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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

#151

Post by potato3732842 »

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.

The government does it too.

Pretty much every 4+ figure civil violation, fine, etc, etc, is assessed on the basis of "what's the most we can get away with that won't have them taking us to court where it'll get knocked down or cause a public outcry if they tell the news"

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

#152

Post by foldr »

whimsicalism wrote: post #131
sixothree wrote: post #126

Earlier quoted context omitted.

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 noth…

In the US care like that is rationed by wealth rather than by need. Your parents are getting MRI scans that they may not really need, while uninsured Americans aren't getting MRI scans that they may actually need.

I bet we could cut down NHS waiting lists a fair bit if we arbitrarily decided that ~10% of the population were no longer entitled to a wide range of non-emergency treatments.

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

#153

Post by scottlamb »

candiddevmike wrote: post #2

While it's an interesting story, I doubt they needed Claude to work a hospital bill down to that amount. Hospital billing folks are acutely aware that the initial bill is outrageous and indefensible from their end. I've heard a ton of cases where folks basically "pay what they can" for the bill and that's good enough for both parties. I doubt the reasoning Claude provided was ultimately what got the hospital to knock…

> While it's an interesting story, I doubt they needed Claude to work a hospital bill down to that amount. Hospital billing folks are acutely aware that the initial bill is outrageous and indefensible from their end.

OP agrees: "Ultimately, my big takeaway is that individuals on self-pay shouldn’t pay any more than an insurance company would pay—and which a hospital would accept as profitable business—than the largest medical payer in the country. I had access to tools that helped me land on that number, but the moral issue is clear. Nobody should pay more out of pocket than Medicare would pay. No one. ... Hospitals know they are the criminals they are and if you properly call them on it they will back down."

> I've heard a ton of cases where folks basically "pay what they can" for the bill and that's good enough for both parties. I doubt the reasoning Claude provided was ultimately what got the hospital to knock the bill down, probably more around the legal action and PR threats. Ironically, the hospital will probably count this as charity even though OP didn't want to be considered charity, as they had to write off part of the bill.

I read that OP refused to sign something that fraudulently said the full price was $195k but rather insisted on signing on a bill that said the full price was $33k or $37k or something. (Maybe $4k was called charity.) They might have presented a completely different bill to the IRS to justify tax-exempt status, but that illegal action would be totally on them; OP is not participating in their tax fraud. I applaud OP for that and hope this becomes the norm.

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

#154

Post by itissid »

Does someone here understand how exactly to fight Facility Fees — outside of indiana or a state where its outlawed — which is what the author mentioned most of their fees were? Could one when signing admission forms accidentally agree to paying them without fully understanding it? After one gets the the bill can one simply get an itemized breakdown, spot these fees and negotiate them down?

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

#155

Post by jlarocco »

thaumasiotes wrote: post #78
a4isms wrote: post #24

Earlier quoted context omitted.

Old poker adage: "The more wild cards and crazy rules, the greater the expert's advantage." Poker has nothing on Commercial Lawfare.

This reflects a common complaint in social engineering. People keep trying to enact rules to stick it to the elites and make the downtrodden better off. And as the rules get more and more complex, the position of the elites gets more and more solid.

Exactly. The elites hire experts to do it for them, while everybody else has to deal with the complex rules themselves.

It's like auditting tax returns of the rich - of course they didn't cheat, they already lobbied for the loopholes making their shenanigans legal.

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

#156

Post by nonethewiser »

embedding-shape wrote: post #94
nonethewiser wrote: post #89

Earlier quoted context omitted.

> 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…

Absolutely. It's cheap (as far as the user is concerned) to just fire off a question. And it can even be really fuzzy/ambiguous/ill-defined sometimes. It's a great starting point.

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

#157

Post by itsthecourier »

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…

double charging on purpose systematically sounds slightly criminal to me

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

#158

Post by Aloisius »

fatnoah wrote: post #62
mjr00 wrote: post #42

Earlier quoted context omitted.

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…

>The wider implications of this are left to the reader. IMHO, it's actually worse than we realize. The Medical Loss Ratio requirement is good because it requires insurance companies to spend 80% or 85% of premiums on health care. It's bad because one way for insurance companies to make more money is to have inflated health care prices to justify increasing premiums so they can get 80% of a bigger pie. It also gives t…

> one way for insurance companies to make more money is to have inflated health care prices to justify increasing premiums

This only makes sense if they have no competitors since another insurance company would just steal their customers by having lower rates.

The truth is though, healthcare providers are ultimately responsible for prices.

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

#160

Post by whimsicalism »

foldr wrote: post #152
whimsicalism wrote: post #131

Earlier quoted context omitted.

> 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 noth…

In the US care like that is rationed by wealth rather than by need. Your parents are getting MRI scans that they may not really need, while uninsured Americans aren't getting MRI scans that they may actually need. I bet we could cut down NHS waiting lists a fair bit if we arbitrarily decided that ~10% of the population were no longer entitled to a wide range of non-emergency treatments.

This is true to an extent, but with the massive age-based confounder that is medicare, which renders the elderly close to price insensitive as well as by far the largest utilizers.

I think there are lessons to learn and improvements from both systems - for instance, catastrophic healthcare is a disaster in the US (in terms of cost), but we are better at timely care and providing incentives for pharma R&D.

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