Multimillion-dollar medical claims continue to rise – Sun Life US | Insurance business America
Annual report examined 60,000 stop loss claims from 2020 to 2023
Life & Health
By Terry Gangcuangco
Sun Life US released its latest report, “High-Cost Claims and Injectable Drug Trends Analysis,” examining 60,000 stop-loss claims from 2020 to 2023. The report found that 87% of self-funded employers faced at least one large claims claim during the period.
A key finding is that for the first time in the report’s 12-year history, cardiovascular disease (CVD) has risen to the second highest spot in paid claims, overtaking blood cancers. Since 2020, the average cost of CVD claims has increased 33%, outpacing the overall increase in medical claims costs.
Malignant neoplasms (solid tumors) continue to lead the way, causing medical costs twice as high as cardiovascular disease.
According to key trends in the report, the top 10 most costly medical conditions accounted for 72% of all stop-loss reimbursements, while the top 20 most common conditions accounted for 92%.
Claims related to newborn and infant care experienced a significant increase, with an average cost increase of $100,000 from 2022 to 2023, bringing the average annual cost to $470,800.
Orthopedics and musculoskeletal diseases ranked fourth in 2023 reimbursements and had the highest number of individual high-cost claims, excluding solid cancers, although with a lower average cost of just over $100,000.
According to Sun Life’s US report, multimillion-dollar claims continue to rise. The insurer noted that all of the top 20 loss categories recorded claims exceeding $1 million, with the highest claim exceeding $11 million for newborn and infant care.
In 2023, there was a significant increase in the $3 million-plus category with 32 such claims, nearly double the number in 2022. Half of these claims over $3 million were related to congenital anomalies that the A person’s health throughout their life can affect life.
Jen Collier (pictured), president of health and risk solutions at Sun Life US, emphasized: “Our extensive claims database allows us to provide guidance to our self-funded customers to help them understand how to best manage their health insurance plans and costs .” Ensuring they can choose additional solutions that ensure the best possible care for their employees.
“In addition, the data informs our health and risk product development team in developing solutions and programs that directly support the health and well-being of our members, regardless of whether their condition has resulted in a high-cost claim.”
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2024-05-31 11:55:28
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