But the doctor was not in her insurance plan's network of providers, leaving his bill open to negotiation by her insurer. Once back on her feet, Lawson received a letter from the insurer, UnitedHealthcare, advising that Rabinowitz would be paid $5,449.27 — a small fraction of what he had billed the insurance company. That left Lawson with a bill of more than $100,000.
The answer is a little-known data analytics firm called MultiPlan. It works with UnitedHealthcare, Cigna, Aetna and other big insurers to decide how much out-of-network medical providers should be paid. It promises to help contain costs using fair and independent analysis.
But a New York Times investigation, based on interviews and confidential documents, shows that MultiPlan and the insurance companies have a large and mostly hidden financial incentive to cut those reimbursements as much as possible, even if it means saddling patients with large bills. The formula for MultiPlan and the insurance companies is simple: The smaller the reimbursement, the larger their fee.
Legislation (No Surprise Act) that took effect in 2022 now protects patients from certain kinds of surprise bills but does not cover a vast majority of the claims directed to MultiPlan.
MultiPlan assured investors shortly before the law's passage that it was likely to have "limited impact" on the company. In fact, MultiPlan said, 90% of its revenue involved out-of-network claims that wouldn't be affected.
Multiplan also works with MA plans . . .
Our network is your partner in delivering care to individuals participating in Medicare Advantage and related health plans.
The answer is a little-known data analytics firm called MultiPlan. It works with UnitedHealthcare, Cigna, Aetna and other big insurers to decide how much out-of-network medical providers should be paid. It promises to help contain costs using fair and independent analysis.
But a New York Times investigation, based on interviews and confidential documents, shows that MultiPlan and the insurance companies have a large and mostly hidden financial incentive to cut those reimbursements as much as possible, even if it means saddling patients with large bills. The formula for MultiPlan and the insurance companies is simple: The smaller the reimbursement, the larger their fee.
Legislation (No Surprise Act) that took effect in 2022 now protects patients from certain kinds of surprise bills but does not cover a vast majority of the claims directed to MultiPlan.
MultiPlan assured investors shortly before the law's passage that it was likely to have "limited impact" on the company. In fact, MultiPlan said, 90% of its revenue involved out-of-network claims that wouldn't be affected.
Insurers Reap Hidden Fees by Slashing Payments. You May Get the Bill.
Weeks after undergoing heart surgery, Gail Lawson found herself back in an operating room. Her incision wasn’t healing, and an infection was spreading. At a hospital in Ridgewood, New Jersey, Dr. Sidney Rabinowitz performed a complex, hourslong procedure to repair tissue and close the wound...
news.yahoo.com
Multiplan also works with MA plans . . .
Our network is your partner in delivering care to individuals participating in Medicare Advantage and related health plans.
Medicare Advantage
Improving payment accuracy & reducing the cost of care for payers.
www.multiplan.us
