Monograph - Chapter 7 - Group Medical Insurance Large ... · 6 14 25 21 22 4 I0 30 2 3 1 27 17 20...

VII Analysis of Most Frequent

Diagnoses and Analysis of Total Charges by Diagnosis Category,

Age, and Gender

VII. Analysis of Most Frequent Diagnoses and Analysis o/" Total Charges by Diagnosis Categor3~, Age and Gender 215

TABLE VII-1 ICD-9-CM CODES AND DISEASE CLASSIFICATIONS FOR SECTION VII

ICD-9-CM

153

162

174

185

197

198

250

296

30O

3O3

410

411

414

424

427

428

486

560

574

585

592

715

722

724

DISEASE

Malignant neoplasm of colon

Malignant neoplasm of trachea, bronchus and lung

Malignant neoplasm of female breast

Malignant neoplasm of prostate

Secondary malignant neoplasm of respiratory and digestive systems

Secondary malignant neoplasm of other specified sites

Diabetes mellitus

Affective psychosis

Neurotic disorders

Alcohol dependence syndrome

Acute myocardial infarction

Other acute and subacute forms of ischemic hcart disease

Other forms of chronic ischemic heart disease

Mitral valve disorder

Cardiac dysrhythmias

Heart failure

Pneumonia, organism unspecified

Intestinal obstruction

Cholelithiasis

Chronic renal failure

Calculus of kidney and ureter

Osteoarthrosis and allied disorders

lntervertebral disc disorders

RANK COMBINED :

23

8

6

14

25

21

22

4

I0

30

2

3

1

27

17

20

18

26

13

11

24

5

7

Other and unspecified disorders of the back 29

216 Group Medical Insurance Large Claims Database Collection and Analysis

TABLE VII- l - -Cont inued ICD-9-CM CODES AND DISEASE CLASSIFICATIONS FOR SECTION VII

765 Disorders related to short gestation and unspecified 12 low birthweight

780 General symptoms 19

786 Symptoms involving respiratory system and other 16 chest symptoms

799 Other ill-defined and unknown causes of morbidity 15 and mortality

996 Complications peculiar to certain specified 9 procedures ( cardiac implant, transplant, etc.)

V30 Single liveborn 28

VII. Analysis of Most Frequent Diagnoses and Analysis of Total Charges by Diagnosis Category, Age and Gender 217

TABLE VII-2 THIRTY MOST FREQUENTLY OCCURRING DIAGNOSES BY RANGE

OF CLAIMANT TOTAL CHARGES BY NUMBER OF CLAIMANTS, TOTAL AND AVERAGE CHARGES FOR ALL PLAN TYPES AND ALL PARTICIPANTS IN 1991 AND 1992

Diagnosis (ICD-9): 414 Minimum

Total Charge

per Claimant $25,000 $40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $400,000 $500,000 $750,000

$1,000,000 Totals Averages

Maximum Total

Charge per Claimant

$40.000 $55,000 $70,000 r~5,ooo

$1 00,000 $120,000i $150,00¢ $200,000 $250,000 $300,000 $400,000 $500,000 $750,000

$1,000,000 $10,000,000

Combined Rank : 1.00

Claimants in

Range 1991

1,381i 1,216

643 276 167 130 66 49 14 9 5 3 0 0i 1

3,940

Claimants in

Range 1992

1,598 1,443

821 425~ 221 132 96 54 13 15 8 3 4 0 0

4,833

Total Charges in

Range 1991

$44216231 $57,386,577 $39,726,602 $21,112,504i $15,395,850 $14,111~222 $8,855,109 $8.378,168 $3,003,176 $2,459,061 $1,777,968 $1,300,743

$0 $0

$1,075,000

$218,798,211 $55,533

Total Charges in

Range 1992

$51,608.726 $67,923,O70 $50,646,745 $32,379,385 $20,322,086 $14.458,182 $12,782,513 $9,072,142 $2,911,997 $4,162,724 $2.748,477 $1,285,743 $2,209,133

$0 $0

$272,410,923 $56,365

Dia, lnosis (ICD-9): 410 Minimum

Total Charge

per Claimant $25,000 $40,000 $55,000 $70,000 $85,000

$100,000 $I 20,000 $150,0O0 $200,000 $250,000 $300,000 $400,000 $500,000 $750,0OO

$1,00O,O00 Totals Averages

Maximum Total

Charge per Claimant

$40,000 $55,000 $70,00O $85,000

$1 00,000 $120,00O $150,00O $200,000 $250,000 $300,000 $400,000 $500,000 $750,000

$1,000,000 $1 O,OOO,00O


Claimants in

Range 1991

1,316 694 420 187 91 64 58 31 11 3 4 2 0 2 0

2,883

Claimants in

Range 1992

1,679 923 529 284 155 112 79 47 18 4 7 3 3 0 1

3,844

Total Charges in

Range 1991

$41,436,756 $32,598,113 $25,886,191 $14,375,605 $8,350,900 $7,009,056 $7,719,868 $5,214,370 $2,352,527

$817,510 $1,371,592

$862,543 $0

$I ,598,421 S0

$149,593,451 $51,888

Total Charges in

Range 1992

$53,127,479 $43,223,126 $32,586,229 $2.1,812,727 $14,149,093 $12,254,503 $10,413,562 $7,932,013 $4,060,597 $1,134,601 $2,453,063 $1,369,652 $1,903,764

$0 $1,167,451

$207,1rd!7,850 $64,003


TABLE V l l - 2 - - C o n t i n u e d THIRTY MOST FREQUENTLY OCCURRING DIAGNOSES BY RANGE

OF CLAIMANT TOTAL CHARGES BY NUMBER OF CLAI'MANTS, TOTAL AND AVERAGE CHARGES FOR ALL PLAN TYPES AND ALL PARTICIPANTS IN 1991 AND 1992


Total Charge

per Claimant $25,000 $40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $15O,O00 $200,OO0 $250,000 $300,000! $400,000 $500,000 $750,000


Maximum Total

Charge per Claimant

$40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $40O,00O $500,000 $750.000

$1,000,000 $10,000,000


Claimants in

Range 1991

795 679 361 177 8O 45 29 18 3 5 2 0 1 0 0

2,195

Claiman~ in

Range 1992

1,025 8O2 459 229 134 73 55i 30 8 2 4 0 2 0 0

2,823

Total Charges in

Range 1991

$25,546,961 $31,727,092 $22,278,316 $13,554,825 $7,326,361 $4,886,914 $3,831,118 $3,119,145

$668,371 $1,356,082

$664,244i $0

$635,211 $0 SO

$115,614,639 $52,672

Total Charges in

Range 1992

$32,662,535 $37,731,500 $28,179,319 $17,621,768 $12210,266 $7,883,779 $7,289.347 $5,105,643 $1,806,225

$555,322 $1,381,869

$0 $1,133,522

$0 $0

$153,561,096 $54,396

Diagnosis (ICD-9): 296

Minimum Total

Charge per Claimant

$25,000 $40,O00 $55,000 $70,0O0 $85,000

$100,000 $120,000 $15O,O00 $200,000 $250,000 $300,000 $400,000 $500,000 $750,000

$1,000,000 Totals

Maximum Total

Charge per Claimant

$40,000 $55,0O0 $70,000 $85,000

$100,000 $120,000 $150,000 $20O,000 $250,000 $300,000 $400,000 $500,000 $750,000

$1,000.000 $10,000.000

Averages


Claimants in

Range 1991

1,564 414 170 83 38 28 14 14 3 1 1 0

ol 2,330

Claimants in

Range 1992

1,724 480 151 59 37 17 12 8 5 0 0 0 0 0 0

2,493

Total Charges in

Range 1991

$48,485,995 $19,089.209 $10,531,518 $6,423,202 $3,500,716 $3,076,005 $1,878,164 $2,334,700

$692,237 $267,819 $310,519

$0 $0 SO $0

$96,590,083 $41,455

Total Charges in

Range 1992

$53,304,659 $22,142.605 $9,210,585 $4,466,919 $3,401,852 $1,795,924 $1,595,987 $1,350,375 $1,110,084

$0 SO $0 $0' $0~ $6

$98,378,991 $39,462

VII. Analysis of Most Frequent Diagnoses and Analysis of Total Charges by Diagnosis Catego~, Age and Gender 219

TABLE V I I - 2 - - C o n t i n u e d THIRTY MOST FREQUENTLY OCCURRING DIAGNOSES BY RANGE


Dia Inosis (ICD-9): 715

Minimum Total

Charge per Claimant

$25.000 $40.000 $55.00C $70.000 $85,000

$100,000 $120,000 $150.000 $200.000 $250.000 $300.000 $400,000 $500.000 $750.000

$1.000.000 Totals Averages

Mmdmum Total

Charge per Claimant

$40,000 $55,000 $70.000 $65 ,OOG

$100,000 $120,000 $150,000 $200.000 $250.000 $300,000 $400,000 $50O.O0O $750.00O

$1.000.000 $10.000.000


Claimanl~ in

Range 1991

974 247 107 33 15 8 6 7 0 0 0 0 0J 0 C

1,397

Claimants in

Range 1992

1,417 368 147 44 21 5 2 3 0 2 0 0 0 0 0

2,009

Total Charges in

Range 1991

$50.180.900 $11 290.756 $6.636.637 $2.524.717i $1,389,928

$868.680 $827.753

$1 212.189 $0 $0 $0 $0 $0 $0 $0

$54,931,561 $39,321

Total Charges in

Range 1992

$44256,513 $16,918,829 $8,995,327 $3,364,325 $1,939,133

$537,489 $248,343 $477,737

$0 $543,915

$0 $0 S0 $0 $0

$77,261,609 $38,468


Total Charge

per Claimant $25.0OO $40.000 $55.000 $70.000 $85,000

$100.0OO $120.000 $150.000 $200.000 $250,000 $300,000 $400,000 $5O0,OO0 $750.000

$I ,000,000 Totals Averages

Ma)dmum Total

Charge per Claimant

$40.000 $55.000 $70.000 $85.000

$1 00,000 $12o,000 $150.000 $200,000 $250.000 $300.000 $400.000 $500.000 $750.000

