Navigating the United States healthcare system can often feel like a maze. Which doctor should I go to? Who takes care of my insurance? What is a co-payment anyway?
That’s why Chris Hamby, an investigative reporter, has devoted much of his five-year career at The New York Times to guiding readers through such dizzying questions. His most recent article, published online this month, addressed the complex issue of insurance bills.
Last year, Mr. Hamby began investigating MultiPlan, a data company that works with several major health insurance companies, including UnitedHealthcare, Cigna and Aetna. After a patient sees an out-of-network medical provider, the insurer often uses MultiPlan to recommend how much to reimburse the provider.
Mr. Hamby’s investigation found that MultiPlan and insurers have an incentive to reduce payments to providers; In doing so, they achieve higher fees, which are borne by the patient’s employer. Many patients are forced to pay the rest of the bill. (MultiPlan said in a statement to The Times that it uses “recognized and widely accepted solutions” to promote “affordability, efficiency and fairness” by recommending a “fair refund that providers are willing to accept in lieu of the billing plan . “Members for the remaining amount.”)
In an interview, Mr. Hamby shared his experiences combing through more than 50,000 pages of documents and interviewing more than 100 people. This conversation has been edited.
Where did your investigation begin?
Last year we dealt extensively with health insurance issues. MultiPlan came up again and again in my conversations with medical groups, doctors and patients. At first it was unclear what exactly MultiPlan was doing. There have been some legal disputes regarding its collaboration with UnitedHealthcare, but it has been difficult to understand the company’s role in the industry. Finally, we gathered more information about MultiPlan’s relationships with major insurance companies.
What did doctors and other providers say?
Especially because their reimbursements had been drastically reduced in recent years and it was becoming increasingly difficult for them to maintain their practices. They said they had previously had more success negotiating and receiving higher payments.
Perhaps the most surprising of your findings is that MultiPlan gets a share of the cost savings it saves employers.
Yes, but I wouldn’t call it a cut. It is very complicated. MultiPlan charges a fee based on the savings they generate for employers. However, in some cases these savings are passed on to the patient as a bill. Both insurers and MultiPlan have financial incentives to keep payments low because in many cases they receive more money.
But it wasn’t always like that, right?
Right. Founded in 1980, MultiPlan was a fairly traditional off-network cost containment company. Doctors and hospitals agreed to modest discounts with MultiPlan and agreed not to try to collect more money from patients. It was a balancing act.
But this balancing act changed over time. MultiPlan’s founder sold the company in 2006 to the Carlyle Group, a large private equity firm. There was a shift from negotiations to automated pricing. They bought a company in 2010 and another key company in 2011, acquiring these algorithm-driven tools that became the backbone of MultiPlan’s business.
You read more than 50,000 pages of documents for your investigation. How do you start sifting through so much information?
I love a good document trove. There was no major leak. Rather, it was about pulling together information from many different sources – court records, documents that providers and patients shared with me, their communications with MultiPlan and insurers. We have asked federal judges to unseal some previously confidential documents, including emails between Cigna executives, documents describing how some of MultiPlan’s tools work and data on thousands of medical claims.
What was the biggest challenge in your reporting?
Finding patients and providers who were willing to speak publicly about their experiences because it’s a really sensitive topic. A number of providers feared insurance companies would retaliate if they spoke confidentially. For many of the patients I spoke with, it also meant making their personal medical history available to the public.
What sparked your interest as a reporter in the healthcare and pharmaceutical industries?
For many Americans, health care is an almost universally frustrating or confusing experience. It has a direct impact on people’s health, their wallets, or both. I really enjoy learning about the things that affect people’s health. I’m trying to make this information available to millions of people who are affected by it but may not have much time to understand it.
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2024-04-18 07:00:12
www.nytimes.com