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Paduda: WCRI: Deductibles and Claims

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I showed up late to the Workers Compensation Research Institute's annual meeting Thursday in Phoenix, and thanks to American Airlines I missed three great sessions. Two dealt with opioids and one was a deep dive into coordinating medical and return-to-work services.

Joe Paduda

Joe Paduda

OK, the whining is now over.

A session I’ve been looking forward to — nerd bomb alert — is a discussion of the relationship between group health deductibles/copays and coinsurance and claim classification.

This study follows two others that looked at capitated versus non-capitated plans and provider reimbursement impacts on claim classification — aka, shifting claims to work comp.

So, is there a correlation between higher deductibles and a greater propensity by patients to file work comp claims?

It appears high deductibles are correlated with higher rate of work comp claim filing for patients, especially those with soft tissue injuries, but the impact isn’t great. More specifically, the data indicates a 1.4% increase in filing associated with high deductibles. When WCRI looked at claims over an 11-year period, this is much more likely in states where workers can pick their initial treating provider.

In fact there was little correlation between high deductibles and increased WC claiming in employer-choice states.

However, it appears that much of that increase has occurred more recently, as deductibles have grown significantly.

The entire research report is here. There’s a fee for non-WCRI members.

The finding is somewhat complicated by earlier research that found a significant percentage of workers who actually had occupational injuries didn’t file them under work comp.

There’s no question deductibles have grown by leaps and bounds of late — the average is now over $1,500 — and for out of five plans have deductibles. Deductibles are a lousy idea for lots of good reasons. Mostly, they don’t work.

So, what does this mean for you?

Two things: We all know WC claims frequency has been declining for decades, but the “increase” in WC filing offset about 20% of that decline.

And, we do not know if those claims were actually occupationally related. It could be that claims are just getting filed more accurately of late.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers. This column is republished with his permission from his Managed Care Matters blog.

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