ST LUCIE COUNTY SCHOOL BOARD
Health Plan Performance Monitor
Large Claimant Reports
Current Year High Claims Exceeding $100,000
Status Report through December 2015
Current
Claimant
1
2
3
4
5
6
7
8
Relationship to Subscriber
Employee
Employee
Spouse
Employee
Employee
Spouse
Employee
Employee
Employee
9
10
Employee
11
Employee
12
Employee
13
14
15
Spouse
Spouse
Employee
Primary Diagnosis
PULMONARY HYPERTENSION
MITRAL VALVE DISORDERS; HEMATOMA COMPLICATING A PROCEDURE
DIABETES WITH OTHER SPEC MANIFESTATIONS; END STAGE RENAL DISEASE
ACUTE & CHRONIC RESPIRATORY FAILURE
ACUTE INFECTIVE POLYNEURITIS; ACUTE UPPER RESPIRATORY INFECTIONS OF
UNSPECIFIED SITE; UNSPECIFIED MONONEURITIS OF LOWER LIMB
END STAGE RENAL DISEASE, DIABETES WITH NEUOLOGICAL MANIFESTATIONS
SPINAL STENOSIS IN CERVICAL REGION; BRACHIAL NEURITIS OR RADICULITIS NOS OTH
MALAISE; FATIGUE
MALIGNANT NEOPLASM OF LOWER-INNER QUADRANT OF FEMALE BREAST
ACUTE MYELOBLASTIC LEUKEMIA, NOT HAVING ACHIEVED REMISSION; ACUTE
PHARYNGITIS
LOCALIZED OSTEOARTHROSIS IN LOWER LEG
ABDOMINAL PAIN, LEFT UPPER QUADRANT; INTESTINAL INFECTIONS DUE TO
CLOSTRIDIUM DIFFICILE; OTHER PULMONARY EMBOLISM AND INFARCTION
SEPTICEMIA; JAUNDICE
ENCOUNTER FOR ANTINIEOPLASTIC CHEMOTHERAPY; ACUTE MONOCYTIC LEUKEMIA IN
REMISSION; CHEST PAIN
ACUTE RESPIRATORY FAILURE FOLLOWING TRAUMA AND SURGERY
ATRIAL FIBRILLATION
Total
$364,801
$213,842
$179,057
$166,654
Pooling Point Claims over
$295K
$69,801
$0
$0
$0
$162,063
$155,709
$0
$0
$152,145
$133,489
$0
$0
$128,047
$113,364
$0
$0
$112,009
$0
$109,202
$0
$106,089
$105,412
$104,394
$0
$0
$0
Total Claims Paid
$2,306,279
11
$69,801
ST LUCIE COUNTY SCHOOL BOARD
Health Plan Performance Monitor
Large Claimant Reports
Prior Year High Claims Exceeding $100,000
Current
Claimant
Relationship to
Subscriber
Subscriber
1
Spouse
Primary Diagnosis
ERYTHEMATOUS CONDITIONS; OTH COMPLICATIONS OF PROCEDURES; OTHER DISEASES
OF LUNG
VIRAL PNEUMONIA; MULTIPLE MYELOMA AND IMMUNOPROLIFERATIVE NEOPLASM;
ENCOUNTER FOR OTHER AND UNSPECIFIED PROCEDURE AND AFTERCARE
2
Subscriber
3
Subscriber
4
5
Subscriber
Dependent
6
Subscriber
ENCOUNTER FOR OTHER AND UNSPECIFIED PROCEDURE AND AFTERCARE; MYELOID
LEUKEMIA; OTH ALVEOLAR AND PARIETOALVEOLAR PNEUMONOPATHY
ACUTE MYOCARDIAL INFARCTION; CHRONIC KIDNEY DISEASE; OTH FORMS OF CHRONIC
ISCHEMIC HEART DISEASE
SEPTICEMIA; ARTHEROSCLEROSIS; OTHER PERIPHERAL VASCULAR DISEASE
NEOPLASMS OF UNSPECIFIED NATURE; DIABETES MELLITUS W/O MENTION OF
COMPLICATION; PULMONARY HEART DISEASE
VIRAL HEPATITIS; VARICOSE VEINS OF OTH SITES; CHRONIC LIVER DISEASE & CIRRHOSIS
7
Subscriber
8
Subscriber
9
OTH ALVEOLAR & PARIETOALVEOLAR PNEUMONOPATHY; NEOPLASM OF UNCERTAIN
BEHAVIOR OF UNSPEC SITES & TISSUES; OTH DISEASES OF LUNG
HUMAN IMMUNODEFICIENCY VIRUS; SPRAINS & STRAINS OF BACK; ACQUIRED
HYPOTHYROIDISM
MALIGNANT NEOPLASM OF LIVER, GALLBLADDER & BILE DUCTS
10
Spouse
11
Subscriber
OTH DISORDERS OF CERVICAL REGION; INTERVERTEBRAL DISC DISORDER
Subscriber
MALIGNANT NEOPLASM OF TRACHEA, BRONCHUS AND LUNG; SYM INV RESPIRATORY
SYSTEM & OTH CHEST SYMPTOMS; PLEURISY
AORTIC ANEURYSM & DISSECTION; OTH CONGENITAL ANOMALIES OF CIRCULATORY
SYSTEM; OTH DISEASES OF ENDOCARDIUM
ACUTE MYOCARDIAL INFARCTION; OTH FORMS OF CHRONIC ISCHEMIC HEART DISEASE;
CARDIOMYOPATHY
MULTIPLE MYELOMA & IMMUNOPROLIFERATIVE NEOPLASMS; OTH DIS OF BREAST;
ESSENTIAL HYPERTENSION
DISEASES OF WHITE BLOOD CELLS; DUODENAL ULCER
12
Subscriber
13
Subscriber
14
Spouse
15
16
Subscriber
Subscriber
17
Subscriber
18
MALIGNANT NEOPLASM OF TRACHEA, BRONCHUS AND LUNG; CHRONIC ISCHEMIC
HEART DISEASE; SYMPTOMS INV RESPIRATORY SYSTEM & OTH CHEST SYMP
CHRONIC PULMONARY HEART DISEASE; OTH ILL DEFINED AND UNKNOWN CAUSES OF
MORBIDITY AND MORTALITY; HEARING LOSS
Subscriber
HUMAN IMMUNODEFICIENCY VIRUS (HIV); GENERAL SYMPTOMS; APLASTIC ANEMIA
AND OTHER BONE MARROW FAILURE SYNDROMES
Subscriber
MALIGNANT NEOPLASM OF BODY OF UTERUS; DISEASES OF WHITE BLOOD CELLS;
OTHER UNSPECIFIED ANEMIAS
Subscriber
MALIGNANT NEOPLASM OF FEMALE BREAST; SECONDARY MALIGNANT NEOPLASM OF
OTH SPEC SITES; SYMPTOMS INVOLVING RESPIRATORY SYSTEM
Total
19
20
21
12
Total Claims Paid
Pooling Point
Claims over $260K
$731,434
$471,434
$469,599
$209,599
$259,099
$0
$252,872
$0
$228,064
$0
$217,863
$0
$197,931
$0
$186,887
$0
$185,161
$0
$182,719
$0
$154,700
$0
$142,746
$0
$137,830
$0
$137,140
$0
$123,713
$0
$122,598
$0
$118,703
$0
$115,801
$0
$115,319
$0
$106,579
$0
$101,653
$4,288,410
$0
$681,032