5 ms·

What percentage of the recepients costs are insurance related overhead as well? (Yes, that includes the time doctors spend arguing with insurers).

by phonon 7y ago

lotsofpulp 7y ago
Surely, there is room for optimization, but in the alternative case of taxpayer funded healthcare, I'm sure the government is going to ask doctors for justifications for the same reasons insurers do. Someone needs to provide a second opinion on whether or not procedures and medications are appropriate for accountability purposes.
- Retric 7y ago
  Governments add far less overhead in this area because they have more data and can thus use random inspection of bills for validation. Further, when setting rates every insurer has a separate negotiation involving even more overhead.
  - lotsofpulp 7y ago
    The government hires health insurance companies to do the inspections. I don't know of any US government that doesn't contract implementation of Medicaid/Medicare to UHG/Anthem/Humana/etc. So all the insurers have all the data anyway, and they are not inspecting each and every bill, they are also using heuristics.
    - Retric 7y ago
      Using heuristics on smaller sample sizes is inherently less efficient. You can get reasonable polling data on 50 million voters using 10,000 samples. That’s 1 sample per 5,000 voters. Drop the election down to a local election with 10,000 voters and the same ratio provides 2 samples telling you almost nothing. Thus, if 5 insurance companies send patients to the same doctor you simply have more overhead.
- phonon 7y ago
  Fraud in government programs have much harsher criminal penalties and are more aggressively pursued. https://www.propublica.org/article/health-insurers-make-it-easy-for-scammers-to-steal-millions-who-pays-you https://www.propublica.org/article/health-insurers-make-it-e... https://www.propublica.org/article/we-asked-prosecutors-if-health-insurance-companies-care-about-fraud-they-laughed-at-us https://www.propublica.org/article/we-asked-prosecutors-if-h... https://www.propublica.org/article/how-to-make-health-insurers-take-fraud-seriously https://www.propublica.org/article/how-to-make-health-insure...

What percentage of the recepients costs are insurance related overhead as well? (Yes, that includes the time doctors spend arguing with insurers).

by phonon 7y ago

What percentage of the recepients costs are insurance related overhead as well? (Yes, that includes the time doctors spend arguing with insurers).

lotsofpulp 7y ago

Surely, there is room for optimization, but in the alternative case of taxpayer funded healthcare, I'm sure the government is going to ask doctors for justifications for the same reasons insurers do. Someone needs to provide a second opinion on whether or not procedures and medications are appropriate for accountability purposes.

Retric 7y ago
Governments add far less overhead in this area because they have more data and can thus use random inspection of bills for validation. Further, when setting rates every insurer has a separate negotiation involving even more overhead.
- lotsofpulp 7y ago
  The government hires health insurance companies to do the inspections. I don't know of any US government that doesn't contract implementation of Medicaid/Medicare to UHG/Anthem/Humana/etc. So all the insurers have all the data anyway, and they are not inspecting each and every bill, they are also using heuristics.
  - Retric 7y ago
    Using heuristics on smaller sample sizes is inherently less efficient. You can get reasonable polling data on 50 million voters using 10,000 samples. That’s 1 sample per 5,000 voters. Drop the election down to a local election with 10,000 voters and the same ratio provides 2 samples telling you almost nothing. Thus, if 5 insurance companies send patients to the same doctor you simply have more overhead.
phonon 7y ago
Fraud in government programs have much harsher criminal penalties and are more aggressively pursued. https://www.propublica.org/article/health-insurers-make-it-easy-for-scammers-to-steal-millions-who-pays-you https://www.propublica.org/article/health-insurers-make-it-e... https://www.propublica.org/article/we-asked-prosecutors-if-health-insurance-companies-care-about-fraud-they-laughed-at-us https://www.propublica.org/article/we-asked-prosecutors-if-h... https://www.propublica.org/article/how-to-make-health-insurers-take-fraud-seriously https://www.propublica.org/article/how-to-make-health-insure...