{ "cells": [ { "cell_type": "markdown", "metadata": {}, "source": [ "# Claims Denials Analysis\n", "\n", "Data from: https://www.cms.gov/marketplace/resources/data/public-use-files\n", "\n", "`Sheet IDs`\n", "- 2 = Individual Marketplace Medical Qualified Health Plans (QHPs)\n", "- 3 = Individual Marketplace Stand Alone Dental Plans (SADPs)\t\n", "- 4 = Small Business Health Options Program (SHOP) Medical and Dental Plans\t" ] }, { "cell_type": "markdown", "metadata": {}, "source": [ "" ] }, { "cell_type": "code", "execution_count": 1, "metadata": {}, "outputs": [], "source": [ "import polars as pl\n", "import pandas as pd\n", "import altair as alt\n", "\n", "alt.data_transformers.disable_max_rows()\n", "\n", "\n", "# For some reason, I can't get Polars to skip the rows properly.\n", "# So using Pandas, for the reader.\n", "df = pl.from_pandas(pd.read_excel(\n", " \"data/Transparency_in_Coverage_PUF.xlsx\", \n", " sheet_name=1,\n", " skiprows=2,\n", " na_values=[\"**\", \"*\"]))" ] }, { "cell_type": "code", "execution_count": 2, "metadata": {}, "outputs": [ { "data": { "text/html": [ "
State | Issuer_Name | Issuer_ID | Is_Issuer_New_to_Exchange? (Yes_or_No) | SADP_Only? | Plan_ID | QHP/SADP | Plan_Type | Metal_Level | URL_Claims_Payment_Policies | Issuer_Claims_Received | Issuer_Claims_Denials | Issuer_Internal_Appeals_Filed | Issuer_Number_Internal_Appeals_Overturned | Issuer_Percent_Internal_Appeals_Overturned | Issuer_External_Appeals_Filed | Issuer_Number_External_Appeals_Overturned | Issuer_Percent_External_Appeals_Overturned | Plan_Number_Claims_Received | Plan_Number_Claims_Denied | Plan_Number_Claims_Denied_Referral_Required | Plan_Number_Claims_Denied_Out_of_Network | Plan_Number_Claims_Denied_Services_Excluded | Plan_Number_Claims_Denied_Not_Medically_Necessary_Excl_Behavioral_Health | Plan_Number_Claims_Denied_Not_Medically_Necessary_Behavioral_Health_Only | Plan_Number_Claims_Denied_Other | Rate_Review | Financial_Information | Average Monthly Enrollment | Average Monthly Disenrollment |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
str | str | i64 | str | str | str | str | str | str | str | f64 | f64 | f64 | f64 | f64 | f64 | f64 | f64 | f64 | f64 | f64 | f64 | f64 | f64 | f64 | f64 | str | str | f64 | f64 |
"AK" | "Premera Blue C… | 38344 | "No" | "No" | "38344AK1060001… | "QHP" | "PPO" | "Gold" | "https://www.pr… | 603348.0 | 143208.0 | 2156.0 | 1079.0 | 50.05 | null | null | null | 259304.0 | 59633.0 | 11433.0 | 143.0 | 6071.0 | 818.0 | null | 89942.0 | "https://ratere… | "https://www.na… | 6428.0 | 728.0 |
"AK" | "Premera Blue C… | 38344 | "No" | "No" | "38344AK1060002… | "QHP" | "PPO" | "Silver" | "https://www.pr… | 603348.0 | 143208.0 | 2156.0 | 1079.0 | 50.05 | null | null | null | 100437.0 | 26239.0 | 4720.0 | 95.0 | 2663.0 | 182.0 | null | 36773.0 | "https://ratere… | "https://www.na… | 2109.0 | 232.0 |
"AK" | "Premera Blue C… | 38344 | "No" | "No" | "38344AK1060004… | "QHP" | "PPO" | "Bronze Expande… | "https://www.pr… | 603348.0 | 143208.0 | 2156.0 | 1079.0 | 50.05 | null | null | null | 115878.0 | 26136.0 | 4786.0 | 20.0 | 2765.0 | 127.0 | null | 43716.0 | "https://ratere… | "https://www.na… | 3605.0 | 479.0 |
"AK" | "Premera Blue C… | 38344 | "No" | "No" | "38344AK1070002… | "QHP" | "PPO" | "Bronze Expande… | "https://www.pr… | 603348.0 | 143208.0 | 2156.0 | 1079.0 | 50.05 | null | null | null | 75481.0 | 20063.0 | 1322.0 | 37.0 | 1586.0 | 87.0 | null | 31298.0 | "https://ratere… | "https://www.na… | 3139.0 | 391.0 |
"AK" | "Premera Blue C… | 38344 | "No" | "No" | "38344AK1080001… | "QHP" | "PPO" | "Gold" | "https://www.pr… | 603348.0 | 143208.0 | 2156.0 | 1079.0 | 50.05 | null | null | null | null | null | null | null | null | null | null | null | "https://ratere… | "https://www.na… | null | null |