Charges and Allowed Amounts for Services for Patients with Opioid Abuse or Dependence Diagnoses Rose over 1,000 Percent since 2011

In dollars and cents, professional charges—the amount that a provider bills for a service or procedure— associated with opioid abuse and dependence diagnoses climbed nationally from $71.66 million in 2011 to $721.80 million in 2015. Allowed amounts—the maximum amount an insurer will pay for a covered health service—increased from $32.42 million in 2011 to $445.74 million in 2015.

Following up on FAIR Health's previous study, The Opioid Crisis among the Privately Insured: The Opioid Abuse Epidemic as Documented in Private Claims Data, the new white paper draws on FAIR Health's database of over 21 billion privately billed healthcare services to delve into the specifics of healthcare services and costs associated with the nation's ongoing epidemic of abuse of prescription painkillers and heroin. All information in the report is based on data in the FAIR Health repository, which represents the claims experience for approximately 150 million individuals, or approximately 75 percent of the privately insured market.

Among other top findings in the report:

Per-Patient Costs
In 2015, the total annual charges associated with an individual who was diagnosed with opioid abuse or dependence were 556 percent higher than the average annual per-patient charge based on all patients' charges (including those for patients with opioid abuse or dependence diagnoses and those without). With respect to imputed allowed amounts on a per-patient basis, the difference was similar: 563 percent.

Top Codes
In the period 2011-2014, emergency department codes were the two codes with the highest aggregated charges associated with opioid abuse diagnoses—but were not among the top 18 codes associated with opioid dependence diagnoses. Patients diagnosed with opioid dependence are more likely than those diagnosed with opioid abuse to be treated in substance abuse programs rather than on an emergency basis.

State-by-State Pattern
In 2014, the average per-service charge associated with opioid abuse and dependence diagnoses varied widely by state, from a low of $45 in Rhode Island to a high of $263 in Iowa.

FAIR Health President Robin Gelburd stated, "By peeling back the curtain on the impact of opioid abuse and dependence on privately billed healthcare services and costs, we hope to provide information that will help all healthcare stakeholders—including payors, providers, legislators and policy makers—address the opioid crisis."

For the full white paper, click here.

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About FAIR Health
FAIR Health is a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health uses its database of billions of privately billed medical and dental claims to power an award-winning free consumer website and to create data products serving all healthcare stakeholders, including government officials, researchers, consumers, providers, insurers and other businesses. FAIR Health has been certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity, eligible to receive all Medicare claims data for use in nationwide transparency efforts. In addition, FAIR Health's data have been designated as the official data source for a variety of state health programs, including workers' compensation and Personal Injury Protection (PIP) programs, as well as state consumer protection laws governing surprise out-of-network bills and emergency services. For more information, visit www.fairhealth.org.

Contact:
Dean Sicoli
Executive Director of Communications and Public Relations
FAIR Health
646-664-1645
[email protected]
Twitter: @deansicoli

Photo - http://photos.prnewswire.com/prnh/20160912/406635-INFO

SOURCE FAIR Health

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