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New health insurance “transparency data” looks suspiciously wrong

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Re: New health insurance “transparency data” looks suspiciously wrong

#91

Post by rqtwteye »

ethbr0 wrote: post #82
medellin wrote: post #78

Earlier quoted context omitted.

If this is the best they can do maybe capital markets don’t work best for insurance companies and they should be taken over. Dealing with them right now feels like dealing with the government might as well just have the government run it

Not going to argue. In their defense, I'd say insurers are more innovative (especially on the operations side and post-ACA) than the federal government. IMHO, best of both worlds would be the federal government taking over and centralizing the most core services (rates, interchange, data systems, etc) and allowing private insurance companies to build offerings on top of that (customer service, servicing, product mix,…

"insurers are more innovative (especially on the operations side and post-ACA) than the federal government."

They are certainly very creative in making the system as expensive as possible. See Medicare Advantage.

"IMHO, best of both worlds would be the federal government taking over and centralizing the most core services (rates, interchange, data systems, etc) and allowing private insurance companies to build offerings on top of that (customer service, servicing, product mix, etc)."

This would be best. There is so much unnecessary bureaucracy at providers and insurers because the insurers have different setups. The medicare setup would be a good foundation .

Re: New health insurance “transparency data” looks suspiciously wrong

#92

Post by rqtwteye »

xupybd wrote: post #45
maxwell wrote: post #31

Earlier quoted context omitted.

And why federal governments make the best health insurance carriers. Brokers, medical billing staff, and other middlemen serve no purpose other than increasing cost (in order for an inefficient, openly colluding private cabal to invest premiums, deny claims, and collect profit) because everybody needs access to medical treatment.

I live with free healthcare. The last three trips to the emergency department have been over eight hour waits. My father's cancer treatment was not covered so the last year of his life cost him everything. On the other side my child's healthcare is amazing and all free. We get instant access to great services.

Last time I was the ER in the US, I waited four hours with a pretty serious fever. Talked to a doctor for maybe 5 minutes and got sent home. Cost me only $500.

Re: New health insurance “transparency data” looks suspiciously wrong

#93

Post by xupybd »

yamtaddle wrote: post #74
xupybd wrote: post #45

Earlier quoted context omitted.

I live with free healthcare. The last three trips to the emergency department have been over eight hour waits. My father's cancer treatment was not covered so the last year of his life cost him everything. On the other side my child's healthcare is amazing and all free. We get instant access to great services.

Last time I went to the ER with my dad it was about a 3-hour wait, and he really needed to get in. Saw a few people who looked like they definitely ought to get help, given the runaround and told it'd be hours and hours of waiting, until they left to try to find another ER with a shorter wait (in one case, the patient was delirious, sweating, and being guided around by a couple friends—I hope she got help somewhere),…

I have never heard of anyone in my city getting in within 3 hours. That would be amazing.

Re: New health insurance “transparency data” looks suspiciously wrong

#94

Post by lostlogin »

TedDoesntTalk wrote: post #89
lostlogin wrote: post #61

Earlier quoted context omitted.

I have both, and the wait at the paid clinic is long, as is the wait at the free clinic. It’s not whether the cost is socialised or not that decides how long the wait will be. It also doesn’t help that the private system is incentivised to undermine the ‘free’ system at every turn.

> It’s not whether the cost is socialised or not that decides how long the wait will be If care is free, aren’t you more likely to go than if you had to pay even a minimal cost?

It more complicated than that unfortunately.

New Zealand has an accident compensation system which pays for accidents (though there may be a small surcharge) but not most medical events. They split the hair finer that is sane. Swallow a foreign body? Medical problem. Swallow a foreign body as say ‘it feels scratched’? Accident. Insect bite? Medical. Mosquito bite? Accident (it’s a distant memory from when I billed these things but I’m fairly confident I’m right).

It’s all to do with cause and effect, and each must be identified.

The accident compensation scheme covers a portion of wages too. Medical problems cost, not US style but not free.

Re: New health insurance “transparency data” looks suspiciously wrong

#95

Post by aintgonnatakeit »

aintgonnatakeit wrote: post #85
yunohn wrote: post #15

Earlier quoted context omitted.

But the given examples are basic procedures like “wrist x-ray” or “endoscopy”. Surely they have simpler rate calculations than the potential special cases you mention?

Let’s do wrist x-ray and keep it simple. I’m sure I’ll mess up the formatting here. When you get an x-ray, you would expect to see 3 claims (again, simplifying). —— One is the x-ray tech taking the picture. That gets a professional claim with a CPT code and is straightforward. —- One is the interpretation by a radiologist of the imaging. That is a professional claim with a CPT and a modifier. —- The last depends on t…

Forgot one. The doctor who looked at the X-ray practices under one ID on Sundays, another ID MWF, and another T,Th,Saturday. In each case he’s also part of a different provider group. He might still have more than 9 TINs or NPIs under which he bills, all with different rates. How much does it cost to have this doctor interpret your x-ray?

Re: New health insurance “transparency data” looks suspiciously wrong

#96

Post by CraigJPerry »

Alupis wrote: post #59
nhinck2 wrote: post #52

Earlier quoted context omitted.

No, functioning, so not like the US, universal public health care with costs covered by the government. I'm not sure why you're ignoring a lot of Europe, Canada, Australia and New Zealand.

