Tuesday, February 19, 2013

Wish I could charge those fees....

Some interesting numbers in the AP article about Pre-Existing Condition Insurance Plan (PCIP) quietly being shut down:

"PCIP has served more than 135,000 people ..."the administration said the program has spent about $2.4 billion in taxpayer money on medical claims and nearly $180 million on administrative costs"

The numbers that really jumped out to me were the 135,000 people and $180 million on administrative fees, as I make my living on administrative fees.  So I did some quick looking around, and found that PCIP programs  started rolling out in August through October of 2010. Only 103,160 were covered as of 12/31/12 so 135,000 was the total; not everyone was covered the entire time.

Assuming everyone started in August, that is 29 months, so the numbers don't look as bad. Let's even assume that for all 29 months they covered 135,000 individuals. Their administrative cost averaged $45.98 Per Member Per Month. On small groups I am a happy camper at $25 Per Employee Per Month (which includes dependents). On a PMPM basis I would be elated with $20.

From what I have heard and seen of the program, they didn't even expect you to manage claims, just shuffle the paper. Which explains the $17,777 in average claims. I need to keep a closer eye out for the next RFP they put out: wouldn't take many contracts like this to retire very early. 
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