Out-of-Pocket Costs for Advanced Imaging Across the US Private Insurance Marketplace.
Purpose: The aim of this study was to characterize out-of-pocket patient costs for advanced imaging across the US private insurance marketplace.Methods: Using the 2017 CMS Health Insurance Marketplace Benefits and Cost Sharing Public Use File, which details coverage policies for qualified health pla...
| Publicado en: | Journal of the American College of Radiology Vol. 15; no. 4; pp. 607 - 608 |
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| Autores principales: | , , , , , , |
| Formato: | Journal Article |
| Publicado: |
Elsevier B.V.
Apr2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128649483&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 128649483 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15461440 EAO jtl: Journal of the American College of Radiology issn: 15461440 maglogo: N pubinfo: dt: Apr2018 vid: 15 iid: 4 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 128649483 128649483 NLM29477290 10.1016/j.jacr.2017.12.010 NLM29477290 128649483 ppf: 607 ppct: 1 formats: tig: atl: Out-of-Pocket Costs for Advanced Imaging Across the US Private Insurance Marketplace. aug: au: Rosenkrantz, Andrew B. Sadigh, Gelareh Carlos, Ruth C. IIISilva, Ezequiel Jr.Duszak, Richard Silva, Ezequiel 3rd Duszak, Richard Jr. affil: Department of Radiology, NYU Langone Medical Center, New York, New York sug: subj: Diagnostic Imaging Economics Health Care Costs Statistics and Numerical Data Insurance, Health Economics Health Insurance Exchanges Economics Fees and Charges Statistics and Numerical Data United States Insurance Economics Family Inventory of Life Events and Changes ab: Purpose: The aim of this study was to characterize out-of-pocket patient costs for advanced imaging across the US private insurance marketplace.Methods: Using the 2017 CMS Health Insurance Marketplace Benefits and Cost Sharing Public Use File, which details coverage policies for qualified health plans on federally facilitated marketplaces, measures of out-of-pocket costs for advanced imaging and other essential health benefits were analyzed for all 18,429 plans.Results: Independent of deductibles, 48.0% of plans required coinsurance (percentage fees) for advanced imaging, 9.7% required copayments (flat fees), and 8.0% required both; 34.3% required neither. For out-of-network services, 91.5% required coinsurance, 0.1% copayments, and 1.0% both; only 7.4% required neither. In the presence of deductibles, patient coinsurance burdens for advanced imaging in and out of network were 27.7% and 47.7%, respectively, and average in- and out-of-network copayments were $319 and $630, respectively. In the presence of deductibles, patients' average coinsurance ranged from 10.0% to 40.9% in network and from 29.1% to 75.0% out of network by state; these tended to be higher in lower income states (r = -0.332). For no-deductible policies, patients' average out-of-network coinsurance burden for advanced imaging was 99.9%. Among assessed benefits, advanced imaging had the highest in-network and second highest out-of-network copayments.Conclusions: In the US private insurance marketplace, patients very commonly pay coinsurance when undergoing advanced imaging, both in and out of network. But out-of-network services usually involve drastically higher patient financial responsibilities (potentially 100% of examination cost). To more effectively engage patients in shared decision making and mitigate the hardships of surprise balance billing, radiologists should facilitate transparent communication of advanced imaging costs with patients. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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