The 10th annual report on high-cost medical claims analyzed nearly 50,000 stop-loss claims at over 2,800 self-insured workplaces from 2018 to 2021.
Nine key takeaways:
- Among all reimbursed stop-loss claims, 70 percent are from the top 10 conditions.
- From 2017 to 2020, 21 percent of employers had a member with over $1 million in claims.
- From 2020 to 2021, total million-dollar claims increased 19 percent.
- In 2021, the conditions with the most frequent claims for $1 million or more were cancer, complications around newborn/infant care and COVID-19.
- In 2021, COVID-19 was the eighth-highest condition for claims reimbursement. There was a 276 percent increase in COVID-19 spending and a 354 percent increase in total number of claims compared to 2020.
- COVID-19 claims that topped stop-loss deductibles averaged $231,300, with the highest claim at $1.75 million.
- The number of members with a mental or behavioral health claim has increased 21 percent since 2020.
- Cancer conditions have remained the first and second highest-cost claims over the past decade.
- The highest-cost claim this year was for a hemophilia/bleeding disorder at $6.23 million.
Read the full report here.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 17–19 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
