Privately Insured Catheter Users Incurred High Out-of-Pocket Costs

Catheter users who received health insurance coverage from private health plans incurred higher annual out-of-pocket costs compared to catheter users on a government or public health plan, according to a survey sponsored by the Spina Bifida Association.

The Christopher and Dana Reeve Foundation, the Paralyzed Veterans of America, and the United Spinal Association co-sponsored the survey.

To understand how much catheter users paid in out-of-pocket costs and whether the prices vary by health plan, Duke University researchers surveyed catheter users over 18 years and adult caregivers for children or adults who regularly use catheters.

Through an online survey, the researchers collected data from just over 2,500 individuals between January 19, 2021, and February 15, 2021. The individuals represented the communities of the four nonprofit sponsors.

Most of the survey respondents (71 percent) were adults who used catheters regularly. The remaining participants were parents, spouses, or caregivers of someone who used a catheter.

A quarter of respondents received commercial or private health plan coverage, while 36 percent were on a government or public health plan. Ten percent of respondents received coverage from a VA or military plan, and 25 percent had multiple plans.

Blue Cross Blue Shield (BCBS) plans were the most common among privately insured participants, with 45 percent of individuals receiving coverage from the payer. UnitedHealthcare (13 percent), Aetna (10 percent), and Cigna (seven percent) followed.

The survey found that a handful of catheter users on private health plans received limited coverage for catheter costs. While eight percent of catheter users on public plans responded that their plan did not cover any catheter costs, that percentage rose to 17 for individuals on private health plans.

Further, 42 percent of catheter users on a UnitedHealthcare plan reported that the payer did not cover any of their costs for the catheters they used most often.

As a result of private plans providing less coverage than public plans, catheter users on private plans incurred higher out-of-pocket costs.

Nearly 80 percent of privately insured respondents had to pay out of pocket for catheters and catheter supplies. Most UnitedHealthcare members (88 percent), 79 percent of BCBS members, and 75 percent of Aetna members incurred out-of-pocket costs.

Conversely, only 53 percent of individuals on public health plans had to pay out-of-pocket costs for catheters and catheter supplies, the survey found.

For catheter users who had to pay anything out-of-pocket for catheters and catheter supplies, the annual cost was $1,464. Among all catheter users, the average annual out-of-pocket cost was $789.

However, the average annual out-of-pocket cost varied depending on the health plan. For example, catheter users with a private plan incurred an average of $1,621 each year in out-of-pocket expenses. UnitedHealthcare members faced the highest average out-of-pocket costs at $2,188 per year.

Catheter users on Aetna and BCBS plans paid $1,385 and $1,670 annually in out-of-pocket costs.

Catheter users on a public plan incurred the lowest annual out-of-pocket costs at an average of $531.

While the majority of survey respondents said they did not try to appeal their insurance costs, nearly 10 percent of respondents did file an appeal with their health plan. Around two-thirds of those individuals said their claim was entirely or partially approved.

Overall, the survey participants were not satisfied with the coverage they received from their health plans for catheters and catheter supplies. In response to additional comments about health plans and catheters, 72 percent of participants provided negative remarks.

Nearly half of the negative comments were about the cost of catheters and the lack of health insurance coverage. One in five comments were about paying out-of-pocket for catheters and dissatisfaction with not receiving coverage for preferred catheter types.

Past data has revealed other instances where public health plans have offered better coverage for healthcare services compared to private plans.

For example, a recent study found that pregnant people experienced high out-of-pocket healthcare spending, but privately insured individuals spent significantly more than people with public health plans.