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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

#151

Post by paulddraper »

vsareto wrote: post #30
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…

IIRC the "initial encounter" refers to the first visit between the patient and doctor about the duck bite, and "subsequent encounter" means a follow-up visit about the issue, not a second maiming by the duck. It makes for a fun first impression though

That is correct. Obviously, there's little value in distinguishing between the first and second occurrences of duck bites. Rather, the suffix describes which treatment it is.

A - initial encounter (initial treatment)

D - subsequent encounter (continued treatment)

S - sequela (after the treatment plan is completed)

Re: A petabyte of health insurance prices per month

#152

Post by sandworm101 »

maweaver wrote: post #39
bradgessler wrote: post #20

Earlier quoted context omitted.

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…

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?

>> I could understand from a treatment perspective the type of animal mattering

Rabies, which is not just animals but also predators (snakes) that eat animals with rabies. There is even a disease called "seal finger" that is linked to seal bites. And bats, all sorts of nasty stuff can come from bats.

Re: A petabyte of health insurance prices per month

#154

Post by gruez »

AnthonyMouse wrote: post #135
lotsofpulp wrote: post #127

Earlier quoted context omitted.

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…

That's their profit margin, not including the administrative overhead that counts against the 20%.

There are actual figures that don't include admin overhead and are only claims paid out vs premiums collected. It's called medical loss ratio, and just from eyeballing the charts it looks like it's around 85% for insurance companies as a whole.

https://www.oliverwyman.com/our-expertise/insights/2023/mar/...

https://www.oliverwyman.com/our-expertise/insights/2022/mar/...

Re: A petabyte of health insurance prices per month

#155

Post by ryandrake »

calibas wrote: post #16
searine wrote: post #6

Earlier quoted context omitted.

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.

They made a ridiculously complex and obscure system because it was insanely profitable. It's not really stupidity or maliciousness that's responsible, but simple greed.

Yea, we need a corollary to Hanlon: Never attribute to malice OR stupidity that which can be explained by greed.

Re: A petabyte of health insurance prices per month

#156

Post by lotsofpulp »

ADuckOnQuack wrote: post #140
lotsofpulp wrote: post #106

Earlier quoted context omitted.

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...

For sure, and that is where the government should be handing out heavy penalties. There supposedly is an appeals process, but obviously not enough auditing is being done:

https://www.healthcare.gov/appeal-insurance-company-decision...

Although, even with those fraudulent denials, Cigna's profit margins are suffering:

https://www.macrotrends.net/stocks/charts/CI/cigna-group/net...

Wonder if they went into too much debt to buy Express Scripts.

Re: A petabyte of health insurance prices per month

#157

Post by efsavage »

amluto wrote: post #131
thedougd wrote: post #118

Earlier quoted context omitted.

Yes. https://www.healthcare.gov/health-care-law-protections/rate-... .

And this is a bad law . What do you think happens when a company has limited margins? Hint: almost all companies try to make a profit (which is fine). If the margins are unrestricted, the company can cut costs to increase profit, which is a good thing. If the margins are limited, the company must raise revenue to increase profit. For an insurance company (or a utility, and California has exactly the same broken rule…

I don't think it's a _bad law_* as much as it's an _incomplete law_. I don't know what the complete version looks like, but it would include both customer cost controls and reward innovation-based efficiency gains. Alternatively, some places have taken the approach that these are mutually exclusive and just generally removed profit from the picture entirely by socializing it.

* Health care costs were growing out of control before these laws, which seem to have slowed that trend short-term but not long-term as the industry pivoted.

Re: A petabyte of health insurance prices per month

#159

Post by zo1 »

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…

It's funny how people casually throw out how something has "conclusively" been proven and yet it's a hot debated contentious issue that 50% of people don't agree with.

Well gee, zo1, if it's been "conclusively" proven then it should be trivial to convince them to change their mind, right? Perhaps it hasn't been as "conclusively" proven as we've been led to believe.

Re: A petabyte of health insurance prices per month

#160

Post by ochoseis »

jtbayly wrote: post #148
lotsofpulp wrote: post #127

Earlier quoted context omitted.

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…

You haven’t done anything but prove the GP’s point. 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...

There is certainly nuance but UHC’s net income has grown from under $4B in 2010 to over $20B today.

https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g...

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