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Using AI to negotiate a $195k hospital bill down to $33k

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Re: Using AI to negotiate a $195k hospital bill down to $33k

#91

Post by CGMthrowaway »

aeturnum wrote: post #8

It seems like the AIs role was in applying lengthy and complex medicare billing rules - it did not do negotiating and it doesn't seem like the accuracy of its understanding of medicare practices was actually checked. The author reasonably accused the hospital of gouging and the hospital came back with a much lower offer. I'd be interested to hear from a charge coding expert about Claude's analysis here and if it was…

>It seems like the AIs role was in applying lengthy and complex medicare billing rules - it did not do negotiating and it doesn't seem like the accuracy of its understanding of medicare practices was actually checked. The author reasonably accused the hospital of gouging and the hospital came back with a much lower offer.

What exactly do you think negotiating is? Real negotiation in business transactions is more often based on agreements around certain facts than emotional manipulation.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#92

Post by joshstrange »

tonymet wrote: post #48

We suddenly woke up in the Kafka-esque purgatory of critical American healthcare billing. We’re in our 50s and had been perfectly healthy, then suddenly we got diagnosed with what will be over $500k in treatment over the next 12 months— and multiple millions for the foreseeable future. We have insurance, but many of the required procedures are “out of network” and there’s no way to tell (we have “the best” insurance,…

> Absolutely no one will tell you how much things are, and when you ask, they sass you that it is a ridiculous question.

> You’ll be asked to take a diagnostic not knowing whether it will cost $10 or $15000

I feel this in my bones and it makes me irrationally (or maybe it's rational actually) angry. Find me any other industry where you can get away with not telling how much something will cost (or even a realistic range) before services are rendered.

I had a medical procedure a year or so ago and when I asked how much it would cost I got an eye roll, a lengthy and exasperated lecture, and in the end the number they quoted was wildly different. I knew I was going to hit my out-of-pocket maximum so I gave up after a while and moved on but it makes me so mad. I _wish_ I could "vote with my wallet" but good luck doing that unless you have unlimited time and energy. By the time I finally got to asking about the price I had been through multiple appointments that took forever to schedule, were weeks or months in the future, all while I needed relief. After being strung along for 6 months I gave up and rolled the dice even though I disliked how they treated me when I asked for the price.

People talk about how you need to be an informed customer but I have to assume those people are lying snakes, have never used the system, or just too stupid to understand that it's impossible.

"I don't know" should _not_ be a valid answer when asking how much something costs, it's ridiculous.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#94

Post by embedding-shape »

nonethewiser wrote: post #89
aeturnum wrote: post #8

It seems like the AIs role was in applying lengthy and complex medicare billing rules - it did not do negotiating and it doesn't seem like the accuracy of its understanding of medicare practices was actually checked. The author reasonably accused the hospital of gouging and the hospital came back with a much lower offer. I'd be interested to hear from a charge coding expert about Claude's analysis here and if it was…

> it did not do negotiating and it doesn't seem like the accuracy of its understanding of medicare practices was actually checked. The author reasonably accused the hospital of gouging and the hospital came back with a much lower offer. Im increasingly of the opinion that AI gives people more confidence than insight. The author probably could have just thought of the same or similar things to assert to the hospital a…

I've found LLMs helpful for figuring out what I don't know, then I can go and look up how those things work, again together with an LLM.

But in the past, once I got to the point where I know I could maybe do something about it, but not exactly what, and I don't know any of the domain words used, you got pretty much stuck unless you asked other people, either locally or on the internet.

At least now I can explore what I don't know, and decide if it's relevant or not. It's really helpful when diving into new topics, because it gives you a starting point.

I would never send something to a real human that a LLM composed without me, I still want to write and decide everything 100% myself, but I use more LLMs as a powerful search engine where you can put synonyms or questions and get somewhat fine answers from it.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#95

Post by itissid »

What's crazier is that for 80k you can get a jet to fly you anywhere in the world and for far lesser than that get world class treatment. What's even more bonkers is that the private and govt insurance companies, and hospitals have negotiated those rates and there is a market to fly people to other countries that is just sitting there and no one is really exploiting it.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#96

Post by morleytj »

sixothree wrote: post #67
cpursley wrote: post #55

Earlier quoted context omitted.

A large portion of the US economy is based on this entire grift pipeline (settling before getting to court). And it's very costly and pushes up insurance costs and costs in general for everyone else.

When people talk about government inefficiency, I always think of how prevalent these kinds of shenanigans really are. I think they are more costly than inefficient government.

