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A petabyte of health insurance prices per month

blog.turquoise.health

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Re: A petabyte of health insurance prices per month

#101

Post by hospitalJail »

redandblack wrote: post #84
tiffanyg wrote: post #41

Because our (US) system is at Monty Python levels of absurdity. We waste more money with this "system" than most other countries spend as a total, and with worse outcomes on average [1]. Fundamentally, there are two factors, IMO, that have been conclusively proven (repeatedly, and for decades - much more strongly, recently) to be incompatible with delivering quality healthcare with some level of efficiency: 1) For-pr…

How come medicare "system" become the defacto standard

We own a clinic and medicare pays decent enough.

Medicaid isnt enough to run a business. Its like break even if you are super efficient.

Private insurance is sooo cash money. If someone with private insurance wants us to get access to a pool for therapy, you got it.

All 3 are good for us owners.

None of it is good if you pay taxes.

Re: A petabyte of health insurance prices per month

#102

Post by Buttons840 »

Companies are going to grow around this data. An entire industry might grow around this data, and it will be an industry that I support every time I pay an insanely high insurance premium or medical bill.

15% of our workers are in the medical system [0], and this doesn't even include the surrounding insurance industries or pharma industries (I think). Someone has to pay all these people, and that someone is me when I pay high insurance premiums and high medical bills.

I'm picturing a satirical 40s style poster that shows the doctor putting a bandaid on Timmy's knee, and then mom doing her patriotic duty and writing out a $1000 check. The poster then shows that the $1000 supports medical coders who know all the codes for duck attacks, and the pharma advertisers who one-up even Broadway and Hollywood with their 90-second advertisements, and the people who reassemble the poorly organized data this article talks about, and--oh yeah, there's a few bucks left for the doctor too.

I used to work at a company that does background checks on doctors. We'd gather data from all 50 states, all of it in different formats, all of it a pain to work with. Hundreds of people were involved in this process, all of us ultimately paid through high hospital bills (hospitals were our customers). With the right regulation, we all could have been replaced with a 50 line Python script.

Ultimately, if we're going to build a medical system that takes 15% to 20% of our workers to run, then we're going to have to pay for that. The problem is that "let's make the industry more efficient and put a lot of people out of work" is not politically popular.

[0]: https://www.census.gov/library/stories/2021/04/who-are-our-h...

Re: A petabyte of health insurance prices per month

#103

Post by brendanyounger »

88913527 wrote: post #44
maweaver wrote: post #39

Earlier quoted context omitted.

But why? I could understand from a treatment perspective the type of animal mattering (but even then initial vs subsequent encounters?). From a billing perspective, wouldn't it make sense to have animal bite exam fee, with possible additional charges for bandaging, stitches, rabies shot, etc based on doctor's discretion?

Well, it employs a lot of people to have this complex billing. And whoever argued the need for it got to do some major empire building, maybe scored a promotion.

Medical billing is a dreary business. Check out https://www.reddit.com/r/CodingAndBilling/. It's not clear that anyone is _trying_ to build an empire out of this. More likely, they're trying to build a bigger trash heap to climb on top of.

Re: A petabyte of health insurance prices per month

#105

Post by johntiger1 »

lisasays wrote: post #95
thomascgalvin wrote: post #15

There are separate charge codes for everything , and all of those codes need to be reflected in the pricing data. There's a price to slap on a bandaid. There's a price to give someone a Tylenol. Hell, W61.61XA is the medical code for "Bitten by duck, initial encounter." Presumably, this means there's also a code for "Bitten by duck, again." Medical billing is broken , and it's no surprise that the amount of data is o…

Medical billing is broken Is it? Seriously - how do you know ? More specifically: broken compared to what ? What would you replace it with? Be specific, please. Keeping in mind that it's like, an extremely complex domain and all, you know.

