Vision Payment Claims Analyses with Health Insurance

Abstract

 The purpose of  this study was to identify associations between insurance type and costs and to investigate specified variables’ influence on individuals’ access to adequate coverage. This was a cross sectional study, using secondary data analyses. The study was completed at The Eye Institute (TEI) East Oak Lane Campus in Philadelphia, PA. The study population was all patients seen at TEI East Oak Lane Campus, specifically patients seen at TEI clinic from January 1st, 2019, - to December 31st, 2019, whose encounter generated an insurance claim (n=68,484). The exposure was insurance type and outcomes were patient total amount, billed amount, and pay amount by patient. Data analyses were performed using SAS, version 9.4. In all statistical analyses, p-values were one-sided and considered statistically significant if 0.05 or lower. The study protocol was approved by the Institutional Review Boards of Salus University. The sample represented an older population with an average age of about 55. There was a significant association found between financial class with patient total amount (p<0.0001), billed amount(p<0.0001), and pay amount (p<0.0001). People with managed PPO pay the least, while those on Medicaid and workers compensation pay the most out of pocket. The two Philadelphia zip codes which pay the most out of pocket have two of the lowest average household incomes in the Greater Philadelphia area. Insurance type and out of pocket expenses potentially have a negative effect on patient vision health and affordability of care as well as access to care. These findings contribute to the identification of variables that influence individual’s healthcare accessibility and evidence for opportunities to improve insurance coverage.