|
 Researchers examined government data on out-of-pocket cost for
imaging and other essential health services for 18,429 plans
available in the U.S. private insurance marketplace last year.
Overall, 48 percent of plans required patients to pay the
co-insurance, or a percentage of the fee, for advanced imaging,
while almost 10 percent had co-pays, or flat fees, and 8 percent
required both types of out-of-pocket payments.
In addition, almost 92 percent of plans required patients to pay
co-insurance for imaging done at facilities outside of their
insurance network.
Cost-sharing has increased in recent years as insurers try to curb
unnecessary use of expensive advanced imaging like magnetic
resonance imaging (MRI), computed tomography (CT) and positron
emission tomography (PET) scans, researchers note in the Journal of
the American College of Radiology.
Including any deductibles patients had to pay out-of-pocket before
insurance benefits kicked in, people typically averaged co-payments
of $319 for advanced imaging in their insurance network and $630 for
out-of-network advanced imaging. Co-insurance fees averaged 28
percent for in-network imaging and 48 percent for studies done at
out-of-network facilities.
For no-deductible plans, patients typically footed the entire bill
for out-of-network advanced imaging, the study also found.
“This may most impact patients when obtaining imaging
out-of-network, where costs were drastically higher than when
in-network, potentially being 100 percent of examination costs which
could be thousands of dollars,” said lead study author Dr. Andrew
Rosenkrantz, a radiology professor at New York University Langone
Medical Center in New York City.
These steep bills can often take patients by surprise, Rosenkrantz
said by email.
“A patient may be referred for an imaging test by their in-network
physician within that referrer's health network, yet the radiology
group within that same network could be out-of-network,” Rosenkrantz
said. “Patients may not be aware of which physicians are or are not
contracted with the network, leading to possible very high surprise
bills for out-of-network costs.”
[to top of second column] |
And, when they’re aware of the costs, steep out-of-pocket fees may
lead some patients to delay imaging or skip it altogether,
Rosenkrantz added.
While cost-sharing isn’t limited to advanced imaging, these services
tended to have higher co-payments than other essential services like
x-rays, lab tests, medications and urgent care visits.
The study wasn’t a controlled experiment designed to prove whether
or how patients’ out-of-pocket fees for advanced imaging might
influence their decisions about whether, when or where to get these
services.
Other limitations include the lack of data on certain types of
private insurance or government options like Medicare or Medicaid,
the authors note. Researchers also lacked data on other attributes
of health plans beyond just co-pays or co-insurance that might
impact access or affordability of care.
Even so, the results suggest that patients would benefit from more
transparency in advanced imaging costs to help them make informed
decisions about treatment, Rosenkrantz said.
“No question it is important for patients to have skin in the game,
and price transparency is an increasing trend throughout the health
care industry,” Rosenkrantz said. “Ideally, price transparency will
help patients in considering cost, along with other factors, when
choosing among possible providers, without actually deterring needed
care.”
SOURCE: http://bit.ly/2pg2yfZ Journal of the American College of
Radiology, online February 22, 2018.
[© 2018 Thomson Reuters. All rights
reserved.] Copyright 2018 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
Thompson Reuters is solely responsible for this content.
 |