Yep, this seems like surface level complexity. Like adding a new/non-existing key to a dictionary, it shouldn't surprise us that there can be different codes for getting bitten by different things

Re: A petabyte of health insurance prices per month

#106

Post by lotsofpulp »

Sevii wrote: post #49

There is so much data because of insurance. Insurers are in the business of declining claims. They have discovered that the best way to decline claims is to create byzantine rules while offloading all the work to comply with those rules to healthcare providers. The only way to fix it at this point is to nationalize the system or to exclude all routine care from the insurance system. Something like a legal ban on dedu…

Per federal law (ACA), health insurers in the US are required to spend 80% to 85% of revenues on healthcare expenses. Their profit margins are 2% to 6%. Therefore, the higher the revenue, the higher the profit.

Where is the incentive to deny legitimate claims?

Re: A petabyte of health insurance prices per month

#107

Post by leetcodesucks »

searine wrote: post #6
FollowingTheDao wrote: post #2

They are making it impossible to handle the data so everyone gives up trying so they can go on screwing people over.

Hanlon's razor. Never attribute to malice what can be explained by stupidity. The US healthcare system is a mess, but I don't think it's intentionally malicious. It is just a mash of a thousand different systems, creating one big stupid system.

[dead]

Re: A petabyte of health insurance prices per month

#108

Post by brendanyounger »

michaelmrose wrote: post #93
natosaichek wrote: post #61

Earlier quoted context omitted.

It's kinda ridiculous that because it costs x billion in doctors overcharging, we'll spend 100x on administration to control costs. Cutting off one's nose to spite one's face and all that.

Actually if you think about it insurance is forced investment in a fund where the amount they make is driven as much by the amount they can get you to pay in as much as efficiency. It is only beneficial not to be so obviously egregious that nobody will touch you in an environment full of people who are tacitly collaborating to increase prices so that the pie gets bigger for everyone. Everyone is actually collaboratin…

And why this has not been prosecuted as giant racketeering operation is beyond me.

Re: A petabyte of health insurance prices per month

#109

Post by coldcode »

chimeracoder wrote: post #80
valleyer wrote: post #52

Earlier quoted context omitted.

Because, like it or not, a doctor's discretion can sometimes be self-serving. The more treatments a doctor gives, the more they get paid, and there is an enormous information imbalance between doctor and patient. (As in, they went to medical school, and you didn't.) Unfortunately, some doctors are willing to take advantage of this.

> The more treatments a doctor gives, the more they get paid You could say this 30 years ago, but it's not really the case today. The majority of physicians are now salaried, not independent. And even for many of the ones in independent private practice, the amount they make is not necessarily tied anymore to the services they provide, due to the rise of capitation and other forms of bundled service agreements. Nowad…

This is the basis of all Medicare Advantage Plans, where the physician or their employer gets X$ a month per MAP patient and must pay for most of the cost of care. The insurance company gets to keep most of its share of what Medicare pays. Nice profit ensues for the insurance company.

Re: A petabyte of health insurance prices per month

#110

Post by pixelatedindex »

bradgessler wrote: post #20
thomascgalvin wrote: post #15

There are separate charge codes for everything , and all of those codes need to be reflected in the pricing data. There's a price to slap on a bandaid. There's a price to give someone a Tylenol. Hell, W61.61XA is the medical code for "Bitten by duck, initial encounter." Presumably, this means there's also a code for "Bitten by duck, again." Medical billing is broken , and it's no surprise that the amount of data is o…

Here's the full list of codes for "Bitten by ____, _____ encounter" https://www.icd10data.com/ICD10CM/Codes/V00-Y99/W50-W64/W61- The hierarchy looks like this: W61.6 Contact with duck = W61.61 Bitten by duck == W61.61XA …… initial encounter == W61.61XD …… subsequent encounter == W61.61XS …… sequela = W61.62 Struck by duck == W61.62XA …… initial encounter == W61.62XD …… subsequent encounter == W61.62XS …… sequela = W6…

Thankfully, W61 is a non-billable code family… hope it stays that way! I do wonder what all the billable code families are, maybe I should find out.
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