At least half of all patients are accountable for the costs of secondary medical imaging interpretations, with those people who cannot afford to pay the full amount and bear the brunt, reveals the latest study.
Subspecialists and experts, who did not request an original exam from patients to confirm and/or clarify complicated cases, are performing additional reads. Of late, demand for second looks increases, and payers like Medicare have more coverage for the opinions due to this.
Despite this fact, radiologists of Emory University say that the costs are falling onto the patients. At the institution, patients are given bills for services of at least 47.5% and made payments out-of-pockets for over 17%.
While the patient bill seemed small, nearing approximately $27, and payments made out-of-pocket were even smaller at $14.55, which is an issue as organizations lack transparency, according to the authors of a report published in the JACR in Atlanta.
Sean P.Doyle, Ph.D., together with this colleague at the Emory Department of Radiology and Imaging Sciences added, “In situations like this wherein no third-party payers are involved or when the reimbursement of claims are denied, expenses should be borne by patients directly.” They also added, “When patient liabilities are focused on secondary interpretations, they are a surprise for patients who have paid their initial interpretation expenses, thereby imposing upon the additional as well as unexpected financial load.”
Doyle with his co-investigators based the conclusion on over two years of insurance payments, professional charges, corresponding payments made out-of-pocket, and patient bills. Largely, they depended on approximately 7740 secondary interpretations.
Younger as well as uninsured patients further received a higher amount of bills and spent more for a second opinion. Simultaneously, Black patients and the ones holding insurance sponsored by the government also faced smaller expenses compared to the whites and commercially insured patients.
Doyle and his colleagues also noted that several radiology practices used secondary interpretations as additional sources of revenue. Mean charges for such exams were approximately $306.50, and insurance reimbursement reached $108.02.
Depending on the institutional data, payments that patients made out-of-pockets, however, did not cover the costs fully in 68% of the situations, according to the authors, which suggests that “many” individuals might face difficulties settling up.
Organizations using the secondary reads for bolstering the bottom line must bear this in their minds. However, further research should be done to investigate if payments made one time could save patients from future headaches.
The team concluded, “What is still unknown is that exactly how much downstream savings can result from improved medical decision making involving secondary interpretations and whether the upfront patient expenses might ultimately lead to overall reduced financial burdens to both patients and insurers.”
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