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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

#231

Post by webnrrd2k »

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 don't know... I've been bitten by a goose, and, when you're a small kid, they are fairly terrifying.

Re: A petabyte of health insurance prices per month

#232

Post by yardie »

lotsofpulp wrote: post #202
yardie wrote: post #194

Earlier quoted context omitted.

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.

I would prefer to buy my health insurance on the open market. But without the subsidies its pretty uneconomical. The fact that your employer offering it automatically locks you out of the best plans on the marketplace is anticompetitive and anti-labour.

Re: A petabyte of health insurance prices per month

#233

Post by skissane »

thfuran wrote: post #225
skissane wrote: post #217

Earlier quoted context omitted.

Yes, but the ICD isn’t for health insurance, it is for international standardisation of mortality and morbidity statistics, so they can be compared between countries. That’s its purpose and the reason for its existence The fact that the US chooses to use it for something which was not its originally intended purpose is the fault of the US, not the fault of the ICD. The WHO doesn’t force the US health insurance system…

ICD-10-PCS is produced by the Center for Medicare and Medicaid Services.

Most of the complaints in these comments have been about diagnosis codes (ICD-10-CM) not procedure codes (ICD-10-PCS).

Both ICD-10-CM and ICD-10-PCS are produced by Centers for Medicare and Medicaid Services (CMS). But ICD-10-CM is just a national version of WHO ICD-10, and as such entirely comparable to other national versions such as Australia's ICD-10-AM or Germany's ICD-10-GM. Whereas, ICD-10-PCS, despite its name, doesn't really have anything to do with WHO ICD at all, it is a purely American invention. Other countries have their own equivalents to ICD-10-PCS–for example, the Australian equivalent is ACHI (Australian Classification of Health Interventions), but unlike the US, Australia doesn't mislead people into thinking that our national procedure coding system is part of WHO ICD

Re: A petabyte of health insurance prices per month

#234

Post by lisasays »

lmm wrote: post #218
lisasays wrote: post #95

Earlier quoted context omitted.

Medical billing is broken Is it? Seriously - how do you know ? More specifically: broken compared to what ? What would you replace it with? Be specific, please. Keeping in mind that it's like, an extremely complex domain and all, you know.

Broken compared to what literally any other country in the world does? Personally I'd replace it with publicly funded healthcare, but even those countries that still feel the need to bill the victim have avoided the whole billing-insurance complex that the US has.

Well obviously (or so I thought) was referring to how it's modeled (with the crazy codes and all) based on the way the system currently is -- not on how the system "should be".

The comment I was responding to just seemed to be saying: "Gee, this is complicated." Well yeah. Because what it has to do is (based on the way things are presently, and beyond anyone's ability to change in the near-term) complicated.

Crazy billing codes are a pain signal. They aren't the underlying malady itself.

Re: A petabyte of health insurance prices per month

#235

Post by btown »

lotsofpulp wrote: post #96
btown wrote: post #47

Earlier quoted context omitted.

Not even ironically, this all smells of insurers wanting sufficient data to raise rates on different types of farmers and breeders. It might be scandalous if they didn’t collect the data and then were biased against, say, chicken farmers. But if they do collect the data, they can say they analyzed it, whether or not they did, to support any kind of tactic they desired.

You are smelling something that is not there because, in the US, health insurers are only allowed a few factors to determine someone’s premium. https://www.healthcare.gov/how-plans-set-your-premiums > Five factors can affect a plan’s monthly premium: location, age, tobacco use, plan category, and whether the plan covers dependents.

True for marketplace insurance, but private plans (which companies would provide to employees at enticingly lower premiums than public options) vary considerably. See, for but one example, https://www.lgbtmap.org/img/maps/citations-nondisc-insurance...

Re: A petabyte of health insurance prices per month

#236

Post by tanseydavid »

searine wrote: post #6
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.

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.

The amount of human labor involved in the US healthcare system, that has nothing at all to do with medical professionals helping patients, is astonishing.

Re: A petabyte of health insurance prices per month

#237

Post by skylanh »

marvin wrote: post #214
petsfed wrote: post #201

Earlier quoted context omitted.

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…

What if it was a lemur, though? Bet they don't have a code for that.

The codes are possibly (also) related to incidents that CDC or other organizations would like statistics on.

Lemur's aren't common, ducks are, and "Chlamydia psittaci in ducks: a hidden health risk for poultry workers" is (via https://pubmed.ncbi.nlm.nih.gov/25854003/)

Re: A petabyte of health insurance prices per month

#238

Post by orangepurple »

paulddraper wrote: post #189
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?

> 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?

I have only ever had the chance to sign up for United Healthcare plans in my last 3 jobs

Re: A petabyte of health insurance prices per month

#239

Post by amluto »

izzydata wrote: post #221
amluto wrote: post #183

Earlier quoted context omitted.

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 te…

Wouldn't a free market eventually lead to all these insurance companies combining into 1-2 even more mega insurance companies until there is no competition again? At least if all their profits are capped there is no reason to merge.

Let me quote myself:

> An actual, non-corrupt, free market where customers are not locked in and there are more than just a handful of providers

I’m not suggesting an unregulated market. I’m suggesting a market in which antitrust laws are aggressively enforced.

Re: A petabyte of health insurance prices per month

#240

Post by swalsh »

DoreenMichele wrote: post #200
swalsh wrote: post #193

Earlier quoted context omitted.

I'm in healthcare analytics, the codes are for me.

We were drowning in data. It was a Fortune 200 company and every few years they completely overhauled their system for looking up state exceptions etc, which meant longstanding employees could no longer use it efficiently and new people still didn't magically get it instantaneously and inevitably some important thing could no longer be accessed at all. It was all in-house, homegrown software, I tried more than once t…

We're one of the guys who are creating all that work for you lol. We too have been through a number of systems. Since i've been with the company, we've gone from SQL Server, to an on-prem Hadoop cluster, to Databricks on the cloud, and plenty of home grown software. The cloud has been a real game changer for us from the simple fact that we finally have enough compute to start running some machine learning models. We have this standard data model with something like 300 columns, but every clients data is so different, some of them have around 400 columns in the data.... We're in theory using the medallian architecture, but there's so many legacy business processes we're not anywhere close to an ideal implementation. We've also recently started using AI in a big way as well.

My email is in my bio, we should chat sometime i'd be facinated to hear more of your perspective.

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