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Biotech / Medical : Oxford Health Plan (OXHP)

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To: Michael Burry who wrote (624)	12/19/1997 10:10:00 PM
From: jeffbas	Read Replies (1) of 2068

Mike, I disagree with your technical comments. The major insurance company I worked for did very extensive modelling (based on actual and theoretical data) of what the expected claim costs would be for various different plans. Things considered were items like the richness of in and out of network benefits, how it drove utilization one way or the other, the effect of restricted networks vs. less restricted, etc. Obviously a straight HMO plan or straight indemnity plan is much simpler, but this industry is not in the dark ages, unless it chooses to be by mgmt direction or otherwise. That said, I do not think there is an industry where it is more difficult to estimate the costs that your price is to cover, as I have discussed in a previous post. There also is not standard industry data you can make adjustments to for your own situation; but there certainly are competitor's prices that you see every day for the products they offer. If your price is better than everyone else's mgmt should be asking why, not patting themselves on the back for all the business they are writing (which I have seen happen several times).

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