"Shared Savings" Is the Bill: How Repricing Vendors Turn Underpaid Therapists Into Employer Fees

On March 30, 2026, a federal judge ruled that Zelis and five of the country’s largest insurers, Aetna, Cigna, Elevance, Humana, and UnitedHealth, have to answer antitrust claims that they used something called “repricing” to hold out-of-network payments down. The case is now in discovery. (Insurance Business Magazine, April 2026)

If you run benefits for a self-funded employer, that word, repricing, is closer to home than it sounds. It shows up on your own invoices under a friendlier name: “shared savings.” And the number next to it is not money you kept. It is a fee you paid.

Quick answer: When an out-of-network mental-health claim comes in, many big insurers route it through a repricing vendor like Zelis or MultiPlan (now Claritev) that cuts the payment to the provider, then bills the self-funded employer a percentage of the gap as “shared savings.” UnitedHealthcare has typically charged employers 30 to 35 percent of the difference between what the clinician billed and what got paid, and the smaller that payment, the bigger the fee. So the vendor and the insurer both come out ahead the less the therapist is actually paid. The “savings” line is provider underpayment with a markup on top. (New York Times investigation, April 2024)

I spent years directing behavioral health programs, and I have watched this from the provider side of the desk. A clinician bills a fair rate, the payment comes back at a fraction of it, and everyone shrugs and calls the difference savings. Follow the money one step further and the shrug stops making sense.

The Line That Says “Savings” Is a Fee You’re Paying

Start with how the money actually moves. Most Americans with job-based coverage are in a self-funded plan, which means the employer pays the real medical bills out of its own pocket and hires an insurer to administer the plan. When an employee sees an out-of-network provider, the insurer often runs the claim through a repricing vendor. The vendor recommends paying the provider far less than billed. Then the insurer and the vendor each take a cut of the difference.

A 2024 New York Times investigation put numbers on it. UnitedHealthcare typically charged employers 30 to 35 percent of the gap between the billed amount and the portion paid. The paper’s read on the incentive was blunt: the smaller the reimbursement, the larger their fee. UnitedHealthcare alone was pulling in about $1 billion a year from these out-of-network savings programs, and MultiPlan told investors it had flagged nearly $23 billion in bills it recommended not be paid. (PNHP, April 2024; MedCity News, April 2024)

Sit with the direction of that incentive. In a normal negotiation, the party paying wants the price to drop. Here, the parties setting the price get paid more the lower it goes, and the party actually footing the bill, the employer, is handed an invoice that frames its own extra cost as a discount it won. The therapist gets pennies. The patient often gets balance-billed for the rest. The “savings” everyone is congratulating themselves on is the fee.

One Vendor Touches Most of the Country’s Out-of-Network Claims

This is not a niche arrangement. MultiPlan, now operating as Claritev, reprices more than 80 percent of the nation’s commercial out-of-network claims, over 370,000 of them a day. (HFMA, April 2026) When one company sits in the middle of four out of five out-of-network claims, its formula effectively becomes the market’s formula.

The company is candid about what that formula produces. Its Data iSight tool markets “savings of 61%-81% off billed charges” and “provider acceptance rates of 89%-98%.” (Claritev, 2026) Read those two numbers together. Cut the payment by two-thirds or more, and nine out of ten providers take it anyway, because the alternative is an appeal the same page lists as getting filed only 2 to 11 percent of the time. Acceptance that high is not a sign the price is fair. It is a sign there is nowhere else to go.

A Judge Just Sent the Case to Discovery

For years this ran quietly. It is not quiet anymore.

On March 30, 2026, the U.S. District Court for the District of Massachusetts refused to throw out an antitrust case against Zelis and five insurers, Aetna, Cigna, Elevance, Humana, and UnitedHealth, that provider groups say used Zelis’s repricing tools to suppress out-of-network pay. One plaintiff said a claim it submitted came back repriced at a discount of more than 88 percent. The court let the price-fixing theory proceed, and the case moved into discovery. (Insurance Business Magazine, April 2026)

Discovery is the part that matters. It is where the internal emails and the fee formulas stop being described in a complaint and start being produced as evidence. The pressure is not coming from one courtroom either. In July 2026, Arizona’s attorney general sued MultiPlan and eight insurers over what the state calls an out-of-network pricing cartel, alleging the defendants control roughly 80 to 90 percent of that market by dollar volume. (Insurance Business Magazine, July 2026) Whatever the courts ultimately find, the mechanism is no longer a secret, and plan sponsors are named in the story as the ones paying the fee.

Why This Lands Hardest on Mental Health

Repricing hits every specialty, but it presses on mental health with particular force, and the reason sits upstream. Commercial mental-health networks are thin. Pay a therapist a fraction of what the same plan pays a surgeon, and a lot of therapists stop taking that plan, which is exactly the pattern regulators keep documenting. Connecticut’s insurance department found higher out-of-network utilization for behavioral health than for medical care inside the same plans this year. (Mental Wealth Solutions, 2026)

That thin network is what feeds the repricing machine. When the in-network options are booked out or gone, the patient goes out of network, the claim gets repriced, and the plan sponsor pays a fee on the underpayment. So the care your employees already have the hardest time reaching is the care most likely to generate a “shared savings” line. The system produces a shortage, then charges the employer a fee for routing around the shortage it produced.

That is the part that should bother a benefits leader most. You are not only paying for care. On out-of-network mental-health claims, you may be paying a percentage-of-savings fee that runs largest precisely when your employee was served the worst.

