The Effect of Monthly Cost‐Sharing Limits on Out‐of‐Pocket Costs for Privately Insured Patients

2021 ◽  
Vol 56 (S2) ◽  
pp. 23-23
Author(s):  
Paul Shafer ◽  
Michal Horný ◽  
Stacie Dusetzina
Keyword(s):  
Cost Sharing ◽  
Monthly Cost ◽  
Insured Patients ◽  
Out Of Pocket Costs ◽  
Privately Insured

scholarly journals Increasing Out-of-Pocket Costs for Neurologic Care for Privately-Insured Patients

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011278
Author(s):  
Chloe E. Hill ◽  
Evan L. Reynolds ◽  
James F. Burke ◽  
Mousumi Banerjee ◽  
Kevin A. Kerber ◽  
...  
Keyword(s):  
Cost Sharing ◽  
Diagnostic Testing ◽  
Service Cost ◽  
Number Of Patients ◽  
The Mean ◽  
Insured Patients ◽  
High Deductible Health Plan ◽  
The Cost ◽  
Out Of Pocket Costs ◽  
Privately Insured

Objective:To measure the out-of-pocket costs of evaluation and management (E/M) services and common diagnostic testing for neurology patients.Methods:Utilizing a large, privately-insured healthcare claims database, we identified patients with a neurologic visit or diagnostic test from 2001-2016 and assessed inflation-adjusted out-of-pocket costs for E/M visits, neuroimaging, and neurophysiologic testing. For each diagnostic service each year, we estimated the proportion of patients with out-of-pocket costs, the mean out-of-pocket cost, and the proportion of the total service cost paid out-of-pocket. We modeled out-of-pocket cost as a function of patient and insurance factors.Results:We identified 3,724,342 patients. The most frequent neurologic services were E/M visits (78.5%), electromyogram/nerve conduction studies (EMG/NCS) (7.7%), MRIs (5.3%), and electroencephalograms (EEGs) (4.5%). Annually, 86.5-95.2% of patients paid out-of-pocket costs for E/M visits and 23.1-69.5% for diagnostic tests. For patients paying any out-of-pocket cost, the mean out-of-pocket cost increased over time, most substantially for EEG, MRI, and E/M. Out-of-pocket costs varied considerably; for an MRI in 2016, the 50th percentile paid $103.1 and the 95th percentile paid $875.4. The proportion of total service cost paid out-of-pocket increased. High deductible health plan (HDHP) enrollment was associated with higher out-of-pocket costs for MRI, EMG/NCS, and EEG.Conclusions:An increasing number of patients pay out-of-pocket for neurologic diagnostic services. These costs are rising and vary greatly across patients and tests. The cost sharing burden is particularly high for the growing population with HDHPs. In this setting, neurologic evaluation might result in financial hardship for patients.

scholarly journals Out-of-Pocket Spending for COVID-19 Hospitalizations in 2020

2021 ◽  
Author(s):  
Kao-Ping Chua ◽  
Rena M Conti ◽  
Nora V Becker
Keyword(s):  
Cost Sharing ◽  
Financial Burden ◽  
Ancillary Services ◽  
Medicare Advantage ◽  
Cross Sectional ◽  
Outcomes Measures ◽  
Ambulance Transport ◽  
Insured Patients ◽  
Sectional Analysis ◽  
Privately Insured

