:40 The Call From the White House
27:00 The Gas Station Story That Convinced the Economists
30:00 Why Only the Free Market Can Fix Healthcare
36:00 The Transparency Rules Already on the Books
38:11 Sponsor Break
43:45 The Right to Self-Pay Nobody Uses
46:00 The \"Grand Bargain\" — Pay in 3 Days, Save 30%
48:00 Why Reference-Based Pricing Alone Isn't the Answer
51:00 The Lean Health Plan & How Employers Lost Control of Risk
53:00 The McKinsey Report: 30% of Employers Reconsidering
54:00 The $2,000,000 NICU Baby Story
56:32 How Amaze Predicts a Hospital Visit Before It Happens
1:00:53 PBMs, Rebates, and Formulary Control
1:01:09 Employers Have Had This Power Since 1974 (ERISA)
1:02:00 Why CEOs Tolerate It: Taxes, Complexity, Groupthink
1:06:00 AI, Up-Coding, and the Next Wave of Cost Inflation
1:08:24 The Employer Health Plan Maturity Curve
1:12:28 Direct Contracts and How Amaze Actually Works
1:13:59 The $4M Spend Example — Where's the Opportunity?
1:15:24 Hitting the Reset Button — A 30-40% Correction
1:16:12 Brokers' Private Jets and Masters Tickets — Who's Paying?
1:18:49 The Coming Litigation Bubble Over the $6 Trillion Question
1:20:26 Final Thoughts
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