Feb 20, 2024 - Health

In-network insurance claims jumped after surprise billing ban took effect

Data: FAIR Health; Chart: Axios Visuals
Data: FAIR Health; Chart: Axios Visuals

The amount of in-network care patients received across different specialties and settings jumped significantly as surprise billing protections took effect, according to a FAIR Health analysis shared first with Axios.

Why it matters: The federal No Surprises Act, which shields insured patients from large unexpected medical bills from out-of-network providers, and similar efforts may have also resulted in more providers becoming part of insurers' networks, the data suggests.

By the numbers: FAIR Health used its database of roughly 42 billion commercial insurance claims to examine in-network claims between 2019 and the third quarter of 2023, capturing the period before and after enactment of the No Surprises Act and surprise billing laws in multiple states.

  • During that period, the share of in-network care increased from about 84% of all claims to 90% of claims nationally.
  • There was a particularly steep increase of 2.3% between the fourth quarter of 2021 and the first quarter of 2022, when the federal protections took effect.

Between the lines: There was also an increase in the share of in-network care for specialties that were among the most common sources of surprise bills, such as anesthesiology, emergency medicine, pathology and radiology.

  • In-network care for these "specialties of interest" increased 4.7% to 88.2% of claims between 2019 and the third quarter of 2023.
  • Of those specialties, emergency medicine had the greatest increase (13.2%) while pathology saw the smallest increase (0.6%).
  • FAIR Health authors said they also found a narrowing gap between the in-network and out-of-network amounts allowed by payers and amounts billed by providers.
  • "We hope that these findings will also be starting points for further research on in-network and out-of-network utilization and pricing against the backdrop of federal and state surprise billing laws," FAIR Health president Robin Gelburd said in a statement.
Go deeper