Behind the scenes at a health insurer: How the money is made, or why the Medical Loss Ratio matters

Behind the scenes at a health insurer: How the money is made, or why the Medical Loss Ratio matters

A contributor to one of my online communities, Scott Haas, wrote this to the group the other day in the context of what happens behind the scenes in health insurance. His note primarily concerns the Medical Loss Ratio formula and the way it was changed by the Affordable Care Act — and the role of […]

How much does IVIG (IV Immunoglobulin) cost? Or, no wonder healthcare is so expensive: Morgan Gleason

How much does IVIG (IV Immunoglobulin) cost? Or, no wonder healthcare is so expensive: Morgan Gleason

By Morgan Gleason I am thinking that we might really need to just burn the healthcare system to the ground and completely start over. Although I am pretty experienced with healthcare, the financial piece is one that I haven’t really been as involved in since I am still on my parents’ insurance and they pay […]

How much do Focalin and Adderall cost? When patients have to ‘fail’ treatments to get the right meds

How much do Focalin and Adderall cost? When patients have to ‘fail’ treatments to get the right meds

“Step therapy” is the seemingly innocuous name that insurance companies give to the practice of insisting that patients try and fail treatment on less expensive drugs before moving on to more expensive ones. A friend writes: As a parent of two children diagnosed several years ago with ADHD, I have come to find that there […]

Hey, Humana! Can we help you figure out how much an X-ray costs?

Hey, Humana! Can we help you figure out how much an X-ray costs?

Humana, the big health insurer, came visiting the other day to ask ClearHealthCosts how much an X-ray costs. They spent 8 minutes and 46 seconds reading this blog post. You can see on the screenshot here of our analytics program. Interestingly, they came to us via the sketchy informationvine.com search. They came lots of other […]

Under one roof: Narrow networks, and provider-owned insurers

Summary: Very, very narrow networks are rising in popularity. These often seem to be formed by an incumbent insurance company (think Aetna or UnitedHealthcare) with a local health care system. This is an interesting phenomenon, especially given the statements by UnitedHealthcare that it’s not making enough money on the health insurance plans under the Affordable […]

When Aetna visits us to learn about medical billing codes

Filed Under: Costs, Health plans

Summary: Interesting things about our visitors from our analytics: Someone from Aetna in Connecticut visited us to learn about medical coding. Here’s a screenshot from our analytics page (click to enlarge). The post, “Alphabet soup: HCPCS codes, as well as ICD, DRG, CPT,” gets a fair amount of traffic. We’re happy to help when the […]

Aetna, paying 45 percent less than Medicare, is schooled on Twitter

Filed Under: Costs, Health plans, Patients

Aetna pays 45 percent less than what Medicare pays, at least for one treatment in California. Aetna also pays half of what other insurers pay. This is startling because a lot of the noise in the health-care marketplace is about low government reimbursement rates, via Medicare  (the federal program for the elderly and disabled) and […]

Aetna profits up: revenue’s the same, but claims are down

Filed Under: Costs, Health plans, Patients

Revenue is up slightly, but claims are down at the health insurer Aetna, meaning that the company posted a sharply higher quarterly profit. Because of the low use of health services by members, in connection with the weak economy, “Aetna spent 80.7 percent of its premium revenue on medical claims in the quarter, well below the 83 […]

Aetna sues in New Jersey, Pt. 2

Aetna sues in New Jersey, Pt. 2

The Aetna lawsuit in New Jersey seemed so puzzling that we continued reporting on it, following links. Why would Aetna pay such ridiculous rates, including a payment of $56,980 for a bedside consultation and “$59,490 for an ultrasound that typically costs $74”? That just seems absurd; we have a hard time getting $23.40 out of […]