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Which specialties bill out of network the most?

The prevalence of out-of-network billing varies significantly across provider specialties, according to research from the Health Care Cost Institute. 

The researchers examined the distribution of out-of-network claims among individual clinicians in 2017 in six specialties: emergency medicine, pathology, radiology, anesthesiology, behavioral health and cardiovascular services. The researchers used a sample of 13.8 million visits by more than 35,000 providers. 

The analysis revealed that more than half of providers in each specialty never billed out of network. Among providers who did bill out of network, the plurality to vast majority — depending on the specialty — did so infrequently. However, there were some providers who almost exclusively billed out of network. 

Researchers said 36 percent of pathologists billing out of network for inpatient visits and 20 percent of pathologists billing out of network for outpatient visits did so more than 90 percent of the time. In contrast, virtually no cardiologists billed out of network this often, according to the report. 

Below is the share of providers who billed out of network at least once for inpatient and outpatient visits across the six specialites researchers examined. 

Emergency medicine 
Inpatient: 44 percent of providers billed out of network 
Outpatient: 49 percent of providers billed out of network 

Pathology
Inpatient: 44 percent
Outpatient: 33 percent 

Radiology
Inpatient: 28 percent 
Outpatient: 33 percent

Anesthesiology
Inpatient: 26 percent
Outpatient: 32 percent 

Behavioral Health
Inpatient: 30 percent
Outpatient: 15 percent

Cardiovascular 
Inpatient: 18 percent
Outpatient: 17 percent

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