$618 million in stop-loss
reimbursements for cancer patients
reimbursements for cancer patients
Cancer accounts for more than one quarter of total reimbursement: report
July 15, 2016
by Christina Hwang, Contributing Reporter
In The Top Ten Catastrophic Claims Conditions report, insight about factors impacting medical costs is explored, such as the most expensive medical conditions covered by stop-loss insurance and emerging trends, as reported in Sun Life Financial U.S.
The report examines medical conditions covered by Sun Life’s stop-loss insurance, a type of insurance that protects insurers against “large claims”, and found that charges billed by medical care providers amounted to $9 billion, and self-insured employers paid $5.3 billion of the $9 billion. Additionally, they received $2.3 billion in reimbursements from stop-loss protection.
From 2012 to 2015, the time period the report was analyzing, the average that an employer paid on a claim above $1 million was $1.45 million, which decreased to $491,000 after applying the average stop-loss claim reimbursement ($962,000).
According to the report, cancer is number one and two, with $618 million in stop-loss reimbursements, and also accounts for $26.6 percent of all stop-loss claims. Breast cancer is responsible for $13.6 percent of cancer claims, and intravenous (IV) medications are the “key driver” in rising cancer costs.
Number three on the list is chronic/end-stage kidney disease, which accounts for over $369 million first-dollar claims — covering copays and deductibles — and stop-loss claims reimbursements. The report mentions how to improve cost management and increase the use of transplants to reduce the costs associated with kidney disease.
The complete list of stop-loss claims is as follows:
“By highlighting the conditions that create catastrophic claims and providing insights into trends influencing high costs, we can help employers anticipate what they’ll see when self-funding and raise awareness about the importance of cost-containment resources and stop-loss insurance,” said Brand Nieland, vice president of stop-loss at Sun Life Financial U.S. in a statement.
The report examines medical conditions covered by Sun Life’s stop-loss insurance, a type of insurance that protects insurers against “large claims”, and found that charges billed by medical care providers amounted to $9 billion, and self-insured employers paid $5.3 billion of the $9 billion. Additionally, they received $2.3 billion in reimbursements from stop-loss protection.
From 2012 to 2015, the time period the report was analyzing, the average that an employer paid on a claim above $1 million was $1.45 million, which decreased to $491,000 after applying the average stop-loss claim reimbursement ($962,000).
According to the report, cancer is number one and two, with $618 million in stop-loss reimbursements, and also accounts for $26.6 percent of all stop-loss claims. Breast cancer is responsible for $13.6 percent of cancer claims, and intravenous (IV) medications are the “key driver” in rising cancer costs.
Number three on the list is chronic/end-stage kidney disease, which accounts for over $369 million first-dollar claims — covering copays and deductibles — and stop-loss claims reimbursements. The report mentions how to improve cost management and increase the use of transplants to reduce the costs associated with kidney disease.
The complete list of stop-loss claims is as follows:
- Malignant neoplasm (cancer): $429.5 million
- Leukemia/lymphoma/ multiple myeloma (cancers): $188.6 million
- Chronic/end-stage renal disease (kidneys): $156.5 million
- Congenital anomalies (conditions present at birth): $96.3 million
- Disorders relating to short gestation/low birth weight (premature birth): $75.2 million
- Transplant: $62.2 million
- Congestive heart failure: $57.8 million
- Cerebrovascular disease (brain blood vessels): $57.4 million
- Pulmonary collapse/respiratory failure (lungs): $55 million
- Septicemia (infection): $54.7 million
- All other conditions: $1.09 billion
“By highlighting the conditions that create catastrophic claims and providing insights into trends influencing high costs, we can help employers anticipate what they’ll see when self-funding and raise awareness about the importance of cost-containment resources and stop-loss insurance,” said Brand Nieland, vice president of stop-loss at Sun Life Financial U.S. in a statement.