141–150 of 275 posts
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…
The medical cartels need to be destroyed. They are mathematically the most corrupt industry according to open secrets all time lobbying data. Physicians are the richest profession in the US, and limit their supply by weaponizing the ACGME/AMA. Hospitals/clinics make so much money. We own one, and while it was slow to start, the profits are insane. Marketing is the hardest thing, once a patient comes in the door (and…
Aren't there laws that require insurance companies and utility companies to have specific margins? They could in theory just print infinite money so they need to be reigned in by governments.
Insurance companies must pay 80% of all premiums directly to reimbursement. The remaining 20% is for administration, marketing, and profit.
But that's a control for premium prices...it doesn't really say anything about the costs that doctors charge.
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https://twitter.com/NavalInstitute/status/123054297912482202... Here's a video of a guy getting sucked into a jet engine and surviving. Most, of course, do die. I don't quite understand why everyone is so bothered by the extensive ICD taxonomy; it clearly needs to be extremely extensive to cover even fairly common scenarios, and once you're past the point that things can be easily managed why not cover everything?
Sure, it's necessary to have some specificity so that providers and insurance companies can be reasonably informed about what's going on, but this stuff has a very real cost. Healthcare providers have entire departments of people dealing with coding. The more complex it gets, the more time consuming and expensive it is to correctly code things. At some point (I suspect well behind us), the added cost isn't worth the…
There’s an ICD-10 code for executions - Y35.5 - can you bill an execution to health insurance? I hope not, but as a possible value for a cause of death field in a death certificate database, it makes sense.
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In the US, federal law requires the insurance company to offer any applicant insurance coverage and pay for necessary healthcare (after accounting for deductible/out of pocket maximums). https://www.healthcare.gov/how-plans-set-your-premiums >Five factors can affect a plan’s monthly premium: location, age, tobacco use, plan category, and whether the plan covers dependents. > FYI Your health, medical history, or gende…
I understand the law says so. My point is this makes no sense as an "insurance". It's basically a service plan now.
Once an event goes from unlikely to likely, buying insurance for it turns into simply prepaying an amortized amount for future expenses. Not dissimilar to paying taxes for road maintenance.
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…
I wish instead of charging 100x for random things to pay for the hospital, they'd just charge per minute of room and per minute of doctor contact. I understand why you need to charge me $2000 to have an entire hospital ready in case I need stitches at 3am. But I get annoyed when you try to play it off as having to charge $85 for an aspirin. Just be upfront and say, we charge $100 a minute and this is going to take 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…
I wish them well. Health care in the US has problems, opaque pricing being only one of them.
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> So, if you’re an insurer who wants to increase nominal profits, then you’re ok with spiraling healthcare costs. Not just okay, but actively incentivized to cause it, because then you get 20% of a bigger number. Laws like that are some of the most expensive of the perverse incentives created by naive idealists (or cynical opportunists, since the lobbyists for the medical providers know exactly what that would do).
In reality, there is sufficient competition such that the 7 largest publicly listed health insurance companies have 4% or less profit margins, and one has 6%. I always find it funny when people on this forum act like a certain business is so powerful when it can only earn low single digit profit margins, yet tech company employees work for companies so powerful they can earn 20%+ and 30%+ profit margins for years and…
Their margins are necessarily low, so they should want total medical costs to increase in order for their gross profit to increase. And in fact, just checking one of them from your links, it has:
https://www.macrotrends.net/stocks/charts/HUM/humana/gross-m...
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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?
The incentive is probably to get their profit margin up to the maximum 15-20% https://www.propublica.org/article/cigna-pxdx-medical-health...
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That's their profit margin, not including the administrative overhead that counts against the 20%.
I do not think health insurance company shareholders are interested in paying employees extra for no reason and earning less profit for themselves.
And a lot of the administrative overhead is proportional to expenses. Commissions are commonly a fixed percentage. How much it's worthwhile to spend on fraud prevention is in proportion to the size and amount of claims. So when premiums and claims costs go up, actual administrative costs go up, but shareholders and executives still prefer that to making less profit and compensation once you take lowering claims costs off the table as a way to make more money.