I’m not saying this is not a good effort as it is, but lets look at the reality of all of this as insurers change their business models frequently and it’s done with algorithms that change parameters on underwriting, playing claims, you name it.  It’s a constant adjustment in the business world today and financial companies do it too.  My question for this is how to you make it work?  The minute a new policy type is introduced, then in my opinion, someone needs t change the text that consumers see and it will be under constant editing, right? 

If you read the article below it even states that one of their primary concerns was to explain breast cancer treatment and says HHS doesn’t quite know how to address this.  Back in April of 2010 it was in the news that WellPoint had a “breast cancer algorithm” out there, perfect example of how this explanation that will be required and the algorithms clash.  A while back a medical records vendor told me they hired an analyst from an insurance company who stated that insurers just live and die by the algorithms as those are their business models for profit. 

WellPoint Ran a Breast Cancer Algorithm to Target Members for Cancellation of Policies - “Fraud Detection” is the Catch All that Justifies the Reporting

I do agree with the point made by insurers with this being a “huge” cost to keep up as those printing factories will be running non stop with revisions and that part they have right.  I dug back in my archives for this one, an HIV algorithm was found and now this is compounded with the rising issue of flawed data out there too. 

Health Insurance Company Ran an “HIV” Algorithm To Cancel Consumer’s Policy –An Automatic Fraud Investigation Revealing “False Positives” Or “Unhealthy Patients”

Here’s another archived post of mine from a couple years ago and this plays right in to my series on the Attacks of the Killer Algorithms. 

Are We Ever Going to Get Some Algorithm Centric Laws Passed for Healthcare!

The health insurers themselves back in December of 2008 suggested “more algorithms” to provide health insurance solutions, so again this is a nice gesture by all means but how’s it going to work is my question and will it be dead on arrival before it gets out the door. 

Health Care Insurers Suggest Algorithms and Business Intelligence solutions to provide health insurance solution

Insurers and others also use a lot of 3rd party consultants and those play a role too with how your insurance works and here’s one who had some major problems with using actual patient files to look for investors on Wall Street, notebook was stolen and this all came t light.  The state has take their license and is bringing the folks to court over their algorithms to seek investors here, bad mistake. I bring this up as the third party consultants used have an impact on how health insurance policies are created and impact what is covered, how much is covered and so on with their business intelligence analytics and here you are the patient just wanting to know if you get cancer what will be covered so it appears investors are having some input here on such items when they are not being caught.

Accretive Health Debt Collector Employee Has Laptop Stolen With Non Encrypted Patient Data from 2 Hospitals And Had Access to All the Data Via Revenue Cycling - Patient Information Was Shared With Wall Street Investors – Algorithms For Profit Again?

Some banks are getting tired of this business too as they are very complicated algorithms and I think they have had enough with all the mortgage algorithms out there used and with matching up data to what they sold. 

HealthSmart Holdings Inc. Purchases Third Party Medical Administration Business From Wells Fargo Insurance Services

So, with explaining our health insurance in easy text on paper, will there be any provisions to explain how your data gets sold?  That should be part of this deal too as we all want to know and are in the dark with privacy policies that are very difficult to understand.  I have a suggestion for that too and you can read it and kick it around and see what you think.

What you pay for premiums and what you get could very well be dependent on how much money some insurers make from subsidiaries too as all of this goes to their bottom line, so again if we are going to explain insurance policies, let’s go the whole transparency route and explain how they function and how the face of healthcare has changed with the huge onslaught of mergers and acquisitions over the last couple of years and how data aggregation works with both intelligence and profit.  We need a business model for it for sure, just like corporate USA uses to make this work. 

The Alternative Millionaire’s Tax–License and Tax Big Corporations Who Mine and Sell Taxpayer Data They Get for Free From the Internet-Phase One to Restore Middle Class With Transparency, Disclosure and Moneyimage

I guess this remains to be seen if such explanations can be created and enjoy some levels of success here as we do need that but it won’t happen using old technologies with bombing consumers with more “paper print” rhetoric to read that will be updated whenever some algorithms change, right? 

I keep a garbage can right next to my mail box at home in my garage so I only go 2 feet to dump it as I don’t have time to read all the paper text advertisements and other information mailed to me and it does all go to be recycled, all the stuff I don’t have time to read.  BD 

WASHINGTON — Don’t have the slightest clue what your health insurance covers?

The Obama administration says that’s going to change, starting this year. Officials announced Thursday that private health plans will have to provide consumers with a user-friendly summary of what’s covered, along with key cost details such as copays and deductibles.

For example, the summaries won’t include premiums. Administration officials said they ran into logistical problems trying to do that, and that premiums will be easily available anyway to consumers, either from their employer or from a health plan directly.

“These documents will allow consumers to compare plans on an apples-to-apples basis,” said Medicare chief Marilyn Tavenner, who is also overseeing implementation of President Barack Obama’s health care law. If an insurance plan offers substandard coverage in some respect, they won’t be able to hide it in dozens of pages of text, she added.

Insurers and employers had complained that providing paper copies of the summaries would be a huge new cost. The administration will allow them to comply by providing an online version, but consumers must be told that they can receive a paper copy promptly upon request.



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