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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

#161

Post by gowld »

shubb wrote: post #88
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?

Because these are world health organisation 'international disease classification' codes that are designed for population health study and happen to be used for insurance billing in the US. There are requirements for some data to be reported to federal and international organisations. For instance, these codes are also used on death certificates I think, so they can track whether a lot of people are dieing of flu (pr…

But if an app developer in a different industry doesn't know the history behind it then a must be worthless.

Re: A petabyte of health insurance prices per month

#162

Post by banannaise »

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…

I like that you specifically chose "Bitten by duck" which you could say is itself a form of billing.

Re: A petabyte of health insurance prices per month

#163

Post by lotsofpulp »

ochoseis wrote: post #160
jtbayly wrote: post #148

Earlier quoted context omitted.

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...

Nominal profits are more work to analyze since you have to figure out if UHC is selling to 5x as many customers in 2020 as they were in 2010, and then also adjust for inflation and a bunch of other stuff. It is simpler to just look at profit margin.

Re: A petabyte of health insurance prices per month

#164

Post by flangola7 »

talldatethrow wrote: post #94
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.

While there are huge problems, I think the majority of the problem is people expect their health insurance plan to be like a prepaid maintenance plan. If you crash your car today without insurance, you understand it won't be covered by getting insurance tomorrow. Why people think they can finally get healthy "insurance" at 45 from company xyz, knowing they need this pill or that pill, and expect the new insurance com…

Why wouldn't they expect it? If they need that medicine/treatment, they need it. If I don't have car insurance my organs won't shut down and I won't die. If I don't have medicine, they do and I will.

Re: A petabyte of health insurance prices per month

#165

Post by AnthonyMouse »

gruez wrote: post #154
AnthonyMouse wrote: post #135

Earlier quoted context omitted.

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/...

That's basically what you'd expect to see if they're using the 80% as a target. They're not going to hit it exactly and it's politically disadvantageous to come in on the wrong side of the line, or for that matter to come in exactly on the line.

Much more advantageous to raise premiums and therefore profits by 400% and then be able to say that they're at 15% vs. the permitted 20%, even though the 15% would be 60% if they'd kept claims from going up.

Re: A petabyte of health insurance prices per month

#166

Post by banannaise »

lotsofpulp wrote: post #106
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?

Is that real profit or profit after a bunch of accounting sleight of hand? Are they cutting their "profit" by taking heavy debt burdens via leveraged buyouts or other schemes, pulling way more than 20% off the top for their shareholders and then making it look like much less?

Re: A petabyte of health insurance prices per month

#167

Post by lotsofpulp »

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...

I agree with AnthonyMouse that a business might be incentivized, but only if the business has so much market share that they can singlehandedly drive those prices up. Or if there is collusion between all the businesses.

But the fact that there are so many publicly listed companies, and they have such similarly low profit margins, indicates they have very little pricing power.

Re: A petabyte of health insurance prices per month

#168

Post by hospitalJail »

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…

>they are required to spend 80% of that money

I know someone that worked for BCBS and they had the nicest parking garage and a park on top of the building. Always renovations being done. I believe they even bought buildings nearby in the dense part of the city. I also think this person talked about getting a bonus.

They had some high tech security along with low tech security. It was pretty impressive at the time. 24/7 security, got to use their parking garage to for some sports game on a sunday.

Re: A petabyte of health insurance prices per month

#169

Post by banannaise »

colejohnson66 wrote: post #145
talldatethrow wrote: post #86

Earlier quoted context omitted.

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…

But then there’s an incentive to be slow

So then you also add a constant per patient, but then there's an incentive to be rushed. Gosh, it seems like profit incentive is a really bad way to run a healthcare system, doesn't it!

Re: A petabyte of health insurance prices per month

#170

Post by [deleted] »

AnthonyMouse wrote: post #150
lotsofpulp wrote: post #139

Earlier quoted context omitted.

I do not think health insurance company shareholders are interested in paying employees extra for no reason and earning less profit for themselves.

Health insurance company executives are though, aren't they? Their compensation is the "administrative overhead." 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 shareh…

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