The New York Times deserves credit for publishing a recent investigative report spotlighting rampant medical overbilling (“Insurers Reap Hidden Fees by Slashing Payments. You May Get the Bill”). But there’s more to the story that needs to be told.

Much of the focus was on a private-equity-backed firm called MultiPlan, whose work was depicted as helping “drive down payments to medical providers and drive up patients’ bills, while earning billions of dollars in fees for itself and insurers.” After reviewing more than 50,000 pages of documents and interviewing former MultiPlan employees, the NYT noted a built-in incentive to secure unreasonably low provider payments by tying bonuses to the size of reductions.

But a key detail was left out. Not all medical bill review and repricing companies are created equal. There are many different approaches to plan design, repricing, bill review and advocacy that generate significant savings for self-funded health plans and the plan participants. The more than 150 million working Americans who are covered by employer-provided health plans can use a helping hand navigating the complexity of the U.S. healthcare system. We offer comprehensive patient advocacy services that arm members and their families with the information they need to choose the highest-quality providers at the lowest cost. They also can use high-level expertise that provides them with both financial and legal protection from balance billing.

Bill review and repricing services seek to help employers that lack the bargaining power of large insurance companies and the federal government make the most of their health benefits. This, in turn, allows health plan members wider access to more affordable care.

What was also missing from this report was a need to pay closer attention to the root cause of egregious medical overbilling. Many doctors and hospitals have long benefitted from a lack of transparent pricing – even in the face of legislative and regulatory attempts to strip away decades of opacity. Healthcare payers and providers are also constantly haggling over prices and network size, which means that patients are often caught in the crosshairs of attempts to increase reimbursements for medical services.

For some Americans, unpaid medical bills are a contributing factor to their decision to file for personal bankruptcy. Worse, millions delay or forego important medical care, or ration medicine. Medical overbilling undercuts the ability of households to save for emergency expenses, erodes take home pay and undermines productivity. However, these are systemic problems for which a cure is within reach.

There is an urgent need for clear and accurate price transparency in healthcare to avoid medical overbilling in the first place. Securing the right administrative capabilities and plan design will go a long way toward achieving this goal.

Value of a Medical Billing Partnership

To support annual enrollment and help manage plan design and administration, plan sponsors are benefiting from partnerships that provide them with insights through data-driven solutions. Real-time price information of the true cost of health care services enables sponsors and members to make the most advantageous cost-benefit decisions regarding enrollment options. As your partner, aequum can help lower costs, achieve savings, enhance member experience and maximize your plan’s success in 2023/24 and beyond. Please contact us if you have any questions or need support.