A petabyte of health insurance prices per month

Post by lotsofpulp » Tue, Jul 11, 2023, 8:59 PM UTC

banannaise wrote: post #166

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?

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?

Post by lotsofpulp » Tue, Jul 11, 2023, 9:01 PM UTC

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…

Post by lesuorac » Tue, Jul 11, 2023, 9:02 PM UTC

elcritch wrote: post #128

Buttons840 wrote: post #102

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…

There's a similar issue in academia. Tuition costs have risen far faster than inflaction but the number of professors per student is roughly similar. Where does all the extra go? Administrators and bureaucracy!

Post by ryneandal » Tue, Jul 11, 2023, 9:03 PM UTC

chimeracoder wrote: post #37

pc86 wrote: post #25

Earlier quoted context omitted.

My personal favorite is V97.33XD "Sucked into jet engine, subsequent encounter."

> My personal favorite is V97.33XD "Sucked into jet engine, subsequent encounter." If you were sucked into a jet engine, you'd probably sustain serious injuries, so hopefully you'd have a followup visit with your doctor about it after the fact, rather than just one single visit. (Yes, I get that you're joking, but that's what "subsequent encounter" actually means.)

Post by paulddraper » Tue, Jul 11, 2023, 9:04 PM UTC

mwerd wrote: post #36

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…

Nuanced but important distinction: these are ICD-10 diagnosis codes. They are only loosely related to what is billed and would not show up in the pricing data referenced by the OP.