Home/Why Behavioral Health Claims Skyrocket: Opioid Use Lead Cause

Why Behavioral Health Claims Skyrocket: Opioid Use Lead Cause


Behavioral health claims skyrocket for any number and combination of factors. According to the April blog from Berkley Insights, Behavioral health care will increase in cost and utilization with a number of factors driving this, including the:

  • current opioid crisis
  • increased mainstream recognition and decreased stigma among patients seeking care
  • inclusion under essential benefits by ACA
  • federal parity laws for mental health and substance use treatments
  • increased direct-to-consumer advertising, with many providers being out-of-network with unchecked pricing

FAIR Health, a national, independent, nonprofit organization dedicated to transparency in healthcare costs and health insurance information, has analyzed data from its database of over 21 billion privately billed healthcare claims to identify trends and patterns in these costs and services. Among the findings:

  • The national aggregated dollar value of charges for opioid-related diagnoses rose over 1,000% from 2011 to 2015
  • In 2015, private payers’ average costs for a patient diagnosed with opioid abuse or dependence were more than 556%higher—almost $16,000 more per patient—than the per-patient average cost based on all patients’ claims
  • Opioid abuse diagnoses involve significant emergency department charges,
  • Opioid dependence charges are largely represented by laboratory tests and office outpatient visits
  • States’ average charges for services associated with opioid abuse and dependence diagnoses vary widely

Click HERE for the full report.

Behavioral Health Claims Skyrocket: Charges and Allowed Amounts

The total annual charges associated with an individual who was diagnosed with opioid abuse or dependence were 556% higher than the average annual per-patient charge based on all patients’ charges, including charges for patients with opioid abuse or dependence diagnoses and all other patients’ charges. In 2015, a per-patient charge average was $11,404. The per-patient average total charge for a patient identified with an opioid abuse or dependence diagnosis for the same year was $63,356.

Behavioral Health Claims Skyrocket

Year over year national average charges per patient for private insurance claims for all patients and for patients with opioid abuse or dependence diagnoses during the time period 2013-2015.

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