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California appeals court revives antitrust claims over OON repricing
The decision, certified September 21, 2026, concerns insurer and self-funded employer payments to providers that the court said are covered by antitrust law.
Out-of-network (OON) repricing, a cost-control method used by insurers and self-funded employer plans, faces fresh legal exposure after a California appeals court ruled that insurer reimbursements to providers are prices subject to antitrust law, according to Insurance Business.
The unanimous First Appellate District decision revives claims brought by the VHS Liquidating Trust against MultiPlan Corporation, now called Claritev, and the trust’s complaint also targets insurers and self-funded payors that contract with insurers and MultiPlan to administer plans.
The article notes that ERISA challenges to OON repricing arrangements have already arisen in class litigation, including allegations tied to UnitedHealthcare that discounted repricer rates were used instead of the competitive fees plans promised, leaving members owing the remainder of providers’ bills.
The panel said there was no basis to exempt this category of payments from the Cartwright Act and said such payments would also be treated as prices under federal law, reviving a theory that could raise governance questions for plans that use MultiPlan or similar repricing platforms. The piece also cites broader dispute activity under the No Surprises Act’s independent dispute resolution process, including cost estimates since the program’s launch and a 2025 dispute volume increase.