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.