But this sort of organization wouldn't have any of that data except for age (birthdates) and occasionally weight. Birthdates would need to be cleverly tweaked. Maybe randomized by a few days (although this would be problematic with infants).
If someone is using "Insurance Provider", they're being unnecessarily verbose, and probably not accurate - thus the clusterfuck. The term 'Insurer' would be more concise, though not necessarily accurate. The term Payer is used within the industry because it could be insurance, CHAMPUS, the VA, Medicare or Medicaid. IIRC, the CMS-1500 claim form does not even use the term Insurance (it has checkboxes for he type of plan), although it does use Insured. The UB92 uses the term payer (up to three of them). The EDI documentation for the 837 (claim) and (834) use Payer primarily, but sometime Insurer.
Insurance Provider certainly isn't wrong from an English standpoint, but there is a very clear meaning within the health insurance industry when one simply uses the term "Provider".
So ask for universal coverage and not single payer and you'll gain the support of a large bloc without having to give anything up.
If we can provide universal coverage, preserve choice and competition, offer a nationwide marketplace, and allow new approaches to be tried, we can gather support from both sides of the aisle. We can move all of the risk to the private sector and get rid of Medicare and Medicaid.
All we have to determine is how do we determine who needs help with their premiums, and how we provide that help.
Single-payer has nothing to do with it. Tax dollars could be used to buy private insurance for everyone from the most competitive insurance companies. Single payer is just about political control.
Seriously - would you or anyone you know actually think "I never really considered getting a serious helath problem, but it the treatment is free, why the hell not?", or is it just "those other people" you collectively accuse of this insanity?
Yes, I know someone who had some money in his Flexible Spending Account that was going to go away January 1st because that's what happens with FSA's. So he went to his doctor and said "I've got this money until Jan. 1, so run whatever tests might be helpful."
It's not a health insurance company. It's a provider network. The benefit to them is that if the doctors in their network are able to head off problems before hospitalization is needed they can show health insurers that their network reduces costs so that health insurers will make them their in-network plan. This will incentivize patients to go to their doctors. The insurance companies then pay the network a per-member monthly access fee.
And just FYI, HMO's are going extinct. They didn't work very well. They are a different model where (oversimplified...) insurers pay doctors salaries rather than paying for each service.
I've been in the U.S. - where 85% of people with health insurance are happy with it. We need to get more people covered by private insurance. Not kill it.
There are all sorts of organizations doing this - either for themselves or as a service to payers. But most all of them choose people to design a solution. Here, they're looking for the best solution regardless of where it comes from.
Insurers cannot remove people from rolls merely for becoming ill. That would make their entire reason to exist pointless, and their product utterly without value.
You can rest assured that large corporations that purchase health insurance for the employees (and selves) have their own army of lawyers and experts and are not being tricked.
The individual mandate, coupled with a ban in preexisting condition exclusions, is actually supported enthusiastically by health insurance companies. Their only problem with this part is that the penalty for not buying health insurance is not great enough and won't acheive anything near universal coverage.
If there is a misalignment of interests between the patient's interests and those of the payer, it is not eliminated by eliminating competition and making government the payer. That just moves the role of payer to politicians and beurocrats.
No, in this context, insurers are not providers. That term is used because providers can include midwives, ambulance companies, durable medical equipment sellers, pharmacies, etc.
Incorrect. Live, healthy premium payers are good for health insurers. Live, unhealthy premium payers are bad for health insurers. And dead people don't pay premiums, so they're no use to health insurers.
The profit motive ensures that the plans remain viable and competition ensures that the insurers will keep the premiums as low or lower than their competitors. And if an employer suspects that the insurers are raping them, then they can self insure and just pay an administrative fee to a Third Party Administration company and assume the risk themselves or with them help of a reinsurance company.
Profitable healths plans are good as long as there is competition. It's sustainable. If you look at the U.S. national debt, you'll immediately see that our government is not so good about managing these things, so we are left worrying about the sustainability of Medicare and Social Security.
They're using claims data because that's the data they have. They don't have the full medical records. They're a provider network. They don't set premiums.
I have to wonder if WP7 will still be Microsoft's smartphone OS in 2015 or if they'll have moved to WP8.
I have to wonder whether, in 2015, Microsoft will be in the phone software business at all.
Microsoft is not known for strong initial offerings. The original IE was awful. The original Windows was unusable. They tend to stay in and fight, and sometimes win.
These things could be a godsend for troops that have to clear buildings as they had to in, say, Fallujah. Being able to survey the situation before going through the door could save a lot of lives (well, on the American side at least).
I just tried it. The reaction didn't happen. I put a nickel from my pocket in a glass. I didn't have any pure hydrogen around, but decided to use water, which has, like, twice as much hydrogen as oxygen. So I poured the water into the glass, expecting the nickel to be transformed into five copper pennies, some oxygen to be released, and a heating of the remaining water.
Slashdot Mirror
Repeat Until EndOfLife(Member) //$Profit!!!
{
PrintAndMail("Hospital Horror Story", Member);
Bill(Member.Insurer);
}
For $3M, they can have it. The scary thing is if they require that every entry becomes their property.
But this sort of organization wouldn't have any of that data except for age (birthdates) and occasionally weight. Birthdates would need to be cleverly tweaked. Maybe randomized by a few days (although this would be problematic with infants).
Actually, that is not true. It is true that you may be financially ruined, but after that, Medicaid kicks in to cover necessary treatments.