IMPORTANCE: Many insurers waived cost-sharing for COVID-19 hospitalizations during 2020. Nonetheless, patients may have been billed if their plans did not implement waivers or if waivers did not capture all hospitalization-related care, including clinician services. Assessing out-of-pocket spending for COVID-19 hospitalizations in 2020 could demonstrate the financial burden patients may face if insurers allow waivers to expire, as many chose to do during early 2021. OBJECTIVE: To estimate out-of-pocket spending for COVID-19 hospitalizations in 2020 DESIGN: Cross-sectional analysis SETTING: IQVIA PharMetrics Plus for Academics Database, a national claims database PARTICIPANTS: COVID-19 hospitalizations for privately insured and Medicare Advantage patients during March-September 2020 MAIN OUTCOMES/MEASURES: Mean total out-of-pocket spending, defined as the sum of out-of-pocket spending for facility services billed by hospitals (e.g., accommodation charges) and for professional/ancillary services billed by clinicians and ancillary providers (e.g., clinician inpatient evaluation and management, ambulance transport) RESULTS: Analyses included 4,075 hospitalizations. Of the 1,377 hospitalizations for privately insured patients and the 2,698 hospitalizations for Medicare Advantage patients, 981 (71.2%) and 1,324 (49.1%) had out-of-pocket spending for facility services, professional/ancillary services, or both. Among these hospitalizations, mean (SD) total out-of-pocket spending was $788 (1,411) and $277 (363). In contrast, 63 (4.6%) and 36 (1.3%) hospitalizations had out-of-pocket spending for facility services. Among these hospitalizations, mean total out-of-pocket spending was $3,840 (3,186) and $1,536 (1,402). Total out-of-pocket spending exceeded $4,000 for 2.5% of privately insured hospitalizations, compared with 0.2% of Medicare Advantage hospitalizations. CONCLUSIONS: Few COVID-19 hospitalizations in this study had out-of-pocket spending for facility services, suggesting most were covered by insurers with cost-sharing waivers. However, many hospitalizations had out-of-pocket spending for professional/ancillary services. Overall, 7 in 10 privately insured hospitalizations and half of Medicare Advantage hospitalizations had any out-of-pocket spending. Findings suggest insurer cost-sharing waivers may not cover all hospitalization-related care. Moreover, high cost-sharing for some hospitalizations suggests out-of-pocket burden could be substantial if waivers expire, particularly for privately insured patients. Rather than rely on voluntary insurer actions to mitigate this burden, federal policymakers should consider mandating insurers to waive cost-sharing for all COVID-19 hospitalization-related care throughout the pandemic.

Out-of-pocket Costs for Commercially-insured Patients in the Years Following Bariatric Surgery

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Grace F. Chao ◽  
Jie Yang ◽  
Jyothi R. Thumma ◽  
Karan R. Chhabra ◽  
David E. Arterburn ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Insured Patients ◽  
Out Of Pocket Costs

scholarly journals Nonoperative Management of Uncomplicated Appendicitis Among Privately Insured Patients

JAMA Surgery ◽  
2019 ◽  
Vol 154 (2) ◽  
pp. 141 ◽  
Author(s):  
Lindsay A. Sceats ◽  
Amber W. Trickey ◽  
Arden M. Morris ◽  
Cindy Kin ◽  
Kristan L. Staudenmayer
Keyword(s):  
Nonoperative Management ◽  
Uncomplicated Appendicitis ◽  
Insured Patients ◽  
Privately Insured

Pediatric emergency medical services in privately insured patients: A 10-year national claims analysis

2019 ◽  
Vol 37 (8) ◽  
pp. 1409-1415
Author(s):  
Lucas Oliveira J. e Silva ◽  
Jana L. Anderson ◽  
M Fernanda Bellolio ◽  
Ronna L. Campbell ◽  
Lucas A. Myers ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Pediatric Emergency ◽  
Medical Services ◽  
Claims Analysis ◽  
Emergency Medical ◽  
Insured Patients ◽  
Privately Insured

scholarly journals Increasing Trends in the Use of Hospital Observation Services for Older Medicare Advantage and Privately Insured Patients

2017 ◽  
Vol 76 (2) ◽  
pp. 229-239 ◽  
Author(s):  
Keith D. Lind ◽  
Claire M. Noel-Miller ◽  
Lindsey R. Sangaralingham ◽  
Nilay D. Shah ◽  
Erik P. Hess ◽  
...  
Keyword(s):  
Data Warehouse ◽  
Older Patients ◽  
Claims Data ◽  
Veterans Affairs ◽  
Inpatient Stay ◽  
Medicare Advantage ◽  
Younger Patients ◽  
Insured Patients ◽  
Increasing Trends ◽  
Privately Insured

Policy and financial pressures have driven up use of observation stays for patients in traditional Medicare and the Veterans’ Affairs Healthcare System. Using claims data (2004-2014) from OptumLabs™ Data Warehouse, we examined whether people in private Medicare Advantage (MA) and commercial plans experienced similar changes. We found that use of observation increased rapidly for patients in MA plans—even though MA plans were not subject to the same pressures as government-run programs. In contrast, use of observation remained constant for people in commercial plans—except for enrollees 65 and older, for whom it increased somewhat. Privately insured patients returning to the hospital after an inpatient stay were increasingly likely to be placed under observation. Our results suggest that observation is rapidly replacing inpatient admissions and readmissions for many older patients in MA and commercial plans, while younger patients continue to be admitted as inpatients at relatively constant rates.