$1.000.000 $I 0,000,000


Claimants in

Range 1991

890 246

92 35 29 24 16 14 8 3i 4

1,364

Claimants in

Range 1992

1,233 410 155 69 38 38 33 26 13 10

4 2 1 1 0

2,033

Total Charges in

Range 1991

$27,346,726 $11,356,357 $5,696,782 $2,687,155 $2,695,543 $2,613,661 $2,079,042 $2,400,097 $1,823,152

$858,333 $1,308,672

$835,781 $576,680

$0 $0

$62,277,983 $45,658

Total Charges in

Range 1992

$38,603,856 $18,957,334 $9,561,546 $5,333272 $3,463,431 $4,164,622 $4,335,142 $4,431,868 $2,861,171 $2.750,664 $1,433276

$866,743 $521,831 $752,6O6

$0

$98,037,361 $48,223


TABLE Vl l -2 - -Con t inued THIRTY MOST FREQUENTLY OCCURRING DIAGNOSES BY RANGE

OF CLAIMANT TOTAL CHARGES BY NUMBER OF CLAIMANTS~ TOTAL AND AVERAGE CHARGES FOR ALL PLAN TYPES AND ALL PARTICIPANTS IN 1991 AND 1992


Total Charge

per Claimant $25,000 $40,000 $55,000 $70,0O0 $65,000

$1 00,000 $120,000 $150,000 $200,000 $250,000 $300,000 $400,000 $500,000 $750,00O

$1,000,000 Totals

Maximum Total

Charge per Claimant

$40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $400,000 $500,00O $750,000

$1,000,000 $10,0O0,000

Averages


Claimants in

Range 1991

881 245

80 35 10 5 4 2 1 1 1 0 0 0 0

1,265

Claimants in

Range 1992

1,475 373 133 48 26

8 4 2 1 0 0 0 0 0 0

2,070

Total Charges in

Range 1991

$26,570,177 $11,355,127 $4,873,232 $2,682,164

$923,228 $541,668 $532,599 $317,187 $207,182 $280,530 $329,731

$0 $0 S0 $0

$48,612,825 $38,429

Total Charges in

Range 1992

$44,966,555 $17,273,556 $8,158 ,251 $3,649,758 $2,415,569

$878,906 $519,514 $332,800 $210,754

SO $0 $0 $(1 S0 $0

$78,4O5,665 $37,877


Total Charge

per Claimant $25,000 $40,000 $55,000 $70,000 $55,000!

$100,00(1 $120,00(1 $150,000' $200,000 $250,000= $300,00(1 $400,00(1 $500,00(1 $750,00(1

$1,000,00(1 Totals

Maximum Total

Charge per Claimant

$40,000 $55,000 $70,000 $65,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $400,000 $500,000 $750,000i

$1,000,00Q $10,000,000

AveragDs


Claimants in

Range 1991

571 329 191 99 60 37 31 18 8 2 2 0 0 0 0

1,348

Claimants in

Range 1992

698 440 229 14( 80 65 58 22 12 2 3 0 0 1 0

1,750

Total Charges in

Range 1991

$18,264,586 $15,370,742 $11,828,821 $7,593,175 $5,501,198 $4,033,954 $4,181,955 $3,020,833 $1,743,200

$563,476i $659,963

$0 $0 $O so i

$72,781,903 $53,9e3

Total Charges in

Range 1992

$22,314,798 $20,595,073 $14,257,094 $10,729,605

$7,361,173 $7,948,408 $7,640,854 $3,753,014 $2,765,743

$533,859 $997,311

$0 $0

$969.197 $0

$98,NK,129 $50,552



OF CLAIMANT TOTAL CHARGES BY NUMBER OF CLAIMANTS, TOTAL AND AVERAGE CHARGES fOR ALL PLAN TYPES AND ALL PARTICIPANTS IN 1991 AND 1992


Minimum Total

Charge per Claimant

$25,000 $40.000 $55.000 $70.000 $85.ooo

$100.000 $120.000 $150.000 $200,000 $250.000 $3O0.000 $400.000 $500.000 $750.000


Maximum Total

Charge per Claimant

$40.000 $55.000 $70.000 $85.000

$100.000 $120.000 $150.000 $200.000 $250.000 $300.000 $400.000 $500.000 $750.00O

$1.000.000 $10.000.000


Claimants in

Range 1991

409 221 136 81 54 41 41

6 7 2 0 1 0

1,035

Claimants in

Range 1992

518 318 195 123 75 68 47 51 14 11 11 3 5 1 2

1,44Z

Total Charges in

Range 1991

$12,678,580 $10,481,302 $8,390,931 $6252,820 $4,983,403 $4,441,052 $5,445,880 $5,094,194 $1,589,679 $1,689,369 $2,451 ,O60

$945.107 $0

$970.404 $0

$65,613,780 $63,395

Total Charges in

Range 1992

$16.304.527 $14.812.255 $12.148.447; $9.486.136 $6.921.209 $7.440.271 $6.232.813 $8.814.480 $3.147.699 $2.968.868 $3.690.275 $1.333.787 $2.918.955

$753.979 $2.196.456

$99,170.156 $68,773


Total Charge

per Claimant $25.000 $40.000 $55.000 $70.000 $85.000

$100.000 $120.000 $150.000 $200.000 $250.000 $300.000 $400.000 $500.000 $750.000


Maximum Total

Charge per Claimant

$40.000 $55.000 $70.000 $85.00O

$100.000 $120.000 $150.000 $200,000 $250.000 $300.000 $40O.00O $50O.00O $750.000

$1.000.000 $10.000.000


Claimants in

Range 1991

689 307 143 69 29 17 11 6 3 2 0 0 0 0 0

1,276

Claimants in

Range 1992

512 216 97 50 19 21 12 6 1 1 0 0 0 0 0

935

Total Charges in

Range 1991

$21.525.965 $14.276.925 $8.849.227 $5.186.945 $2.649.157 $1.846.051 $1.473.931 $1.050.087

$688,313 $571.763

SO $0 SO SO $0

$58,118.364 $45,547

Total Charges in

Range 1992

$15.976.085 $10.075.346 $5.977.180 $3.823.395 $1.741.560 $2.302.029 $1.548.387

$987.373 $236.605 $269.385

$0 $0 $9 $0 $9

$42,937,348 $45,922




Dia Inosis (ICD-9): 585 Minimum

Total Charge

per Claimant $25,000 $40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $15O,000 $200,000 $250,000~ $300,00(] $400,00(] $500,00(] $750,000

$1,000,000 Totals

Maximum Total

Charge per Claimant

$40,000 $55,000 $70,000 $65,000

$100.000 $120.000 $150,000 $200,000 $250,000 $300,000 $400.000 $500,000 $750,000

$1 ,ooo,oooi $10,000,000

Averages


Claimants in

Range 1991

279 173 141 92 70 38 37 25

8 6 4 1 2 0 1

877

Claimants in

Range 1992

372 261 194 143 83 72 45, 31

6 6 2 2 0 0 0

1,217

Total Charges in

Range 1991 $8,851.116 $8241.426 $8.669.049 $7.129.716 $6.491.656 $4,112,888 $4.955.952 $4.175.284 $1,781,566 $1,664,150 $1,450,813

$483,8o51 $1,203,384

$o $1,277,169

$80,487,975 $88,971

Total Charges in

Range 1992

$11,950,629 $12,255,881 $12,008,584 $10,917,456 $7,816,856 $7,890,837 $6,038,171 $5.322.090 $1.309.358 $1,609.875

$728.783 $873.345

So $o $o

$78,521,867 $64,521

Dia Inosis (ICD-9): 765 Minimum

Total Charge

per Claimant $25,000 $40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $15O,000 $200,000 $250,000 $300,000 $400,000 $500,000 $750,0O0

$1,000,000 Totals

Maximum Total

Charge per Claimant

$40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $400,000 $500,000 $750,000

$1,000,000 $10.000,000

Averages


Claimants in

Range 1991

278 123 113 58 47 57 59 73 31 24 16 9 6 5 4

003

Claimants in

Range 1992

298 180 137 77 62 82 61 86 42 41 25 20 14 2 3

1.130

Total Charges in

Range 1991 $8.874,913 $5.799.911 $6.939.365 $4.479.429 $4.298.555 $6.327.199 $7,958.490

$12.535,946 $6,843.566 $6.547.912 $5,575,362 $3,894,842 $3.394.899 $4,221,951 $6.536.619

$94,228.960 $104,351

Total Charges in

Range 1992 $9.572,708 $8.422.886 $8.524.416 $5.919,793 $5,709,283 $8.999,589 $8,152.797

$15.148.048 $9,262,382

$11,166,2631 $8.579.424 $8,704,368 $8,120,561 $1,683,579 $3,754,074

$121,720,171 $107,717




Dia Inosls (ICD-9): 574

Minimum Total

Charge per Claimant

$25,000 $40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $400,000 $500,000 $750,000


Ms,~dmum Total

Charge per Claimant

$40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,0OO $250,00(] $300,000 $400,00O $500,000 $750,000

$1,0000,000 $10,000,000


Claimants in

Range 1991

524 126 45 15 5 4 3 1 4 0 0 0 1 0 0

730

Claimants in

Range 1992

883 140 59 21

8 14 4: 3 1 0 1 0 0 0 0

1,134

Total Charges in

Range 1991

$15,754,400 $5,942~47 $2,600,664 $1,166,731

$454,767 $412,075 $403,672 $156,744i $914,482

SO SO $0

$565,894 SO SO

$28,671,688 $39,139

Total Charges in

Range 1992

$26,463,886 $8,396,320 $3,550,447 $1,614,982

$734,307 $1,557,167

$530,393 $512,580 $243,832

$0 $347,471

SO $0 SO SO

$41,951,385 $36,994


Minimum Total

Charge per Claimant

$25,000 $40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,000 $250,00O $300,000 $400,000 $500,000 $750,000


