Sun Life US published its latest report, “Analysis of High Cost Claims and Injectable Drug Trends,” which examined 60,000 stop-loss claims from 2020 to 2023. The report revealed that 87% of self-funded employers experienced at least one stop-loss claim Stop loss claim during the period.

An important finding is that cardiovascular disease (CVD) rose to the second highest paid claims position, overtaking blood cancers for the first time in the report’s 12-year history. Since 2020, the average cost of CVD claims has increased by 33%, exceeding the overall increase in medical claims costs.

Malignant tumors (solid tumors) continue to lead, with medical spending on cardiovascular diseases weak.

Meanwhile, according to key trends in the report, the top 10 high-cost medical conditions accounted for 72% of all stop-loss reimbursements, while the top 20 made up 92%.

Claims for newborn and infant care saw a significant rise, with an average cost increase of $100,000 from 2022 to 2023, bringing the average annual cost to $470,800.

Orthopedics and musculoskeletal surgery ranked fourth in 2023 reimbursements and had the highest number of high-cost individual claims, excluding solid cancers, although the average cost was lower at just over $100,000.

According to the US company Sun Life’s report, multi-million dollar claims are still on the rise. The insurer noted that all of the top 20 claim categories saw claims exceeding $1 million, with the highest claim exceeding $11 million for neonatal and infant care.

In 2023, there was a notable increase in the category of claims exceeding $3 million, with 32 such claims, nearly double the number from 2022. Half of these claims exceeding $3 million were related to congenital anomalies, which can It affects an individual’s health throughout his life. life.

“Our comprehensive claims database allows us to provide guidance to our self-funding clients so they can better understand how to manage their health plans and costs, while ensuring they can Choosing additional solutions that provide the best care for their employees.

“Additionally, the data informs our health product development and risk teams as they create solutions and programs that directly support the health and wellness of our members, regardless of whether their condition has resulted in a high-cost claim.”

What do you think about this story? Share your thoughts in the comments below.