How to get a million dollar claim

We’re off in the land of catastrophic claims as the Republicans in the House talk about inadequately funded high cost pools and carve-outs and we’ve talked about a single individual in Iowa dominating strategic decision making on their Exchange market.

So what are some of the ways we can get to a million dollar claim?

Babies are the easiest ones.

They are adorable but expensive. Even healthy babies are expensive as they are very little people with very immature bodies where lots of things can and do go wrong. Going back to 2014 and revisiting the AOL blow-up, a mother describes her experience with her very premature baby:

She weighed 1 pound, 9 ounces. Her skin was reddish-purple, bloody and bruised all over. One doctor, visibly shaken, described it as “gelatinous.” I couldn’t hold my daughter or nurse her or hear her cries, which were silenced by the ventilator. Without it, she couldn’t breathe.

That day, we were told that she had roughly a one-third chance of dying before we could bring her home. That she might not survive one month or one week or one day. She also had at least a one-third chance of being severely disabled, unable to ever lead an independent life…

My daughter had to spend three months in the NICU, dependent on many high-tech medical apparatuses and round-the-clock care. She endured more procedures than I can count: blood transfusions, head ultrasounds, the insertion of breathing tubes, feeding tubes, and a central line extending nearly to her heart.

Jimmy Kimmel’s son has a decent chance of running up a million dollar year.

Antibiotic resistant bacteria can also run up massive charges on complex cases. Reuters had a good story from the Fall of 2016 detailing one case that came to over $5 million dollars for a man who had a liver-kidney transplant:

But then, less than three weeks into his recovery at University of California-Los Angeles Medical Center, Greulich contracted an antibiotic-resistant infection – a common and often lethal hazard of hospital stays. Over the next five months, according to thousands of pages of medical and billing records reviewed by Reuters, Greulich was attacked by no fewer than half a dozen different “superbugs,” most of them strains that are encountered almost exclusively in healthcare facilities.

Greulich’s immune system, suppressed by medications to prevent organ rejection, had no way to fight the bacteria. When the usual antibiotics failed to snuff them, he was pumped full of powerful alternatives, sometimes as many as half a dozen a day. Some had alarming side effects — hearing loss, severe pain, nausea. The infections kept coming….

Records show that from the time he first entered UCLA Medical Center in December 2011, until he died seven months later, Dan Greulich racked up a total bill of $5.7 million

Even a non-complicated liver-kidney transplant can run a million dollars:

However, at $5.7 million, the charges for Greulich’s seven-month hospitalization were nearly five times what the National Foundation for Transplants says are the average first-year charges for a liver-and-kidney transplant.

Complex care is expensive even without major unexpected complications.

And then we hit the specific super high cost drug cases. The FDA approved a new drug this week with a $700,000 list price.

The Food and Drug Administration (FDA) on Thursday gave its green light to the medicine, BioMarin Pharmaceutical Inc.’s (BMRN, -1.72%) Brineura. It’s the first-ever drug approved for a form of Batten disease, a rare genetic disorder that ravages the nervous system and can cause symptoms ranging from seizures to trouble coordinating muscles to vision loss… the $702,000 annual list price

Finally, there are the oldie but goodies. My first exposure to catastrophic claims was discussions about hemophilia. An individual with severe hemophilia during a bleed can be in an ICU for months and be receiving multiple $10,000 injections per day. It is not hard for a bad bleed to run up multi-million dollar claims.

There are a lot of other ways people can hit a million dollar claim in a year much less multi-million dollar life time experience. This is not exhaustive, it is indicative. And it neglects future probable million dollar claims.

A reliable genetic cure for Cystic Fibrosis is easily worth $5 million dollars. The first true cures for blindness can be worth a million dollars. We had a massive collective cash flow freak out over the Hep-C pricing levels as those delivered real cures that provided real value through both improved health and avoided treatment costs but it brought forward years of spending into a single policy year. If and when genetic cures proliferate, the Hep-C angst will look adorable.

Complex care is expensive.






28 replies
  1. 1
    Crusty Dem says:

    Kimmel, not Fallon.

    I still want some details about the $12 million/yr Iowa patient that has destroyed their market… Crazy.

  2. 2
    Taylor says:

    The Amazon Prime series The Man In The High Castle has a storyline that is apropos. John Smith, loyal Nazi Party member and devoted to the Fuhrer, is head of the SS in the United States.

    But then his son is diagnosed with a genetic disorder.

    The kindly family doctor offers him the injection he can use to quietly euthanize his son and avoid embarrassment.

    Welcome to the ultimate Republican plan for healthcare.

  3. 3
    OzarkHillbilly says:

    Complex care is expensive.

    Shhhhh…. A Republican voter might hear you.

  4. 4
    Davey C says:

    Can we please get a “call your Congressperson” thread about the AHCA?