Maximum Total

Charge per Claimant

$40,000 $55,000 $70,000 $85,000

$100,000 $120,0001 $156,000 $200,0O0 $250,0OO $300,00O $400,00O $500,0OO $750,000

$1,000,000 $10,000,000


Claimants in

Range 1991

364 95 34 13 8 5 7 2 0 0 0 0 0 0 0

528

Claimants in

Range 1992

784 196 38 19 8i

10 4 3 1 0 1 0 0 0 0

1,064

Total Charges in

Range 1991

$11,248,379 $4,348,414 $2,160,113

$988,794 $752,560 $836,255 $926,600 $314,531

SO SO SO SO $0 $0~ SO

$21,27S,946 $40,296

Total Charges in

Range 1992

$24,178,674 $8,998,988 $2,299,120 $1,470,787

$752,087 $1,081,559

$522,345 $557,898 $244,116

SO $328,472

$0 $0 $0 SO

$40,434,046 $38,002



OF CLAIMANT TOTAL CHARGES BY NUMBER OF CLAIMANTS~ TOTAL AND AVERAGE CHARGES FOR ALL PLAN TYPES AND ALL PARTICIPANTS IN 1991 AND 1992

DJa Inosis (JCD-9): 799

Minimum Total

Charge per Claimant

$25.00O $4O.000 $55.000 $70.000 $85.000

$100,000~ $120,000 $150.000 $200,000 $250.000 $300.000 $4O0.000 $500.00O $750.000


Maximum Total

Charge per Claimant

$40.000 $55,000 $70,000 $95.O00

$100,000 $120,000 $150.0001 $200.00O $250.00O $300.00O $400.000 $500.000 $750.000

$1,000,000 $10,000,000


Claimants in

Range 1991

603 180 79 53 31 34 25 2O 11 7 5 4 3 3 7

1,06 5

Claimants in

Range 1992

24O 8i 48 21 14 10 19 11 16 6

12 3 8 4 9

$12

Total Charges in

Range 1991

$18,651,180 $8,4O5.082 $4.879.062 $4,061,364 $2,836.246 $3,619.548 $3.367,518J $3.430.803! $2.482.959 $1.891.233 $1.576.953 $1.751.097 $1.669.855 $2.872242

$15.939.455

$77,434,599 $72,709

Total Charges in

Range 1992 $7,402,300 $4.173,477 $2.994,859 $1.633.637 $1.271.464 $1.081.780 $2,544,436 $1.865.542 $4.051.439 $1.647.076 $4.109.003 $1.366.115 $4.777.043 $3.465.352

$29.169.435

$71,883,087 $139,752


Minimum Total

Charge per Claimant

$25.000 $40.000 $55.000 $70.000 $85.000

$1 00.000 $120.000 $150,000 $2OO,OOO $250,000 $300,000 $400.000 $500.000 $750.O00

$1.000.000 Totals Average*;

Ma~mum Total

Charge per Claimant

$40.000 $55.000 $70,000 $85.000

$100.000 $120.000 $150.000 $200,000 $250.000 $300,000 $400.000 $500.000 $750.000

$1.000.000 $10.000.000

Combined Rank: 16.00

Claimants Claimants in in

Range Range 1991 1992

409 398 137 151 72 78 58 42 22 28 19 28 21 21 18 15 10 10 3 8 3 5 3 3 2 3 0 2 1 01

778 790

Total Charges in

Range 1991

$12.704,517 $6,356.652 $4.467.367 $4,434.340 $2,009.903 $2,067.691 $2,844.585 $3,107.693 $2.202,810

$817,835 $951,960

$1,364,858 $1,310.748

$o $1,061.671

$45,704,629

Total Charges in

Range 1992

$12.293.091 $9.953.497 $4.872.394 $3.265.938 $2.560.978 $3.108,858 $2,822.655 $2.597.180 $2.306,490 $1.648,885 $1,767,979 $1.359.071 $1.685.723 $1.804.810

$0

$49.947,550 $62,086

VII. Analysis of Most Frequent Diagnoses and Analysis of Total Charges by Diagnosis Category, Age and Gender 225



Diagnosis (ICD-9): 427 M~nimum

Total Charge

per Claimant $25,000 $40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $400,000 $500,000 $750,000

$1,000,0O0 Totals Averages

Madmum Total

Charge per Claimant

$40,000 $55,000 $7O,OOO $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $3OO,OOO $400,000 $500,000 $750,0O0

$1,000,000 $10,000,000


Claimants in

Range 1991

326 104 80 35 28 26 31 18 10 6 41 1; O 0 0

869

Claimants in

Range 1992

411 157 74 67 38 29 34 19 9 6 6 2 0 0 0

852

Total Charges in

Range 1991

$10,093,578 $4,889,339 $4,890,571 $2,678,918 $2,588284 $2,810,806 $4,191,596 $3,176,644 $2,267,640 $1,683.920 $1,406,635

$410,191 $0 $0 SO

$41,068,122 $61,387

Total Charges in

Range 1992

$12,855,546 $7207,301 $4,544,900 $5,158,796 $3,52O,087 $3,174,695i $4,471,589i $3,191,569 $2,075,412 $1,591,955 $2,022,813

$875,797 $0 $0 $0

$50,690,460 $59,496


Minimum Total

Charge per Claimant

$25,000 $40,000 $55,000 $70,000 $85,000

$1 00,000 $I 2O,OOO $150.000 $2O0,0OO $250,000 $300,000 $400,000 $500,000 $750,000

$I ,000,000 Totals Averages

Maximum Total

Charge per Claimant

$40,000 $55,000; $70,000i $85,000

$100,000 $120,00O $150,000 $200,000 $250,000 $300,00O $400,000 $500,000 $750,000

$1,000,000 $10,000,000


Claimants in

Range 1991

301 11~ 59 53 22 26 19 18 4 4 4 4 1 1 3

63:

Claimants in

Range 1992

346 166 63 47 39 25 23 19 10 2 4 0 2 1 0

747

Total Charges in

Range 1991 $9,422,853 $5281,73g $3,660,895 $4,048,992 $2,038,245 $2,872,348 $2,546,026 $3,065,69§

$930,367 $1,110,197 $I ,259,42O $I ,750,344

S648,968 $795,020

$3,574290

$43,005,402 $67,939

Total Charges in

Range 1992

$10,844,350 $7,720,768 $3,871,005 $3,596,072 $3,581,616 $2,694,118 $3,159,882 $3,211,433 $2,219,614

$539,103 $1,450,149

$0 $1,068,154

$815,521 SO

$44,771,785 $50,935





Minimum Total

Charge per Claimant

$25,000 $40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $400,000 $500,000 $75O,OO0


Maximum Total

Charge per Claimant

$40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $400,000 $500,000 $750,000

$1,000,000 $10,000,000


Claimants in

Range 1991

314 11: 59 34 21 23 27 15 13 6 5 3 3

635

Claimants in

Range 1992

378 135 67 4(] 25 19 16 17 14 9 9 0 3 0 0

732

Total Charges in

Range 1991 $9,7O9,509 $5,133,641 $3,688,603 $2,609,197 $1,940,594 $2,513,205 $3,575,171 $2,574,804 $2,938,638; $1,624,460 $1,683,944 $1.364,342 $1,900,290

$0 $0

$41,256,400 $64,971

Total Charges in

Range 1992

$11,860,034 $6,264,678 $4,157,170 $3,106,939 $2,255,999 $2,052,829 $2,112,396 $2,892,954 $3,149,731 $2,454,703 $3,071,578

$0 $1,801,842

$0 $0

$45,180,853 $61,722


Total Charge

per Claimant $25,000 $40,000 $55,000 $70,000! $85,000

$100,000 $120,000i $150,000 $200,000 $250,000 $300,000 $400,000 $500,000 $750,000

$1,000,000 Totals

Maximum Total

Charge per Claimant

$40,000 $55,000 $70,000 I $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $4O0,00O $500,000 $750,000

$1,000,000 $10,000,000

Averages


Claimants in

Range 1991

213 121 44 45 33 29 30 19 6 8 4 2 0 0 0

554

Claimants in

Range 1992

344; 172 89 53 32 36 29 22 9 6 6 3 1 1 2

805

Total Charges in

Range 1991 $6,552,361 $5,760,927 $2,708,717 $3,506,283 $2,992,413 $3,147,291 $4,068,059 $3,253,015 $1,357,328 $2,130,840 $1,332,097

$850,444 $0 $0 $0

$37,659,795 $67,978

Total Charges in

Range 1992

$10,790,583 $8,033,576 $5,508,854 $4,059,994 $2,928,845 $3,959,700 $3,824,932 $3,688,178 $1,991,317 $1,686,741 $1,993,314 $1,345,371

$706,511 $847,017

$2,584,11~

$53,949,045 $67,017

VII. Analvsis of Most Frequent Diagnoses and Analysis of Total Charges by Diagnosis Catego~, Age and Gender 227

TABLE V l l - 2 - - C o n t i n u e d

THIRTY MOST FREQUENTLY OCCURRING DIAGNOSES BY RANGE OF CLAIMANT TOTAL CHARGES BY NUMBER OF CLAIMANTS, TOTAL AND AVERAGE CHARGES

FOR ALL PLAN TYPES AND ALL PARTICIPANTS IN 1991 AND 1992

Dia inosis (ICD-9): 198 Minimum

Total Charge

per Claimant $25,000i $40.000 $55.000 $70.000 $85,000

$1 00,000 $120,OO0 $150,OO0 $200,000 $250.000 $300.000 $400.000 $500.000 $750.000


Ma~mum Total

Charge per Claimant

$40.0OO $55.000 $70.000 $85.000

$1 00.000 $120.000! $150.000 $200.000 $250,000 $300,000 $400.000 $500.000 $750.000

