Report finds COVID and mental health drivers of growth in 'high claims'

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Private Healthcare Australia’s Annual High Claims Report has revealed that health funds paid more than $7.7 billion for 379,991 ‘high claims’ for hospital care in 2022.

High claims are those exceeding $10,000.

CEO Dr Rachel David said the report showed private health insurance supported many Australians to get high-quality hospital care across treatment areas, especially mental health care, which can be difficult to access in the public system.

In 2022m compared to the pre-pandemic period of 2019, high claims for mental health treatment for people with private health insurance under 30 increased by 281 to 7,253 claims, with benefits paid up $8.79 million to $151.41 million.

High claims for mental health treatment for members aged 15 to 24 increased by 244 to 4,803.

For these young high claimants under 30, the average length of stay in the hospital for their mental health treatment episode of care was around 26 days.

Claims for COVID-19 treatment during 2022 have also increased significantly and continue to do so.

Since the start of the pandemic, there have been 7,504 confirmed COVID-19 hospitalisations funded by private health insurance. The average member age with confirmed COVID-19 hospitalisation funded by private health insurance is 74. The highest benefit paid for COVID-19-confirmed hospitalisation in 2022 was $238,462.

High claims where members were hospitalised and had Long COVID, totalled 560, representing a 46-fold increase on the previous year. The average age was also 74 for these high claims.

The highest benefit paid for hospitalisation in 2022, where a member also had Long COVID, was $431,635.