MultiPlan: Customer Complaints and Reviews
MultiPlan gets many complaints, but people are often confused about what MultiPlan does.
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MultiPlan creates networks of doctors, hospitals and medical providers that are used by insurance companies.
MultiPlan, and its subsidiary PHCS, don't determine what's covered by your health insurance plan or how much you pay for medical care. That's set by the insurance company and the plan you select. Instead, a MultiPlan network determines the doctors and medical providers that will accept your health insurance plan.
What is MultiPlan, and how does it work?
MultiPlan assembles national and regional provider networks that insurance companies use to set where you’ll be covered for medical care. The provider networks are made up of doctors, hospitals, laboratories, rehabilitation centers, and other places you can get health care.
When you use a medical provider that’s listed in the insurance plan’s network, you’ll usually pay less for medical care than if you got health care outside of the network.
A common mistake when looking at your insurance card
In some cases, the MultiPlan logo or the logo of its subsidiary, Private Healthcare Systems (PHCS), appears on health insurance cards. This could make you think that MultiPlan and PHCS are insurance companies that pay for some of your health care.
MultiPlan and PHCS are network providers, not insurance companies. This means MultiPlan and PHCS do not provide benefits, nor do they pay medical claims.
If you see a MultiPlan logo on your insurance card, that means you can use the MultiPlan website to search for a doctor or medical facility that will accept your insurance plan. However, questions about coverage or benefits should be directed to the health insurance company, which is probably the other logo on your insurance card.
How Multiplan’s pricing data is used by insurance companies
Behind the scenes, your insurance company could also use MultiPlan to help reduce the cost of how much it pays for medical care. This technology can help insurance companies keep their costs low.
Multiplan’s cost management technology is used by large insurance companies like Aetna, Cigna, UnitedHealthcare and Humana. But this service is under scrutiny because of a lawsuit about how out-of-network medical claims are paid.
About the MultiPlan networks
MultiPlan is one of the largest providers of health care networks in the United States, with its networks encompassing 1.2 million health care providers. PHCS has contracts with more than 1 million health care providers throughout the country.
MultiPlan and PHCS, because of their size, are able to recruit doctors and medical facilities into their networks, often requiring them to offer services at discounted rates.
MultiPlan also focuses on providing networks for PPO plans. With a PPO (preferred provider organization) plan, you’ll have coverage for health care that’s administered by an in-network or out-of-network provider, but it is usually much more expensive to get care outside your network. Beneficiaries can cut health care costs in half in some instances, by staying within the networks.
What types of insurance plans use MultiPlan networks?
MultiPlan contracts with some of the nation’s largest private insurers, including Cigna and UnitedHealthcare.
MultiPlan and PHCS provide networks for multiple types of insurance plans:
- Private and employer-sponsored health plans
- Medicaid
- Medicare Advantage
- Workers’ compensation plans
- Car insurance medical payment coverage
MultiPlan access card program
ValuePoint by MultiPlan is a medical discount card that gives you cheaper rates for medical care than if you paid the full cost yourself.
It’s not insurance. It’s more like a coupon that can help you avoid having to pay full price. When you go to a doctor in the ValuePoint by MultiPlan network, you’ll show the card and pay the discounted rates that MultiPlan negotiates with the doctors in the network.
The medical discount card is typically purchased through another company or employer. The program is not traditional health insurance, so it may not have benefits like an out-of-pocket maximum to limit your medical costs, and it may not cover essential health services.
ValuePoint’s participating providers include about 340,000 doctors, hospitals, and medical providers.
Are MultiPlan networks good?
MultiPlan and PHCS networks vary in size and scope. And they can be good or bad depending on what you’re looking for.
For example, some of the networks provide nationwide access to doctors and medical facilities, and if the network is used by a full-benefit health insurance plan, you could have a good combination of benefits and access to care. Other networks are designed for limited-benefit plans, appealing to beneficiaries who want to supplement existing coverage.
MultiPlan has four types of provider networks:
- National primary PPO networks: MultiPlan is the largest provider of PPO (preferred provider organization) networks in the country.
