> At most big old and public insurance companies, claims payable represents a significant chunk of expenses, but not even close to 100% (it's closer to 60-70%).
By law, it's required to be at least 80%.
By law, it's required to be at least 80%.
For health insurance, the rule is:
> Health Insurance companies must spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs.
As a health insurer, you can lower premiums while increasing spending on "Quality improvement", to provide a better experience at a lower rate, and increase your market share. This is one dimension of competition that is only beginning to be competitively explored.
If you can get quality improvement at lower marginal costs (which is ultimately a tech problem), you're a more competitive health insurance company.
Yes, this is a common criticism of the ACA.
Controlling medical expenses isn't easy. Neither is getting admin + overhead under 10%. You need both to get a reasonably profitable insurance product.
If you assume it costs the health care providers the same amount to file a claim as it takes to process it, then the total overhead of having the insurance industry jumps up to > 30%.
I’ve heard the US numbers are comparable to that, but it is nice to be able to derive it from first principles.
Interestingly, this analysis suggests that the cost of filing a claim should be paid by insurance, not the customer.
Currently the cost is an externality for the insurance company, so they can waste time with nonsensical revisions and rejections before finally paying out.
If the insurance company had to pay for the paperwork on both sides of the process, they’d have a strong incentive to streamline claims.