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- Title
Frequency and Costs of Out-of-Network Bills for Outpatient Laboratory Services Among Privately Insured Patients.
- Authors
Sen, Aditi P.; Meiselbach, Mark K.; Wang, Yang; Eisenberg, Matthew D.; Anderson, Gerard F.
- Abstract
<bold>Importance: </bold>Patients may be unaware of which laboratory is processing their clinical tests, limiting their ability to choose an in-network laboratory. Out-of-network laboratory services could increase patients' out-of-pocket costs and their reluctance to obtain necessary tests.<bold>Objective: </bold>To evaluate the frequency and cost of out-of-network bills for outpatient laboratory services compared with other services.<bold>Design, Setting, and Participants: </bold>This retrospective cohort study of claims data from the Truven MarketScan Commercial Claims database evaluated claims from 3 946 210 individuals (30.5% of the total) in the MarketScan database who were continually enrolled in health maintenance organization plans, preferred provider organization plans, exclusive provider organization plans, or consumer-driven health plans/high-deductible health plans with at least 1 outpatient clinical laboratory service in 2018. Outpatient laboratory services occurred in independent laboratories, physician offices, and outpatient centers. Laboratory bills from January 1, 2010, to December 31, 2018, were studied.<bold>Exposures: </bold>Receipt and cost of outpatient laboratory service.<bold>Main Outcomes and Measures: </bold>The primary outcome was the proportion of outpatient laboratory services billed as out of network. The secondary outcome was the total potential out-of-pocket cost associated with the out-of-network bill, the sum of observed cost sharing, and the potential balance bill.<bold>Results: </bold>Of the 12 958 130 in the total sample, 30.5% (3 946 210) had a laboratory test, of whom 5.9% received an out-of-network laboratory test. In comparison, 7.1% of the total sample had an emergency department visit, of whom 4.9% had a service billed as out of network, and 1.6% had an inpatient anesthesiology service, of whom 3.4% had an out-of-network service. Observed out-of-pocket spending was $24.59 higher for an out-of-network laboratory service than an in-network laboratory service. In addition, patients with an out-of-network laboratory service may receive an additional balance bill from the laboratory service; the estimated mean balance bill was $80.63. For the most common laboratory services, the total potential out-of-pocket cost associated with an out-of-network bill ranged from $15.68 for venipuncture to $88.09 for lipid panel but was as high as $303.18 for a drug screening test.<bold>Conclusions and Relevance: </bold>In this cohort study, out-of-network laboratory services were 5 times more common than out-of-network emergency department visits and 34 times more common than out-of-network anesthesiology services. It is important for patients that consumer protections against out-of-network bills apply to laboratory services.
- Subjects
DATABASES; RESEARCH; OUTPATIENT medical care; RESEARCH methodology; MEDICAL care costs; RETROSPECTIVE studies; EVALUATION research; COMPARATIVE studies; HEALTH insurance; LONGITUDINAL method; ECONOMICS
- Publication
JAMA Internal Medicine, 2021, Vol 181, Issue 6, p834
- ISSN
2168-6106
- Publication type
journal article
- DOI
10.1001/jamainternmed.2021.1422