$I ,000.000 $10.000.000


Claimants in

Range 1991

219 111 80 45 36 17 23 23 5 2 0 0 0 0 0

58

Claimants in

Range 1992

256 155 100 73i 42 42 32 32 11 10 4 3 1 0 0

76'

Total Charges in

Range 199-1 $6,947,441 $5,174,800 $4,905,031[ $3,444.811 $3.289.047 $1.851.260 $3.004.707 $3,936,664 $1.100,803

$562.057 $0 $0 $0 $0 $0

$34,222.620 $61,003

Total Charges in

Range 1992 $8.187.849 $7.329.976 $6.185.491 $5.649.082 $3.852.750 $4.639.510 $4.336,001 $5,471,091 $2,476,695 $2,746,427 $1,309,301 $1.344.70(~

$590.908 $0 S0

$54,119,842 $71.117


Minimum Total

Charge per Claimant

$25,000 $40,000 $55,000 $70,000 $85,000

$100.000 $120.000 $150.000 $200.000 $250.000 $300.000 $400.000 $500.000 $750.000

$1.0O0.00O Totals Averages

Ma3dmum Total

Charge per Claimant

$40.000 $55.000 $70.000 $85.000

$100.000 $120.000 $150.O00 $200.000 $250.000 $300,000 $400.000 $500.000 $750.00O

$1.000.000 $10.000.000


Claimants in

Range 1991

259 104 53 48 27 25 19 22 6 4 2 1 1 0 0

57

Claimants in

Range 1992

315 135 86 39 26 32 21

Total Charges in

Range 1991 $8.121.988 $4.776.215 $3.288.369 $3.712.113 $2.504.410 $2,723,626 $2.608,292

28 $3.725.204 8 $1.349.983 1 $1.097.918 2 $717.822 0 $409,636 1 $553,304 0 $0 0 $0

694 $35,588,880 $62,327

Total Charges in

Range 1992 $9.877.506 $6.320.580 $5.329.878 $2,994,491 $2,363,340; $3,489,546 $2,829,114 $4,792,505 $1,750,494

$263,305 $680,920

$0 $574.890

SO SO

$41,266,569 $S9,462


TABLE V l I - 2 - - C o n t i n u e d THIRTY MOST FREQUENTLY OCCURRING DIAGNOSES BY RANGE

OF CLAIMANT TOTAL CHARGES BY NUMBER OF CLAIMANTS~ TOTAL AND AVERAGE CHARGES rOR ALL PLAN TYPES AND ALL PARTICIPANTS IN 1991 AND 1992


Minimum Total

Charge per Claimant

$25,000 $40,000 $85,000 $70,000 $95,000

$100,000 $120,000 $150,OO0 $2OO,OOO $250,000 $300,000 $400,000 $500,000 $750,000

$1,000,0O0 Totals Averages

Maximum Total

Charge per Claimant

$40,000 $85.O0O $70,000 $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $400,000 $500,000 $750,000

$I ,000,000 $10,000,000!


Claimants in

Range 1991

258 128 55i 3C 14 13 8 7 3 1 1 1 0 0 0

519

Claimants in

Range 1992

369 187 73 35 23 2O 14 7 3 2i 0 2 0 0 0

735

Total Charges In

Range 1991 $8,037,OO8 $8,923,319 $3,423,297 $2,333,416 $1.771,112 $1,422,882 $1,053,653 $I ,106,468

$623,417 $286,275 $341,490 $487,917

$0,

$(~

$26/100.?.53 $50,868

Total Charges in

Range 1992

$11,646,101 $9,660,446 $4,524,453 $2,695,684 $2,105,458[ $2,180,227 $1,877,432 $1,208,585

$665,301 $539,979

$0 $853,720

$0 $0 $0

$36,957,386 $S0,282


Minimum Total

Charge per Claimant

$25,000 $4o,ooo $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,0O0 $250,000 $300,000 $400,000 $500,O00 $750,000

$I ,000,000 Totals

Maximum Total

Charge per Claimant

$40,000 $55,000 $70,000 $85,000

$1 00,000 $120,000 $1 50,000 $200,000 $250,0OO $300,000 $400,000 $500,000 $750,000

$I ,000,000 $10,000,000

Averages


Claimants Claimants in in

Range Range 1991 1992

375 65 25 8 4 2 1 4 0 0 0 0 0 0 0

484

546 108 23 13 2 2 3 0 1 0 0 0 0 0 0

698

Total Charges in

Range 1991

$11,323,156 $2,989,929 $1,535,135

$610,601 $363,661 $205,456 $132,242 $844,2O3

$0 $0 $0 $0 $8 $8 $0

$17,804,384 $36,78'~

Total Charges in

Range 1992

$16,668,580 $4,979,104 $1,406,673

$975,747, $187,120 $22O348! $405,1131

$0 $235,8O5

$0 $8 $0 $0

$25,078,888 $3S,930





Minimum Total

Charge per Claimant

$25,000 $40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,00O $200,000 $250,000 $300,000 $400,000 $500,000 $750,000


Maximum Total

Charge per Claimant

$40,000 $55,000 $70,000 $65,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $400,000 $500,000 $750,000

$1,000,000 $10,000,000

Combined Rank : 2S.00

Claimants in

Range 1991

183; 121 61 39 21 19 19 18 1 4 2 0 0 0 0

488

Claimants in

Range 1992

221 146 93 49 46 36 25 20 14 2 5 1 1 0 0

659

Total Charges in

Range 1991 $6,898,573 $5,622,808 $3,764,564 $2,986,851 $1,643,809i $2,058,0361 $2,557,395 $3,009,825

$237,925 $1,118,240

$689,445 $0 $0 $0 $0

$29,887,469 $61,245

Total Charges in

Range 1992 $7,140,439 $6,766,823 $5,837,609 $3,755,574 $4,258,638 $3,968,832 $3,371,935 $3,425,637 $3,160,660

$531,787 $1,820,911

$448,500 $595,559

$0 $0

$46,082,904 $66,411


Minimum Total

Charge per Claimant

$25,000 $40,000 $55,000 $7O,0O0 $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $400,000 $500,000 $750,000


Maximum Total

Charge per Claimant

$40,000 $55,000 $70,000 $65,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $400,000 $500,000 $750,000

$1,000,000 $10,00o,oo0


Claimants Claimants in

Range 1991

210 94 50 3O 23 15 11

in Range 1992

10 8 4 4 2 1 0 0

462

309 122 58 36 38 25 24 15 10 3 3 1 2 0 0

641

Total Charges in

Range 1991 $6,602,874 $4,488,615 $3,136,214 $2,293,050 $2,122,985 $1,652,072J $1,521,895 $1,675,580 $1,853,037 $1,095,678 $1,214,035

$886,489 $557,286 !

$01 $0

$29,099,812 $62,987

Total Charges in

Range 1992 $9,686,699 $5,706,247 $3,642,721 $2,748,047 $3,485,193 $2,713,834 $3,220,821 $2,568,636 $2,216,636

$807,705 $1,071,085

$426,506 $1,319,946

$0 $0

$39,614,077 $61,322





Minimum Total

Charge per Claimant

$25,000 $40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $300,OO0 $400,000 $500,0O0 $750,000

$1,000,000 Totals

Maximum Total

Charge per Claimant

$40,000 $55,000 $70,000i $85,00O

$100,000 $120,000 $150,000 $200,000 $250,O0O $30O,O00 $400,000 $500,000 $750,000

$1,000,000 $10,000,000

Averages


Claimants in

Range 1991

109 128 94 56 35 21 20 7 4 2 0 0 0

476

Claimants in

Range 1992

94 167 150 82 37 27 22 17 2 1 3 1 1 0 0

604

Total Charges in

Range 1991 $3,622,373 $8,110,545 $5,795,8371 $4,318,054 $3,243.471 $2,269,068 $2,670,196 $1,174,635

$864,079 $556,542

$0 $0 $0 $0 $0

$30,624,800 $64,338

Total Charges in

Range 1992 $3,068,863 $8,015,886 $9,242,902 $8,243,956 $3,394,290 $2,970,301 $2,884,358 $2,816,265

$426,343 $281,512

$I ,055,686 $408,913 $669,686

$0 $0

$41,478,960 $68,674

Diagnosis (ICD-9): V30

Minimum Total

Charge per Claimant

I

$25,000 $40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,000 $250,OOO $30O,0OO $400,000 $500,0OO $75O,0O0

$1,000,000 Totals

Ma3dmum Total

Charge per Claimant

$40,000 $55,000 $70,000 $85,000i

$100,000 $120,000 $150,000 $200,000 $250,000 $300,000 $40O,00O $500,000 $750,000

$1,000,000 $10,000,000

Averages


Claimants in

Range 1991

129 83 55 33 23 26 27 23 8 7 7 1 4 1 0

427

Claimants in

Range 1992

263 108 75 39 31 29 27 34 12 7

10 6 2 1 0

644

Total Charges in

Range 1991 $4,053,930 $3,985,185 $3,421,729 $2,576,994 $2,132,627 $2,832,822 $3,615,042 $3,893,749 $1,763,907 $1,882,234 $2,401,167

$437,986 $2,365~71

$870,275 SO

$36,232,9111 $84,855

Total Charges in

Range 1992 $8,317,228 $5,004,696 $4,668,647 $2,982,223 $2,852,719 $3,130,590 $3,679,801 $5,922,883 $2,669,760 $1,849,359 $3,475,588 $'2,585,092 $1,072,686

$962,871 $0

$49,174,143 $76,357




Dia inosis (ICD-9): 724 Minimum Maximum

Total Total Charge Charge

per Claimant per Claimant $25,000 $4O,O0O $40,00O $55,00O $55,00O $70,000i $70,000 $85,000 $85,000 $100,000

$100,000 $120,000 $120,000 $150,000 $150,000 $200,000 $200,000 $250,0OO $250,000 $300,000 $300,000 $400,000 $400,000 $500,000 $500,000 $750,000 $750,000 $1,000,000

