Health Insurance

Health Insurance

Health insurers hold a unique and often controversial place in our health care system, acting both as sellers of insurance coverage and buyers of various provider services. The costs of health care run heavily through this complex network of third-party payers and can only be understood with a strong knowledge of the industry. NERA's health insurance experts bring deep industry experience, expertise in the economics of the industry, and a practical understanding of the market dynamics that drive competition in health care. Our work requires a full understanding of the market power issues on both the selling side (monopoly) and the buying side (monopsony). NERA experts have worked on numerous mergers and acquisitions in the health insurance industry. With a broad knowledge of the industry as a whole and of the interplay between consumers, providers, employers, and third-party payers, NERA economists have played major roles in evaluating the competitive impact of proposed mergers and acquisitions in the field.

NERA's experts have also been engaged in a variety of litigation matters involving health insurers. For example, NERA economists have been retained to address the competitive implications of a variety of contractual practices and business conduct, such as exclusive contracting between health insurers and providers, the alleged bundling and tying of different health care services, and the conversion of health plans from not-for-profit status to for-profit status. We have also worked on a major MDL class action that alleged conspiracy to deny, diminish, or delay reimbursement to physicians and other health care providers by manipulating the claims processing software. By combining deep industry knowledge with expertise in economics and statistics, the analyses and testimony of NERA’s health care experts have been influential and decisive.

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