New health insurance “transparency data” looks suspiciously wrong
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Re: New health insurance “transparency data” looks suspiciously wrong
#2The healthcare industry is actively hostile to the well-being of citizens.
Re: New health insurance “transparency data” looks suspiciously wrong
#3Everyone assumed there would be malicious compliance here but it's definitely eye opening just how malicious they made it. Speaks volumes for the perceived risk releasing this data, IMO. Still waiting to hear about someone using this data to negotiate down a hospital bill, seems like it's just insurance companies that can weaponize this data for better rates.
Re: New health insurance “transparency data” looks suspiciously wrong
#4Seems like really important work that gains more value as more people hear about it. I hope that what you're doing will lead to better data and greater transparency.
Re: New health insurance “transparency data” looks suspiciously wrong
#5The healthcare industry is actively hostile to the well-being of citizens.
"Never come between a man and his meal" playing out right here
Re: New health insurance “transparency data” looks suspiciously wrong
#6Whoever is doing this due diligence is truly helping millions and millions of people. Good luck. There are very few among us here that could pretend the same, and I'm not one of them.
Re: New health insurance “transparency data” looks suspiciously wrong
#7The healthcare industry is actively hostile to the well-being of citizens.
Yes, I try to avoid it as much as I can.
Re: New health insurance “transparency data” looks suspiciously wrong
#8The healthcare industry is actively hostile to the well-being of citizens.
"Never come between a man and his meal" playing out right here
Unfortunate that the man in this analogy is Hannibal Lecter (Silence of the Lambs, Hannibal is a violent psychopathic cannibal in that movie), and should be stopped from getting his meal.
Insurance companies are a problem, and they've grown fat skimming a fair fraction of this nation's GDP for no observable value provided. Our healthcare system is more expensive and has on average worse outcomes than other first world economies.
Re: New health insurance “transparency data” looks suspiciously wrong
#9Can GPT4 help process this data?
Re: New health insurance “transparency data” looks suspiciously wrong
#10There are two problems here:
1) Hanlon’s razor
2) The author doesn’t understand health insurance data.
I’m not trying to excuse the other bad behavior, but within the data itself, he’s experiencing a combination of health insurers’ incompetence, the kludged up data models they’ve had to build to represent the output of the multiple generations of claims processing systems and other administrative processes, and the general mess that provider identifiers are. Every payor calculates values differently. Every payor uses different codes (beyond the standard CMS and CPTs). Every payor has different arrangements that are difficult to represent in standard schema, eg capitation in Florida, delegation in California, or the oddness that are Taft-Hartley plan.
There is a link in the article to a discussion with CMS. Another participant in the discussion works for IQVIA, a long-time claims data aggregator (and CRO and a bunch of other things), and clearly understands what’s going on. It would be extremely difficult to do this work at all without significant experience working with multiple payors’ data, which requires time and access, and pays well once you do have that specialized experience.