$1,000,000 $10,000,000 Totals Averages


Claimants in

Range 1991

304 91 40 12 9 3

11 1 2 0 1 0 0 o; Oi

47,

Claimants kl

Range 1992

352 128

58 18 12 10 7 3 2 1 1 0 0 0 0

590

Total Charges in

Range 1991 $9,500,053 $4,230,451 $2,452,739

S941,3e5 $831,160 $332,23o

$1,477~50 $166,801 $425,457

SO $316,874

SO SO SO SO

$20,674,400 $43,617

Total Charges in

Range 1992

$10,907,948 $5,943,555 $3,514,873 $1,348,637 $1,137,132 $1,126,075

$949,900 I $489,040i $416,301 $253,111 $378,587

$0 $0 $0 $0

$26,465,160 $44,8rdS


Total Charge

per Claimant $25,000 $40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $20O,O00 $25O,000 $300,000 $400,000 $500,000 $750,000


Ma)omum Total

Charge per Claimant

$40,000 $55,000 $70,000 $85,000

$100,000 $120,000 $150,000 $200,000 $250,000 $3O0,000 $400,000 $500,000 $750,000

$1,000,000 $10,000,000


Claimants Claimants in

Range 1991

385 93 33 16 3 9 1

in Range 1992

3 1 0 0 0 0 0 0

544

390 85 22 10 1 1 1 1 0 0 0 0 0 0 0

511

Total Charges in

Range 1991

$11,900,864 $4270,362 $2,023,395 $1,195,760

$278,725 $973,261 $125,412 $495,659 $241,941

$0 $0 $0 SO $0 $0

$21,S05,379 $39,532

Total Charges in

Range 1992

$11,890,207 $3,972,068 $1,339,309

$771,332 $87,264

$102,208 $141,296 $190,245

SO $0 $0 $0 $0 $0 $0

$18,493,929 $36,192


C3

I'O

TABLE VII -3 TOTAL CHARGES BY AGE RANGE, GENDER AND DIAGNOSIS CATEGORY

FOR ALL PLAN TYPES AND ALL PARTICIPANTS IN 1991

Age At Least : 0 Gender : Male

Low High ICD9 ICD9

of Rankle of Range 680 290 630 580 710 380 280 240 001 320

390 459 140 239 800 999 460 510 780 799 520 570 V00 V83 740 779

Totals for Gender

Age Less Than : 2

Diagnosis Category Number of Percent of Percent of Descdption Claimants Claimants Total Charges j Total Charges

709 Skin Disorders 1 0.0 % $35,375 0.0 % 319 Mental Disorders, Drug, Alcohol 3 0.t % $91,584 0.0 % 679 Pregnancy & Childbirth 5 0.2 % $540,689 0.3 % 629 Genitourinary System 9 0.4 % $660,756 0.3 % 739 Skeleton & Muscle System 9 0.4 % $709,291 0.4 % 389 Sense Organs 11 0.5 % $911,459 0.5 % 289 Blood Related Disorders 10 0.5 % $1,001,064 0.5 % 279 Endocdne & Metabolic Disorders 20 1.0 % $2,074,171 1.1% 139 Infectious & ParesiUc Disease 26 1.3 % $2,1')2,697 1.1% 359 Ner4ous System 29 1.4 % $2,230,875 1.2 %

Unknown Diagnosis 32 1.5 % $2,399,890 1.2 % C4rculatory System 31 1.5 % $2,438,364 1.3 % Malignant Neop lam 43 2.1% $3,715,205 1.9 % Injury & Poisoning 50 2.4 % $4,458,971 Respiratory System 97 4.;r % $7,145,071 Symptoms & IIl-Oeflned Condition 83 4.0 % $7,534,134 DigesUve System 61 2.9 % $8,356,328 Health Status or Service 250 12.0 % $22,630,774

Average Total Charges per Claimant

$35,375 $30,528

$108,138 $73,418 $78,810 $82,860

$100,106 $103,709

$84,335 $76,927 $74,997 $78,592 $86,4O0

2.3 % $89,179 3.7'% $73,661 3.9 % $90,773 4.3 % $137,022

11.7 % $90,523' Congenital & Pednatal 1,309 63.0 % $124,437,025 64.3 %

2,079 $193,563,725

$95,063

$93,104

t,o L~

3"

TABLE Vll-3--Continued TOTAL CHARGES BY AGE RANGE, GENDER AND DIAGNOSIS CATEGORY

EOR ALL PLAN TYPES AND ALL PARTICIPANTS IN 1991

Age At Least : 0 Gender : Female

Low High ICD9 ICD9

of Range, of Range 680 290 710 630 240 580 280 001 360

800 999 390 459 140 239 320 359 460 519 520 579 780 799 V00 V83 740 779

Tota~ forGender Totals forAge Range

Age Less Than: 2

Diagnosis Category Number of Percent of Percent of Description Claimants Claimants Total Charges Total Charges

709 Skin Disorders 1 0.1%: $44,148 0.0 % 319 Mental Disorders, Drug, Alcohol 3 0.2 % $122,871 0.1% 739 Skeleton & Muscle System 6 0.3 % $267,425 0.2 % 679 Pregnancy & Childbirth 3 0.2 % $487,895 0.3 % 279 Endocrine & Metabolic Disorders 11 0.6 % $775,980 0.5 % 629 Genitourinary System 12 0.7 % $866,020 0.5 % 289 Blood Related Disorders 9 0.5 % $1,247,365 0.8 % 139 Infect~us & Parasitic Disease 23 1.3 % $1,628,314 1.0 % 389 Sense Organs 11 0.6 % $1,733,625 1.1%

Unknown Diagnosis 37 2.0 % $2,402,385 1.5 % Injury & Poisoning 39 2.2 % $2,698,406 1.7 % Circulatory System 28 1.5 % $2,734,973 1.7 % Malignant Neoplasms 39 2.2 % $3,087,116 1.9 % Nervous System 38 2.1% $3,723,320 2.3 Respiratory System 58 3.2 % $5,148,352 32 ~q Digestive System 48 2.7 % $5,371,718 3.3 % Symptoms & Ill-Defined Condition 77 4.3 % $8,192,334 5.0 ~( Health Status or Sendce 232 12.8 % $20,402,299 12.5 CongenRal& Perinatal 1,135 62.7 % $101,679,453 62.6

1,810 $162,814,000 3,889 $356,377,725


$44,148 $40,9571 $44,5711

$162,632 $70,544 $72,166

$136,596 $70,796

$157,602 $94,929 $89,190 $97,676 $79,157 $97,982 $88,76S

$111,911 $106,394

$87,941 $89,762

$89,952 $91,637

t%

t,O



Age AtLeast: 2 Gender: Ma~

360 389 580 629 V00 V83 001 139 390 459 280 289 710 739 460 519 240 279 320 359 520 579

Tota~forGender

Age Less Than: 18

Diagnosis Category Number of Percent of Description Claimants Claimants

Pregnancy & Childbirth Skin Disorders Unknown Diagnosis Sense Organs Genitourinary System Health Status or Service Infectious & Parasitic Disease Circulatory System Blood Related Disorders Skeleton & Muscle System Res~atory System Endocrine & Metabolic Disorders Nervous System Digesl~e System Symptoms & Ill-Defined Condition

& Pefinatal Neoplasms

injury & Poisoning Disorders, Drug, Alcohol

Pement of Total Char~les Total Charges

0.1% $250,087 0.1% 10" 0.3 %" ' $552,33() 0.3 % 15 0.5 % $971,760 0.5 % 38 1.3 % $1,664,843 0.9 % 43 1.5 % $2,854,810 1.6 % 52 1.8 % $3,339,212 1.9 % 32 1.1% $3,696,750 2.1% 81 2.8 % $4,414,264 2.4 % 72 2.5 % $5,269,017 2.9 %

124 4.2 % $8,663,323 3.7 % 107 3.7 % $7,012,132 3.9 % 151 5.2 % $7,584,300 4~. % 106 3.6 % $7,970,217 4.4 % 120 4.1% $8,635,104 4.8 % 123 4.2 % "$9,513,505 5.3 % 261[ 8.9 % $16,398,306 9.1 % 232 / 7.9 % $25,026,839 13.9 % 410l. 14.0 % $26,106,942 14.5 % 9521 32.5 % $42,335,607 23.5 %

2,931 $180,259,349


$125,044 $55,233 $64,784 $43,812 $66,391 $64,216

$115,523 $54,497 $73,181 $53,736 $65,534 $50,227 $75,191 $71,959 $77,346 $62,829

$107,874 $63,675 $44,470

$61,501

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TABLE VlI-3--Continued TOTAL CHARGES BY AGE RANGE, GENDER AND DIAGNOSIS CATEGORY


Age At Least : 2

Gender : Female

Low High ICD9 ICD9

of Range of Range 680 709 630 679

360 389 390 459 V00 V83 580 629 001 139 280 289 240 279 710 739 460 519 780 799 520 579 320 359 740 1 779 800 i 999 140 239 290 319

Totals for Gender

Age Less Than : 18

Diagnosis Category Description

Skin Disorders Pregnancy & Childbirth Unknown Diagnosis Sense Organs Circulatory System Health Status or Service Ger~;;ourinary System Infectious & Parasitic Disease Blood Related Disorders Endocrine & Metabolic Disorders Ske|e~u. & Muscle System Re~;,,,;ory System S~-n~oms & lll-Definod Condition l~ei~ve Sy~te,~ Nervous System Congenital & Perinatal Injury & Poisoning "Malignant Neopla.~ms Me,,t.l Disorders, Drug, Alcohol

Average Number of Percent of Percent of Total Charges Claimants Claimants Total Charges Total Che~_-~_ per Claimant

13 0.5 % $699,500 0.4 % $53,808 15" 0.5 % $702,534 0.4 % $46,8~'~_ 11 0.4 % $799,238 0.5 % $72,6~r~_ 36" 1.3 % $1,644,004 1.0 % $45,667 58 2.1% $3,289,806 1.9 % $56,721 38 1.3 % $3,367,009 2.0 % $88,L~__

