School of Medicine and Health Sciences Poster Presentations

Title

Insurance Coverage of Patch Testing: A Retrospective Review in a University Dermatology Clinic

Poster Number

193

Document Type

Poster

Status

Dermatology Research Fellow

Abstract Category

Clinical Specialties

Keywords

skin allergy, contact dermatitis, patch test, insurance coverage

Publication Date

Spring 2018

Abstract

Background: Patch testing is considered both cost effective and beneficial to quality of life in patients with allergic contact dermatitis (ACD). Furthermore, increased number of allergens tested has been shown to correlate with increased relevant test results. However, health insurance providers and plans have differing allergen testing limits and guidelines for coverage. A more robust understanding of how patch testing contributes to patient financial burden is needed.

Objective: To determine differences in insurance coverage and out-of-pocket (OOP) patient costs of patch testing.

Methods: A retrospective chart review of patients at the George Washington University Dermatology Clinic receiving patch testing between January 1, 2015 and June 30, 2017 was performed. Data regarding patient demographics, testing plans, testing regimens, and calculated OOP costs were collected. Means of continuous variables were compared using Student’s T-test and proportions of categorical variables were compared using Fisher’s Exact Test.

Results: Of the 414 charts reviewed, 367 met inclusion and exclusion criteria. Of the 367 patients, 316 had private insurance, including CareFirst® (N=162), United Healthcare® (UHC) (N=49), Aetna® (N=39), and Cigna® (N=38), while 51 patients were insured by Medicare. Patients with private coverage were 45.7 years old on average, compared to a mean age of 70.5 for Medicare patients. Medicare patients paid $180.06 in OOP costs on average, which was significantly less than CareFirst® patients ($396.58, p<0.01) and all privately-insured patients combined ($403.70, p<0.01). No significant differences in average OOP costs between patients of different individual private insurers were found. About 65% of UHC patients encountered allergen limits, in comparison to about 21% of Aetna® patients (p<0.0001), 1.2% of CareFirst® patients (p<0.0001), and 0% of Cigna® patients (p<0.0001). The highest percentages of patients encountering treatment changes due to private insurance coverage were found in Aetna® (about 15%) and UHC (about 14%) patients, which contrasted 0% of both CareFirst® and Cigna® patients.

Limitations: This study did not control for differences in insurance coverage due to age or patient preference for paying OOP costs.

Conclusion: Allergen limitations imposed by insurance coverage are associated with altered treatment plans in patients undergoing patch testing. Further studies are warranted to delineate whether the cause of differences in OOP costs between privately and publically insured patients are due to confounding age-based differences in healthcare expenses and/or preferences.

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Insurance Coverage of Patch Testing: A Retrospective Review in a University Dermatology Clinic

Background: Patch testing is considered both cost effective and beneficial to quality of life in patients with allergic contact dermatitis (ACD). Furthermore, increased number of allergens tested has been shown to correlate with increased relevant test results. However, health insurance providers and plans have differing allergen testing limits and guidelines for coverage. A more robust understanding of how patch testing contributes to patient financial burden is needed.

Objective: To determine differences in insurance coverage and out-of-pocket (OOP) patient costs of patch testing.

Methods: A retrospective chart review of patients at the George Washington University Dermatology Clinic receiving patch testing between January 1, 2015 and June 30, 2017 was performed. Data regarding patient demographics, testing plans, testing regimens, and calculated OOP costs were collected. Means of continuous variables were compared using Student’s T-test and proportions of categorical variables were compared using Fisher’s Exact Test.

Results: Of the 414 charts reviewed, 367 met inclusion and exclusion criteria. Of the 367 patients, 316 had private insurance, including CareFirst® (N=162), United Healthcare® (UHC) (N=49), Aetna® (N=39), and Cigna® (N=38), while 51 patients were insured by Medicare. Patients with private coverage were 45.7 years old on average, compared to a mean age of 70.5 for Medicare patients. Medicare patients paid $180.06 in OOP costs on average, which was significantly less than CareFirst® patients ($396.58, p<0.01) and all privately-insured patients combined ($403.70, p<0.01). No significant differences in average OOP costs between patients of different individual private insurers were found. About 65% of UHC patients encountered allergen limits, in comparison to about 21% of Aetna® patients (p<0.0001), 1.2% of CareFirst® patients (p<0.0001), and 0% of Cigna® patients (p<0.0001). The highest percentages of patients encountering treatment changes due to private insurance coverage were found in Aetna® (about 15%) and UHC (about 14%) patients, which contrasted 0% of both CareFirst® and Cigna® patients.

Limitations: This study did not control for differences in insurance coverage due to age or patient preference for paying OOP costs.

Conclusion: Allergen limitations imposed by insurance coverage are associated with altered treatment plans in patients undergoing patch testing. Further studies are warranted to delineate whether the cause of differences in OOP costs between privately and publically insured patients are due to confounding age-based differences in healthcare expenses and/or preferences.