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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

#181

Post by woadwarrior01 »

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…

> What the author calls criminal is the way hospitals typically bill Medicare and private insurance providers.

Interestingly enough, the FBI considers double billing and phantom billing by medical providers, to be fraud.

https://www.fbi.gov/investigate/white-collar-crime/health-ca...

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

#183

Post by ruralfam »

I had a 20 minute appointment with a doctor at Kaiser in WA. I thought I had set up a free, yearly wellness meet. However due to Epic's really epically bad UI (they provide Kaiser's online presence), I had setup a standard meeting. My bill was nearly $1,700 discounted to $200 which I was fully responsible for as I/We (family) had not yet reached our deductable limit. Funny things: 1) Doctor wanted me to approve the use of AI to take notes of the meeting so she would not have to (I agreed). 2) The one issue I cited caused my doctor to say (pretty close paraphrase), "I have an idea what the problem is." I asked what it was, but the appointment was over so was advised to setup another meeting. I decided to keep working on it myself as I am pretty sure it is a stiff-ligament issue. Thanks Doc. Also: I like Kaiser overall. This one doc (who is not my regular one) was not as asset to Kaiser imho.

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

#184

Post by whimsicalism »

foldr wrote: post #164
whimsicalism wrote: post #160

Earlier quoted context omitted.

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.

Medicare has pretty good negotiating power, rather like the NHS. Medicare patients may not care how much Medicare is paying for their treatment, but the US government cares how much it spends on Medicare, and the IRA has given it some additional powers to negotiate drug prices in recent years.

Imagine if the U.S. government gave out free smartphones to some segment of the population. Over the years, they’d get used to replacing their phones for the smallest reason — a scratch, a tiny crack, dropped it a little hard — because it costs them nothing. Some might even start swapping phones every month or every week.

“Ah,” someone says, “but the government negotiates huge discounts with the phone makers since it buys in bulk!” I think this misses the forest for the trees when it comes to cost control.

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

#185

Post by Zambyte »

hathawsh wrote: post #171
Zambyte wrote: post #163

Earlier quoted context omitted.

Software I write at work is not artistic expression yet is covered by copyright. This isn't a counter argument, just pointing out how absurd copyright is.

Consider these thoughts: https://wiki.c2.com/?SoftwareIsArt

Our role as programmers being closer to artists than engineers does not make code closer to paintings than bridges. We do have highly repeatable patterns. Nearly every program can be essentially boiled down to some subset of CRUD + tranformation.

Even if it is art (I'm not convinced), the recent artificial scarcity on art is absurd. Some other thoughts to consider:

- https://drewdevault.com/2020/08/24/Alice-in-Wonderland.html

- https://drewdevault.com/2021/12/23/Sustainable-creativity-po...

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

#186

Post by huevosabio »

"figured it could just grab money from unsophisticated people"

This sums up my experience with US Healthcare. They bill expecting you to autopay, and either have no incentive to bill correctly or they outright are trying to scam but the result is that every hospital bill is sus.

This also makes insurance a lot less inherently valuable: you are paying for someone to do this untangling shitshow on top of the actual insurance. As if the hospitals just put the billing burden on the client.

There has to be a penalty for sending wrong bills, or they should pay me for my time wasted.

Finally, the prices are so inflated that often the price without insurance in Europe is the same as the copay/coinsurance in the US.

Its a fucking catastrophe.

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

#187

Post by fluoridation »

Zambyte wrote: post #163
pbhjpbhj wrote: post #138

Earlier quoted context omitted.

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.

Software I write at work is not artistic expression yet is covered by copyright. This isn't a counter argument, just pointing out how absurd copyright is.

A code in this sense is something different. It's a shorthand for a longer description of an object. It'd be like a hotel copyrighting the relationship between a room number and its physical location within the building, or copyrighting resistor colors.

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

#189

Post by BurningFrog »

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…

It's important to understand that a "nonprofit" can be just as greedy as any other organization.

It can't pay out profits to shareholders, but it can hire its owners as employees and pay them any number of millions.

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

#190

Post by bazmattaz »

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…

How do the hospital determine how much you’re able to pay though. You could say $20k is the max I can afford or $2k is the max
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