2.3 % $3,547,248 2.1% $55,426 54! 1.9 % $3,881,241 2.3 % 48 1.7 % $3,932,565 2.3 %

123 4.4 % $6,204,718 3.7 %

$71,875 $61 ; ~ a $50,445 $40,211 $642~2 $72,557 $63,76O $85,015 $65,6O4 $70,823 $96,748

6.4% $7,278,134 4.3% 126 4.5 $8,093,194 4.8 % 115 4.1%| $8,344,058 4.9% 13;2 4.7%| $8,416,277 5.0% 108 3.8% . | $10,261,597 6.0% 253 9.0 %[ $16,597,932 9.8 % 27 9.9 %[ $19,759,507 11.6 % 22 7.9 %| $21,922,001 12.9 % 94 33.5 %L $40,972,275 24.1% $43,449

2,819 $169,712,837 $60,203

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TABLE VII-3--Continued TOTAL CHARGES BY AGE RANGE, GENDER AND DIAGNOSIS CATEGORY


Age At Least : 2 Gender : Blank Field

Low High ICD9 ICD9

of Range of Range 390 459 740 779

Totals for Gender Totals for Age Range

Age Less Than: 18


Circulatory System Congenital & Perinatal

Number of Percent of Percent of Claimants Claimants I Total Charges Total Cha~es

I 50.0 % $35,324 34.1% 1 50.0 % $68,378 65.9 %

2 $I O3,7O2 5,752 $350,075,888


$35,324 $68,378

$51,851 $60,862

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TABLE Vll-3--Continued TOTAL CHARGES BY AGE RANGE~ GENDER AND DIAGNOSIS CATEGORY


Age At Least : 18 Gender Male

Lo~ Higl ICDI ICD Rat o:Rar 63C 67.¢

74C 77S 36Q 388 680 708 280 288 240 279 320 35g V00 V83 290 319 580 629 460 519 001 139 710 739 780 799 520 579 800 999 140 239 390 459

Totals for Gender

Age Less Than : 65


Pregnancy & Childbirth Unknown Diagnosls Congenital & Pednatal Sense Organs Skin Disorders "Blood Related Disorders "Endocrine & Metabolic Disorders "Nervous System "Health Status or Service ~lental Disorders, Drug, Alcohol Genitourinary System Respiratory System infectious & Paras;~; Disease Skeleton & Muscle System Symptoms & Ill-Defined Condition biges~ve System injury & Poisoning Malignant Neoplasms Circulatory System

Number of Percent of Percent of Claimants Claimants Total Char~les Total Charges

16; 0.6 =A $6,095,44( 0.4 % 13;2 '0.4 %" $10,418,525 0.5 % 188 0.6 %" $10,507,335 0.6 % 241" 0.8%. $11.585_71:1 $11,585,713 0.7 % 263 0.9 % $1"4,872,387 0.9 % 267 0.9 %" $7~.521,94.5 1.3 % 572 1.9 % $34,654,974" 2.0 % 463~ 1.6 % $36,711 397 2.i % 610 2.0 % $39,726,055 2.3 %

1,579 5.3 % $65,928,673 3.8 % 1,227." 4.1% $66,130,311 3.8 % 1,172 3.9 % $76,468,760 1,018 3.4 % $82,827,053

4.4 % 4.e%; 5.0 % 5.5 % 7.0 %

10.6 % 15.4 % 29.1%

2,086 7.0 % $87,349,015 1,451 4.9 % $95,384,799 2,009 6.7 % $121,185,888 2,756 9.2 % $183,672,802 4,410 i4.8 % $267,049,755 9,213 30.9 % $505,998,909

29,824 $1,739,090,135

Average Total Charges per Clali~ant

$36,50C $78,e2 $55,8 $48,073 $56,s4d $84,352" $6o,s $79,291i $65,125 $41,753 $53,896 $65~4e $61,383 $41,874 $65,737 $60,321

,S45 $60,5 , $54,922

$58,312

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TABLE Vll-3mContinued TOTAL CHARGES BY AGE RANGE, GENDER AND DIAGNOSIS CATEGORY



360 389 680 709 280 289 740 779 240 279 320 359 001 139 VO0 V83 630 679 460 519 780 799 580 629 290 319 710 739 800 999 520 579 390 459

Totals for Gander

Age Less Than : 65

Diagnosis Category Number of Percent of Percent of Description Claimants Claimants Total Charges Total Cha~es

Unknown Diagnosis 136 0.5 % $7,149,121 0.5 % Sense Organs Skin Disorders Blood Related Disorders Congenital & Pednatal Endocrine & Metabolic Disorders Nervous System Infec'dous & Parasitic Disease Health Status or Service Pregnancy & Childbirth i Resplratory System Symptoms & lU-Definod Condi~on ;Genitourinary System Mental Disorders, Orug, Alcohol Skeleton & Muscle System Injury & Poisoning Digestive System Circulatow System Malignant Neoplasms

175 0.6 % $7,308,842 0.5 % 236 0.8 % $12,920,989 0.8 % 256 0.9 % $15,809,517 1.0 % 294 1.0 % $16,162,506 1.1% 591 2.1% $34,677,734 2.3 % 587 2.1% $41,452,945 2.7 % 585 2.0 % $42,291,714 2.8 '~


$52,567 $41,765 $54,750 $61,756 $54,975 $58,676 $70,818 $72,294

699 2.4 % $42,798,751 2.8 % $61,229 1,212 42 % ~p48,967,459 3.2 % $40,402 1,167 4.1% $66,937,777 4.4 % $57,359 1,4~;4 5.0 % $75,930,216 5.0 % $52,950 2,187 7.7 % $97,657,032 6.4 % $44,653 2,441 8.5 % $102,658,085 6.7 % $42,056 2,649 9.3 % $i09,573,436 7.2 % $41,394 2,035 7.1% $123,444,126 8.1% $60,861 2,495 8.7 % $138,039,406 9.0 % $55,3~R 3,969 13.9 % $241,089,646 15.7 %! $60,743 5,403 18.9 % $306,439,922 20.0 % $56,717

28,551 $1,531,309,224 $53,634

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Age At Least : 18 Gender : Blank Field

Low High ICD9 ICD9

of Range of Rankle 710 739 520 579 140 239


Age Less Than : 65

Diagno-~s Category Description

Skeleton & Muscle System sysism

Number of Claimants

2 2

i

Percent of Claimants

28.6 % 28.6 %

L Total Charges $mS,STe

Percent of Total Cha~es

22.8 %


$33,288 $33,990 $67.98C 23.3 %

Malignant Neoplasms 3 42.9 % $157,75-9 54.0 % $52,58e i i

7 $292,315 $41,759 5 8 , 3 8 2 $3,270,691,674 $,56,022

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High ICD9

i r y

360 389 680 709 280 289 z~J 319 240 279 320 359 001 139 V00 V83 580 o,'u 710 739 520 579 8OO 999 460 519 780 799 140 239

Totals for Gender

Age Less Than : 120

Dtagnosk; Category Number of Percent of Percent of : Descdplion Claimants Claimants Total Cha~es Total Charges i

Congenital & Perinatal 0.1% $483,049 02 % Unknown Diagnosis Sense Organs Skin Disorders Blood Related Disorders Me.ia; Disorders, Drug, Alcohol Endocrine & Metabolic Disorders Nervous System Infec~ous & Parasitic Disease Health Status or Senlice Genitourinary System Skeleton & Muscle System Diges~ve System Injury & Poisoning Resp;ra;ory System Symptoms & lll-Deflned Condition Malignant Neoplasms Circulatory System

16, 0.3 % $772,129 0.3 %1 291 0.6 % $1,261,364 0.4 %1 30 0.6 % $1,473,715 0.5 % 2~ 0.5 % $1,497,717 0.5 % 531 1.1 % $2,507,788 0.9 % 73 1.5 % $4#.91,166 1.5 % 74 1.5 % $4,820,297 1.7

100 2.1% $6,037,131 2.1% 103 2.1% $6,147,524 2.1% 19! 4.1% $11,081,868 3.8 % 35' 7.3 % $14,915,906 52. % 272 5.6 % $15#.37,386 5.3 .,o: 5.5 % $15,473,580 5.4 302 62. % $19,534,148 6.8 % 19( 3.9 % $24,668,043 8.6 % 83C 17.2 % $42,633,369 14.8 %

1,917 39.6 % $115,643,314

4,836 $288,479,495

40.1%


$69,O07 $482~ $43,495 $49,124 $S7,605 $47,317 $58,783 $65,139 $60,371 $59,RAr. $55,~o $42,49S $ 5 6 , ~ m,3Sl $64.0e3

$129,632 $51,3~ $60,325

$59,653

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Age At Least: 65 Gender: Femab

Low High ICD9 ICD9

of Range of Range 630 679 740 779 " 360 389 "

680 709 280 289 290 319 240 279 320 359 V00 V83 001 139 580 629 780 799 460 519 800 999 520 579 710 739 140 239 390 459

Totals forGender Totals forAge Range

Age Less Than: 120

Diagnosis Category Number of Percent of Percent of l Description Claimants Claimants Total Charges Total Cha~es Pregnancy & Childbiith 2 0.1% $56,414 0.0 Congenital & Perinatal 8 0.3 % $346,726 0~. %" Sense Organs Unknown Diagnosis Skin Disorders Blood Related Disorders Mental Disorders, Drug, Alcohol Endocrine & Metabolic Disorders Nervous System Health Status or Service Infe~.ous & Parasitic Disease Genitourinary System Symptoms & ,I-Defined Condition Respiratory System Injury & Poisoning Dige~:e System Skcl¢ton & Muscle System Malignant Neoplasms Circulatory System

