Private Health Insurance: Provider Participation and Payments for Selected Services Before and After the No Surprises Act

Why It Matters

The findings suggest the No Surprises Act modestly improved network participation but did not alter existing payment trajectories, signaling limited financial impact for insurers and providers.

Key Takeaways

• In‑network claims rose for three of four specialties
• Emergency medicine facility claims increased post‑act
• Physician emergency payments fell despite higher facility rates
• Payment trends largely continued pre‑act trajectories
• GAO used 2019‑2023 claims and stakeholder interviews

Pulse Analysis

The No Surprises Act was enacted to curb balance‑billing practices that left patients with unexpected out‑of‑pocket costs, especially after emergency care. By prohibiting surprise bills for privately insured individuals in specific scenarios, the law aimed to tighten the relationship between insurers and out‑of‑network providers. GAO’s recent report leverages a five‑year claims dataset and stakeholder interviews to assess whether the legislation reshaped provider networks and payment dynamics across high‑impact specialties such as emergency medicine, radiology, anesthesiology and air‑ambulance services.

Analysis of the in‑network claim percentages reveals a nuanced picture. While three of the four examined specialties showed higher in‑network claim shares after the act’s rollout, the most notable shift occurred in emergency‑medicine facility claims, which rebounded from a pre‑act decline. This uptick hints that hospitals may have adjusted contracts to avoid balance‑billing penalties, yet the overall magnitude suggests providers are still cautious about network commitments. Radiology and anesthesiology displayed similar, albeit smaller, improvements, whereas air‑ambulance services showed mixed results, reflecting the unique logistical and reimbursement challenges of that sector.

Payment trends, however, largely mirrored pre‑act trajectories. Inflation‑adjusted rates for in‑network emergency‑medicine facilities continued to climb in 2022‑23, while physician‑billed emergency services experienced a persistent decline. These patterns indicate that the act’s consumer‑focused protections did not fundamentally disrupt existing pricing structures. For insurers, the modest network gains may reduce surprise‑bill exposure, but the unchanged payment trends suggest limited cost‑containment benefits. Policymakers and industry leaders will likely monitor these dynamics as they consider further refinements to balance‑billing regulations and network adequacy standards.