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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

#181

Post by flangola7 »

talldatethrow wrote: post #174
flangola7 wrote: post #164

Earlier quoted context omitted.

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.

If you need medicine to live, you should pay for it. If you can't, the government should step in. However, making me pay $400 a month for insurance in case I need stitches next month because I have to subsidize your medicine is annoying. I want insurance in case something I don't know about goes wrong. You want something you know you need.

Right, but the government doesn't step in. I've voted for universal healthcare sorry supporting candidates at every local, state, and federal election.

I'm sorry that my illness is "annoying" you, but your anger is misplaced. Not that long ago I used to only have insurance for stitches too.

Re: A petabyte of health insurance prices per month

#182

Post by DoreenMichele »

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 worked in health insurance. The code is supposed to make it easy to pay. It doesn't.

We could do away with the codes. In addition to having to look up the codes, I read records all day, called and wrote providers for additional info, consulted my technical lead regularly to see if it was covered and once had to print the entire file and get it reviewed by the retired surgeon who came in once a week to read surgical reports on difficult cases.

I'm underwhelmed with the value they provide and I paid claims as my job for 5+ years.

Re: A petabyte of health insurance prices per month

#183

Post by amluto »

efsavage wrote: post #157
amluto wrote: post #131

Earlier quoted context omitted.

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 c…

IMO the most effective consumer cost control is competition. An actual, non-corrupt, free market where customers are not locked in and there are more than just a handful of providers generally results in low prices.

We do not have this in healthcare. Providers form cartels - at least in Northern California, this is so bad that the state AG is investigating (not very effectually) [0]. Customers generally can't even tell what a provider charges, so there is no price competition. There aren't many insurers, and they compete on so many incomprehensible dimensions that customers can't usefully choose. (And the most useful thing customers can look at is the network, but see the above issue with provider cartels.) Pharmacy benefits are highly corrupt and incomprehensible.

[0] We have Sutter Health, UCSF, Stanford, and Kaiser. There is very little in the way of independent providers left. Sutter Health in particular has aggressively merged with any available competition.

Re: A petabyte of health insurance prices per month

#184

Post by paulddraper »

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?

> 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?

That is FFS (fee-for-service) billing. And indeed that does not use the diagnosis code, except for reporting purposes and documentation that the treatments were appropriate/necessary.

The diagnosis code would be used if billing in a DRG (diagnostic-related groups) model, which is an overall fee for overall treatment related to the condition -- exam, stitches, etc.

Re: A petabyte of health insurance prices per month

#186

Post by paulddraper »

boredpeter wrote: post #180
Alupis wrote: post #126

Earlier quoted context omitted.

It's not when you want statistics about all injury types, treatments, etc.

You don’t need arbitrary codes to get statistics for something that can be typed in a description field.

You don't need to type arbitrary descriptions for something that can be a standardized code.

Re: A petabyte of health insurance prices per month

#187

Post by 0cf8612b2e1e »

zo1 wrote: post #159
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.

The bar for conclusively proven relies upon the public to agree? Have you met the public?

Re: A petabyte of health insurance prices per month

#188

Post by vanattab »

boredpeter wrote: post #180
Alupis wrote: post #126

Earlier quoted context omitted.

It's not when you want statistics about all injury types, treatments, etc.

You don’t need arbitrary codes to get statistics for something that can be typed in a description field.

Well the codes are just a standard way to enter the data so you don't have x reports of "duck bite" and y cases of "bitten by duck" or "mallard bite"

Re: A petabyte of health insurance prices per month

#189

Post by paulddraper »

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?

> Where is the incentive to deny legitimate claims?

Because they want to be competitive and gain customers.

Which would you sign up for? Insurance that costs $800/month or $1200/month?

Re: A petabyte of health insurance prices per month

#190

Post by paulddraper »

FireBeyond wrote: post #60

I used to work for a company that writes claims benefit management software. This: > Notice how every item has a price that requires external information to understand: > Per diem rates are paid for each day a patient is in the hospital. We need to know how long the patient will be in the hospital to know the total amount. > Rates for Cardiac Studies require knowing the price the hospital will bill in the future. The…

I'm curious...who was that company?
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