A new Harvey L. Neiman Health Policy Institute study found that, by 2021, only 1.1% of radiologists’ commercial claims were out of network (OON), down from 12.6% in 2007. As such, by 2021, radiologists practiced almost exclusively in-network. This Journal of the American College of Radiology study was based on 80 million commercial radiology claims (2007-2021) for individuals covered by a large commercial payer.

“The overall radiology OON rate decreased from one in eight claims in 2007 to only one in ninety claims. There were similar declines for claims associated with inpatient stays—10.2% to 1.4%—and for claims associated with ED visits—3.9% to 0.4%”, says Eric Christensen, PhD, research director at the Neiman Health Policy Institute. “Both the share of OON claims and the downward trend from 2007 to 2021 were similar across all imaging modalities, indicating broader in-network access for all radiology services.”

“The financial impact of surprise billing, also called balance billing, for patients has led to various state laws and the federal No Surprises Act that aim to protect patients financially when they unknowingly receive OON care. Radiology is one of the specialties of focus for surprise billing patient protections,” adds Christensen. “The results of this study show that by 2021, before the No Surprises Act went into effect, radiologists were already working almost exclusively in network.”

Jay Parikh, MD, lead author and professor at the University of Texas MD Anderson Cancer Center in Houston, also spoke about the issue, commenting: “The No Surprises Act went into effect in 2022, after our study period.”

“To the degree that the No Surprises Act rulemaking decreases the incentive for insurers to maintain their provider networks because patients are only required to pay the in-network rate, which, in turn, increases the bargaining power of insurers, we may see the radiology OON share increase in 2022 and beyond. If so, the No Surprises Act rulemaking may be counterproductive to the law’s intent,” Parikh adds.