{"id":11631,"date":"2024-08-21T14:37:54","date_gmt":"2024-08-21T14:37:54","guid":{"rendered":"https:\/\/medexperts.pro\/?p=11631"},"modified":"2024-08-21T15:24:38","modified_gmt":"2024-08-21T15:24:38","slug":"congress-presses-health-insurance-regulators-on-troubling-billing-tactics","status":"publish","type":"post","link":"https:\/\/medexperts.pro\/?p=11631","title":{"rendered":"Congress Presses Health Insurance Regulators on \u2018Troubling\u2019 Billing Tactics"},"content":{"rendered":"
<\/div>\n

Lawmakers are zeroing in on MultiPlan, a firm that has helped insurers cut payments while sometimes leaving patients with large bills.<\/p>\n

\n
\n
\n

Lawmakers on Tuesday called on health insurance regulators to detail their efforts against \u201ctroubling practices\u201d that have raised costs for patients and employers.<\/p>\n

In a letter<\/a> to a top Labor Department official, two congressmen cited a New York Times investigation<\/a> of MultiPlan, a data firm that works with insurance companies to recommend payments for medical care.<\/p>\n

The firm and the insurers can collect higher fees when payments to medical providers are lower, but patients can be stuck with large bills, the investigation found. At the same time, employers can be charged high fees \u2014 in some cases paying insurers and MultiPlan more for processing a claim than the doctor gets for treating the patient.<\/p>\n

The lawmakers, Representatives Bobby Scott of Virginia and Mark DeSaulnier of California, both Democrats in leadership positions on a House committee overseeing employer-based insurance, highlighted MultiPlan as an example of \u201copaque fee structures and alleged self-dealing\u201d that drive up health care costs. In their letter, they pressed the department for details on its efforts to enforce rules meant to promote transparency and expose conflicts of interest.<\/p>\n<\/div>\n<\/div>\n

<\/div>\n
\n
\n

MultiPlan\u2019s business model focuses on the most common way Americans get health coverage: through an employer that \u201cself-funds,\u201d meaning it pays medical claims with its own money and uses an insurance company to process claims. Insurers such as Aetna, Cigna and UnitedHealthcare have pitched MultiPlan\u2019s services as a way to save money when an employee sees a provider out of network.<\/p>\n

In many cases, MultiPlan uses an algorithm-based tool<\/a> to generate a recommended payment. Employers typically pay insurers and MultiPlan a percentage of what they call the \u201csavings\u201d \u2014 the difference between the recommendation and the original bill.<\/p>\n

\n
\n
<\/div>\n
\n
\n
\n

We are having trouble retrieving the article content.<\/p>\n

Please enable JavaScript in your browser settings.<\/p>\n<\/div>\n<\/div>\n

\n
\n

Thank you for your patience while we verify access. If you are in Reader mode please exit and\u00a0log into<\/a>\u00a0your Times account, or\u00a0subscribe<\/a>\u00a0for all of The Times.<\/p>\n

\n<\/div>\n
\n
\n

Thank you for your patience while we verify access.<\/p>\n

Already a subscriber?\u00a0Log in<\/a>.<\/p>\n

Want all of The Times?\u00a0Subscribe<\/a>.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n","protected":false},"excerpt":{"rendered":"

Lawmakers are zeroing in on MultiPlan, a firm that has helped insurers cut payments while sometimes leaving patients with large bills.Lawmakers on Tuesday called on health insurance regulators to detail their efforts against \u201ctroubling practices\u201d that have raised costs for patients and employers.In a letter to a top Labor Department official, two congressmen cited a New York Times investigation of MultiPlan, a data firm that works with insurance companies to recommend payments for medical care.The firm and the insurers can collect higher fees when payments to medical providers are lower, but patients can be stuck with large bills, the investigation found. At the same time, employers can be charged high fees \u2014 in some cases paying insurers and MultiPlan more for processing a claim than the doctor gets for treating the patient.The lawmakers, Representatives Bobby Scott of Virginia and Mark DeSaulnier of California, both Democrats in leadership positions on a House committee overseeing employer-based insurance, highlighted MultiPlan as an example of \u201copaque fee structures and alleged self-dealing\u201d that drive up health care costs. In their letter, they pressed the department for details on its efforts to enforce rules meant to promote transparency and expose conflicts of interest.MultiPlan\u2019s business model focuses on the most common way Americans get health coverage: through an employer that \u201cself-funds,\u201d meaning it pays medical claims with its own money and uses an insurance company to process claims. Insurers such as Aetna, Cigna and UnitedHealthcare have pitched MultiPlan\u2019s services as a way to save money when an employee sees a provider out of network.In many cases, MultiPlan uses an algorithm-based tool to generate a recommended payment. Employers typically pay insurers and MultiPlan a percentage of what they call the \u201csavings\u201d \u2014 the difference between the recommendation and the original bill.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and\u00a0log into\u00a0your Times account, or\u00a0subscribe\u00a0for all of The Times.Thank you for your patience while we verify access.Already a subscriber?\u00a0Log in.Want all of The Times?\u00a0Subscribe.<\/p>\n","protected":false},"author":1,"featured_media":11633,"comment_status":"close","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[33],"tags":[],"class_list":["post-11631","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health"],"_links":{"self":[{"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/posts\/11631","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=11631"}],"version-history":[{"count":2,"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/posts\/11631\/revisions"}],"predecessor-version":[{"id":11634,"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/posts\/11631\/revisions\/11634"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=\/wp\/v2\/media\/11633"}],"wp:attachment":[{"href":"https:\/\/medexperts.pro\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=11631"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=11631"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medexperts.pro\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=11631"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}