Patients without insurance could be asked to pay twice as much or more than insurers pay for chemotherapy, according to a study published in he April issue of Health Affairs.
Charges for health services-the amounts providers request before payments are negotiated-have not been widely known for services delivered in physicians’ offices. Charges can be considered the maximum amount that would be paid by a person without insurance who does not or is unable to negotiate for a lower price.
DusetzinaIn the study, lead researcher Stacie Dusetzina, an assistant professor at the University of North Carolina at Chapel Hill's Gillings School of Global Public Health, and colleagues used recently released data from the Medicare Provider Utilization and Payment Public Use File and other sources to measure what physicians charged for chemotherapy drugs delivered intravenously in 2012 and the amounts reimbursed by Medicare and private health plans for the same services.
Dusetzina and her colleagues found that uninsured cancer patients may be asked to pay from 2 to 43 times what Medicare pays for chemotherapy drugs, according to Dusetzina.
“Medicare and insurers don’t pay the sticker price of healthcare,” she said. “They pay a discounted rate. However, uninsured patients don’t have the bargaining power, or they may not try to negotiate for a better price.”
On average, Medicare paid approximately 40% of the charged amounts for chemotherapy drugs. Private insurers paid nearly 57% of the charged amounts on average.
The researchers also looked at what cancer patients were asked to pay for an office visit. Uninsured patients may be asked to pay from $129 to $391, depending on the complexity of the visit. Medicare paid between $65 and $188 and private insurance paid between $78 and $246 for the same visits.
“Although our study does not measure hospital-specific charges, other studies have found similar differences between charges and reimbursed amounts in the hospital setting,” Dusetzina said. “Providing greater transparency into pricing practices, including how charges are set, may help to reduce variation across providers and ensure that uninsured individuals are not asked to pay an unreasonable difference from large payers’ negotiated rates.”
There is a lot of variation in charges across physicians and the prices paid for health services delivered in physicians’ offices, according to Dusetzina.
“Uninsured patients who do not negotiate may ultimately pay more than insurers pay for those same services,” she said. “More work is needed to determine whether uninsured patients are able to receive needed health services and how much patients ultimately paid for services they did receive. Increasing transparency in health service pricing may also help consumers to understand what payments are expected from them for services delivered,” she said.