Million-dollar medical claims are on the rise
The number of patients with claims that exceeded $1 million grew by 87 percent between 2014 and 2017.
Big medical claims are on the rise and they’re hitting employers with self-funded insurance plans hard. A new report from Sun Life Financial finds that between 2014-17, stop-loss claims that were over $1 million rose 87 percent.
The number of patients with claims that exceeded $1 million rose from 104 to 194 during the four-year time period. The total spending on such claims grew to $935 million.
In a statement accompanying the study’s release, Sun Life President Dan Fishbein noted that the high cost was likely a reflection of the increased use of life-saving treatments. “We’re seeing continued significant growth in the number of million-dollar-plus claims as the result of new life-saving treatment options coming to market, as well as existing treatments getting approved for expanded use.”
Related: 10 most catastrophic claims for self-funded employers
While million-dollar claims only accounted for 2 percent of total stop-loss claims in 2017, they made up 20 percent of the total value of such claims.
The most expensive patient during the four-year period racked up $6.7 million in medical bills in 2016 for treatment of hereditary angioedema, a serious condition that leads to severe swelling in different parts of the body. The next costliest patient led to roughly $5 million in spending on a blood condition.
But the trend is largely driven by expensive cancer treatments. Sun Life notes that other advances in medical technology, such as gene therapy, will likely result in even more multi-million dollar medical bills to treat serious conditions.
Sun Life is a major provider of stop-loss insurance to large employers that self-fund their employee health plans. Stop-loss coverage is an insurance policy that the employer takes out to protect it from claims that rise above a certain level –– perhaps several hundred thousand dollars or $1 million.