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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

#311
post #233
post #201

Why is the man's wife worried about being sent to collections? She owes nothing to the hospital, the dead man's estate owes money. Let the hospital line up with the other creditors. She shouldn't be paying her late husband's hospital bills out of her own funds.

I don’t think she likely had to pay a dime and wouldn’t have faced any consequence besides a few months of annoying calls. Her credit score wouldn’t have even been impacted. I think given this story they totally messed up.

A lot of people are unaware of who is responsible for what, and may be convinced to pay debts they don't owe. And creditors absolutely take advantage of this. Any debt collector worth his salt will hound everyone they can identify until they are told to stop in the particular way the law prescribes.

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

#312

I fought insurance over this past summer after they declined covering a life saving surgery for my 6-year-old child at the last minute. We were in despair that my child's life was at risk each day we waited because of insurance incompetence. ChatGPT literally guided me through the whole external appeal process, who to contact outside of normal channels to ask for help / apply pressure, researched questions I had, hel…

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The US is only ostensibly a democracy. It's not a functioning one, due to widespread voter disenfranchisement.

Voter ID laws, voter roll purges, registration barriers, polling place accessibility, early and mail-in voting restrictions, and perhaps most importantly gerrymandering, misinformation, and intimidation all serve to reduce the power of the ballot box.

And that's before we even get to US citizens in Puerto Rico, Guam, the US Virgin Islands, and American Samoa being unable to vote in Presidential elections at all.

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

#313

Earlier quoted context omitted.

> 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. I live in U.S. and know people on ACA Marketplace plans, employer HDHP, Medicaid, Medicare, Medicare Advantage, people who are uninsured, people who are overinsured, and people who have crazy expensive fly-me-out-of-the-jungle emergency plans (one who actually used it in the…

First, I didn't say same day and specifically caveated for the MRI. That said, the CT was either same-day or next-day, I forget which. It was for hyponatremia and was in the Washington, DC region. My primary point was comparative - wait times are considerably longer for the NHS than in the US.

> My primary point was comparative - wait times are considerably longer for the NHS than in the US.

So we're talking about a situation where a doctor thought a patient required an MRI-- using your word-- "immediately."

In the NHS when a doctor requests a patient get an immediate MRI, what are you claiming is the average wait time?

Edit: clarification

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

#314
post #164

Earlier quoted context omitted.

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…

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

#315

$33k is still lot of money! What happens if you don't have that sum? How does the system allow to be arbitrary charged on health? I'm Argentinian and while we might be a country lagging behind in so many things these kind of ripoffs do not happen. How come the US government allows this? From other stories sometimes posted, the US seems to be one of the worst countries in the world to either die or get sick.

You just don’t pay. Hospitals eat the cost.

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

#316

I fought insurance over this past summer after they declined covering a life saving surgery for my 6-year-old child at the last minute. We were in despair that my child's life was at risk each day we waited because of insurance incompetence. ChatGPT literally guided me through the whole external appeal process, who to contact outside of normal channels to ask for help / apply pressure, researched questions I had, hel…

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In part because hospital bills are monopoly money and most people just play a game of chicken with debt collectors, and the only actually sue a small fraction of the time and mostly either settle for a small fraction, give up besides annoying phone calls, or it gets discharged in bankruptcy.

Almost no one gets a bill from the hospital and just pays it, and in most cases if you do it's totally financially illiterate.

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

#317

Earlier quoted context omitted.

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I think the reason is that people know it is a problem but ideologically they really disagree about what to do about it. The impasse creates an opportunity for profit driven actors to fight reforms. Also, democracies do dumb things sometimes. See Brexit. But also, sometimes people from other countries-- I am thinking parts of Europe-- underestimate how well paid people in the US often are. They compare the averages,…

Yes, a challenge for major structural alterations to the American system is that the median American family is probably better off under this system than they would be under any of the European-style systems: the wage premium enjoyed by many Americans and the lower tax level offsets the cost of insurance and copays.

So when you're talking about how bad the American system is, you're really talking about a minority of its users. That doesn't make everything OK, but does highlight the political difficulty of enacting seemingly-popular changes.

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

#318
post #291

Earlier quoted context omitted.

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 othe…

Credit score is another thing I have hard time comprehend. I wanted to borrow car outside of EU and was not unable to because there was no record on me with some private company that stored data about credit cards. That was wild experience - like some social credit in China. I just prefer rule of law than these hacks on society.

How do they track credit-worthiness inside the EU? I thought Germany had something equivalent? Maybe it's government-managed instead of private? Not that I like the US system, but it sort of makes sense (barely).

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

#319

Earlier quoted context omitted.

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...

Yes. Though I think technically none of that happened here.

If I sound like I'm defending the morality of the hospital for billing a private individual $190k for services they'd expect to be paid $37k for, please know that I'm not. But it helps to understand WHY the hospital billed that much, and whether it's legal for the hospital to bill that much.

The biggest semantic "mistake" the author makes in their thread is saying, "Claude figured out that the biggest rule for Medicare was that one of the codes meant all other procedures and supplies during the encounter were unbillable."

The Medicare rule does not make those codes "unbillable" - it makes them unreimburseable.

The hospital can both bill Medicare for a bigger procedure code, and the individual components of that procedure, but Medicare is gonna say, "Thanks for the bill, you're only entitled to be paid for the bigger procedure code, not the stuff in there."

Neither the FBI nor Medicare is gonna go after the hospital for submitting covered procedure codes and individual codes that are unreimbursable under those procedure codes. That's not crime, that's just medical billing.

Actual double billing would occur if, say, your insurnace paid the hospital for a procedure, and then they came after you for more money, or billed a secondary insurance for the same procedure. Or if they'd said, "Oh no, the OP's brother in law wasn't here for just 4-hours, they were here overnight so now we're billing for that as well."

NOW - a much better way for the hospital to handle this scenario would be to see that the patient is cash-pay, and then have separate cash-pay rates that they get billed that essentially mirror Medicare reimbursement. That's essentially what the author got them to do, and it absolutely sucks that's what he had to do.

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

#320

Earlier quoted context omitted.

I was under the impression that if you were to go to an emergency room, life saving surgery would be scheduled regardless of who is paying (or not paying), due to EMTALA. I can't imagine a hospital waiting for an insurance company's approval to pay for a procedure to schedule a child's life saving surgery. Is this incorrect?

Presumably parent is describing a non-emergency situation.

Good reminder that "life saving" and "elective" are orthogonal.
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