Investigation Reveals UnitedHealth, Cigna, Aetna Made Millions in Fees from out-of-network claims. 

Investigation Reveals UnitedHealth, Cigna, Aetna Made Millions in Fees from out-of-network claims. 

<byline>Rylee Wilson | Edited by JAG for the SRA<byline>

NOTE: AT&T has informed the SRA directly regarding this article that:  “UHC confirmed that Multiplan is not used in relation to its Medicare Advantage plan, so it does not impact our (AT&T) MAPD plan.  All provider payments for Medicare-covered services at non-network providers are set by Medicare and are not negotiate

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.

UnitedHealthcare has made $1 billion in fees annually from out-of-network savings programs, according to the report. Aetna and Cigna have also made millions from the fees, according to the Times.

The investigation, published April 7, was based on confidential corporate records, legal filings, claims information and more than 100 interviews, including with former MultiPlan employees.

UnitedHealthcare, Cigna and Aetna told the Times in separate statements MultiPlan helps them control costs for employers. Providers often charge "egregious" out-of-network prices, a UnitedHealthcare spokesperson told the Times. Cigna told the outlet some providers are charging rates more than 1,000% of Medicare rates for out-of-network claims.

The report sparked calls from the American Hospital Association for an investigation into MultiPlan's practices.

The Labor Department is responsible for oversight of employer-sponsored health plans. The agency has one investigator for every 8,800 health plans, according to the Times.

"Even so, the AHA urges the Department of Labor to immediately open an investigation into these practices and hold companies like MultiPlan and its corporate commercial insurer partners to account for these unconscionable practices, distorted incentives, potential violations of ERISA, and ultimately, harms to American patients and employees," the association said in an April 9 letter to the department.

Becker's has reached out to UnitedHealthcare and Cigna for comment and will update this article if more information becomes available.