Abstract
BACKGROUND: Health insurance reimbursement has been changing continuously with patients being increasingly responsible for their healthcare costs. Lack of transparency for patients and providers with limited understanding of out-of-pocket expenses may produce a financial burden for patients. Increased out-of-pocket expenses may delay access to care and treatment. The present study sought to evaluate nationwide insurance coverage type and out-of-pocket expenses for patients undergoing primary rhinoplasty.
METHODS: The Truven MarketScan Database was analyzed to identify patients who underwent primary rhinoplasty (CPT 30400, 30410 and 30420) in 2021. Total and out-of-pocket expenses paid for the surgery including deductible, co-payment, and coinsurance were assessed. Furthermore, analyses were performed to evaluate cost variation between the regions. To compare these characteristics t-test was applied, and all values were reported as mean (standard deviation).
RESULTS: In total, 1491 patients were identified in the year 2021. The majority of patients were female (n = 844, 56%), 18-34 years old (n = 739, 50%), and were residing in South region (n = 521, 35%). Most patients were insured either through preferred provider organization plan (PPO) (n = 710, 48%), health maintenance organization (HMO) (n = 225, 15%) or high deductible health plan (HDHP) (n = 205, 14%). Out-of-pocket cost did not vary by region (p = 0.741) but varied by insurance plan type (p < 0.001) with HMO plan type being lowest and HDHP highest (mean $234 ($653) vs $936 ($1125)). For total cost expenses there was statistical significance for both region (p < 0.001) and insurance plan type (p = 0.011). The highest cost was in North Central region ($6194 ($5281)) and exclusive provider organization (EPO) coverage ($6377 ($7685)).
CONCLUSION: When compared to other plans where patients may be subjected to the effects of gatekeeping and have limited access to care, majority of patients in the present study had a PPO plan and were freely able to obtain treatment from preferred or out-of-network providers. Given the difference in expenses for out-of-pocket costs between insurance plans, healthcare systems and providers should be more transparent in sharing cost information. To minimize the financial burden placed on patients, providers and policymakers should be aware of the impact of out-of-pocket expenses for patients requiring surgery.
LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .