Obscure health insurance question
April 18, 2014 10:47 AM Subscribe
I am doing some rather obscure research on the health insurance industry. I'm having some trouble finding the information I'm looking for. Hopefully someone here can help!
posted by prunes to Grab Bag (3 answers total) 1 user marked this as a favorite
In the parlance of the health insurance industry, there are providers and subscribers. Providers are your doctors, for example. You, the patient, are the subscriber.
Medical service providers account for the majority of medical claims. Generally, subscribers only submit claims when they go to out of network providers.
I'm trying to find the data on subscriber claims--dollar amount and percentage of the overall total (provider + subscriber).
I tried emailing one health insurer and was told that this was something that they didn't actively track. I've tried searching through Google and haven't had any luck.
Anyone have any idea how to dig into this further?
P.S. It is also worth noting that I expect there to be significant geographic variations in how large subscriber claims are. For example, in NYC, mental health services are almost entirely provided on an out of network basis. This is not the case in other parts of the country. This makes it more difficult to extrapolate one insurer's experiences to the entire country. (Notwithstanding the fact that insurers have differing levels of exposure to different types of the market.)
To the extent that I can find more granular data the better. However, I'm thinking that I'm going to have to take whatever I can get.