FAQ
MultiPlan is an insurance company and service provider that contracts with large health insurance companies to price reimbursement of out-of-network claims. MultiPlan, along with its subsidiaries Data iSight and Viant, is accused of colluding with insurers to eliminate competition and suppress reimbursement rates for out-of-network health providers.
MultiPlan and its subsidiaries are facing numerous federal and state lawsuits filed by health providers who may have been paid too little for their services. Medical service providers and physicians who accepted out-of-network insurance payments from MultiPlan may have been paid lower fees due to an anti-competitive scheme utilized by MultiPlan and may be eligible for compensation.
Out-of-Network Services Reimbursement
Health insurance plans often provide members with access to out-of-network services at a higher cost than is paid for in-network services. The insurance companies should be competing with each other to pay fair rates for out-of-network services, sometimes referred to as usual and customary rates.
MultiPlan acts as an intermediary between insurance companies and health providers, setting the reimbursement rates the insurance companies will pay for out-of-network services. They have been accused of acting as the hub of an insurance industry cartel to control and suppress pricing for out-of-network provider services, designed to reduce payments to those providers below competitive levels.
Out-of-network providers who have been affected by MultiPlan unfair reimbursement negotiations may include:
- Ambulatory surgery centrs
- Chiropractic treatment providers
- Development disorder testing services
- Mental health and recovery services
- Orthopedic treatment services and facilities
- Orthodontist, and restorative dentistry practices
- Physical rehabilitation facilities
- Plastic surgery services and facilities
- Spine and pain management services
- Urgent care centers
MultiPlan and its subsidiaries are facing numerous federal complaints and lawsuits which accuse the companies of a scheme that may violate the antitrust and other laws.
Out-of-Network Provider Payments Unfairly Reduced
MultiPlan provides out-of-network pricing services to many large health insurance companies. They, along with subsidiaries Data iSight and Viant, have been accused of colluding with insurers to suppress reimbursement rates for out-of-network providers below competitive rates.
The company may be facing numerous complaints and federal lawsuits filed by healthcare providers who claim that MultiPlan collects and commingles detailed data provided by insurance claims to fix the amounts competing insurers will pay for the same service—and to set maximum, below-market prices the insurers will pay. The collusion between MultiPlan and large insurers also may have pressured providers to take below-market reimbursement rates or risk losing business altogether.
MultiPlan Price Fixing Allegations
MultiPlan and its co-conspirators are accused of dominating the market to set compensation to physicians and providers at prices which are far lower than insurance companies would be able to negotiate on their own in competition with each other. This may have deprived medical providers of appropriate compensation for their services and restricted individual physicians and healthcare agencies from dispute resolution. This unfair practice may result in increased profits for insurance companies and may also violate the Antitrust laws.
Physicians and health providers who accepted insurance payment reimbursements for Out-Of-Network services priced through MultiPlan or its subsidiaries, Data iSight and Viant, may be eligible for compensation.