Maybe. Or maybe I didn't express myself well and wasn't well understood?
Let's say a person has had an ongoing "condition X" for many years that has needed and will continue to need treatment. There is a set of visits, a set of lab tests, and some prescriptions that are in this person's future. The exact details are not known, but precision is not what's important since the idea is to run a
comparison between plans with this likely scenario.
This person has the ability to pull out old EOB's and that enables assembly of a specific procedure codes, lab codes, and prescriptions. The insurance company obviously has this information. They've got hundreds of people that fit the profile.
The idea would be you take a set of specifics, along with a predicted in-network/out-of-network split assumption, and
get an out of pocket expense estimate for for policy A, B, and C (or how many ever policies you were comparing). This "out of pocket expense estimate" would be for products and servicies (not premiums, not subsidies...that is simple math and could be done after).
So let's say under the above "Usage Scenario 1", "A" costs $2,000, "B" costs $3,000, and "C" costs $5,000.
Now you create a second scenario. It is the same as the first, but it includes a hospital stay of 10 days. Exactly what happens in the hospital is less important than the fact that it's consistently priced in all policies.
In this "Usage Scenario 2", out of pocket expenses are A costs $20,000, B costs $21,000 and C costs $10,000.
If you say scenario 1 is 95% likely and scenario 2 is 5% likely, you end up calculating "expected out of pocket expenses" as follows:
Code:
Weight Scenario 1 Weight Scenario 2 Expected $
A $2,000 0.95 $20,000 0.05 $2,900
B $3,000 0.95 $21,000 0.05 $3,900
C $5,000 0.95 $10,000 0.05 $5,250
Yes, the above numbers are pure fiction...they'll never happen exactly this way. But having these scenarios priced-out is not worthless to the insurance buyer! The better one can predict what will happen, the more valuable having the ability to get out-of-pocket estimates would be. But even if the scenarios do not end up matching reality, it still shows how the policies "behave" from an out-of-pocket expense standpoint.
But like I said earlier, it will never happen. At least won't happen without legislation. It won't happen because it's in the insurance company's best interest to make it as confusing and opaque as possible; when people optimize their policy choice, they are trying to get the most bang for their buck and so reducing the profit to the insurance company.