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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

#121

Post by sixothree »

dekhn wrote: post #34

I had an odd but successful experience with medical billing recently. My daughter went to urgent care for an urgent problem; after things were mostly cleared up, they transferred her by ambulance to an ER (even though there was no emergency). Both the urgent care and ER were handled by our insurance but the ambulance company sent us a large bill ($4K for a short drive) which felt too large to us (they had already tri…

> we ended up paying $500 to the ambulance company.

I'm sure people from first world countries would be stunned by this number. And that makes it even sadder.

> Maybe AI will help, but I really doubt it long term.

I'm guessing it will help up until the point where hospitals start using AI for this process.

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

#122

Post by EvanAnderson »

joshstrange wrote: post #92
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 ra…

> I got an eye roll, a lengthy and exasperated lecture...

This is the part that is galling to me. Apparently no healthcare worker I've ever spoken with about billing has ever had the same considerations I do re: finances. My inquiries have almost always been met with zero empathy and contempt that I would even be so gauche as to ask.

(It's 1000x worse when you're talking to them about your child's medical care. My daughter, at 3 y/o, had a short fall and received a small cut on her face. It bled profusely so we took her to the ER. We ended up with x-rays because I couldn't successful "negotiate" that we didn't want that. The shaming was intense.)

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

#123

Post by alistairSH »

eqvinox wrote: post #102

> So the hospital had billed us for the master procedure and then again for every component of it. Uh. Call me naïve, but how is this not fraud?

It sounds like it would be only be fraud if the bill was submitted to Medicare/Medicaid. But, yes, that practice is morally bankrupt, even if they're getting away with up-charging on a technicality.

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

#126

Post by sixothree »

whimsicalism wrote: post #119
dekhn wrote: post #34

I had an odd but successful experience with medical billing recently. My daughter went to urgent care for an urgent problem; after things were mostly cleared up, they transferred her by ambulance to an ER (even though there was no emergency). Both the urgent care and ER were handled by our insurance but the ambulance company sent us a large bill ($4K for a short drive) which felt too large to us (they had already tri…

as long as we have a significant portion of healthcare users who are basically fully price insensitive but not subject to any rationing, absurd US medical costs will continue.

Hard to believe you say we aren't subject to rationing when pre-authorization is as big as it is.

You should see some of the proposed rules. Pre-authorization will start to use a medical language called CQL and there will be literally thousands of queries EHRs will need to implement to ensure their customers can get the care they need.

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

#127

Post by wbronitsky »

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,…

Matt Stoller, a journalist who blogs about monopolies, just wrote all about the pricing issue this week: https://www.thebignewsletter.com/p/monopoly-round-up-obamaca...

America has doubled down on middlemen controlling the prices of medical care and making sure that there is no set price for anything. With the ACA effectively falling apart in the new budget, we do have a chance to move to a different reality, one where medicare prices are the set prices for everything, but that is nearly a political impossibility given the amount that these middlemen spend in keeping politicians who support that from winning primaries. Instead, we are stuck in a situation where companies get to dictate prices and access to care while we get diminishing returns in health quality and longevity.

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

#128

Post by dcow »

atourgates wrote: post #101
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…

What the author calls criminal is the way hospitals typically bill Medicare and private insurance providers. If the OPs brother-in-law had had insurance, the hospital would have billed the insurance company the same $195k (albeit with CPT codes in the first place). The insurance company would have come back and said, "Ok, great, thanks for the bill. We've analyzed it, and you're authorized to received $37k (or whatev…

I think the argument is that it’s criminal to take advantage of the patient without insurance and ask them to ruin their life trying to come up with 195k when your system is setup to reasonably profit off the 37k you get from the insured patients. I firmly believe that even in a capitalist society the idea of profiting off of anything let alone healthcare in the thousands of percentage points is criminal.

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

#129

Post by siliconc0w »

Never pay the first hospital bill if it's a non-trivial amount and you've waited a few months to get all the bills. 100% of time there is an error, mis-code, up-code, outright fabrication, etc. In California you cannot be taken to collections for less than $500 and they have to wait at least 180 days. If insurance denies a claim, you can ask for an internal appeal and then ask an independent medical review(IMR) (always do this, the internal appeal never works). With today's context windows, you can shove the whole insurance coverage booklet into the LLM and have it draft everything.

I've had $10k+ bills brought down to $200. $2k+ tests re-coded and fully covered, etc.

There is definitely a business in a LLM-powered medical billing agent that could handle this end to end (esp, contacting hospitals/insurance, waiting on hold, etc).

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