For Uninsured Cancer Patients Outpatient Charges Can Be Costly Putting Treatments Out Of Reach
Author: Stacie B. Dusetzina, Ethan Basch, Nancy L. Keating
Reimbursement information for public and private payers has long been available. However, information about charges—the amounts that providers request before payments are negotiated—has been scarce, particularly for outpatient care. Using the new Medicare Provider Utilization and Payment Data Public Use File and other sources, we evaluated physician charges, reimbursements by Medicare and large private health plans, and expected patient cost sharing for outpatient oncology care. In 2012 the average Medicare reimbursement for chemotherapy was 39.6 percent of charges; for private insurance, the share was 55.7 percent. Uninsured patients faced potential prices for chemotherapy that were 2–43 times as much as the total Medicare-allowed amount and 2–5 times as much as the private insurance–allowed amount. Charges for outpatient chemotherapy and office visits were substantially higher than insurer-reimbursed amounts, which is consistent with previous evidence about hospital charges. The charges for outpatient services underscore the pressure that the current system places on the people who are least able to pay. Encouraging rational pricing for health care services will be an important step toward ensuring access to care for everyone.