Investigation reveals UnitedHealth, Cigna, Aetna made millions in fees from out-of-network claims

Becker's Healthcare April 10, 2024
Rylee Wilson

Major insurers made millions in fees by using MultiPlan, a data analytics firm, to determine how much to pay providers for out-of-network claims, according to an investigation from The New York Times.

MultiPlan helps plans handle out-of-network claims, advising insurers what to pay providers. According to the Times, the plans often pay much less than providers bill — and charge self-funded employers a percentage of the savings as a processing fee. The formula incentivizes payers to pay providers less so they can charge employers higher fees. Meanwhile, patients are potentially responsible for the remainder.

Some patients interviewed by the Times were left with large medical bills after insurance did not pay the full out-of-network cost.

UnitedHealthcare has made...

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