In-Network and Out-of-Network Utilization and Pricing
In-Network and Out-of-Network Utilization and Pricing
28 PagesFederal and state efforts to address surprise billing, particularly through the No Surprises Act (NSA) effective January 2022, have impacted healthcare trends. A FAIR Health study analyzed private healthcare claim records from 2019 to 2023, focusing on specialties linked to surprise bills: anesthesia, emergency medicine, pathology, and radiology. Key findings include a 7% national increase in in-network care from Q1 2019 to Q3 2023. The NSA’s implementation in 2022 saw a sharp rise in in-network care across all specialties. However, the gap between allowed and billed amounts widened, with allowed amounts decreasing by 14.3% for in-network services during the study period.
