Recent trends in private health insurance prices and cost-sharing for hospital-based professional services

Numerous consumer protection regulations (e.g., No Surprises Act, Transparency in Coverage) have been implemented recently in the United States that could impact private health insurance prices and patient cost-sharing for many health care services. We use a large multi-payer database of health insurance claims for employer-sponsored health plans in the U.S. to describe the trajectory of prices and patient cost-sharing for the services of clinicians that are likely most affected by these regulatory changes: emergency physicians, radiologists, pathologists, and neonatologists. We find that in-network prices and patient cost-sharing generally increased for all four specialties between 2012 and 2022. However, all four specialties experienced periods of decline in out-of-network prices and cost-sharing, with different starting points, and substantial reductions in prices and cost-sharing from 2021 to 2022, particularly for self-funded health plans. Although we cannot isolate the causal impact of any law or regulation, our results suggest that out-of-network prices and cost-sharing decreased when the NSA and TIC were implemented in 2022, especially for the previously less regulated self-funded health plans. Our results imply that patients who previously struggled with the financial burdens of surprise out-of-network medical bills may have benefited significantly from the recent regulatory changes.