Increasing spending on privately insured patients seeking neurological diagnostic services

According to the results of the study published in Neurology, the cost of neurological diagnostic services has increased, resulting in an increasing number of high-cost patients (OOP).

University of Michigan study researchers analyzed data from 3,724,342 patients from Clinformatics Datamart, a database of patient claims from people insured with UnitedHeathcare who had a neurological outpatient visit between 2001 and 2016. for specific neurological diagnostic services.

The study population consisted of people with a mean age of 47.5 years (standard deviation ± 20.8). 57.4% were women, 68.4% were white, 36.8% were covered by point-of-service insurance, and 30.5% were covered by a health maintenance organization.

A total of 14,222,479 neurological diagnostic services were provided among these patients (assessment and management) [E/M]: n = 11,159,552; Electromyogram or nerve conduction study [EMG/NCS]: n = 1,098,986; Magnetic resonance imaging [MRI]: n = 751930; electroencephalogram [EEG]: n = 641,693; Polysomnogram [PSG]: n = 410,460; Carotid ultrasound [CUS]: n = 95.211; Computed Tomography [CT]: n = 64,647).

Over time, the average OOP cost increased. The cost increase between 2001 and 2016 was 190% for EEG, 188% for MRI, 187% for E / M, 119% for CT, 107% for EMG / NCS, 59% for CUS and 49% for PSG.

Stratified by the amount paid in 2016, the OOP cost for patients in the 95th percentile was $ 875.4 for MRI, $ 560.5 for PSG, $ 538.0 for EMG / NCS, $ 374.7 for EEG, 330 , $ 9 for CT, $ 193.4 for CUS, and $ 146.9 for E / M visits.

Between 2014 and 2016, the cumulative cost of neurological testing over a year was $ 1,419.2 for patients in the 99th percentile, $ 558.1 for the 95th percentile, and $ 126.7 for the 75th percentile. These values ​​corresponded to an increase in the average cumulative costs of 28.2%.

Patients with high deductible health insurances were at increased risk of paying OOP costs above the 90th percentile after undergoing an EMG / NCS (odds ratio) [OR]4,609; 95% CI, 4.49-4.90; P <0.05), EEG (OR, 3.90; 95% CI, 3.607-4.16; P <0.05) and MRI (OR, 1.209; 95% CI, 1.202-1.36; P < 0.05).

Because this study only focused on total service costs and OOP costs within UnitedHealthcare insurance, these results may not be transferable to other insurance companies in the United States.

The study’s authors concluded, “More and more patients are paying OOP for neurological diagnostic services. The cost sharing burden is particularly high for the growing population with [high-deductible health plans]. “As a result, a neurological assessment can lead to financial difficulties in these patients.

Disclosure: Several authors have stated that they are part of the pharmaceutical industry. For a full list of details, see the original article.


Hill CE, Reynolds EL, Burke JF et al. Increase in expenses for neurological care for privately insured patients. Neurology. 2021; 96: e322-e332. doi: 10.1212 / WNL.0000000000011278

Related Articles