Louis Bernardi was once part of the problematic insurance system, full of unnecessary procedures and misaligned incentives. But when a personal challenge changed his perspective, he transformed into a change agent. Through the stories of his mother and his daughter, Lou shares how the failures of the healthcare system impact real families, not just balance sheets. Because of this turning point, he finally understood that he needed to make a significant career shift and how he could change people’s lives for the better.
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From Insider To Change Agent
Why I Flipped And Joined The Fight To Fix It
Welcome to the show, where we pull back the curtain on one of the biggest, most misunderstood expenses in your business. I am your host, Louis Bernardi, founder of BritePath and a benefit optimization officer. For over 30 years, I have been inside the system, and now I help employers understand it, challenge it, and take back control of their healthcare strategy. If you are a CEO, CFO, or HR leader who knows something is not adding up with your plan, and you want to do something about that, you are in the right place. Let us get into it.
Working Behind The Scenes At A Radiology Practice
In the last episode, we talked about the healthcare heist. My new book, Inside the Healthcare Heist: An Insider’s Guide to Beating the System and Reclaiming Millions. We focused on the machine and the crew behind it. I want to take a step further because this is not just something I studied from the inside. I lived it. I was inside it. For a long time, I was part of the crew. My first real experience with healthcare was not as a broker. It was behind the scenes at a radiology practice in New York City. I processed claims, balanced deposits, and made collection calls. This was before managed care. This was when people were paying by check and by cash, and a lot of it.
I saw something early on that never left me. Busloads of elderly patients are waiting for hours every day, waiting for scans they did not always need. I remember someone saying, “They do not pay anyway, what is the harm?” I was the one calling them later, trying to collect that money, asking for money they did not have. They all sound like my grandparents. I wrote off a lot of debt and knew, inevitably, as I was starting my own family, that this was not a place that I wanted to hang my hat. That was my first real look at the machine, claim forms, volume over value.
Confidential contracts became the law of the land, gag orders, and deals behind closed doors. What was supposed to protect people from high costs started enabling them. Share on XIt was not a concept. It was a system. I had a real look at the machine in action. A system where good people were not trying to do harm, but were operating exactly how they were incentivized. Volume over value, billing over care. That is when you start to realize this is not about bad actors. It is about a system designed to produce a certain outcome. It is not a coincidence that for many years, insurance carriers did not send an explanation of benefits to members before the day of these high-deductible health plans.
You paid your copay, and you moved on. Even if you did get an explanation of benefits, you did not understand it, and you really did not care. You had paid $5, $10, $25, and $50. Thirty years after the first variation of managed care, more and more people are walking around with $5, $10,000 deductibles, paying premiums in the 20,000s to 30,000, and even more for a family, and not having any coverage except for preventative care until they incur $10,000 of additional out-of-pocket cost. That is not insurance.
Transition From Healthcare To Insurance
I left the healthcare world, and I joined my father in the insurance business in 1991. I got to see healthcare from a completely different angle. Back then, insurance was supposed to be protection. Indemnity plans were what most people had. What does that mean? There were no networks, there were no books. You did not have to look up a doctor in a directory to see if they took your insurance. You went to the doctor.
You had a small deductible. It may have been 250, 500. They were approaching $1,000 even back in 1991. You had a relationship with your doctor. Primary care doctors were abundant. That is who you saw. They did house calls, home visits. They checked in on you. Now there is hardly a primary care doctor to be found. It was supposed to be protection. Employers believed insurers were on their side. They were concerned even back then when premiums were $20, $50 a month for a single person, depending on your age and your gender. $100, $200, $300 for a family, depending on how large the family was.
There was medical underwriting. Some things needed to be improved upon. Guaranteed issue is not a bad thing. After all, the people who are the sickest should be the ones who can get insurance. I do not think we all mind because that can be us one day, funding a little higher premium, but things have gotten out of control. Confidential contracts became the law of the land, gag orders, and deals behind closed doors.
What was supposed to protect people from high costs started enabling them. Health systems changed, and insurance companies came and went. None of the carriers today existed back in 1991. There was no UnitedHealthcare, there was no Aetna. There was a Blue Cross Blue Shield, I should not say that. That is probably one exception to the rule. They are franchises. They did exist even back then. They started incurring high costs. Looking back now, I can see exactly where I fit. I was part of the muscle, helping employers navigate the system without knowing what was happening behind the scenes or questioning it.
What was really driving the increases year after year after year? We were led to believe that members were to blame, that people were just going to the doctor too much, and that utilization was too high. That is what the insurance carriers told us. You need more skin in the game. You need a higher out-of-pocket cost so that there is a decision to be made before you just go to the doctor. There may have been some truth to that early on, but that certainly is not the case today.
