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[S2E7] Mark Flores - The Healthcare Black Hole
Recovering Millions in Mismanaged Employee Benefits
When employers sign healthcare contracts, they assume they're getting what they pay for. Mark Flores, Vice President and Co-Founder of AVYM Corporation, reveals a disturbing reality: most employers are losing 15-30% of their healthcare spend to undisclosed fees and systematic billing errors—and they don't even know it.
In this eye-opening episode, Mark walks Vincent through his experience as a key architect of a landmark $100 million settlement against Horizon Blue Cross Blue Shield of New Jersey, exposing how insurance carriers operating in hybrid arrangements acting as both provider and administrator create inherent conflicts of interest that cost employers millions.
Mark explains why most companies lack the independent resources needed to verify claims and fees, leaving them unable to fulfill their fiduciary responsibilities to employees. From the "lesser of" provision violations to the cultural shift employers need to make, this conversation delivers practical insights on protecting your organization's healthcare investments and ensuring employees receive the benefits they've earned.
About Mark Flores: Mark Flores is Vice President and Co-Founder of AVYM Corporation, a leading consulting firm specializing in medical claim transactions and ERISA-governed health plan compliance. Recognized by courts and regulators as a subject-matter expert, Mark has pioneered claims validation and recovery programs that have saved self-insured health plans millions while identifying fiduciary breaches and systemic inefficiencies.
About Vincent Catalano: Vincent Catalano brings over 23 years of employee benefits experience as an independent consultant and host of The CLEARly Beneficial Podcast. His unique position outside corporate constraints allows him to have frank conversations about healthcare issues that others can't address.
This episode is brought to you by HealthNEXT. HealthNEXT partners with employers to transform their employee health benefits through innovative, results-driven solutions that prioritize both cost savings and improved health outcomes.
Disclaimer: The information provided in this podcast is for educational and informational purposes only and should not be construed as legal, financial, or professional advice. Listeners should consult with qualified professionals regarding their specific situations.
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By Vincent CatalanoRecovering Millions in Mismanaged Employee Benefits
When employers sign healthcare contracts, they assume they're getting what they pay for. Mark Flores, Vice President and Co-Founder of AVYM Corporation, reveals a disturbing reality: most employers are losing 15-30% of their healthcare spend to undisclosed fees and systematic billing errors—and they don't even know it.
In this eye-opening episode, Mark walks Vincent through his experience as a key architect of a landmark $100 million settlement against Horizon Blue Cross Blue Shield of New Jersey, exposing how insurance carriers operating in hybrid arrangements acting as both provider and administrator create inherent conflicts of interest that cost employers millions.
Mark explains why most companies lack the independent resources needed to verify claims and fees, leaving them unable to fulfill their fiduciary responsibilities to employees. From the "lesser of" provision violations to the cultural shift employers need to make, this conversation delivers practical insights on protecting your organization's healthcare investments and ensuring employees receive the benefits they've earned.
About Mark Flores: Mark Flores is Vice President and Co-Founder of AVYM Corporation, a leading consulting firm specializing in medical claim transactions and ERISA-governed health plan compliance. Recognized by courts and regulators as a subject-matter expert, Mark has pioneered claims validation and recovery programs that have saved self-insured health plans millions while identifying fiduciary breaches and systemic inefficiencies.
About Vincent Catalano: Vincent Catalano brings over 23 years of employee benefits experience as an independent consultant and host of The CLEARly Beneficial Podcast. His unique position outside corporate constraints allows him to have frank conversations about healthcare issues that others can't address.
This episode is brought to you by HealthNEXT. HealthNEXT partners with employers to transform their employee health benefits through innovative, results-driven solutions that prioritize both cost savings and improved health outcomes.
Disclaimer: The information provided in this podcast is for educational and informational purposes only and should not be construed as legal, financial, or professional advice. Listeners should consult with qualified professionals regarding their specific situations.