MultiPlan: Customer Complaints and Reviews
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MultiPlan creates networks of doctors, hospitals and medical providers that are used by insurance companies.
MultiPlan, and its subsidiary PHCS, do not determine what’s covered by your health insurance plan or how much you pay for medical care. That’s determined by the insurance company and the plan you select. Instead, a MultiPlan network determines the doctors and medical providers that will accept the associated health insurance plan.
What is MultiPlan, and how does it work?
MultiPlan contracts with some of the largest health insurance companies in the country, offering them national and regional provider networks that determine where you can go for covered health services. The provider networks are made up of physicians, hospitals, laboratories and rehabilitation centers, among other entities.
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 received health care outside of the network.
A common mistake
In some cases, the MultiPlan logo or the logo of its subsidiary, Private Healthcare Systems (PHCS), appears on health insurance cards, giving enrollees the mistaken impression that MultiPlan and PHCS are insurance companies, responsible for determining the extent and provisions of health coverage.
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.
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 contracts with more than 700,000 health care providers throughout the country.
MultiPlan and PHCS, because of their size, are able to recruit providers and other entities into their networks, requiring them to offer services at discounted rates, which are then passed on to the consumer in the form of lower medical costs.
MultiPlan also focuses on providing networks for PPO plans. With a preferred provider organization (PPO) 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 access care outside of the network. Beneficiaries can save more than 50% in health care costs, 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
MutiPlan also operates a specialty-network program where enrollees can get discounted rates on health care if they go to a medical provider in the MultiPlan network. Called MultiPlan ValuePoint, you'll only get the discount if you present the access card and pay the provider directly when you receive medical care.
The program is available through some employers or buying clubs. Keep in mind that 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 nearly 1,200 hospitals, 50,000 ancillary facilities and more than 450,000 practitioner locations.
Are MultiPlan networks good?
MultiPlan and PHCS networks vary in size and scope. And they can be good or bad depending on what the consumer is looking for.
For example, some of the networks provide nationwide access to doctors and medical facilities, and if the network is used by a comprehensive health insurance plan, the consumer 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 preferred provider organization (PPO) 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 furnishes networks for the Texas Medicaid program.
- Complementary "wrap around" networks: These limited-benefit networks are designed to augment an insurance plan's coverage. 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 frequently obtain network access outside of the network service area, for example.
Watch out for limited-benefit plans
MultiPlan and PHCS both provide networks of medical professionals that are used by limited-benefit health insurance plans. Even though MultiPlan provides the networks, not the benefits, many consumers are upset about the poor health benefits they receive with these plans.
Limited-benefit plans are primarily designed to supplement comprehensive health care policies, not to replace them. They do not provide comprehensive 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 are vulnerable to unforeseen costs if you get sick or have an accident.
Customer complaints
Many consumers 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 cite a lack of physicians 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 is always a good idea to find out particulars about the provider network.
One of the best ways to start is to review a list of providers within the insurance plan’s network, determining, for example, whether it will be difficult or easy for you to access physicians and other providers within the plan network.
Ask yourself the following questions:
- Are there enough primary care and specialist physicians within the network to have health care options?
- Does the network contain 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, it creates provider networks, which are groups of doctors and medical professionals where you can use your health insurance plan's benefits.
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.
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.