OBJECTIVES : The U.S. Preventive Services Task Force recommends use of Ambulatory Blood Pressure Monitoring (ABPM) for the identification of white coat hypertension. However, data regarding the out-of-pocket payment (OPP) for ABPM among privately insured patients is lacking. We analyzed the OPPs for ABPM overall and stratified by type of claim, benefit plan, and provider.

METHODS : A retrospective analysis of Truven Commercial database was conducted for beneficiaries ≥18 years old with ABPM from January 2012 to December 2016. The date of first ABPM claim (Healthcare Common Procedure Coding System codes 93784, 93786, 93788, or 93790) was considered as the index date. Patients with 12 months of continuous enrollment pre-index and 30-days post-index were included. Per-beneficiary ABPM episode OPPs were calculated by aggregating all ABPM-related OPPs within the 30-day post-index window.

RESULTS : A total of 20,875 adult beneficiaries with ABPM claims (both paid and unpaid) were identified. The mean OPP per beneficiary for an ABPM episode was $58 (standard deviation [SD] =84) whereas the mean OPP for a full component ABPM claim was $45(SD=50). Among individual components of ABPM, the highest median OPP was for procedure recording at $37 (n=1,787; interquartile range [IQR], $16, $105) followed by scan analysis & report claims at $36 (n=1,031; IQR, $15, $105) and physician review & report at $15(n=1,927; IQR, $4, $24). Consumer Directed Health Plans were associated with higher mean OPP ($65) compared to Preferred Provider Organization ($46), Point of Service ($35) and Health Maintenance Organization ($34) plans. Additionally, beneficiaries which were provided ABPM services from a facility incurred higher mean OOP ($88) compared to those provided ABPM services by non-physicians ($47), non-admitting physicians ($45) and admitting physicians ($39).

CONCLUSIONS : Among commercially-insured Americans, OPPs for ABPM varied considerably. Our findings highlight the need for policymakers to advocate for adequate ABPM coverage in the commercial insurance marketplace.