Kidney Disease Continues To Rank In Top 3 Catastrophic Claims

Kidney disease continues to rank in top 3 catastrophic claims

Chronic/end-stage renal disease continues to be in the top three catastrophic claims, according to the newest annual stop-loss research report from Sun Life.

Dialysis costs can cost health plans $2,600 per month and skyrocket to $200,000 per month. Renalogic typically sees a range of $90,000 to $120,000 per month for self-insured health plans. Self-insured plans can have a higher exposure due to poor PPO discounts and overpricing.

Because more than 10% of the American population has some form of kidney disease, claims and the costs associated with them are expected to continue to climb in the coming years.

Early detection is key for chronic kidney disease because if detected early, the progress can be delayed or reversed, depending on the stage. Health plan members that are not diagnosed with CKD, should have co-morbid conditions managed. These conditions, such as diabetes or hypertension, to name just two of many, can ultimately lead to kidney failure. This means members and the health plan are at risk for emergent-start dialysis, which has an average cost of $185,000.

A patient needs an access to start dialysis. Emergent dialysis means placement of a quick and temporary access, such as a catheter which is usually inserted at the neck. The catheter is used for blood exchange between the dialysis machine and patient. It has two tubes – venous and arterial – although they are both in the vein. The arterial tube carries blood from the patient to the dialysis machine, while the venous tube returns blood from the dialysis machine to the patient. Depending on the circumstances, a permanent access may be required for long-term dialysis treatment.

Some issues associated with neck catheters are:

  • Uncomfortable and mobility-limiting
  • Higher infection risks
  • Clotting problems – treated with blood thinners (treatment failure will require a new access by an interventional nephrologist)
  • Low blood flow
  • If a neck catheter is left in too long, it can diminish chances of long-term access (e.g. fistula or graft)

Dialysis & emergent-start statistics:

  • 91% of dialysis patients are on in-center programs
  • Over 80% start emergently with a hospitalization, inpatient placement of a neck catheter & inpatient dialysis
  • Patients dialyzing on central catheters have a 53% higher mortality rate in the first year; a 38% higher risk of a cardiovascular event; and double the infection rate

Download the report or see the infographic below for more information about the top catastrophic claims conditions.

What is Stop-Loss insurance?

Stop-Loss insurance mitigates the risk of self-funding a health plan and reimburses eligible catastrophic claims after the stop-loss deductible is met. These claims are referred to as stop-loss claims.

Note: Used with permission from Sun Life.


Renalogic, headquartered in Phoenix, AZ, was founded in 2002 as a specialty dialysis cost-containment company to help clients understand the unique market dynamics in the dialysis provider community. The company has evolved to become a comprehensive provider of data-driven, end-to-end chronic kidney disease (CKD) care and cost management programs for the self-insured industry. Renalogic’s professional team includes leaders in healthcare administration, care management, legal specialists in ERISA and healthcare law, contract negotiation, payer/provider negotiation, and clinical experts.