Who’s Really Standing Between You and Your Medical Provider?
Meet the Corporate Middlemen Draining Your Healthcare Dollars and Blocking Your Care
You pay for health insurance. Your employer pays for it too. That money is supposed to go toward your care – doctor visits, treatments, prescriptions, and the things that keep you and your family healthy.
But here’s the ugly truth: before a single dollar reaches your doctor, a whole army of corporate middlemen takes a cut. They don’t treat patients. They don’t cure diseases. They don’t save lives. But they do make billions by inserting themselves between you and your doctor, blocking care, delaying treatment, diverting you to their affiliate partners, implementing administrative blocks (in the hopes you abandon care), and siphoning money out of the healthcare system that was meant for you.
They call it “cost control.”
We call it what it is: corporate greed.
They assume and convince your employer that every provider is a scammer, so they micromanage every prescription, every test, every treatment – and then reward themselves with a slice of the fabricated “savings” when they block you from getting care. They tell lawmakers they don’t stop your medical provider from providing care – but they control the money. And if they don’t approve the payment, the care simply doesn’t happen. Medical providers can’t pay nurses, buy medicine, keep the lights on, or give you the care you need if these middlemen hold the purse strings shut.
This is why your premiums keep rising. It’s why care keeps shrinking. And it’s why fewer medical providers in your community are able to stay open.
It’s time to name names. Here are the worst offenders – the corporate middlemen that stand between you and your care. Let’s pull back the curtain and see what is really going on.
#1 – Pharmacy Benefit Managers (PBMs): The Prescription Profiteers
What they are:
PBMs are powerful corporations hired to “manage” your prescription drug benefits. Today, just three of them control more than 80% of the market and they are among the most profitable companies in America. Follow the money – the profit is your premium dollars, plain and simple.
How they operate:
- They decide which drugs are covered and which ones aren’t. This is why you see some formularies with more expensive medications listed as preferred and cheaper alternatives totally missing. It’s a “pay to play” scheme – where the drug manufacturers have to pay to be on the list. A simple cover fee to enter the club.
- They pocket secret rebates from drug companies instead of lowering your costs. Furthermore, rebates are based on a percentage of drug cost, so the real incentive is for a PBM to allow the cost to go unchecked, as they make more money from a higher base price.
- They force you to use their mail-order or corporate-owned pharmacies – even if your local pharmacy is cheaper and better. They control the formulary, they control the payment, and they control the patient – so the next step in this empire is to force the patient to use the pharmacy they own.
Why it matters:
PBMs drive up the cost of your medicines while cutting payments to the pharmacies that serve your community. They turn your prescriptions into a profit engine – one that works for them, not for you.
#2 – Re-Pricers: The Bill Slashers
What they are:
Re-pricers are hired to “review” medical bills and “adjust” what’s paid. That sounds helpful, until you realize their job is to slash payments as deeply as possible and take a percentage of the “savings.”
How they operate:
- They arbitrarily cut what they’ll pay your medical provider, often below the cost of providing care.
- They reward themselves based on how much they deny or reduce.
Why it matters:
When your doctor is paid less than the cost of care, they’re forced to make an impossible choice: provide care for free, or stop accepting your insurance. Either way, you lose. These companies re-price with their profit in mind, and consumers can get a significantly better price just asking their provider for a self-pay price. The goal here is to extract as many dollars from your employer as possible under the guise of “savings.”
#3 – Utilization Review (UR) Companies: The Denial Machines
What they are:
UR companies exist for one reason: to decide whether you really need the care your doctor says you do. These reviewers are not your doctor, have never even met you, and often not doctors at all. You are a number on a computer screen with a “deny” or “approve” button.
How they operate:
- They delay or deny treatments, tests, and medications: even when your doctor recommends them.
- They require endless “prior authorizations”- paperwork your doctor must beg them to approve.
- Their reviewers often aren’t even doctors, and certainly not your doctor.
Why it matters:
These companies profit by saying no. Every time they block care, they save money – and you suffer the consequences. Furthermore, these companies receive bonuses for meeting goals and metrics – which all translate to “savings”, which is clearly derived from necessary care that has been denied. Patients face dangerous delays, and doctors spend hours fighting bureaucratic battles instead of treating patients. Lives have been lost waiting for approvals that never came.
