What is the Multiplan PPO Network?
Multiplan started in the 1980’s as a regional NY hospital network, and has grown to be the largest PPO in the US. There are over a million healthcare providers in network. They’ve grown so much because they provide a great value to both insurance companies and to consumers. Multiplan helps insurers reduce the cost of care, which those insurers pass along to consumers with more competitive rates vs benefits. It has a flexible network structure, and covers all specialties. This PPO really does make healthcare flexible.
A Better Reference for Pricing
Often, health insurers base the amount they pay doctors and hospitals on Medicare reimbursement rates, under the name of Reference-Based Pricing. Sadly, Medicare is not only a flawed pricing strategy for many healthcare services, but it also can cause unintended consequences. For instance, doctors frequently raise their rates for Medicare patients, which ends up raising everyone’s rates. And you, the consumer, end up paying more for health insurance as a result.
The better way to set billing rates ties the expense to a doctor’s or hospital’s own operating costs.
Extending the Power of Bill Review
Multiplan uses analytics to find wasteful or abusive medical billing practices, then works to fix those problems. That means that when you go to a doctor who is in-network, you have a netogiating team there to prevent over-billing. And, every in-network doctor had their billing practices reviewed before joining the network.
Let’s see an example:
A spinal fusion procedure billed at $42,452 was reduced by bill review to $24,956. Payment integrity analysis determined that a spinal fusion and lumbar laminectomy were separately billed. Citing CPT Assistant, American Association of Neurosurgeons and the NCCI manual, the lumbar laminectomy is included in the spinal fusion if performed at the same spinal level, and is only as extensive as necessary to prepare the site for the fusion.
After discussion with the provider, the bill was reduced, with provider signoff, by an additional $5,852.
How this affects you
Multiplan is a PPO network that many insurance plans can use for their healthcare payer services. So the Multiplan network encourages even more competition. There are many plans out there that work on this network, all getting cost-reducing benefits, and all fighting to earn your business. It gives you more options and more competitive insurance rates.