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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

#41

Post by tiffanyg »

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-profit entities (particularly, publicly-traded / with "fiduciary responsibility" to shareholders)

2) Administrative burden / bureaucracy (partly stemming from all of the competing private entities, partly stemming from essentially impossible efforts to effectively regulate these entities and the created "market")

The manner in which the US system evolved, tying insurance to employment through basically existing tax policies, and the move by companies to take advantage of this to attract workers (IIRC), created a massive landscape of entrenched interests that works exactly like such ecosystems work. It is a "teergrube" - an absolute tarpit - where any attempt to fix problems ultimately fails.

The administrative situation is out of control, which means fraud (particularly with the turn towards "digital crime" of everyone from traditional organized crime networks to high schoolers) and waste are impossible to effectively control, adding to an already absurd situation where ever-increasing money is spent on marketing, lobbying, administrators / clerks, etc. Meanwhile, we desperately need more doctors, nurses, etc. AND, these professionals are now increasingly being politicized by "exploiters". A great many healthcare professionals are quitting, and those remaining are often trying to move away from areas that often MOST need their services!

It's amazing to watch (from the inside, so far) a country that built such "soft-power" might ... such a dominant "marketed / exported 'culture'", have those same tools (used, in any scenario, intentionally or not) turn against itself (/ be turned against it) - sowing the seeds of collapse in all sorts of systems, top-to-bottom.

There isn't a face or palm big enough for the facepalm this BS deserves.

[1] https://jamanetwork.com/journals/jama/article-abstract/27526... - only providing one of a parade of articles examining the issue in the past decade, especially

Re: A petabyte of health insurance prices per month

#42

Post by marcus0x62 »

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.)

If a person were sucked into a jet engine, they'd be turned into soup. Maybe they could be poured into a container and the doctor could subsequently encounter them in that state.

Re: A petabyte of health insurance prices per month

#43

Post by cool_dude85 »

pc86 wrote: post #25
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…

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

Do we get separate diagnosis codes for each verb? So, sucked into jet engine, walked into jet engine, fell into jet engine, pushed into jet engine, etc.?

Re: A petabyte of health insurance prices per month

#44

Post by 88913527 »

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?

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.

Re: A petabyte of health insurance prices per month

#45

Post by Ylpertnodi »

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?

[flagged]

Re: A petabyte of health insurance prices per month

#46

Post by samstave »

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.

I've been a designer for a number of hospitals (tech, and physical, some systems) but never in the billing, however I can attest that billing codes are complete BS (billing codes are basically a number for the procedure/system/resources used such that they can say 'Code 10 == $10,000" to simplify it...

Hospitals are usually 'health *groups*' and they work just the same as insurance companies - they have actuaries that do all the calc to determine what they CAN charge for a procedure, not what its summary cost actually is...

When youre in a hospital GROUP you have more negotiating power with the insurance companies - so the exact same procedure in one group may be significantly different than what another group charges you....

HOWEVER - and this is important, and they wont ever tell you this - you can "haggle" with hospital billing departments... NEVER pay a hospital bill once you receive it.

ALWAYS call and ask for more details about the bill, with a line item receipt for every single action, drug, interaction 'encounter' and you will generally see your bill reduced significantly.

-

As example, I went to the ER with chest pains. waited 2 hours for an MD to come see me, he didnt even touch me, take a BP, EKG, etc - then 'prescribed' me some motrin (over the counter) and then billed me $1,500 for a 4 minute interaction.

I refused to pay this and they tried to drop it to $900 - and I told them, that if they can drop it from $1500 to $900 with just me protesting, then they needed to pay me for the two hours I waited to speak to the MD

They dropped the bill entirely.

Good Samaratin Hospital, Los Gatos CA.

Re: A petabyte of health insurance prices per month

#47

Post by btown »

coding123 wrote: post #29
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…

I wonder if bitten by duck is more expensive that bitten by chicken.

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.

Re: A petabyte of health insurance prices per month

#48

Post by marcus0x62 »

chimeracoder wrote: post #31
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…

Those are ICD codes, which are not the same as billing codes. ICD represent diagnoses , not services rendered. ICD codes also are somewhat procedural in their generation - that is, there's a whole grammar to how they're formed. For example, you'll have something like "contact with", then a whole number of different animals, and then each of those will have three different varieties (initial encounter, subsequent enco…

That's really interesting, because I had a customer that did nothing but provide medical billing services, and about 15 years ago when the industry was moving from ICD-9 to ICD-10, that customer seemed really focused on their billing coders learning ICD-10.

Re: A petabyte of health insurance prices per month

#49

Post by Sevii »

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 deductibles smaller than 20k/year would work.

Re: A petabyte of health insurance prices per month

#50

Post by [deleted] »

bradgessler wrote: post #20
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…

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…

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