Patients face high out-of-pocket fees for imaging

(Reuters Health) - Patients with private health insurance often face high out-of-pocket fees for advanced imaging, a U.S. study suggests.

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.”

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: Journal of the American College of Radiology, online February 22, 2018.