Increasing Expenses for Privately Insured Patients Seeking Neurologic Diagnostic Services

Study researchers evaluated the out-of-pocket expenses for neurologic care for patients who are privately insured.

Neurologic diagnostic service costs have been rising, causing an increasing number of patients with high out-of-pocket (OOP) expenses, according to study results published in Neurology.

Study researchers from the University of Michigan analyzed data of 3,724,342 patients from Clinformatics Datamart, a database including patient claims from individuals who were insured by UnitedHeathcare and had a neurological outpatient visit between 2001 and 2016. They assessed OOP costs, including copay and deductible payments, for specific neurologic diagnostic services.

The study population comprised individuals with an average age of 47.5 (standard deviation, ±20.8) years. 57.4% were women, 68.4% were White, 36.8% were covered by point of service insurance plans, and 30.5% were covered by a health maintenance organization.

Among these patients, a total of 14,222,479 neurologic diagnostic services were provided (evaluation and management [E/M]: n=11,159,552; electromyogram or nerve conduction study [EMG/NCS]: n=1,098,986; magnetic resonance imaging [MRI]: n=751,930; electroencephalogram [EEG]: n=641,693; polysomnogram [PSG]: n=410,460; carotid ultrasound [CUS]: n=95,211; computerized tomography [CT]: n=64,647).

Over time, the mean OOP expense rose. The increase in cost 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 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 neurologic testing over a 1-year period was $1419.2 for patients in the 99th percentile, $558.1 for the 95th percentile, and $126.7 for the 75th percentile. These values represented a 28.2% increase for the mean cumulative cost.

Patients who had high-deductible health plans were at increased risk for paying OOP expenses over the 90th percentile when they underwent EMG/NCS (odds ratio [OR], 4.609; 95% CI, 4.49-4.90; P <.05), EEG (OR, 3.90; 95% CI, 3.607-4.16; P <.05), and MRI (OR, 1.209; 95% CI, 1.202-1.36; P <.05) testing.

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

The study authors concluded, “An increasing number of patients pay OOP for neurologic diagnostic services…The cost sharing burden is particularly high for the growing population with [high-deductible health plans].” Consequently, neurologic evaluation may lead to financial hardships in these patients.

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Hill CE, Reynolds EL, Burke JF, et al. Increasing Out-of-Pocket Costs for Neurologic Care for Privately Insured Patients. Neurology. 2021;96:e322-e332. doi:10.1212/WNL.0000000000011278