Multimillion-dollar medical claims proceed to rise – Solar Life US

Solar Life US has revealed its newest “Excessive-Price Claims and Injectable Drug Tendencies Evaluation” report, which examined 60,000 stop-loss claims from 2020 to 2023. The report revealed that 87% of self-funded employers encountered at the very least one high-cost declare through the interval.

A big discovering is that heart problems (CVD) has risen to the second-highest paid claims place, overtaking blood cancers for the primary time within the report’s 12-year historical past. Since 2020, the common value of CVD claims has surged by 33%, surpassing the general enhance in medical claims prices.

Malignant neoplasms (stable tumors) proceed to guide, with twice the medical expenditure of CVD.

In the meantime, in response to the important thing tendencies within the report, the highest 10 high-cost medical situations accounted for 72% of all stop-loss reimbursements, whereas the highest 20 situations accounted for 92%.

Claims associated to new child and toddler care noticed a big rise, with a median value enhance of $100,000 from 2022 to 2023, reaching an annual common value of $470,800.

Orthopedics and musculoskeletal situations ranked fourth in 2023 reimbursements and had the best variety of particular person high-cost claims, excluding stable cancers, though with a decrease common value of simply over $100,000.

Based mostly on the Solar Life US report, multimillion-dollar claims stay on the rise. The insurer famous that each one prime 20 declare classes skilled claims exceeding $1 million, with the best declare being over $11 million for new child and toddler care.

In 2023, there was a notable enhance within the $3 million-plus class, with 32 such claims, practically double the quantity from 2022. Half of those $3 million-plus claims had been associated to congenital anomalies, which might have an effect on a person’s well being all through their life.

Jen Collier (pictured), president of well being and threat options at Solar Life US, highlighted: “Our in depth claims database permits us to supply steering to our self-funded purchasers to allow them to perceive methods to finest handle their well being plans and prices, whereas guaranteeing they’ll select further options that drive one of the best care for his or her staff.

“Moreover, the information informs our well being and threat product growth staff as they create options and applications that immediately help the well being and wellness of our members, no matter whether or not their situation has resulted in a high-cost declare.”

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