What a Plan Sponsor Can Actually Ask

None of this requires you to become a litigator. It requires a few specific questions to your administrator, and a plan sponsor has standing to ask them, because under ERISA the money being spent is the plan’s, held for the benefit of employees.

Ask your third-party administrator or carrier to show you, in writing, how out-of-network claims are priced and by which vendor. Ask what you are charged for it, and whether that charge is a flat fee or a percentage of the “savings.” Ask to see a sample of out-of-network mental-health claims with the billed amount, the paid amount, and the fee on each one, side by side. Ask what a provider’s appeal of a repriced amount costs, and how often it actually succeeds. If the answer to any of these is “that’s proprietary,” that is itself an answer.

We built Mental Wealth Solutions on the opposite premise: that the people delivering care and the people paying for it are on the same side, and the party quietly profiting from underpayment is not one of them. You do not have to accept a line item that pays out more the less your employees’ clinicians are paid. You just have to stop reading it as savings.

FAQ

What does “repricing” mean on an out-of-network claim? Repricing is when an insurer routes an out-of-network claim to a third-party vendor, such as Zelis or MultiPlan (now Claritev), that recommends paying the provider well below the billed charge. MultiPlan/Claritev reprices more than 80% of the nation’s commercial out-of-network claims, over 370,000 a day. (HFMA, April 2026)

Is “shared savings” real savings for my company? Not in the way it reads. “Shared savings” is a fee. The insurer and the repricing vendor each take a percentage of the gap between the billed amount and the reduced payment. UnitedHealthcare has typically charged self-funded employers 30 to 35 percent of that gap, and the smaller the payment to the provider, the larger the fee. (New York Times investigation, April 2024)

Why does this affect mental health claims more? Because mental-health networks are thin, patients go out of network more often for therapy than for medical care, so more mental-health claims run through the repricing machine. Connecticut regulators documented higher out-of-network utilization for behavioral health inside the same plans in 2026. The care that is hardest to access in network is the care most likely to generate a repricing fee.

What is the lawsuit everyone is talking about? On March 30, 2026, a federal court in Massachusetts let an antitrust case proceed against Zelis and five insurers, Aetna, Cigna, Elevance, Humana, and UnitedHealth, over claims they used repricing tools to suppress out-of-network pay. One provider reported a claim repriced at more than an 88 percent discount. The case is in discovery. (Insurance Business Magazine, April 2026)

What can an employer do about it right now? Ask your administrator, in writing, which vendor prices your out-of-network claims, what you are charged, and whether that charge is a percentage of the “savings.” Ask to see billed-versus-paid-versus-fee on a sample of out-of-network mental-health claims. As the plan sponsor, the money is the plan’s, and you have standing to ask.

Sources

1. Insurance Business Magazine, “Massachusetts court greenlights antitrust suit against Zelis, Aetna, Cigna, UnitedHealth”, ruling March 30, 2026; article April 7, 2026. One claim repriced “more than 88 percent”; case entered discovery.
2. HFMA, “Out-of-network pricing lawsuits test MultiPlan, Zelis business models”, April 20, 2026. MultiPlan/Claritev reprices more than 80% of commercial out-of-network claims, 370,000+ daily; Zelis “receives a share of the savings.”
3. Physicians for a National Health Program, “Latest Corporate Intermediary Scam, For Out-of-Network Charges”, summarizing New York Times investigation, April 7, 2024. 30 to 35 percent shared-savings fee; about $1 billion a year in UnitedHealthcare fees; nearly $23 billion in bills recommended not paid.
4. MedCity News, “AHA urges Labor Department to investigate MultiPlan’s practices”, April 11, 2024. $1 billion a year in employer fees; MultiPlan “upwards of $22 billion” flagged; fee tied to the gap between billed and paid.
5. Claritev (formerly MultiPlan), “Tackling Out-of-Network Medical Bills with Data iSight”, 2026. Marketed “savings of 61%-81% off billed charges,” “provider acceptance rates of 89%-98%,” “appeal rates between 2% and 11%.”
6. Insurance Business Magazine, “New lawsuit accuses MultiPlan, insurers of out-of-network pricing ‘cartel’”, July 10, 2026. Arizona AG suit; defendants alleged to control roughly 80 to 90% of the out-of-network market by dollar volume.
7. Mental Wealth Solutions, “Connecticut Fined Every Major Insurer for Blocking Mental Health Care”, July 2026. Higher out-of-network utilization for behavioral health within the same plans (Connecticut Insurance Department, April 2026).

Figures current as of July 2026.

Disclaimer

This article is for educational and informational purposes only. It does not constitute medical, clinical, legal, or therapeutic advice, and reading it does not create a therapist-client relationship with Matthew Sexton, LCSW or Mental Wealth Solutions, Inc. Although the author is a licensed clinical social worker, the content in this article is not clinical assessment, diagnosis, or treatment.

Out-of-network repricing arrangements, “shared savings” fee structures, and the plan documents that govern them vary by health plan, administrator, and state, and the litigation described here is ongoing, with allegations that remain unproven and findings that may change after this article is published. Nothing here is a substitute for reviewing your own plan’s terms and fee schedule with your third-party administrator, benefits counsel, or a qualified ERISA attorney. What a specific plan sponsor, clinician, or patient encounters may not match the patterns described here.

If you are in immediate emotional crisis, you can reach the 988 Suicide & Crisis Lifeline by calling or texting 988 (US). If you are experiencing domestic violence or are in physical danger, contact the National Domestic Violence Hotline at 1-800-799-7233 or visit thehotline.org. In a life-threatening emergency, call 911.