How Insurance Loopholes Hit Louis’ Home
It is an important one. We believe things like discounts were real, carriers were negotiating on our behalf, that switching plans will not fix the underlying problem, the claims are the claims, and over time, we have stopped asking better questions because no one had better answers. For most of my career, that was business until it became personal. Everybody in their lives has someone that they can think of who has had an adverse effect, either because of costs or quality of healthcare.
For me, I think of my mom and my daughter. That changed everything for me. My mom lived with chronic pain most of her life. Before managed care, she had doctors she knew who cared about her. The system changed, and those relationships disappeared. When her surgery failed, it led to more procedures, more medications, less support, and more judgment. At one point, no one wanted to take care of her case.
When the system fails, it does not just hit your P&L. It hits home as well. Share on XA third surgery nearly cost her her life, and that is when I saw it clearly. The system was not built around outcomes. It was built around procedures. My daughter Faith was born just after 9/11. Like a lot of families, we followed the process. Things were flagged early on with Faith. We saw specialist after specialist, new prescriptions, short visits, five to seven minutes, no answers. Until we found something different. A direct primary care doctor, no rush, no quotas, no insurance interference, just time and care. A lot like healthcare used to be back in the ‘70s and the ‘80s, when you had a primary care doctor who knew your family, who knew your grandchildren, who knew what was going on, and checked in on you.
For Faith, something incredible happened. Once she had a doctor who actually gave her time, who paid attention to her, who spent time looking into all of her previous care, something started to miraculously happen. She started to get better. Her energy came back, her smile came back, and honestly, so did mine. It was a tough time, and I know that other people are living with this. That is when everything changed, because I realized something very simple but powerful. When the system fails, it does not just hit your P&L. It hits home.
When I saw the numbers for the first time, I got very upset because I realized I had been manipulated. Those people at open enrollment meetings that I spent year after year loving to go see and spending extra time to help them answer their healthcare questions, some of the answers that I had given them simply were not true. When I was doing my best, and I was helping companies mitigate premium increases, that meant often increasing out-of-pocket costs.
Not significantly, in my opinion, but even a five or $10 or $20 increase matters to a lot of people. When you think about someone like I did, an elderly employee who was working just for the insurance, and she comes up and she says to you, “Mr. Bernardi, it might not seem like a lot to you, but that $20 increase in your prescription copay means I will have to give up another prescription and I am already only taking five of the seven medications I have been prescribed.”
Why The System Is Not Actually Broken
When you connect the dots, and you understand how significantly the prices, the cost, and quality of care have been manipulated, that does not sit well. Here is what every leader tuning in needs to understand. These are not isolated stories. They are happening inside your company right now. Employees are skipping care. Families are draining their savings. People are quietly struggling. Whether you realize it or not, the health plan decisions that you are making are shaping those outcomes. It is worth a second look. It is worth a little bit of extra time.
I realize time is probably your most precious commodity. Once you realize what a high-performance health plan can do, and if you can recover 20% or more of your healthcare spend and reinvest that back into your people, your business, into wages, into pensions, or 401(k) plans, things start changing dramatically. There is a domino effect within your business. Most decisions in business have limits, but healthcare is different. When you renew your plan, you are not just making a financial decision. You are deciding people’s lives, their families, their trust, and their future.
Most decisions in business have limits, but healthcare is different. When you renew your plan, you are not making a financial decision, but also deciding people’s lives. Share on XI came to realize that changed everything. The system is not broken. It is working exactly as designed, just not for the people who matter most. I could not stay a part of that. I flipped from participating in the system to helping employers take back control. We are not talking about throwing insurance away. We are talking about improving it. We are talking about supplementing it.
Discussion Wrap-up And Closing Words
We are talking about reinforcing it with other resources so that you and your employees can make smarter decisions. There is a better way to do this. I have seen companies reclaim millions of dollars, improve care, and turn healthcare into an advantage. We will get into that in the next episodes. Before we do, I want to leave you with one question and one comment. First, the comment.
If you are hearing this and there is still time, please check out Health Rosetta, an organization that I am passionate about. It is filled with advisors like myself, doctors, TPAs, third-party administrators, pharmacy benefit managers, and employers who are doing amazing things, achieving amazing results. Look up RosenCare. Mr. Rosen, down in Orlando, Florida, turned a horrible healthcare story many years ago into hundreds of millions of dollars reinvested into his community and his people. It is an inspirational story of what is possible when you really try to achieve better results.
In closing, if my mom’s story could be your employee’s spouse, if my daughter’s story could be your employee’s child, if your decisions at Renewal help determine those outcomes, how much longer can you afford to let healthcare be the part of your business you do not lead? Thanks for tuning into the show. I hope you learned a thing or two, and more importantly, I hope it helps you get the results you and your people deserve. If this resonates with you, I would love to continue the conversation. Until next time, keep asking questions, keep challenging the system, and do not settle for a health plan that is not working as hard as it should for you and your team. Thank you.
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