While reading about the recently slain UnitedHealth CEO, Brian Thompson, on wikipedia, I also happened to be processing the United transparency data. Out of curiosity, I decided to lookup his former employer of 7 years, the 170 year old company PricewaterhouseCoopers. It so happens that United indexes their negotiated rate files by company name. If you navigate to their MRF search page, and search for "Pricewater", you'll turn up a file named 2024-12-01_PricewaterhouseCoopers_index.json (Note, this page is incredibly slow because there are some 55,000 index files. See this article for details on the files).
If one were to parse this file, you would come up with a mapping of insurance plans to negotiated rate files that look something like this:
| Plan Name | Description | Filename |
|---|---|---|
| POS-CHOICE-PLUS | in-network CMC Cancer shared files | CMC_CRS_MRRF |
| POS-CHOICE-PLUS | in-network files | PPO___NDC_PPO_NDC |
| POS-CHOICE-PLUS | in-network files | PS1_50_C2 |
| POS-CHOICE-PLUS | in-network CMC Orthopedic shared files | CMC_ORTH_MRRF |
| POS-CHOICE-PLUS | in-network files | PricewaterhouseCoopers_CSP_944_C335 |
| POS-CHOICE-PLUS | in-network files | PricewaterhouseCoopers_CSP_911_C344 |
| POS-CHOICE-PLUS | in-network CMC Transplant shared files | CMC_Transplant_MRRF |
| HARVARD-PILGRIM-CHOICE-PLUS-POS--57-P- | in-network files | PS1_57_H5 |
| NATIONAL-PPO | in-network files | PP1_00_P3 |
Typically these files are an uninteresting mapping of esoteric plan names to a geographically specific negotiated rate file, but there are a couple of unusual ones in this table and they're named after the company. So, what's in these? There are only about a dozen billing codes in the file when there are normally hundreds or thousands, and they point to the same clinic in New York City. One of these billing codes is the common 99387, a new patient code for a routine visit, negotiated at $2,564. Let's use our handy query tool to see a typical rate for this code. Below is a KDE plot for billing code 99387 from the United National PPO file also referenced in the index above. See this article for more details on KDE plots.
Note: Plot interactivity disabled on this page because it's very slow due to 35,000 data points.
In the plot above, we can see the highest density of rates is around $170, and 99% of the values are less than $500. So we're looking at a price for an initial visit that's about 15x the average and 5x the 99th percentile. The maximum rate for this billing code in the entire United National PPO file is only $1,076. What's going on here? My guess is it is a special C-Suite only type clinic. What kind of plan can you negotiate with United when you're a company that brings in $55 billion a year in revenue like PwC? Why do you need anything other than catastrophic coverage anyway when you're happy to pay 15x the average price for a routine visit? Maybe someone can drop me a line and let me know how these gold filigreed plans are typically formulated.
Can I get this one on healthcare.gov?
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