Averageges Total Char per C;~,~,ant

$28,207 $43,341 $32,661 $.58,418 $54,454 $_~0_,446

21 0.7 % $685,885 0.4 %" 13 0.4 % $759,428 0.5 %" 14 0.5 % $762,354 0.5 %" 20 0.7 % $1,008,922 0.6 %" 59 2.0 %1 $2,296,698 1.4 %" 62 2.1%1 $3,665,633 2.3 %"

$38,927 $59,123

61 2.1% $3,960,873 2.5 %" 68 2.3 % $4,558,160 2.8 % 78 2.7 % $4,563,924 2.8 %

105 3.6 % $4,562,963 2.8 %

$64,932 $67,032 $58,512 $43,647 $56,533 $58,773 $51,904 $61,07f $42,78e $52,343

118 4.0% $6,670,855 4.1% 181 6.2% $10,637,898 6.6% 207 7.1% $10,744,180 6.7% 226 7.7% $13,802,871 8.5% 352 12.0 % $15,060,507 9.3 % 512 17.5 % $26,799,854 16.6 % 823 28.1% $50,479,375 31.3%

2,930 $161,443,520 7,766 $449,923,015

$61,336

$55,100 $57,935

Totals for All Genders and Age Ranges 75,789 $4,427,068,302 $58,413

.'-W

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TABLE Vll-4 TOTAL CHARGES BY AGE RANGE, GENDER AND DIAGNOSIS CATEGORY



Low High ICD9 ICD9

of Range I of Range 290 319 680 709 280 289 630 -679 710 "739 580 629 360 389 240 279 001 139 320 359

390 459 140 239 800 999 520 579 780 799 460 519 V00 V83 740 779

Totals for Gender

Age Less Than : 2

Diagnosis Category Number of Percent of Percent of Description Claimants Claimants Total Char~les Total Char~les

Mental Disorders, Drug, Alcoho = ' 4 0.2 % $125,918 0.1% Skin Disorders 6 0.2 % $379,951 0.2 % Blood Related Disorders 5 0.2 % $396,847 0.2 % Pregnancy & Childbirth 10 0.4 % $659,171 0.3 % Skeleton & Muscle System 8 0.3 % $758,712 0.3 % Genitourinary System 10 0.4 % $772,411 0.3 % Sense Organs 15 0.6 % $875,613 0.4 % Endocrine & Metabolic Disorder 13 0.5 % $1,800,433 0.8 % InfeclJous & Parasitic Disease 32 1.3 % $2,175,654 p' 0.9 % Nervous System 28 1.1% $2,207,044 1.0 % Unknown Diagnosis 39 1.6 % $2,236,612 1.0 % Circulatory System 45 1.8 % $4,165,630 1.8 % Malignant Neoplasms 36 1.5 % $4,211,220 1.8 % Injury & Poisoning 61 2.5 % $4,803,221 2.1% Digestive System 63 2.6 % $8,585,488 3.7 % Symptoms & Ill-Defined Conditi 73 3.0 % $9,292,088 4.0 % Respiratory System 120 4.9 % $10,533,300 4.5 % Health Status or Service 343 13.9 % $27,017,819 11.7 % Congenital & Pednatal 1,552 63.0 % $150,582,507 65.0 %

2,463 $231,579,636

Average Total Charges per claimant

$31,479 $63,325J $79,369 $65,917 $94,839 $77,241 $58,374

$138,495 $67,989 $78,823 $57,349 $92,570

$116,978 $78,741

$136,278 $I27,289

$87,777 $78,769 $97,025

$94,023

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Low High ICD9 ICD9

of Range !of Range 290 680 360 280 710 240 001 580 320 630 390 800

140 239 520 579 460 519 780 799 V00 V83 740 779

ToMIsforGender

Age Less Than : 2

Diagnosis Category Number of Percent of Percent of De~dption Claimants Claimants Total Charges Total Cha~es

319 Mental Disorders, Drug, Alcoho 3 0.1% $148,319 0.1% 709 Skin Disorders 3 0.1% $188,253 0.1% 389 Sense Organs 7 0.3 % $353,082 0.2 % 289 Blood Related Disorders 7 0.3 % $435,550 02 % 739 Skeleton & Muscle System t3 0.6 % $628,3~;8 0.3 % 279 Endocrine & Metabolic Disorder 11 0.5 % $972,698 0.5 % 139 Infectious & Parasitic Disease 20 1.0 % $1,013,779 0.6 % 629 Ger, itoudnary System 16 0.8 % $1,048,695 ().6 % 359 Nervous System 20 1.0 % $1,1.14,428 0.7 679 Pregnancy & Childbirth 16i 0.8 % $1,259,142 0.7 "J 459 Circulatory System 28 1.4 % $2,574,174 1.4 % 999 Injuw & Poisoning 41 2.0 % $3,264,719 1.8 %

Unknown Diagnosis 40 2.0 ~A $3,519,967 2.0 % Malignant Neoplasms 39 1.9 % $4,740,141 2.6 % DigesUve System 50 2.5 % $4,790,80~ 2.7 % Respiratory System 68 3.3 % $5,275,818 2.9 % Symptoms & III-Definod Conditi 71 3.5 % $6,517,070 3.6 % Health Status or Se~ce 317 15.6 % $25,529,936 14.2 % Congenital & Pednatal 1,260 62.1% $116,735,93-9 64.8 %

| , | ,

2,030 $180,090,844


$49,44o $62,751 $.50,440 $62,221 $48,333 $79,336 $50,869 $65.543 $59,721 $78,696 $91,935 $79,627 $87,999

$121,542 $95,816 $77,586 $91,790 $60,536 $92,648

$88,715

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TABLE Vll-4---Continued TOTAL CHARGES BY AGE RANGE, GENDER AND DIAGNOSIS CATEGORY


Age At Least : 0 Age Less Than : 2 Gender : Blank Field

Low High I I ICD9 ICD9 I Diagnosis Category Number of I Percent of

of Range of Range I Description Claimants 1111 Claimants 740 779 ICoegenNal & Pednatal 50.0 % 520 579 IDiges~e System 50.0 %

Totals for Gender 2 Totals for Age Range 4,495

l Percent of I Average I Total Charges I Total Cha~es Total Charges | per Claimant |

$42,2s01 12.7 '~1 $42~s°1 ~0,2801 87.3 '~1 =~°~a°l

$332,530 $166,265 $412,003,010 $91,658

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680 709 360 389 580 629 390 459 V00 V83 001 139 710 739 780 799 320 359 280 289 460 519 520 579 240 279 740 779 140 239 290 319

Totals for Gender

Age Less Than : 18

Diagnosis Category Number of Description Claimants

Pregnancy & Childbirth 1 Unknown Diagnosis Skin Disorders Sense Organs Genitourinary System Circulatory System Health Status or Service Infe~ous & Parasitic Disease Skeleton & Muscle System Symptoms & Ill-Defined Conditi Nervous System Blood Related Disorders Respiratory System Digestive System Endocdne & Metabolic Disorder Congenital & Pednatal Malignant Neoplasms Mental Disorders, Drug, Alcoho Injury & Poisoning

Percent of Percent of Claimants Total Cherries Total Char~es

0.0 % $26,105 0.0 % 0.2 % $254,700 0.1%

24 0.7 % $1,105,000 0.5 % 36 1.1% $1,360,942 0.7 % 56 1.7 ~ $3,988,036l 1.9 % 68 2.1% $5,182,80g 2.5 % 57 1.7 % $5,201,980 2.5 % 56 1.7 % $5,572,227 2.7 %

14' 4.3 % $6,315,895 3.0 % 107 3.3 % $8,177,655 3.9 % 121 3.7 % $9,117,305 4.4 % 104 3.2 % $9,420,684! 4.5 % 163 5.0 % $10,232,235 4.9 % 174 5.3 % $10,736,171 5.2 % 195 6.0 % Sl 1,573,614 5.6 % 304 9.3 % $18,574,354 9.0 % 297 9.1% $31,879,157 15.4 % 818 25.0 % $33,952,291 16.4 % 53g 16.5 % $34,721,585 16.7 %

3,268 $207,392,744


$26,105 $42,450 ,o42 $37,8O4 $71,215 $76,218 $91,263 $99,504 $44,478 $76,427 $75,350 $90,583 $62,774 $61,702 $59.352 $61,100

$107,337 $41,506 $64,41g

$63,462

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630 679 680 709 360 389 V00 V83 001 139 580 629 390 459 280 289 520 579 780 799 240 279 460 519 710 739 320 359 740 779 800 999 140 239

Totals for Gender

Age Less Than : 18

Diagnosis Category Number of Percent of I I Percent of Description Claimants Claimants |Total Cha~es |Total Charges

Unknown Diagnosis 10 0.3 %1 $420,2951 0.2 % Pregnancy & Childbirth 12 0.4 % $523,447 0.3 %

Sense Organs 1.1 $1,473,007 0.8 % Health Status or Service 43 1.4 % $3,210,990 1.6 % Infectious & Parasitic Disease 50 1.6 % $3,607,951 1.9 % Genitourinary System 68 2.1%! $3,691,394 1.9 % Circulatory System 74 2.3 % $4,142,253 2.1% Blood Related Disorders 63 2.0 % $5,025,001 2.6 ~/, Diges~ve System 165! 5.2 % $7,764,448 4.0 % Symptoms & IIl-Oefinod Conditi 113 3.6 % $6,454,729 4.3 % Endocrine & Metabolic Disorder 196 6.2 % $8,846,552 4.5 % Respiratory System 158 5.0 % $9,564,273 4.9 % Skeleton & Muscle System 240 7.6 %1 $10,649,618 5.5 % Nervous System 135 4.3 %1 $11,850,629 6.1% Congenital & Perinatal 350 11.0 % $24,116,433 12.4 % Injury & Poisoning 35' 11.2 % $25,485,901 13.1% Malignant Neoplasms 286 9.0 % $31,075,289 16.0 % Mental Disorders, Drug, Alcoho 803 25.3 %' $33,883,381 17.4 %

