Private insurers in New York state see surge in claims related to opioid addiction

NEW YORK, NY–April 6, 2017–From 2007 to 2014, private insurance claim lines with opioid abuse and dependence diagnoses increased 1,459 percent in the New York City suburbs of Nassau, Rockland, Suffolk and Westchester counties, according to data from FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information.

The increase was greater than in New York City (324 percent) and the rest of the state (310 percent) for the same time period, as well as in New York State as a whole (487 percent). "Claim lines" are the individual services or procedures listed on an insurance claim.

Those trends were identified when FAIR Health investigated recent opioid-related data from New York State in its national database of over 23 billion privately billed healthcare claims, the largest such repository in the country. FAIR Health previously published two white papers on the national opioid crisis, The Opioid Crisis among the Privately Insured: The Opioid Abuse Epidemic as Documented in Private Claims Data and The Impact of the Opioid Crisis on the Healthcare System: A Study of Privately Billed Services.

Following are other pertinent New York-related findings from FAIR Health's research. (See also the article on this research in Crain's New York Business.)

Distribution of Opioid Abuse and Dependence Claim Lines

With 43 percent of the state's population, New York City is the most populous part of the state, compared to the New York City suburbs (21 percent) and the rest of the state (36 percent), according to US Census estimated figures from July 2016. Yet, New York City had the lowest share (13 percent) of the statewide total of claim lines for privately insured individuals with diagnoses of opioid abuse and dependence during the period 2007-2014. The largest share of the distribution (50 percent) was in the upstate and western parts of the state beyond New York City and its suburbs. In the New York City suburbs, the share was 37 percent.

There may be several reasons why New York City has a disproportionately smaller share of the private insurance claim lines with opioid-related diagnoses. It could be that, at least among the privately insured, the opioid epidemic is having a more severe impact on the rest of the state than on the city. It also could be that, in New York City, a greater share of patients with opioid-related diagnoses are receiving their healthcare under Medicaid than in the rest of the state. FAIR Health data do not show Medicaid utilization. And, it could be that in New York City there are a greater number of higher-income individuals who are not using insurance to cover their opioid-related treatment.

Opioid-Related Diagnoses by Category

There are a number of distinct categories of opioid-related diagnoses, and claim lines associated with them have risen at different rates in different regions of New York State. Of five diagnoses–heroin overdose, opioid overdose (excluding heroin), opioid abuse, opioid dependence and pregnancy drug dependence–the largest increase in New York City from 2007 to 2014 was in pregnancy drug dependence, which rose 2,600 percent. (Pregnancy drug dependence can include other drugs as well as opioids.) But, in the same period in the New York City suburbs, claim lines with an opioid dependence diagnosis rose at the greatest rate–1,867 percent. In the rest of New York, claim lines for one of the diagnoses actually decreased: opioid overdoses fell by 56 percent. Outside New York City and its suburbs, the largest increase was 470 percent for pregnancy drug dependence.

Overdoses by Age and Gender

In New York State in the period 2007-2014, age-related patterns differed for heroin overdoses and overdoses of opioids excluding heroin. Claim lines associated with heroin overdoses occurred overwhelmingly in the younger population, mostly in the age groups 23 to 30 years and 19 to 22 years, with the third most populous age group those 18 years and under. By contrast, claim lines associated with opioid overdoses excluding heroin occurred most often in the age group 51 to 60 years, followed by 41 to 50 years.

Gender-related patterns also differed with respect to heroin overdoses compared to overdoses of opioids excluding heroin. In the period 2007-2014 in New York State, claim lines associated with heroin overdoses were more numerous for males than females in all age groups but one (13 to 18 years). Claim lines associated with opioid overdoses excluding heroin, however, showed a different pattern. The frequency of such claim lines for males was greater than for females from ages 13 to 30, and again from 41 to 60. But, such claim lines occurred more frequently for females from ages 31 to 40, and again from ages 61 to over 80.

FAIR Health President Robin Gelburd commented, "As the opioid epidemic continues to spread across the nation, FAIR Health is committed to using its data to help all healthcare stakeholders understand the complexities and layered impact of this pressing national issue."


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About FAIR Health

FAIR Health is a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information through data products, consumer resources and health systems research support. FAIR Health oversees the nation's largest collection of healthcare claims data, which includes a repository of over 23 billion billed medical and dental procedures that reflect the claims experience of over 150 million privately insured individuals, and separate data representing the experience of more than 55 million individuals enrolled in Medicare. Certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity, FAIR Health receives all of Medicare Parts A, B and D claims data for use in nationwide transparency efforts. FAIR Health licenses its privately billed data and data products–including benchmark modules, data visualizations, custom analytics, episodes of care analytics and market indices–to commercial insurers and self-insurers, employers, hospitals and healthcare systems, government agencies, researchers and others. FAIR Health has earned HITRUST CSF and Service Organization Controls (SOC 2) certifications by meeting the rigorous data security standards of those organizations. As a testament to FAIR Health's data security and validation protocols, its data have been incorporated in statutes and regulations around the country and designated as the official, neutral data source for a variety of state health programs, including workers' compensation and personal injury protection (PIP) programs. FAIR Health data serve as an official reference point in support of certain state balance billing laws that protect consumers against bills for surprise out-of-network and emergency services. FAIR Health also uses its database to power a free consumer website available in English and Spanish and as an English/Spanish mobile app, which enable consumers to estimate and plan their healthcare expenditures and offer a rich educational platform on health insurance. The website has been honored by the White House Summit on Smart Disclosure, the Agency for Healthcare Research and Quality (AHRQ), URAC, the eHealthcare Leadership Awards, appPicker, Employee Benefit News and Kiplinger's Personal Finance. FAIR Health also is named a top resource for patients in Elisabeth Rosenthal's new book, An American Sickness: How Healthcare Became Big Business and How You Can Take It Back. For more information on FAIR Health, visit

Dean Sicoli
Executive Director of Communications and Public Relations
FAIR Health
[email protected]

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Dean Sicoli
[email protected]