- Select regional primary networks: MultiPlan operates regional and statewide networks in Alaska, Arizona, Hawaii, Illinois, Michigan and Utah. The company also provides networks for the Texas Medicaid program.
- Complementary “wrap around” networks: These networks augment an insurance plan’s primary network to give enrollees more choice about where they can get health care. For example, this can be a way that an insurance plan expands its geographic coverage area for enrollees.
- Specialty networks: MultiPlan works with insurance companies to design networks based on their needs. With some of its networks, MultiPlan provides extended access to help beneficiaries who travel often get network access outside of the network service area, for example.
Watch out for limited-benefit plans
MultiPlan and PHCS both provide networks of medical providers to what are called limited-benefit health insurance plans. Even though MultiPlan provides the networks, not the benefits, many people are upset about the poor health benefits they get with these plans.
Limited-benefit plans are primarily designed to supplement regular health care policies, not to replace them. They provide considerably less coverage. For example, a limited-benefit plan may not cover preexisting conditions or prescription drugs. It all depends on the individual plans, which can include fixed indemnity plans or critical illness plans.
The plans can provide helpful coverage in certain circumstances, such as if you need short-term health insurance or supplemental insurance. However, if you rely on a limited-benefit plan as your major source of insurance coverage, you could pay high costs if you get sick or have an accident.
Customer complaints about MultiPlan and PHCS
Many people are confused about what MultiPlan and PHCS do and their role in the health care system.
As a result, many of the complaints lodged against MultiPlan with the Better Business Bureau (BBB) concern the lack of benefits and certain services not being covered. Beneficiaries complain, for example, that a MultiPlan network does not cover physicals or maternity care.
It is important to remember that MultiPlan is not an insurance company, meaning it does not determine what is covered. These complaints should instead be directed to the individual’s health insurance company.
Other, more relevant, customer complaints are about the lack of doctors participating in the MultiPlan networks.
To some degree, the size and the scope of a plan’s network are determined by negotiations between a health insurance company and MultiPlan. However, there are also some medical providers who have declined to participate in MultiPlan networks as a result of cost concerns. Many physicians and other providers say they must accept lower reimbursement rates when providing health care as a part of MultiPlan’s network, and they may choose to not join the network rather than accept the lower prices.
The best way to ensure that you’ll have access to the medical providers you prefer is to check the health insurance plan’s network of providers when choosing your health insurance plan.
How to choose a plan with a good network
When shopping for a health insurance plan, it’s important to review the list of providers within the insurance plan’s network. This will tell you if you’ll be covered to use your usual doctors or local hospital. It could also tell you how much choice you’ll have about where you can get medical care.
Ask yourself the following questions:
- Are there enough primary care doctors and specialists in the network to have health care options?
- Does the network include physicians and other health care providers you want to see?
- If you have a certain condition or disease, does the network have physicians or specialists to treat the condition?
Frequently asked questions
What does MultiPlan insurance mean?
MultiPlan is not an insurance company. Instead, Multiplan creates networks of doctors and medical professionals where you can use your health insurance plan’
What Is PHCS insurance?
PHCS, which stands for Private Healthcare Systems, is not an insurance company. It provides networks of doctors, hospitals and medical professionals, like its parent company, MultiPlan.
Is MultiPlan the same as PHCS?
MultiPlan owns PHCS. But the two entities have different provider networks for their insurance company clients.
Is MultiPlan legit?
Yes, MultiPlan is legitimate. It is important to remember, however, that MultiPlan is a network provider, not an insurance company.
What are the pros and cons of MultiPlan insurance?
MultiPlan discount cards are good because they’
Does Cigna use MultiPlan?
Yes. Cigna and some other major insurance companies use MultiPlan to set the network of doctors and medical providers where your health insurance can be used. If you see the MultiPlan or PHCS logo on your insurance card, it means Cigna is using a provider network supplied by MultiPlan.
Editorial note: The content of this article is based on the author’s opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.