MultiPlan Lawsuit Explained: $1,000 Bills, $200 Payments
Last week, the Texas Medical Association joined a major federal antitrust lawsuit targeting Multiplan (now rebranded as Claritive) — a middleman company whose algorithms impact 80% of commercial out-of-network health insurance claims in the US. The headlines say it’s “doctors vs. insurers,” but as Dan explains, the real story is about billions in hidden fees siphoned off by the algorithms and insurers — fees that employers, patients, and even doctors rarely see.
In this episode, Dan breaks down how Multiplan’s secretive pricing algorithms and the “percentage of savings” model actually work, why the federal lawsuit matters, and the specific actions benefits buyers and CFOs should take before 2027.
Chapters:
00:00 - Multiplan Lawsuit: What You Haven't Heard
01:35 - How the Algorithm Replaced UCR
03:22 - The "Cartel" Lawsuit and DOJ Involvement
04:50 - The Real Fee Math Breakdown
08:22 - What Employers & Benefits Buyers Should Do Now
Sources, lawsuit details, and further reading available in the substack post on https://open.substack.com/pub/danmcco...
#multiplan #healthinsurance #antitrust #algorithm #texmed
Episdoe Note: This piece covers public reporting and active litigation. All allegations are unproven and may ultimately be rejected in court. MultiPlan, Claritev, and the named insurers deny wrongdoing. Nothing here is legal, financial, or medical advice.