Meet the Middleman’s Middleman

An Arm and a Leg

Society & Culture, Medicine, Health, Health & Fitness, Documentary

4.8 • 1.1K Ratings

🗓️ 13 June 2024

⏱️ 25 minutes

🔗️ Recording | iTunes | RSS

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Summary

Folks who expected their health insurance to cover some out-of-network care have been getting stuck with enormous bills instead. Like one couple from Kansas City: Their insurance hung them out to dry for thousands of dollars, all while sending statements touting a “discount” the couple was supposedly getting.

Turned out: A middleman was cutting their coverage — actually a middleman’s middleman — working with their insurance company. The couple’s insurer got the “discount,” and the middlemen got big fees.

And of course this couple wasn’t alone. A recent New York Times investigation from reporter Chris Hamby documented and explained this Russian-nesting-dolls-of-middlemen scheme.

Insurance companies (middleman #1) work with a with a company called MultiPlan (middleman #2), which slashes the amounts the insurance plans actually pay for care.

To show how it all works — and what we can maybe do about it — we dive into the hidden mechanics of health insurance.

Here's a transcript of this episode.

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Transcript

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0:00.0	Hey there, Paul and Kristen live in Kansas City with their two kids.
0:04.3	Kristen and their daughter, the older kid, they have some complex medical issues.
0:08.4	Need to see some specialized folks.
0:10.5	And some of those folks don't take Kristen and Paul's insurance.
0:15.0	They're out of network.
0:17.0	So Kristen and Paul pay out of pocket a lot,
0:21.0	maybe $20,000 a year.
0:24.7	But their health insurance plan does reimburse
0:28.4	some out-of-network care.
0:30.2	So in January 2023, Kristen called a help line connected with the insurance plan to find out how that was going to work.
0:37.0	They basically said, sure, easy, easy, easy, easy, you pay and then you get online and you click this form, you show what you paid,
0:48.6	and then we send you a check and reimburse you.
0:50.8	Kristen was on it. She built a whole spreadsheet to track every bill she paid, every reimbursement form she had submitted, and she waited for the checks.
1:00.0	The insurance company gave itself months just to process the claims and when they finally sent statements
1:08.4	The statements seem weird they were like here's what you paid and here's your discounts and here's what you may owe.
1:17.0	And Kristen was like, what?
1:20.0	Because I was thinking, well I don't owe anything we paid out of pocket but then I was
1:26.3	thinking well this must be the portion that they're paying us back but then the
1:30.4	math didn't add up. Yeah, not at all.
1:34.2	Kristen was expecting to get 50% back,
1:36.8	like her plan said she would.
1:38.5	But this amount wasn't anything like 50%. And what's this discount business? It took months and a lot
	...

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