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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

#131

Post by whimsicalism »

sixothree wrote: post #126
whimsicalism wrote: post #119

Earlier quoted context omitted.

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.

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

If you want to see true rationing, look to the UK (especially) or Canada (less so) where I know plenty of people who have to wait over a year to see a specialist even after doctor referral.

Meanwhile, my parents in the US at a hospital get a CT scan, MRI 'just in case' immediately (or close-to for the MRI) and pay nothing for it.

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

#132

Post by alistairSH »

jack_tripper wrote: post #112
cm2012 wrote: post #106

Earlier quoted context omitted.

Basically the only thing debt collectors can do in the US (if the amount is too small to justify a lawsuit) is harass you with phone calls. I have DND except for contacts on anyway so I dont notice it. Edit: also credit score of course. Almost anything does affect your score. Except for medical stuff for me for some reason - I have a good credit score.

Damn, well in that case that explains why a lot of people in the US can be in debt yet so care free, which is unthinkable to us here in Europe as even small debts carry consequences.

That was an overly simplistic response. We do have credit scores in the US, and defaulting on medical bills can (but doesn't always) impact someone's score.

Without a high score, you don't get the best interest rates on loans. Or, might not be eligible for a security clearance (government work) or jobs in some industries (banking and other "high trust" fields). Or might not be able to rent an apartment.

But, the other response wasn't incorrect. We don't have debtors prisons (unless the debt is owed to the government, then they might be able to jail you).

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

#133

Post by danlugo92 »

jack_tripper wrote: post #41
kojeovo wrote: post #14

[flagged]

Not really. You get a bill in any country when you're not insured not just the US. But most people in most western countries tend to be insured by default through some national system if they have a legal job, or, if their system is private like in the US, then heath insurance is mandatory for everyone, unlike in the US. US is kind of a "wild west" where people can live and work, sometimes illegally, and not be insur…

> You get a bill in any country when you're not insured not just the US.

Non - sequitour. You can travel to Europe (not to a third world country mind you), get your treatment without insurance, pay in full, and fly back and still spend much much less, including cosmetic procedures and dental.

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

#134

Post by Terr_ »

lotsofpulp wrote: post #98
sixothree wrote: post #67

Earlier quoted context omitted.

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.

While you're not wrong that most "justice" processes are expensive, I think the parent-poster is referring to a different kind of "government inefficiency", things like:

1. Single-payer health insurance.

2. Laws that insurance-companies must actually use X% of their premiums on payouts.

3. Laws requiring disclosure of negotiated prices, to encourage competition via free-market forces.

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

#135

Post by NotGMan »

kwanbix wrote: post #51

Having lived in Europe 10 years (I am from south America), it is crazy that the rest of the world doesn't follow Europe's health coverage: everybody is covered, all the time, you can be covered either by public insurance (was my case) or private. There are no preconditions. Kids get covered for almost everything up until they are 18 or 21 (don't remember), drugs for adults is only 5 euro each. No matter the cost. And…

This depends heavily on which EU country you are: some EU countries have great and cheap healthcare, others have shit and cheap healthcare with 6+ months of waiting time and you can't find even a personal doctor in the public system (which you are forced to pay anyway for).

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

#136

Post by [deleted] »

aprdm wrote: post #107
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,…

I am sorry to hear that. A friend of mine who moved from US to Canada moved after his mother had cancer on her 60s. She was retired by then after having a very successful career (C level on some manufacture company). His mom died poor. Crazy country.

[deleted]

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

#137

Post by fucalost »

potato3732842 wrote: post #18
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…

Exactly. You can do this with anything where the racket is based around the layman not being able to take in the amount of arcane subject matter info they'd need to argue their case, not just medical. Tons of institutions that specialize in screwing people are built this way because it's pretty hard to "overtly" build an institution to screw people.

This! People underestimate the extent to which lawyers are negotiable also. “I’m not paying that” is a surprisingly effective method; they’re often willing to compromise on payment terms, work at-risk subject to a successful outcome, significantly reduce their rates, etc.

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

#138

Post by pbhjpbhj »

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…

A code is not an artistic expression and so can't be copyrightable. The layout of a book of codes, for sure, but the information in it... might be protectable with other IPR but not copyright.

Does not stop people threatening you though.

This is my opinion only, not legal advice, and does not relate to my employment.

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

#139

Post by higginsniggins »

itissid wrote: post #95

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.

Honestly, that's not a bad idea for a start up. Maybe a marketplace where people can see what things cost in different places and book a surgery directly.

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

#140

Post by gwbas1c »

mjr00 wrote: post #42
ibash wrote: post #12

Earlier quoted context omitted.

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.

Yeah, US hospital billing is based on the idea that the patient has insurance and won't really care about what their insurer gets charged. (The wider implications of this are left to the reader.) For the uninsured this sort of thing is actually really common. Had an online friend who had to get emergency treatment and they sent him a bill for $20k. His response was, "lol I'm uninsured and don't give a fuck about my c…

> Yeah, US hospital billing is based on the idea that the patient has insurance and won't really care about what their insurer gets charged.

Not quite: US hospital billing is based on the idea that the insurance company does the haggling for you.

Insurance companies negotiate (cough) "the best rate that the hospital has to offer," therefore: What the insurance company pays is confidential, and the official unnegotiated price is highly inflated. That's why hospitals will always negotiate with uninsured patients, because they're deliberately inflating their fees.

---

In 2011 I had surgery. The first bill was for $100,000, which was sent to the insurance company. Then the insurance company got a letter (cough) "reminding" the hospital of the negotiated rates. The next bill was $20,000. On a follow-up visit, they did an X-ray, and sent me the bill. I sat on it, and then called my insurance company. The insurance company called the hospital to (cough) "remind" them that the negotiated rate for that kind of X-ray was $0.

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