A new study published in the Journal of the American College of Radiology suggests that “patients with private health insurance often face high out-of-pocket fees for advanced imaging.” The findings of the study were discovered after 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.” Why are patients with private insurance allegedly paying more, though? How much more are they paying than other patients?According to the study, patients with private insurance typically had co-payments of around $319 “for advanced imaging in their insurance network and $630 for out-of-network advanced imaging.” It should be noted that this is the figure the study found after patients had paid for any deductibles “before insurance benefits kicked in.” The study also concluded that “co-insurance fees averaged 28 percent for in-network imaging and 48 percent for studies done at out-of-network facilities.”Many private insurance plans these days require “patients to pay co-insurance,” but what is that? Well, for those who don't know, co-insurance as a percentage of the fee hospitals charge for advanced imaging services. It turns out that, according to the plans examined in the study, 48% of them “required patients to pay the co-insurance.” Additionally, “almost 92 percent of plans required patients to pay co-insurance for imaging done at facilities outside of their insurance network.” Patients who had no-deductible plans often paid for the entire cost of advanced imaging services from out-of-network providers.

Doctor Looking at an X-Ray; image courtesy of rawpixel.com via Unsplash, https://unsplash.com

This cost-sharing hasn't always been so high for patients, though. In fact, it's a recent development that 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.”When commenting on the findings of the study, Dr. Andrew Rosenkrantz, the lead study author and radiology professor at New York University Langone Medical Center in New York City, said:“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.”He added that oftentimes these high bills take unsuspecting patients by surprise, and said:“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...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.”Even when patients are aware of the high costs associated with the imaging services, high fees often prompt some patients to skip or delay a procedure, and that's not a good position to be in. So what needs to be done? How can the process improve for patients?For starters, the study concluded by calling for “more transparency in advanced imaging costs to help patients make informed decisions about treatment.” Rosenkrantz added:“No question it is important for patients to have skin in the game, and price transparency is an increasing trend throughout the healthcare industry. Ideally, price transparency will help patients in considering cost, along with other factors, when choosing among possible providers, without actually deterring needed care.”

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Patients face high out-of-pocket fees for imagingWhen high deductibles cause even insured patients to postpone care