MultiPlan, established in 1980, is a prominent healthcare cost management company in the United States. It specializes in providing network-based solutions that connect healthcare payers, providers, and patients to facilitate access to affordable and quality care. Over the years, MultiPlan Insurance has developed an extensive provider network and offers a range of services aimed at reducing healthcare costs and improving efficiency within the healthcare system.
Understanding MultiPlan’s Role in Healthcare
MultiPlan operates as an intermediary between healthcare providers and insurance companies. It does not function as a traditional health insurance company but rather offers a platform that insurance companies utilize to access a broad network of healthcare providers. This arrangement allows insurance companies to offer their members a wider selection of in-network providers, thereby enhancing the accessibility and affordability of healthcare services.
MultiPlan’s Provider Networks
One of MultiPlan’s core offerings is its Preferred Provider Organization (PPO) network. This network comprises a vast array of medical professionals, hospitals, and ancillary services that have agreed to provide services at negotiated rates. By integrating MultiPlan’s PPO network, insurance companies can expand their provider base, offering policyholders more options for in-network care. This integration is particularly beneficial for self-funded employer health plans that have a primary presence in a specific region but also have employees residing in other areas.
Services Offered by MultiPlan
MultiPlan provides a suite of services designed to manage healthcare costs effectively:
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Analytics-Based Services: Utilizing data analytics to identify cost-saving opportunities and enhance decision-making processes.
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Network-Based Services: Offering access to a comprehensive network of healthcare providers to ensure broad coverage and negotiated pricing.
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Payment and Revenue Integrity Services: Ensuring accurate billing and reimbursement processes to maintain financial integrity within the healthcare system.
MultiPlan and Medicaid
Since 2004, MultiPlan has partnered with several leading Medicaid plans to support various programs. Its Medicaid networks provide access to healthcare providers for individuals receiving care through Medicaid and related programs administered by its clients. MultiPlan has developed statewide and regional networks to help meet clients’ network adequacy requirements, offering flexibility to build entire networks or fill specific gaps in existing ones.
It’s important to note that while MultiPlan collaborates with Medicaid programs, it is not a Medicaid plan itself. Instead, it serves as a network provider that facilitates access to healthcare services for Medicaid beneficiaries through its extensive provider networks.
The MultiPlan Controversy
In recent years, MultiPlan has faced legal challenges and controversies, particularly concerning allegations of price-fixing and underpayment to healthcare providers. In October 2024, the American Medical Association (AMA) and the Illinois State Medical Society (ISMS) filed a lawsuit against MultiPlan, accusing the company of being at the center of a price-fixing conspiracy with commercial health insurance companies. The lawsuit alleges that this scheme undercut fair payment for out-of-network healthcare services and eliminated market competition, resulting in harm to patients and physicians.
Further developments occurred in March 2025, when the U.S. Justice Department supported medical providers in their lawsuits against health insurers and MultiPlan. The department indicated that the use of a common pricing algorithm by MultiPlan and insurers could violate federal antitrust laws. These lawsuits allege that major health insurers used MultiPlan’s software as part of a price-fixing conspiracy that underpaid providers billions of dollars in reimbursement rates for out-of-network services.
In response to these legal challenges and to perhaps distance itself from the controversies, MultiPlan rebranded itself as Claritev in February 2025. Despite the rebranding, the company continues to face scrutiny over its business practices and the implications of its pricing strategies on the healthcare industry.
Frequently Asked Questions (FAQs)
What kind of insurance is MultiPlan?
MultiPlan is not an insurance company. It is a healthcare cost management company that provides network-based solutions to insurance companies, enabling them to offer their members access to a broad network of healthcare providers at negotiated rates.
Is MultiPlan a Medicaid plan?
No, MultiPlan is not a Medicaid plan. It collaborates with Medicaid programs by providing provider networks that facilitate access to healthcare services for Medicaid beneficiaries. MultiPlan serves as a network provider rather than a direct insurer or Medicaid plan.
What is MultiPlan?
MultiPlan is a healthcare cost management company established in 1980. It offers network-based solutions that connect healthcare payers, providers, and patients, aiming to reduce healthcare costs and improve access to quality care through its extensive provider networks and analytical services.
What is the MultiPlan controversy?
MultiPlan has faced allegations of engaging in a price-fixing conspiracy with major health insurers, leading to underpayment for out-of-network healthcare services. Lawsuits filed by organizations like the AMA claim that MultiPlan’s practices have harmed physicians and patients by suppressing reimbursement rates and eliminating market competition. The U.S. Justice Department has also expressed concerns that the use of MultiPlan’s pricing algorithms by insurers could violate antitrust laws.
Final Thoughts
MultiPlan plays a significant role in the U.S. healthcare system by providing network-based solutions that connect payers, providers, and patients. Its services aim to reduce healthcare costs and improve access to care. However, the company has faced legal challenges related to its pricing practices and relationships with insurance companies. As the healthcare landscape continues to evolve, the outcomes of these legal proceedings and the company’s responses will likely have substantial implications for its operations and reputation.
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About Dr Emily Reed
