NY Times exposes insurance companies' discounts that left patients and doctors irate

On April 7, 2024, the Pulitzer Prize winning NY Times journalist, Chris Hamby, exposed an arrangement by insurance companies and MultiPlan (now Claritev) to reduce payment rates for out-of-network services.

This is a summary: The article illustrates how leading insurance companies worked with MultiPlan and its subsidiaries to set out-of-network rates far below the rates previously paid, rates that are usual and customary, and well below what the benefit level for the patient insurance plan may have paid. If doctors or facilities did not accept these discounts the patient was left holding the bag.

The arrangement would allow Health Insurance companies hired by employers, like United Healthcare, to offer 'cost containment' to the employer plans by working with discount networks like MultiPlan and its subsidiary Data iSight. According to the article, the rates may have been set by the insurance company and then the discount network would tell healthcare provider and patient that this was the appropriate rate. What was not disclosed was that the carriers were benefiting from the savings to the employer. They would advise the employer that a certain percentage of money was saved and therefore they would be entitled to a portion of that savings. They are said to have shared that savings with Multiplan and/or its subsidiaries. Since the healthcare provider was not participating in the plan, they were free to balance bill the patients for the unpaid portion.

Update: (August 16, 2024)

Since this article was written, a follow up article was published showing MultiPlan's stock price had fallen.

Update: (August 21, 2024)

In another follow up article, lawmakers question the health insurance regulators on the matter.

Update: (February 17, 2025)

Multiplan re-bands to Claritev, but healthcare providers still see the same discounts on claims. Our office has even seen these Data iSight discounts being added to claims governed by No Surprise Bill laws.

Update: (March 26, 2025)

The US Dept of Justice filed a statement of interest in a consolidated lawsuit filed against Claritev (formerly MultiPlan) in support of healthcare providers claims that MultiPlan conspired with health insurers to underpay doctors for medical care.

Update: (November 12, 2025)

With the lawsuit approved to move forward a federal judge on June 9, 2025, hearings in the case began October 14, 2025.