Manhattan life is getting out.

[sshafran]

ALL the numbers are overstated vs CSG.

I am not suggesting that CSG is correct and the "other" data is wrong, but there is a SIGNIFICANT variation in the two tables.

Number of lives shown for Omaha doesn't match CSG.

Also, I find it interesting that CSG offer LR information for Medigap but not for MA plans. Wonder why . . .

I think CSG gets its data from the NAIC Loss Ratio reports.

(see 2023 here: https://content.naic.org/sites/default/files/publication-med-bb-medicare-loss-report.pdf).

I would think it's fairly accurate, though there is certainly a lag - i.e. what we're able to see is already old.

 

[somarco]

I think CSG gets its data from the NAIC Loss Ratio reports.

Could be, I have never cared to look into it.

I never found CSG reports to be helpful. With carriers like MOO and Aetna that use half a dozen issuing carriers which LR appears in the reports. Is it the combined LR for the parent or is it for the specific issuing carrier in the state where you are writing the business?

Either way, I find it misleading and disingenuous.

 

[sshafran]

Could be, I have never cared to look into it.

I never found CSG reports to be helpful. With carriers like MOO and Aetna that use half a dozen issuing carriers which LR appears in the reports. Is it the combined LR for the parent or is it for the specific issuing carrier in the state where you are writing the business?

Either way, I find it misleading and disingenuous.

They delineate each subsidiary.

So, carriers report to NAIC yearly on lives covered, premium, loss ratio, etc.

CSG pulls data from those reports.

I believe the data is accurate, just older.

The problem is how agents use it, as if the past predicts the future, or as if the carrier with a 63% LR is somehow in an excellent position (ignoring that there are only 32 lives covered and brand new).

 

[Medicare bro]

If companies are committing fraud left and right, you can be sure they are cooking the books to justify rate increased to the insurance commissioner.

 

[somarco]

you can be sure they are cooking the books to justify rate increased

Carriers are required to submit annual reports and are physically audited by the DOI every 3 to 5 years, depending on the state. These audit are usually quite thorough.

 

[annon123]

The problem is how agents use it, as if the past predicts the future, or as if the carrier with a 63% LR is somehow in an excellent position (ignoring that there are only 32 lives covered and brand new).

And the other issue, I'd imagine, is what their denial rate is with MA's - that saves them money.

 

[Medicare bro]

Carriers are required to submit annual reports and are physically audited by the DOI every 3 to 5 years, depending on the state. These audit are usually quite thorough.

Then how do all insurance companies continue to get away with fraud. Billions worth of fraud? Is the DOI not seeing this?

 

[somarco]

how do all insurance companies continue to get away with fraud

What kind of fraud? You mention "cooking the books" which suggests accounting fraud. This is precisely what DOI audits are designed to explore. The audits also uncover "sloppy" bookkeeping errors, intentional or otherwise.

Here is a checklist . . .

Insurance Audit Checklist

Premium audits are performed to examine and understand your business' risk exposure basis. Learn how an audit can ensure you only pay the premium you owe.

societyinsurance.com

 

[MedicareWAA]

Then how do all insurance companies continue to get away with fraud. Billions worth of fraud? Is the DOI not seeing this?

Who is telling you that Medigap carriers are defrauding taxpayers billions of dollars a year?? Maybe you meant to say MA?

There's not a ton of money in Medigap, and insurance carriers have no way to manage costs. If the underlying risk (fee for service utilization) goes up, the risk premium goes up, too.

 

[Bob G]

I wish people would not offer their opinion on why they think something happened. It's a waste of everyone's time...facts only please