If someone is using "Insurance Provider", they're being unnecessarily verbose, and probably not accurate - thus the clusterfuck. The term 'Insurer' would be more concise, though not necessarily accurate. The term Payer is used within the industry because it could be insurance, CHAMPUS, the VA, Medicare or Medicaid. IIRC, the CMS-1500 claim form does not even use the term Insurance (it has checkboxes for he type of plan), although it does use Insured. The UB92 uses the term payer (up to three of them). The EDI documentation for the 837 (claim) and (834) use Payer primarily, but sometime Insurer.
Insurance Provider certainly isn't wrong from an English standpoint, but there is a very clear meaning within the health insurance industry when one simply uses the term "Provider".
So ask for universal coverage and not single payer and you'll gain the support of a large bloc without having to give anything up.
If we can provide universal coverage, preserve choice and competition, offer a nationwide marketplace, and allow new approaches to be tried, we can gather support from both sides of the aisle. We can move all of the risk to the private sector and get rid of Medicare and Medicaid.
All we have to determine is how do we determine who needs help with their premiums, and how we provide that help.
Single-payer has nothing to do with it. Tax dollars could be used to buy private insurance for everyone from the most competitive insurance companies. Single payer is just about political control.
Except that by law, they're not allowed to do this.
Seriously - would you or anyone you know actually think "I never really considered getting a serious helath problem, but it the treatment is free, why the hell not?", or is it just "those other people" you collectively accuse of this insanity?
Yes, I know someone who had some money in his Flexible Spending Account that was going to go away January 1st because that's what happens with FSA's. So he went to his doctor and said "I've got this money until Jan. 1, so run whatever tests might be helpful."
It's not a health insurance company. It's a provider network. The benefit to them is that if the doctors in their network are able to head off problems before hospitalization is needed they can show health insurers that their network reduces costs so that health insurers will make them their in-network plan. This will incentivize patients to go to their doctors. The insurance companies then pay the network a per-member monthly access fee.
Billing costs do not go to the insurance companies. Billing costs represent the labor involved in submitting claims.
* not from the USA.
Is an HMO legally allowed to cut off people who are currently insured with the HMO?
No - unless you lied about a pre-existing condition, or are a smoker who lied about it to get the cheaper rate, or something like that.
http://attorneypages.com/hot/health-insurance-reciscission.htm
And just FYI, HMO's are going extinct. They didn't work very well. They are a different model where (oversimplified...) insurers pay doctors salaries rather than paying for each service.
I've been in the U.S. - where 85% of people with health insurance are happy with it. We need to get more people covered by private insurance. Not kill it.
There are all sorts of organizations doing this - either for themselves or as a service to payers. But most all of them choose people to design a solution. Here, they're looking for the best solution regardless of where it comes from.
Insurers cannot remove people from rolls merely for becoming ill. That would make their entire reason to exist pointless, and their product utterly without value.
You can rest assured that large corporations that purchase health insurance for the employees (and selves) have their own army of lawyers and experts and are not being tricked.
The individual mandate, coupled with a ban in preexisting condition exclusions, is actually supported enthusiastically by health insurance companies. Their only problem with this part is that the penalty for not buying health insurance is not great enough and won't acheive anything near universal coverage.
If there is a misalignment of interests between the patient's interests and those of the payer, it is not eliminated by eliminating competition and making government the payer. That just moves the role of payer to politicians and beurocrats.
No, in this context, insurers are not providers. That term is used because providers can include midwives, ambulance companies, durable medical equipment sellers, pharmacies, etc.
Incorrect. Live, healthy premium payers are good for health insurers. Live, unhealthy premium payers are bad for health insurers. And dead people don't pay premiums, so they're no use to health insurers.
The profit motive ensures that the plans remain viable and competition ensures that the insurers will keep the premiums as low or lower than their competitors. And if an employer suspects that the insurers are raping them, then they can self insure and just pay an administrative fee to a Third Party Administration company and assume the risk themselves or with them help of a reinsurance company.
Profitable healths plans are good as long as there is competition. It's sustainable. If you look at the U.S. national debt, you'll immediately see that our government is not so good about managing these things, so we are left worrying about the sustainability of Medicare and Social Security.
They will be providing access to a de-identified database. So you should have all the data that would be available in a real world application.
Health insurers are definitely not aiming to maximize the profits of providers. Quite the opposite in fact.
They're using claims data because that's the data they have. They don't have the full medical records. They're a provider network. They don't set premiums.
I have to wonder if WP7 will still be Microsoft's smartphone OS in 2015 or if they'll have moved to WP8.
I have to wonder whether, in 2015, Microsoft will be in the phone software business at all.
Microsoft is not known for strong initial offerings. The original IE was awful. The original Windows was unusable. They tend to stay in and fight, and sometimes win.
Indeed. Look at the 'E's. Some are traditional squared off E's and some are like a C with a horizontal line. It could mean something, or nothing.
These things could be a godsend for troops that have to clear buildings as they had to in, say, Fallujah. Being able to survey the situation before going through the door could save a lot of lives (well, on the American side at least).
Is this the start of a Bladerunner prequel?
I just tried it. The reaction didn't happen. I put a nickel from my pocket in a glass. I didn't have any pure hydrogen around, but decided to use water, which has, like, twice as much hydrogen as oxygen. So I poured the water into the glass, expecting the nickel to be transformed into five copper pennies, some oxygen to be released, and a heating of the remaining water.
Nothing happened. It is therefore debunked.