scholarly journals Public versus Private Drug Insurance and Outcomes of Patients Requiring Biologic Therapies for Inflammatory Bowel Disease

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Amir Rumman ◽  
Roberto Candia ◽  
Justina J. Sam ◽  
Kenneth Croitoru ◽  
Mark S. Silverberg ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Emergency Department Visits ◽  
Drug Coverage ◽  
Timely Access ◽  
Inflammatory Bowel ◽  
Ed Visits ◽  
Insured Patients ◽  
Public Drug ◽  
Privately Insured

Background. Antitumor necrosis factor (anti-TNF) therapy is a highly effective but costly treatment for inflammatory bowel disease (IBD).Methods. We conducted a retrospective cohort study of IBD patients who were prescribed anti-TNF therapy (2007–2014) in Ontario. We assessed if the insurance type was a predictor of timely access to anti-TNF therapy and nonroutine health utilization (emergency department visits and hospitalizations).Results. There were 268 patients with IBD who were prescribed anti-TNF therapy. Public drug coverage was associated with longer median wait times to first dose than private one (56 versus 35 days,P=0.002). After adjusting for confounders, publicly insured patients were less likely to receive timely access to anti-TNF therapy compared with those privately insured (adjusted hazard ratio, 0.66; 95% CI: 0.45–0.95). After adjustment for demographic and clinical characteristics, publicly funded subjects were more than 2-fold more likely to require hospitalization (incidence rate ratio [IRR], 2.30; 95% CI: 1.19–4.43) and ED visits (IRR 2.42; 95% CI: 1.44–4.08) related to IBD.Conclusions. IBD patients in Ontario with public drug coverage experienced greater delays in access to anti-TNF therapy than privately insured patients and have a higher rate of hospitalizations and ED visits related to IBD.

scholarly journals Patient out-of-pocket spending in cranial neurosurgery: single-institution analysis of 6569 consecutive cases and literature review

2018 ◽  
Vol 44 (5) ◽  
pp. E6 ◽  
Author(s):  
Seungwon Yoon ◽  
Michael A. Mooney ◽  
Michael A. Bohl ◽  
John P. Sheehy ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cost Sharing ◽  
Financial Burden ◽  
Vascular Lesions ◽  
Annual Growth Rate ◽  
Model Case ◽  
Patient Cost ◽  
Neurosurgical Patients ◽  
The Mean ◽  
Insured Patients

OBJECTIVEWith drastic changes to the health insurance market, patient cost sharing has significantly increased in recent years. However, the patient financial burden, or out-of-pocket (OOP) costs, for surgical procedures is poorly understood. The goal of this study was to analyze patient OOP spending in cranial neurosurgery and identify drivers of OOP spending growth.METHODSFor 6569 consecutive patients who underwent cranial neurosurgery from 2013 to 2016 at the authors’ institution, the authors created univariate and multivariate mixed-effects models to investigate the effect of patient demographic and clinical factors on patient OOP spending. The authors examined OOP payments stratified into 10 subsets of case categories and created a generalized linear model to study the growth of OOP spending over time.RESULTSIn the multivariate model, case categories (craniotomy for pain, tumor, and vascular lesions), commercial insurance, and out-of-network plans were significant predictors of higher OOP payments for patients (all p < 0.05). Patient spending varied substantially across procedure types, with patients undergoing craniotomy for pain ($1151 ± $209) having the highest mean OOP payments. On average, commercially insured patients spent nearly twice as much in OOP payments as the overall population. From 2013 to 2016, the mean patient OOP spending increased 17%, from $598 to $698 per patient encounter. Commercially insured patients experienced more significant growth in OOP spending, with a cumulative rate of growth of 42% ($991 in 2013 to $1403 in 2016).CONCLUSIONSEven after controlling for inflation, case-mix differences, and partial fiscal periods, OOP spending for cranial neurosurgery patients significantly increased from 2013 to 2016. The mean OOP spending for commercially insured neurosurgical patients exceeded $1400 in 2016, with an average annual growth rate of 13%. As patient cost sharing in health insurance plans becomes more prevalent, patients and providers must consider the potential financial burden for patients receiving specialized neurosurgical care.

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