Yes. Each industry has developed accounting standards that reflect the nature of their business. You couldn't run a bank or a payments company with a simple sales - COGS = gross profit model, it just wouldn't make sense.

In health insurance specifically, profitability is somewhat regulated and this gets at the accounting issue here. Insurance companies should maintain a medical loss ratio of 80-85% meaning that fraction of the premiums should be paid to providers. The remaining 15-20% is split between administrative costs and profit. Most of the article's forensic arguments around this are weak and circular and represent a misunderstanding of the accounting itself.

Should gas stations exclude the cost of the gas they're selling as revenue? There's probably a better argument to be made that they should be included than insurance companies be excluded. Unlike insurance companies, where the costs could come in randomly and over the span of months/years, the gasoline they're selling must be replaced (no randomness element) and is turned over in a matter of days. And if you think gasoline should be exempt because "it's not money", should precious metal or crypto traders get off the hook because those aren't money either?

No - this is a false equivalence. Transaction processing companies for the most part handle the in-and-out flows as a single transaction. Insurance companies hold on to the premium pool ("float") for long enough that they have time to realize gains from investing portions of it - the inflow and outflow are very separate.

That's not a good analogy. Stripe and Visa don't deposit the money in their account and hold on to it, it literally goes directly from the payer to the payee, they just facilitate the technical movement

Insurance money goes from the insured, into the insurance company's bank account, and IF the insured customers need services, it's then paid to service providers. If not, it sits in the insurance company's bank account as profit

Considering insurance premiums that are later paid as insurance claims as not being revenue is absolutely bonkers and there's a reason that's now how the accounting actually works

No, they're collecting money specifically on behalf of a 3rd party and then giving it directly to that 3rd party. They are custodians of that money only, it never even hits their bank account (goes into a dedicated trust account before distribution), and they cannot legally keep it. THAT is an actual passthrough.