In re MultiPlan Multi-District Litigation: Implications for the Health Care Industry

• September 25, 2025

• Long X. Do , Athene Law LLP
• Eric D. Chan , Athene Law LLP

Out-of-network reimbursement disputes between payers and providers are commonplace, if not endemic, in the managed health care system. Payers are incentivized to impose controls over health care utilization and spending. Providers without a written payer contract governing payment for services may, on the other hand, be incentivized to seek higher reimbursement in court to challenge these cost-control efforts. For decades, providers (including physicians, physician groups, and hospital systems) have initiated litigation to directly challenge payers’ policies and methodologies for calculating out-of-network reimbursements (often referred to as “reasonable and customary” payments) that lead to purported underpayment for out-of-network claims. Such strategies came to a climax with national class action settlements circa 2010 over a UnitedHealth Group subsidiary’s alleged manipulation of its proprietary repricing database to calculate artificially low out-of-network payments used by payers.

ARTICLE TAGS

• Payers, Plans, and Managed Care Practice Group
• Health Insurance