It's incredibly costly, and I think it's also incredibly costly in difficult to measure ways. The main method that the average American (read as: not incredibly wealthy person who has lawyers retained) uses to deal with the early stages of this pipeline is engaging in interminably long phone calls, going back and forth between multiple stakeholders, and trying to negotiate as to what actually needs to be paid or done individually. The incentives are aligned for various members of this process to make it a complicated and frustrating experience for customers, because they often benefit from increasing friction for the insured party. I think if you measured working hours lost or impacted by this it would be startlingly high.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#97

Post by patja »

ibash wrote: post #12
aeturnum wrote: post #8

It seems like the AIs role was in applying lengthy and complex medicare billing rules - it did not do negotiating and it doesn't seem like the accuracy of its understanding of medicare practices was actually checked. The author reasonably accused the hospital of gouging and the hospital came back with a much lower offer. I'd be interested to hear from a charge coding expert about Claude's analysis here and if it was…

The thing is the prices are all made up anyway. The hospital hallucinates prices, so they don’t blink an eye when an llm does the same.

We are self-employed in the US and buy our own high deductible plan on our state's marketplace. One of my family members needed a fairly routine planned surgery, so I went through the effort to try to determine in advance how much I would be billed. What a waste of time. My favorite was the hospital who told me the fee for a one night stay would be 73k. But, good news! Your insurance has a contracted discount that brings it down to 13k. So what does the 73k price even mean? At this point I shelved the effort as I correctly concluded we would hit our household max out of pocket for the year, so anything above that would not affect us.

And hey! Silver lining: in a year when we max the out of pocket limit, no more cost-sharing on any other services for that calendar year! Time to pack in some care we have been deferring mostly due to cost. Except the care providers and insurance company are well aware of this, so they don't bill you for up to a year from the date of service, so you can't be sure you "hit your max" until the subsequent year.

It is enough to induce strong negative emotions.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#98

Post by lotsofpulp »

sixothree wrote: post #67
cpursley wrote: post #55

Earlier quoted context omitted.

A large portion of the US economy is based on this entire grift pipeline (settling before getting to court). And it's very costly and pushes up insurance costs and costs in general for everyone else.

When people talk about government inefficiency, I always think of how prevalent these kinds of shenanigans really are. I think they are more costly than inefficient government.

Having to settle because court cases take too long to resolve is due to inefficient government.

Not only does the actual court case and appeals process take years, but even after you “win”, the collection process takes years after it has already been determined who owes what.

See Alex Jones for a ridiculous example. He should have been homeless and shirtless a long time ago.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#99

Post by awillen »

aeturnum wrote: post #8

It seems like the AIs role was in applying lengthy and complex medicare billing rules - it did not do negotiating and it doesn't seem like the accuracy of its understanding of medicare practices was actually checked. The author reasonably accused the hospital of gouging and the hospital came back with a much lower offer. I'd be interested to hear from a charge coding expert about Claude's analysis here and if it was…

Often with these kinds of things it's not even as much about being specifically accurate as it is about presenting yourself in a way that makes the other party believe that have sufficient understanding of the issue at hand and the escalation paths available that you won't just go away if they don't play ball. That is, make yourself credibly as a Dangerous Professional, in patio11 parlance.

I just did this with a pet insurance bill, and ChatGPT was very helpful. They denied based on the pre-existing condition exclusion even where it was obviously not valid (my dog chipped her tooth severely enough to need a root canal, and they denied because years before when she wasn't covered under the policy, she had chipped the same tooth in a minor, completely cosmetic way).

I was sure they were in the wrong and would've written a demand letter even in the pre-AI days, but ChatGPT helped me articulate it in a way that made me sound vastly more competent than the average consumer threatening a lawsuit. It helped make my language as legally formal as possible, and it gave me specific statutes around what comprises a pre-existing condition in CA as well as case law that placed very high standards on insurers seeking to decline coverage by invoking an exclusion (yes I checked, and they were real cases that said what it thought they said).

Gave them fourteen days to reverse the denial before I filed in small claims court, and on day fourteen got a letter informing me that the claim would be paid in full. It's of basically no cost to them to deny even remotely borderline cases, so you have to make them believe that you will use the court system or whatever other escalation paths there are to impose costs, and LLMs are great for that.

Re: Using AI to negotiate a $195k hospital bill down to $33k

#100

Post by GrinningFool »

ecosystem wrote: post #74

The American Medical Association owns copyright to all the codes and their descriptions. They have an extremely restrictive and expensive licensing options and they strictly forbid training models with the codes. This month, the practice was called out ( https://www.help.senate.gov/rep/newsroom/press/chair-cassidy... ) so the Overton window may be opening. The AMA (a nonprofit!) clears ~$300M/year revenue from the co…

Reading between the lines, it seems like this is a threat made to bring AMA in line with the administration's policies around medically supporting transgender people.

I would expect that if (when) the AMA folds on the matter, concerns around the codes will be somehow forgotten

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