Wiki Multi-Plan Information

[gr8gal61]

Can someone help clarify what Multi-Plan does/is? I know negotiate pricing however I was informed that they assist an entity on obtaining an IN network status with plans however I am not wholeheartedly agreeing on this. I have been assisting the start up of a lab and the owner was told this and that they would agree to pay 400% of Medicare/Medicaid rates on the codes the lab would bill?

Any knowledge on this would greatly be appreciated.

Thanks

 

[thomas7331]

In addition to negotiating rates as you mention, Multiplan does offer a network that providers can join and Multiplan will offer this as a 'leased' network to insurance plans that do not have their own networks in certain areas, or which want to offer a more expanded network choice to their members. Their provider contracts function pretty much like a provider contract directly with an insurance company, only you are essentially contracting with them as a middleman instead of directly with the insurance. Whether or not this would allow patients to be 'in network' with those providers or not would depend on their specific plan terms and benefits. For example, I know that some small plans that only contract with providers in a limited area such as a single state or region will offer Multiplan to the members to allow them to have a network if they travel outside that area. Some plans may give the members full in network benefits for those providers, but I've also seen plans where a leased network such as Multiplan will be like a second tier benefit to allow patients access to those providers with the discounted rate but not necessarily give the highest benefit level that they would receive by seeing the plan's own providers.

 

[gr8gal61]

Thank you Thomas. Good information and quite helpful.

In addition to negotiating rates as you mention, Multiplan does offer a network that providers can join and Multiplan will offer this as a 'leased' network to insurance plans that do not have their own networks in certain areas, or which want to offer a more expanded network choice to their members. Their provider contracts function pretty much like a provider contract directly with an insurance company, only you are essentially contracting with them as a middleman instead of directly with the insurance. Whether or not this would allow patients to be 'in network' with those providers or not would depend on their specific plan terms and benefits. For example, I know that some small plans that only contract with providers in a limited area such as a single state or region will offer Multiplan to the members to allow them to have a network if they travel outside that area. Some plans may give the members full in network benefits for those providers, but I've also seen plans where a leased network such as Multiplan will be like a second tier benefit to allow patients access to those providers with the discounted rate but not necessarily give the highest benefit level that they would receive by seeing the plan's own providers.