Out-of-network (OON) prices aren’t an isolated problem—they’re a warning signal of deeper structural dysfunction in the U.S. health care system. This report explores how opaque pricing, misaligned incentives, and hidden intermediary fees drive costs for employers and employees—and outlines market and policy strategies to fix the system at its core.

Catalyst for the report: A 2024 New York Times investigation uncovered how opaque health care billing allows intermediaries to collect millions in fees from taxpayers and employers. This report builds on that revelation, analyzing how such practices persist—and how to bring accountability and transparency to OON spending.

Key Insights

• The problem is systemic—not just a billing glitch. Policies that ban balance billing or cap OON charges can relieve immediate pain but fail to correct the incentives driving inflated costs.
• Opacity drives overspending. Self-funded employers face complex, often intentionally unclear pricing structures that obscure where health care dollars actually go.
• Intermediaries profit from complexity. Third-party administrators and network vendors embed fees in repricing activities, “shared savings” deals, and other hard-to-track arrangements— making tracking accountability nearly impossible.
• Transparency is the first step. Employers need a clear, itemized breakdown of all OON spend—including both claims data and third-party fees—to realign incentives around value.

About the Report

Addressing Out-of-Network Prices and Fees Through Market and Policy-Based Solutions analyzes how OON pricing dysfunction develops, spreads, and persists—and offers practical action steps for employers alongside policy recommendations for legislators and regulators. Drawing on market practices, contract reviews, and purchaser experiences, it highlights how shining a light on hidden fees can realign incentives, curb waste, and reward value.