3,170 $194,623,176 6,438 $402,015,920 Totals for Age Range


$42,029 $43,621 $54,50~ $43,324 $74,674 $72,159 $54,285 $55,976 $79,762 $47,057 $74,821 $45,135 $60.660 $44,373 $67,782 $68,904 $71,791

$108,655 $42,196 $61,395 $62,444

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Low High ICD9 ICD9

of Range o1 Range 630 879

360 389 740 779 680 709 280 289 VO0 V83 320 359 240 279 290 319 580 629 780 799 460 519 001 139 710 739 520 579 800 999 140 239

Totals forGender

Age Less Than: $5


$37,535 $69,011

Diagnosis Category Number of Percent of Percent of Description Claimants Claimants Total Cha~es :Total Char~es

Pregnancy & Childbirth 148 0.4 %1 $5,555,197 0.2 % Unknown Diagnosis 126 0.3 % $11,215,397 0.5 % Sense Organs 247 0.7 % $12,205,331 0.5 % $49,414 Congenital & Perinatal 2401 0.8 % $13,523,091 0.6 % $56,34~ Skin Disorders 289 0.8 ~ $15,310,050 0.7 % $52,978 Blond Related Disorders 314 0.8 ~ $27,811,010 1.3 % $88,570 Health Status or Service 5641 1.5 %1 $39,829,865 1.8 % $70,620

570J 1.5 %1 $42,879,772 1.9 % $75,228 $45,526,2;r'5 2.0 % $66,462

Nervous System Endocrine & Metabolic Disorder Mental Disorders, Drug, Alcoho Genitourinary System Symptoms & Ill-Defined Conditi Respiratory System Infeclk)us & Parasi~c Disease Skeleton & Muscle System DtgeslJve System Injury & Poisoning Malignant Neoplasms Circulatory System

685 1.8 % 1,461 3.9 % 1,569 4.2 1,227 3.3 eA 1,43G 3.8 1,347 3.6 % 3,085 8.3 % 2.700 '7.3 % 3,385 9.1% 6,070 18.3 %

37 ,204

31.8 %

$58,116,191 2.8 % $39,T78 $78,984,634 3.6 % $50,341 $64,275,413 3.8 % $68,684 $90,076,972 4.1% $62,991

$121,485,411 5.5 % $128,045,551 5.8 % $159,223,593 7.2 % $223,048,188 10.0 % $388,503,183 17.5 %

30.5 % $678,070,843

$2,223,685,967

$90,1gC $41,50e S58,972 $65,893 $64,004 $57,723

$59,770

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360 389 680 709 740 779 280 289 VO0 V83 320 359 240 279 001 139 630 679 780 799 460 519 290 319 580 ~zu 710 739 800 999 520 579 390 459

Totals for Gender

Age Less Than : 65

Diagnosis Category Number of Percent of Percent of Description Claimants Claimants Total Char~les Total Charges

Unknown Diagnosis 12; 0.3 % $7,469,226 0.4 % Sense Organs Skin Disorders Congenital & Perinatal Blood Related Disorders Health Status or Service Nervous System Endocrine & Metabolic Disorder Infectious & Parasitic Disease Pregnancy & Childbirth Symptoms & Ill-Defined CondilJ Respiratory System !Mental Disorders, Drug, Alcoho Genitourinary System Skeleton & Muscle System ;Injury & Poisoning i DigesSve System Circulatory System Malignant Neoplasms

242 0.6 % $9,188,081 0.5 % 287 0.8 % $15,181,335 0.8 % 400 1.1% $22,211,126 1.1% 340 0.9 % $24,196,193 1.2 % 738 2.0 % $42,963,419 2.1% 743 2.0 % $48,000,771 2.4 % 843 2.2 % $49,882,628 2.5 % 703 1.9 % $56,552,590 2.8 %

1,765 4.7 % $67,914,134 3.4 % 1,265 3.4 % $68,634,421 3.4 % 1,615 4.3 % $92,884,400 4.6 2,499 6.7 % $103,482,484 5.1% 3,287 8.8 % $137,767,979 6.9 % 3,840 10.2 % $158,889,572 7.9 % 2,617 7.0% $163,159,145 8.1% 3,511 9.4 % $184,193,764 9.2 % 5,061 13.5% $311,598,868 15.5% 7,594 20.3 % $446,937,979 22.2 %

3 7 , 4 7 2 $2,011,108,114


$61#.23 $37,967 $52.897 $55,528 $71.165 $58,218 $64,604 $59,173 $60,445 $38,478 $54.25e $57,514 $41,410 $41,913 $41,377 $62,346 $52.462 $61,56g $58,854

$53,670

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r~

¢%



Age At Least : 18 Gender: Blank Field

Low High ICD9 ICD9

of Range of Range 140 239 630 679 i 390 459


Age Less Than: 65


Malignant Neoplasms

Number of Claimants

1

Percent of Claimants

33.3 % Total Charges

$37,429

Percent of Total Charges

20.6 %


$37,429 Pregnancy & Childbirth 33.3 % $65,438 36.0 % $65,438 Circulatory System 1 33.3 % $78,956 43.4 % $78,956

3 $181,823 $60,608 74,679 $4,234,975,904 $56,709

o~

o~ r~

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¢%

FO

TABLE VlI-4--Continued TOTAL CHARGES BY AGE RANGE, GENDER AND DIAGNOSIS CATEGORY



Low I High ICD9 ICD9

of Range of Rankle 740 779

360 389 280 289 290 319 680 709 V00 V83 320 359 240 279 001 139 580 629 710 739 800 999 520 579 460 519 780 799 140 239 390 459

Totalsfor Gender

Age Less Than: 120

Diagnosis Category Number of Percent of Percent of i Description Claimants Claimants Total Charges Total Charges Congenital & Perinatal 6 0.1% $344,985 0.1% Unknown Diagnosis Sense Organs Blood Related Disorders Mental Disorders, Drug, Alcoho Skin Disorders Health Status or Service Nervous System Endocrine & M,~tabolic Disorder InfeclJous & Paras;=dc Disease Genitourinary System Skeleton & Muscle System Injury & Poisoning D i g ~ , e System R~i~atory System Symptoi~s & ,I-Defined Cond~ Ma;i0nant Neopl~,i.s Circulatory System

24 0.4 % $1,425,364 0.4 % 43 0.7 % $1,519,581 0.4 % 32 0.5 % $1,772,148 0.5 % 47 0.7 % $2,040,370 0.5 % 45 0.7 % $2,389,592 0.6 % 82 1.3 % $4,612,759 1.2 % 81 1.3 % $4,816,377 1.3 %

105 1.7 % $6,434,139 1.7 % 167 2.6 % $9,982,064 2.7 % 263 4.2 % $13,135,871 3.5 % 466 7.4 % $19,198,252 5.1% 339 5.4 % $21,399,566 5.7 % 393 6.2 % $21,732,198 5.8 % 399 6.3 % $24,990jiT 6.6 % 218 3.5 % $43,434,352 11.6 %

1,202 19.0 % $58,606,654 15.6 % 2,399 38.0% $138,183,781

6,311 $376,018,829

36.7 %


$57,498 $59.390 $35,339 $55,380 $43,412 $53.102 $56,253 $59,461 $61,278 $59,773 $49,04e $41,198 $63,126 $55,298 $62,634

$199,240 $48,758 $57,601

$59,581

F O

F O



Age At Least : $5 Gender : Female

I ICD! | ICD9

of Rat I of Rankle

740 360 280 680 290 240 320 V00 780 001 58O 8O0 46O 520 710 140 39O

Age Less Than : 120

Diagnosis Category Number of Percent of Percent of D e s c ~ n Claimants Claimants Total Cha~es Total Charges

Unknown Diagnosis 11 0.3 °A $458,727 0.2 % 779 Congen;'.~; & Pe;.-,a;.| 389 Sense G,w.ns 289 Blood Related Disordem 709 Skin Disorders 319 Mental ~sovders, Drug, Alcoho 279 Endo¢~'.~e & Me~bolic Disorder 359 Nervous System V83 Health Status or Service 799 Sy,,,v;oms & Ill-Defined Cor.~;~ 139 Infectious & Pm,b~.-.c Disease ~2~ Gev~oudnery S ~ v r , ;.--~ Injury & Po;sonh-,.~ 519 Rc, i~v~-tory System 579 D~,,=;-ve System 739 "Sk~;.;;o~, & Muscle System 239 "Malignant Neopl~.~.~s 459 "Circ~i~tov~ System

Totals for Gender

Circ~;~tory System i

Totals for Age Range

11 0.3 % $472,669 0.3 % 33 0.9 % $1,179,253 0.6 % 26 0.7 % $I~.50,346 0.7 % 27 0.8 % $1,611,001 0.9 % 83 1.8 o~ $2,699,779 1.4 % 60 1.7 o~ $3,029,447 1.6 % 52 1.5 % $3,492,505 1.9 % 78 2.2 % $4,631,131 2.5 %

I00 2.8 %" $5,053,479 2.7 % 02 2.9 % $5,789,203 3.1%

128 3.8 % $6,384,441 3.4 % 269 7.8 $13,4M,s75 7.2 % 233 8.6 % $14,028,861 7.5 % 285 8.1%1 $16,083,489 8.6 % 419 11.9 %1 $17,459,155 9.4 % 679 19.3 %1 $34,476,203 18.5 % 950 27.0% 1 $55,104,273 29.5%

3,524 $186,712,537 9,835 $562,731,3'35

Average Total Charges per cl mnt

$41,70"~ $42,970 $35,735 $48 ,O9O $59,667 $42.8~ $_r.o,491 $67,1~.. $61,199 $50.53_': $_r~_,757 $49,878 $50,143 $802.10 $5R_,433 $41,669 $'3n_,775 $58,004

$52,983 $57,217

Totals for All Genders and Age Ranges 95,447 $5,611,726,1 99

Monograph - Chapter 7 - Group Medical Insurance Large ... · 6 14 25 21 22 4 I0 30 2 3 1 27 17 20...

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