#4 – Third-Party Administrators (TPAs): The Middlemen for the Middlemen
What they are:
When employers pay healthcare costs directly (called “self-funding”), they often hire TPAs to run the plan. TPAs handle billing, payments, and networks – and add new layers of fees along the way.
How they operate:
- They charge per-claim and “performance” fees.
- They hire other middlemen – like PBMs and re-pricers – adding even more costs.
Why it matters:
Every layer takes a slice of your healthcare dollars before they ever reach your care. TPAs profit whether you get care or not. These companies have gone a long way from providing the services an employer needs to self-serving entities over the years.
#5 – Alternative Funding Programs (AFPs): The “Assistance Diversion” Scams
What they are:
These programs pretend to “help” you afford high-cost medications. In reality, they pull you off your insurance plan and attempt to shove you into charity programs (that you may not even qualify for) meant for the uninsured – often without your knowledge.
How they operate:
- They secretly enroll patients into drug company assistance programs. Many patients don’t end up qualifying for this assistance, so 3-6 months later, a patient is left without their medication lost in an administrative nightmare.
- They keep a cut of the “savings” and shift the costs elsewhere.
Why it matters:
Patients can face coverage gaps, delays, or even lose access to life-saving medicine – all so a corporate vendor can make a quick buck.
#6 – Network Aggregators & Rental Networks: The Access Brokers
What they are:
These companies don’t treat patients or pay claims. They simply sell “access” to networks of medical providers that other companies already built – and charge a fee for the privilege.
How they operate:
- They lease networks to employers and insurers.
- They layer on costs without providing any actual healthcare value.
Why it matters:
They’re like ticket scalpers for healthcare – charging you for something you’ve already paid for. They collect rent on networks they didn’t build, charging employers and providers while adding zero clinical value.
#7 – Medical Management Vendors: The Micromanagers
What they are:
These vendors promise to “coordinate” your care or manage chronic diseases. But their real job is to control what treatments you get, where you get it, and how much they cost.
How they operate:
- They create cookie-cutter “care plans” focused on saving money, not improving health. These “care plans” may work for 80% of the population, but definitely do not factor in your specific health requirements and limitations, they aren’t designed specifically to your needs – and do not consider what your doctor knows is best for your treatment.
- They second-guess your doctor’s decisions – often without ever speaking to you.
Why it matters:
They’re paid even if they never contact you (per member per month) – and they often push cheaper, less effective treatments. They often direct care toward cheaper, lower-quality services that benefit their corporate partners
#8 – Specialty Carve-Out Vendors: The Fragmenters
What they are:
Some insurers carve out specific types of care – like cancer treatment, dialysis, or mental health – to separate companies.
How they operate:
- Each carve-out adds another set of rules, authorizations, and restrictions.
- Each vendor adds another fee.
Why it matters:
Instead of one plan focused on your care, you get a maze of vendors – each profiting from a slice of your treatment. You are forced to run around town, while you are sick and nauseous, to piece mill your healthcare needs – so that a company can profit.
The Truth: Your Premiums Aren’t Paying for Care – They’re Feeding the Middlemen
The money you and your employer pay into your health plan is supposed to fund your care. Instead, it’s being carved up by middlemen who exist solely to extract profit.
- They delay and deny the treatments your doctor knows you need.
- They push you into corporate-owned pharmacies and clinics.
- They block payments to your local providers, forcing them to operate at a loss or close their doors.
- They increase premiums and out-of-pocket costs for you.
- They lower payments and drain resources for your local providers.
- They change the treatment regimen that your doctor knows will work and require you to try their plan first (by withholding payment for what your doctor knows will work).
And every dollar they pocket is a dollar not going toward your care.
This is why healthcare feels harder to access. This is why medical providers are leaving independent practice. This is why the system is failing patients – because it was never built to serve you. It was built to serve them.
Patients First PAC Is Fighting Back
We believe healthcare decisions should be made by you and your doctor, not by a corporation in another state whose only mission is to maximize shareholder profits.
We are on a mission to educate the public and employers about these issues – so that your employer can make the best decision for you, avoid these schemes, and make sure they are not mislead when making their plan design decisions.
Patients First PAC is working to expose these middlemen, support regulatory reform that rein them in, and restore power to the people who matter most: Arkansans and their chosen medical providers.
It’s time to take healthcare back – one patient, one provider, one Arkansas at a time.