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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

#201

Post by petsfed »

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.

I've spent a lot time around people doing statistics for environmental science, especially regulatory compliance around accidentally killing birds and bats. The unfortunate reality for the statisticians is that every tech thinks they're Henry David Thoreau or something. Like, nobody cares if it was a particular large exemplar of a given species, or that it had magnificent plummage, just write down the species of the carcass and where it was located, and move on. Instead, there's so much variance from (mass produced and standardized) data sheet to data sheet that you can't even use hand writing recognition to automate the process of ingesting the data. Manually entering the data is somebody's whole job, because they've tried to automate it, and failed.

The billing codes exist explicitly to limit the amount of independent thought that can be applied to something that is adequately summarized as "bit by a duck, third visit".

Re: A petabyte of health insurance prices per month

#202

Post by lotsofpulp »

yardie wrote: post #194
paulddraper wrote: post #189

Earlier quoted context omitted.

> 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?

Competitive? In every job I've had it was basically the same 3-4 HMOs: Aetna, Bluecross, Cigna, and United Healthcare. If you are getting employer provided healthplans, as most Americans are, those are your options, 4. With so few options you aren't choosing the most competitive, you're choosing the lease worst.

That is because the messed up pre-tax benefit the US gives to big businesses so they have (another) advantage over small businesses, so you are buying from whoever your employer chooses to let you buy from.

Ideally, everyone in the US would have to buy health insurance from healthcare.gov, and can choose whoever they want with zero input from their employer.

Re: A petabyte of health insurance prices per month

#203

Post by thfuran »

skissane wrote: post #143
thfuran wrote: post #87

Earlier quoted context omitted.

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…

These codes were originally developed by the World Health Organisation to collect public health statistics, and statistics on causes of death - that’s their original purpose, not insurance billing. A lot of codes which seem silly or pointless for insurance have more validity when keeping their original purpose in mind. There’s an ICD-10 code for executions - Y35.5 - can you bill an execution to health insurance? I ho…

Sure, there are other uses for the data. But the fact remains that generating it isn't free. And changing the coding in and of itself incurs significant administrative cost, so "we've come this far; we might a well just keep going" isn't really a compelling reason to expand ICD.

Re: A petabyte of health insurance prices per month

#204

Post by karaterobot »

I read the article, and I understand that the cause of that size is an absurd amount of redundancy.

However, I still can't conceive how it could be that big. A petabyte is a million gigabytes. Wikipedia, uncompressed, is about 42 gigabytes. So, every month there is the equivalent of about 24,000 Wikipedias generated just from pricing data? And it's all just text. Wow.

Re: A petabyte of health insurance prices per month

#205

Post by ekelsen »

esaym wrote: post #178
mensetmanusman wrote: post #53

Earlier quoted context omitted.

"I'd like to file a complaint. This is my fourth time being bitten by a duck not my second time. You have overcharged me!" This is possible in America today. Great job post ww2 employer coverage side effects!

Some ducks are poisonous, this is why the species needs to be known.

What ducks are poisonous?

Re: A petabyte of health insurance prices per month

#206

Post by karaterobot »

Reptur wrote: post #24

They're using information overload tactic. This approach leverages a psychological principle that suggests when people are given too many choices or too much information, they can become overwhelmed and struggle to make decisions. The point is to overwhelm, the consumer, the people trying to fix this system etc.

What? No. This isn't user facing. And they are following a schema created as a result of regulation. It sounds like the schema sucks. It sucks because it implies a lot of redundancy, and allows you to remove some of that redundancy, but does not require it, resulting in a foreseeable and unfortunate amount of redundancy.

Re: A petabyte of health insurance prices per month

#207

Post by cycomanic »

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.

It might be 50% in the US (although studies show that even in the US most (>60 % IIRC) people favor some form of public healthcare if asked in non-polarizing terms), but if you look at worldwide statistics countries that have publically funded healthcare have typically better outcomes at lower costs, which might not be "proven" in the strictest sense, but is pretty strong evidence.

Re: A petabyte of health insurance prices per month

#208

Post by JohnFen »

esaym wrote: post #178
mensetmanusman wrote: post #53

Earlier quoted context omitted.

"I'd like to file a complaint. This is my fourth time being bitten by a duck not my second time. You have overcharged me!" This is possible in America today. Great job post ww2 employer coverage side effects!

Some ducks are poisonous, this is why the species needs to be known.

(Sorry, the pedant in me can't resist)

If you get a toxin through biting it, it's poisonous. If you get a toxin through being bitten by it, it's venomous.

Re: A petabyte of health insurance prices per month

#209

Post by skissane »

thfuran wrote: post #203
skissane wrote: post #143

Earlier quoted context omitted.

These codes were originally developed by the World Health Organisation to collect public health statistics, and statistics on causes of death - that’s their original purpose, not insurance billing. A lot of codes which seem silly or pointless for insurance have more validity when keeping their original purpose in mind. There’s an ICD-10 code for executions - Y35.5 - can you bill an execution to health insurance? I ho…

Sure, there are other uses for the data. But the fact remains that generating it isn't free. And changing the coding in and of itself incurs significant administrative cost, so "we've come this far; we might a well just keep going" isn't really a compelling reason to expand ICD.

> Sure, there are other uses for the data. But the fact remains that generating it isn't free. And changing the coding in and of itself incurs significant administrative cost, so "we've come this far; we might a well just keep going" isn't really a compelling reason to expand ICD.

The WHO expands and revises ICD all the time - and how it gets used by US health insurance isn’t really a concern of theirs. The WHO has 194 member states and the US is only one of them. WHO intends the ICD to be used for collecting public heath and cause of death statistics, and if some countries want to use it for insurance/billing - that’s their problem, not the WHO’s

The US uses its own modified version of ICD-10, ICD-10-CM, which adds even more codes. A lot of those added US-specific codes exist simply because some hospital - or bureau of vital statistics - somewhere in the US, was tracking that. Other countries have done the same thing - Australia has the ICD-10-AM, Canada the ICD-10-CA, Germany the ICD-10-GM, etc

Just because a code exists doesn’t mean you have to use it for any particular purpose. Indeed, most medical software packages permit disabling codes you don’t want clinicians to be able to use. In an insurance system, a code like Y35.5 is likely marked as non-billable.

Re: A petabyte of health insurance prices per month

#210

Post by nradov »

88913527 wrote: post #44
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?

Well, it employs a lot of people to have this complex billing. And whoever argued the need for it got to do some major empire building, maybe scored a promotion.

No one got a promotion out of it. The USA adopted the WHO ICD code system for diagnoses on billing claims because it was good enough, and much easier than defining a whole new code system. Some of the codes are never used, but so what.
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