  5. 5
    Kay says:

    This is just one of the reasons they’re rushing this thru – they’re afraid people will find out about stuff like this:

    While House Republicans lined up votes Wednesday for a Thursday showdown over their bill to repeal the Affordable Care Act, Vickie Glenn sat in her Murphysboro, Ill., office and prayed for it to fail.
    Ms. Glenn, a Medicaid coordinator for Tri-County Special Education, an Illinois cooperative that helps more than 20 school districts deliver special education services to students, was worried about an issue that few in Congress were discussing: how the new American Health Care Act, with its deep cuts to Medicaid, would affect her 2,500 students.

    With all the sweeping changes the Republican bill would impose, little attention has been paid to its potential impact on education. School districts rely on Medicaid, the federal health care program for the poor, to provide costly services to millions of students with disabilities across the country. For nearly 30 years, Medicaid has helped school systems cover costs for special education services and equipment, from physical therapists to feeding tubes. The money is also used to provide preventive care, such as vision and hearing screenings, for other Medicaid-eligible children.

  6. 6
    JMG says:

    According to Bloomberg, it’s on to cuts for Medicare, SS, food stamps and unemployment benefits in the 2018 budget. I really wonder if some subsequent Republican Congressperson’s town hall will become a scene of mob violence. Don’t want it to, but when you’re telling people they can starve or die from illness because of what you did, some are apt to take it personally.

  7. 7
    Bill E Pilgrim says:

    One small step for whatever: Just called and cancelled my NYT digital account. When asked if there was a reason I said yes, yesterday you published a “fact check” on the Republican health care bill that was right-wing propaganda, and recently you hired a right-wing climate change denier as a columnist, and I’m not going to pay to give a platform to Republican propaganda.

    The guy handling the call, after the usual well we’re sorry to see you go, launched into a speech about how “Well we are trying to become a more open newspaper and present all points of view”, and I stopped him right there to say listen, that’s what FOX News says also. We just present the facts, you decide. You have an editorial responsibility not to print patently false claims, and printing them under the guise of “Some are saying…” is the oldest right-wing propaganda trick in the book.

    In fact I wasn’t reading the paper daily as I used to, lots of other sources, but I also am disturbed by their reacting to the election of Trump by meekly becoming more conservative, when precisely the opposite is not only important but desperately necessary. The only even tiny impact I could make was if it affected them financially, so there we have it. Not much I know, but still.

  8. 8
    Baud says:

    @Bill E Pilgrim: Good for you.

  9. 9
  10. 10
    Bill E Pilgrim says:

    @Baud: Thanks. The hideous “Fact check” piece by the way took several outright lies by people like Ryan and equated them with things like this from Nancy Pelosi.

    The statement from the writer says that Pelosi claimed “17 million” could be affected, then includes a direct quote from Pelosi saying “up to 17 million” as evidence of this, then slams Pelosi because it’s not 17 million, it’s up to 17 million, thus Pelosi was being “misleading”.

    Sick of it. No pun intended.

  11. 11
    rikyrah says:

    @Kay:
    Keep spreading the truth.

  12. 12
    rikyrah says:

    @JMG:
    Uh huh.
    This is who they are.

  13. 13
    Kay says:

    @rikyrah:

    I wish people understood how things worked. Maybe it wouldn’t matter but in order to care about this you have to have some understanding about where the funding comes from.

    It seems like too big a job to me sometimes- like it’s not possible to reach the people who should care about it. Parents and teachers of disabled children are really fierce (and excellent) advocates but it’s like 1% of them and it needs to be more. That’s true across the board. The small group of people who understand how this works can’t carry the huge group of people who don’t know and don’t care.

  14. 14
    Elizabelle says:

    @Bill E Pilgrim: I suspect the Fuck the Fucking New York Times has made a business decision to go after the rightwing Wall Street Journal subscriber set.

    Hearing how that subscriptions employee tried to school you sets my teeth on edge. Also tells me they gave him talking points because people ARE calling and cancelling their subscriptions.

  15. 15
    Tilda Swintons Bald Cap says:

    Republicans are monsters.

  16. 16
    Ohio Mom says:

    @Kay: Yes, I already knew that — every parent of a special needs student should be able to figure that out — my district periodically sends out forms for us to sign, giving them permission to bill Medicaid on our kids’ behalf, and if my district does this, I can only assume the rest of them do, too.

    But our local — and I can also only assume this is true all over — disability (so-called advovcacy) organizations have barely made a peep about what looks to be the imminent destruction of the funding our community depends on, literally keeping roofs over the heads of our adults. They are one of the sets of people I look forward to I-told-you-so-ing.

  17. 17
    Ohio Mom says:

    @JMG: No, because those Republicans aren’t going to hold real town halls, they are going to have those telephone things were all the callers are pre-selected instead.

  18. 18
    Kay says:

    @Ohio Mom:

    literally keeping roofs over the heads of our adults.

    Agreed. I have long term relationships with severely mentally ill adults because I act as a guardian and/or conservator. I’m not sure people realize there’s this elaborate web of services they rely on. I’m in our schools quite a bit because I’m on a committee and I’m a volunteer. I remember the first time I entered the K/1 classroom for profoundly disabled children- I simply didn’t know they were there- that they were able to go to public schools. For a lot of them cuts would mean they can’t go.

