It would be nearly impossible to identiry or explain every actor in the U.S. healthcare system. So it’s not all together surprising that one of the most… sinister? controversial?… actors flies largely under the radar. We’re talking about a company called Multiplan.

A recent New York Times investigation dug into exactly how companies like Multiplan work, using specific examples, but here’s what it boils down to:

When you see a doctor who’s out of network, that doctor simply bills your insurance provider for the cost of services rendered (there are no pre-negotiated rates like with in-network doctors). If you have an employer-sponsored insurance plan, a chunk of this bill will be paid by your employer. What percentage your employer pays gets determined by data analytics companies like Multiplan and the insurance providers.

The Times investigation showed that Multiplan and the insurance providers routintely told employers to pay small percentages of the total amount billed by doctors. They promote this as a benefit to employers like you (you’re saving money!).

In reality, however, the patient (your employees/their family) are forced to pay much larger portions. Meanwhile, Multiplan and insurance companies essentially pocket the difference. The Times estimated that UnitedHealthcare (the country’s largest insurance provider) has made as much as $1 billion from this approach, while American families grapple with unweildy medical bills.

We suggest reading the full NY Times article, but the main takeaway is: If insurance plans try to sell you on no fees or significantly lower out-of-pocket payments, look under the hood to see how they’re making it happen. If they’re offering you savings at your employees’ expense, you may be embarking on a slippery slope.

See the article at nytimes.com (subscription required).