Increasing Out-of-Pocket Costs for Neurologic Care for Privately Insured Patients.

Objective: To measure the out-of-pocket costs of evaluation and management (E/M) services and common diagnostic testing for neurology patients. Methods: Utilizing a large, privately-insured healthcare claims database, we identified patients with a neurologic visit or diagnostic test from 2001-2016 and assessed inflation-adjusted out-of-pocket costs for E/M visits, neuroimaging, and neurophysiologic testing. For each diagnostic service each year, we estimated the proportion of patients with out-of-pocket costs, the mean out-of-pocket cost, and the proportion of the total service cost paid out-of-pocket. We modeled out-of-pocket cost as a function of patient and insurance factors. Results: We identified 3,724,342 patients. The most frequent neurologic services were E/M visits (78.5%), electromyogram/nerve conduction studies (EMG/NCS) (7.7%), MRIs (5.3%), and electroencephalograms (EEGs) (4.5%). Annually, 86.5-95.2% of patients paid out-of-pocket costs for E/M visits and 23.1-69.5% for diagnostic tests. For patients paying any out-of-pocket cost, the mean out-of-pocket cost increased over time, most substantially for EEG, MRI, and E/M. Out-of-pocket costs varied considerably; for an MRI in 2016, the 50th percentile paid $103.1 and the 95th percentile paid $875.4. The proportion of total service cost paid out-of-pocket increased. High deductible health plan (HDHP) enrollment was associated with higher out-of-pocket costs for MRI, EMG/NCS, and EEG. Conclusions: An increasing number of patients pay out-of-pocket for neurologic diagnostic services. These costs are rising and vary greatly across patients and tests. The cost sharing burden is particularly high for the growing population with HDHPs. In this setting, neurologic evaluation might result in financial hardship for patients.