  19. 19
    Ohio Mom says:

    @Kay: Why am I not surprised that you are a guardian and conservator? Thank you! I hope one day I’ll be able to find someone like you for my kid.

    In the 1950s, 60s and 70s, families with disabled members — and then, adults with disabilities — fought very hard to have basic rights, among them, the right to an education, recognized and honored.

    Nowadays, the advocacy organizations are apparently fat and happy (is that phrase fat-shaming?). They haven’t rallied our community at all; I wonder if they will do anything after the fact. They disgust me.

  20. 20
    El Caganer says:

    I never did see the actual entire bill, but I’m sure my bypass surgery back in 2015 ran over $1 million and probably well over it. It was a pretty rare procedure; I had to go to Pittsburgh because there weren’t any surgeons in Philadelphia who had done it before. And if I hadn’t had good insurance with my employer at the time, I would have been dead that year. Destroying the average person’s access to health care just to give totally unnecessary tax breaks to the 1% is madness. If they succeed in this, I think they’ll destroy the country.

  21. 21
    Aleta says:

    @Bill E Pilgrim:

    launched into a speech about how “Well we are trying to become a more open newspaper and present all points of view”, and I stopped him right there

    Good thing you stopped him there, because after that the script turns car-rental agent offensive.

    A few days ago they tried to make a friend answer: “Do you understand that after x articles each month, you won’t be able to read any more articles?” Question repeated after she declined to answer such a stupid question.

    As though before cancelling, she needed to fully comprehend the dire consequences of her action. Which was, after all, a stated refusal to read them any more. Their desperate attempt to sow doubt in order to keep making money.

  22. 22
    RobertB says:

    I had a stroke + DVT + pulmonary embolism a few years ago, and it got me close to $1M by the time it was done. AFAIK, that wasn’t even an unusual sequence of events.

  23. 23
    narya says:

    my parents are exhibits A and B. In the past 15 years or so, they have had: a quadruple bypass; continuing care for bladder cancer; fusion of seven vertebrae; dialysis followed by a kidney transplant, a knee replacement; a bout of c. diff; an eye infection following cataract surgery that resulted in complete loss of that eye; and probably some stuff i’m forgetting. they’re in their 80s, and they keep chugging along and are happy and (relatively speaking!) healthy, but any of several of the above could have killed them. however, my dad’s union had/has? great health insurance, so i got to hang out with them for a week, and they’ve been able to watch my nephews grow up and thrive. and my mom delivered Meals on Wheels until only recently, and was phone-banking in the last election (for the side of Good).

  24. 24
    Booger says:

    @Aleta: Oh, wait, unless you can manage to go into your fricking browser settings and delete their fricking cookies. Problem solved.

  25. 25
    Seanly says:

    I don’t know what my wife’s care for her Hodgkin’s Lymphoma was, but I do know that she’s well over $1.2 million since 3/14 with her treatment for Acute Lymphoblastic Leukemia. Her treatment for the ALL included chemotherapy, blood stem cell transplant, near death from pneumonia, 3 weeks in MICU, 6 weeks in a rehab hospital, then several treatments for C. Diff. That was just the first year. She’s had some additional hospital stays with pneumonia so we might be approaching $1.4 million.
    We have an employer-sponsored high-deductible plan with an HSA. Our other option would be slightly higher premiums but no HSA. At the levels we’re spending, our total out of pocket costs (premiums plus checks I have to write) are about the same. I’m very thankful that I have a good career in an industry where decent insurance is expected as part of the compensation.

  26. 26
    maurinsky says:

    I had a baby in 1989. I was in labor for 4.5 hours, from first contraction to baby in arms. I took no drugs, no epidural, no ibuprofen, nothing. It cost $8,000.

    Pregnancy is a pre-existing condition, btw, under AHCA. So is sexual assault and domestic abuse. Basically, being a woman is a pre-existing condition.

  27. 27
    Marina says:

    Girl preemies weighing less than 2 pounds have a 1-in-4 risk of developing psychological disorders when they’re in their teens (an article in the NYT, research done in UK if I remember correctly). Don’t know why girls and not boys. Point being that costs don’t necessarily stop once a million-dollar baby has pulled through the first few months. A big deal in O’Care was the requirement for mental/physical health parity. Ever tried to pay for an eating disorder treatment center stay (inpatient residential was $1,800 PER DAY)? I closed our my Keogh to pay for 3 weeks of day treatment…

    I read that twitter quote from Joe Walsh (the You Lie guy) saying ‘Sorry Jimmy Kimmel: your sad story doesn’t obligate me or anybody else to pay for somebody else’s health care’ and realized I have homicidal impulses in my heart…

    BTW, what are people going to do when Medicaid won’t cover memory care/skilled residential facilities’ fees (aka nursing homes)?

    I was in a high-risk pool pre-Medicare: premiums were $12k per year, before deductibles and co-pays–and that was around ten years ago. The cruelty of the US, that many people just accept as a given, is staggering.

  28. 28
    Dennis says:

    Or we could cost control some of these treatments. Big Pharma would still have incentives to develop things without princely pricing afforded to new patented drugs. This would also reduce incentives to “cook the books” on efficacy research.

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