> I'm not sure why you're ignoring a lot of Europe, Canada, Australia and New Zealand. These are exactly the ones I had in mind. > universal public health care with costs covered by the government. To be pedantic, this doesn't exist anywhere in the world. The taxpayers foot the bill universally. You may not personally care, but it matters when we're discussing spending other people's money. In the US, we already have…

>> These are exactly the ones I had in mind

Those countries citizens rate their happiness with the healthcare system in their country ~2x higher than US citizens do. So that line of thinking doesn’t hold.

>> it matters when we're discussing spending other people's money

That’s not how money works and until that fundamental misunderstanding is eliminated, learned helplessness will prevail. A country that issues its own currency cannot save money in its own currency.

The hard limitation a government faces is resources, not capital.

Re: New health insurance “transparency data” looks suspiciously wrong

#97

Post by joe_the_user »

ethbr0 wrote: post #77
candiddevmike wrote: post #3

Everyone assumed there would be malicious compliance here but it's definitely eye opening just how malicious they made it. Speaks volumes for the perceived risk releasing this data, IMO. Still waiting to hear about someone using this data to negotiate down a hospital bill, seems like it's just insurance companies that can weaponize this data for better rates.

> but it's definitely eye opening just how malicious they made it As someone familiar with insurer, provider, and facility IT systems, I'd offer an alternate explanation -- the data is bad because healthcare IT is understaffed (and often incompetent). These are businesses that have squeezed most costs out, and IT is definitely a cost. Imagine banking... if there were much less competitive pressure and an inability to…

They received a mandate. They tried to respond in the way that required the least amount of effort. From someone in the industry, it's entirely plausible this is the best they can do.

Assuming this is true for the sake of argument, saying that this sort of thing isn't malicious compliance is a sad kind apologistics for bad behavior that seems to regularly appear on HN.

Re: New health insurance “transparency data” looks suspiciously wrong

#98

Post by Alupis »

CraigJPerry wrote: post #96
Alupis wrote: post #59

Earlier quoted context omitted.

> I'm not sure why you're ignoring a lot of Europe, Canada, Australia and New Zealand. These are exactly the ones I had in mind. > universal public health care with costs covered by the government. To be pedantic, this doesn't exist anywhere in the world. The taxpayers foot the bill universally. You may not personally care, but it matters when we're discussing spending other people's money. In the US, we already have…

>> These are exactly the ones I had in mind Those countries citizens rate their happiness with the healthcare system in their country ~2x higher than US citizens do. So that line of thinking doesn’t hold. >> it matters when we're discussing spending other people's money That’s not how money works and until that fundamental misunderstanding is eliminated, learned helplessness will prevail. A country that issues its ow…

> That’s not how money works and until that fundamental misunderstanding is eliminated, learned helplessness will prevail. A country that issues its own currency cannot save money in its own currency.

Ah, the so-called "Modern Monetary Theory"... the same one that told us governments can spend infinitely without consequences... and then runaway inflation and looming recession happened. Of course, not MMT's fault...

In case my sarcasm wasn't thick enough - it is indeed how money works. The attempts to "1984" economics thankfully are failing spectacularly enough to put it to rest.

> Those countries citizens rate their happiness with the healthcare system in their country ~2x higher than US citizens do. So that line of thinking doesn’t hold.

This is a false statistic designed to mislead people into thinking some other system is objectively better.

Re: New health insurance “transparency data” looks suspiciously wrong

#99

Post by JJanos »

aintgonnatakeit wrote: post #95
aintgonnatakeit wrote: post #85

Earlier quoted context omitted.

Let’s do wrist x-ray and keep it simple. I’m sure I’ll mess up the formatting here. When you get an x-ray, you would expect to see 3 claims (again, simplifying). —— One is the x-ray tech taking the picture. That gets a professional claim with a CPT code and is straightforward. —- One is the interpretation by a radiologist of the imaging. That is a professional claim with a CPT and a modifier. —- The last depends on t…

Forgot one. The doctor who looked at the X-ray practices under one ID on Sundays, another ID MWF, and another T,Th,Saturday. In each case he’s also part of a different provider group. He might still have more than 9 TINs or NPIs under which he bills, all with different rates. How much does it cost to have this doctor interpret your x-ray?

I think you're far off base here. An X-Ray will never come on more than 2 claims. It only has two parts, an interpretation and a facility fee. You are right it is confusing. It is true that billing context (as part of a grouper/stand alone) needs to a part of the publication of the files. However, that has nothing to do with the author raising valid points of inconsistency that can make the data unusable.

Re: New health insurance “transparency data” looks suspiciously wrong

#100

Post by sdenton4 »

rqtwteye wrote: post #92
xupybd wrote: post #45

Earlier quoted context omitted.

I live with free healthcare. The last three trips to the emergency department have been over eight hour waits. My father's cancer treatment was not covered so the last year of his life cost him everything. On the other side my child's healthcare is amazing and all free. We get instant access to great services.

Last time I was the ER in the US, I waited four hours with a pretty serious fever. Talked to a doctor for maybe 5 minutes and got sent home. Cost me only $500.

If only there were some automated system you could talk to to decide whether it's worth going to the ER in the first place...
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