Part 1 in an ongoing series about MSK conditions and how advisers are changing their approach to treatment with new benefit solutions.
The irony is inescapable. What happens when a benefits broker is actually stricken by one of the most debilitating and costly ailments that participants in any one of the group health plans sold to employer clients also encounter?
Simple: Face the same excruciating pain, care delays, financial concerns and insurance hassles — even despite deep knowledge about how to navigate a dysfunctional and opaque healthcare system that the average health plan member finds confounding.
However, several top industry advisers and a vendor rep who generously shared their
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They also learned valuable lessons about the importance of improving benefit plan design, pain management and patient advocacy that can be applied to other brokerages and advisory practices. One key takeaway, for example, was that cash is king to providers who would rather be paid upfront than chase unpaid insurance claims — a strong motivation that enabled them to leapfrog other patients scheduled for surgeries.
In the case of Paul "Joey" Stone, VP of business development with Apta Health, there was double irony. As he left a Washington, D.C. hotel last September 11 to attend the 2024 RosettaFest conference to learn all the latest health plan management strategies, he started limping out of nowhere without any swelling or pain.
A lifelong athlete who has squatted 400 pounds, the 61-year-old Stone was in excellent physical shape but soon learned from an X-ray that he had stenosis, a condition in which the spinal column
Immobile after Taylor Swift
For Eric Silverman, trouble began on Nov. 1, 2024 in Indianapolis when he took his 16-year-old daughter to see Taylor Swift perform at Lucas Oil Stadium. "I came home from that trip a few days later, and my back was hurting," says the founder of Voluntary Disruption who has a popular benefits podcast and is on Employee Benefit News's board of advisers, chalking it up to an overly comfortable hotel bed. The experience made him appreciate his company's communication and engagement focus, proving to be a teachable moment for the employee populations he serves.
Having had lower-back problems his entire adult life, several surgeons predicted as far back as his 20s that he'd be in severe pain for many years and suggested removing a disc. Despite this warning, he chose not to seek surgery, chiropractic care or physical therapy. The issue largely disappeared for the next two decades, though he started seeing a chiropractor in recent years.
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Over the coming months, his pain level fluctuated and was as severe as eight out of 10 — culminating with a throbbing shooting pain in one calf the day after Christmas. "I am in great pain; can't walk, can't sit, can't bend, can't move," he recalls. "I'm literally eating laying down."
An MRI ordered in early January revealed a severely herniated disc that would require a minimally invasive microdiscectomy that would remove only a tiny part of the disc. At that point, it became a race against time to manage pain and get his
Facing unaffordable medical costs
To ensure the highest possible quality, Silverman's company engaged AIMM, whose founder "Nurse" Deb Ault vetted his surgeon from a list of local providers. However, it took months of serious legwork to call in favors from a surgeon friend and fellow brokers, as well as negotiate his way onto the operating table ASAP by promising to be a cash-pay customer.
Silverman reviewed an itemized bill that initially was projected to total almost $18,000 out of pocket, then found another surgeon who charged just $7,000 cash. But once Aetna came through, he was fortunate enough to absorb a $7,000 in-network family deductible — an amount that most working Americans simply cannot afford.
