Only 1% of Radiologist Claims were Out of Network in 2021

Newswise — Reston, VA – 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%”, said 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 consistent decline in the OON rate likely reflects, in part, growth in effective good-faith negotiations between radiology practices and commercial payers,” said Jay Parikh, MD, lead author and Professor at the University of Texas MD Anderson Cancer Center. “The result also likely reflects declines associated with new state-level surprise billing laws and provider consolidation over the study period.”

“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,” said Dr. 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.”

“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”, said Dr. Parikh. “If so, the No Surprises Act rulemaking may be counterproductive to the law’s intent.”

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About the Harvey L. Neiman Health Policy Institute

The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at www.neimanhpi.org and follow us on Twitter, LinkedIn and Facebook.