U.S. hospitals charge facility fees for colonoscopy procedures covered by private health insurance that are on average approximately 55 percent higher than facility fees billed by smaller clinics known as ambulatory surgical centers, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.
The findings appear in a peer-reviewed research letter to be published online December 15 in JAMA Health Forum.
Under a Transparency in Coverage requirement that went into effect in July 2022, insurers must publish their in-network rates for covered items and services. The analysis, one of the first to use Transparency in Coverage data, found that hospitals billed an average of $1,530 in facility fees for colonoscopies, $1,760 for colonoscopies with biopsy, and $1,761 for colonoscopies with removal of polyps, compared to $989, $1,034, and $1,030 in facility fees at ambulatory surgical centers.
The researchers determined that colonoscopy facility fees were, respectively, 54, 56, and 61 percent higher for hospitals than ambulatory surgical centers located in the same county and contracting with the same insurer. (The study did not analyze facility fees charged under Medicaid and Medicare insurance.)
In their study, the researchers analyzed Transparency in Coverage data for 13,287 colonoscopy facility fees charged by 3,582 hospitals and 17,052 ambulatory surgical centers in 50 states and Washington, D.C., as of May 2023. The data came from four major private health insurers: Cigna, Anthem, Healthcare Service Corp., and UnitedHealthcare, and covered three types of colonoscopy procedures: colonoscopy, colonoscopy with biopsy, and colonoscopy with removal of polyps.
Johns Hopkins Bloomberg School of Public Health release on Newswise
