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[quote=Anonymous][quote=Anonymous][quote=Anonymous]There was a pretty shocking article in the NYT about a private equity backed company called Multi Plan which insurers use to assess out-of-network claims. The bizarre part is Multi Plan’s feed are based on the amount it denies. You’d have to be stupid to not see the problem with that sort of incentive arrangement.

“For a New Jersey trucking company called New England Motor Freight, UnitedHealthcare used MultiPlan to reduce a hospital bill from $152,594 to $7,879, then charged the company a $50,650 processing fee.”

https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills-takeaways.html[/quote]

I am somewhat familiar with multiplan — what you’re describing isn’t claim denial, it’s negating for a rate that is similar to an in network rate.  (What you’re described about their fee is not consistent with what I’ve seen.). Part of the problem is that hospitals and doctors have all these fake rack rates that no only actually pays.  If you read your EOB, it often says your provider charged $500, insurance paid $125, and you owe $20.  The rest is just a ghost charge.  When you go out of network, they charge the fake rack rate and wait for someone to negotiate it down.  It’s an insane system but the answer is not that the insurers should just pay the crazy rack rates.[/quote]

I understand that inflated charging needs to be kept in check. But there is an inherent danger in compensating Multi Plan based on the amount they deny. There is an incentive to deny as much as possible rather than what is reasonable. If they were paid a fee not linked to the saving, would the amount approved be any different? If not then why not just charge the fee?  If the amount approved would be different, then you really have to question why. [/quote]

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