In a recent report by Fair Health, trends in health insurers’ maximum allowed amount for healthcare services were analyzed, revealing interesting insights, specifically for radiology. While most categories experienced increases in allowed amounts, radiology stood out as the only category to record a decrease, declining by 4 percent year-over-year.  

This 4 percent decrease to health insurers’ allowed amount for radiology services was delivered after the top claim item for private health insurance beneficiaries visiting the emergency room in 2023 was diagnostic radiology of the chest. Historically, radiology is minimally invasive and cost-effective, yet this decrease to private health insurance allowed amounts could be detrimental for patients receiving diagnostic radiology, as their out-of-pocket payment may be higher.  

Fair Health’s extensive database, representing billions of privately insured healthcare claims, serves as a valuable resource for understanding such trends.  Additionally, the convergence of in-network and out-of-network payment amounts in radiology, as observed in a previous report by Fair Health, suggests potential impacts of legislative measures like the No Surprises Act.  

By staying informed about changes in allowed amounts and payment trends, individuals can better navigate the complex healthcare landscape and advocate for fair reimbursement policies that prioritize patient care.