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Using AI to negotiate a $195k hospital bill down to $33k
221–230 of 954 posts
Re: Using AI to negotiate a $195k hospital bill down to $33k
#222The 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…
So what you're saying is the AMA is openly hostile to Americans.
Re: Using AI to negotiate a $195k hospital bill down to $33k
#223I 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…
> had an odd but successful experience
> we ended up paying $500 to the ambulance company
I get where you’re coming from but that’s still a loss to me from the perspective of the broken system.
Re: Using AI to negotiate a $195k hospital bill down to $33k
#224Earlier 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…
Many years ago, I managed to stab my face with a screwdriver (not my proudest moment), and had to go to the ER. After the stitches, I was asked whether I wanted to pay with insurance. If I did, it was something like $2,000. If I didn't, there was a 75% discount off MSRP. My deductible was like 25%, so it ended up basically being the same out of pocket either way. The fact that there seems to be a 4x markup means make…
There's all kinds of shenanigans that these prices enable: https://archive.is/jPE3n
Re: Using AI to negotiate a $195k hospital bill down to $33k
#225Earlier quoted context omitted.
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.
I understand. The different meanings of "code" in this conversation is why I said "software" in my comment instead of code. Copyrighting software is as absurd the other things you listed.
In the US copyright just requires a level of originality. The bar isn't very high, but for example simple logos, like IBMs blue lines logo is not copyrightable.
There are examples of software code that is probably not copyrightable, but that's limited to very simple code that has only obvious implementations.
Re: Using AI to negotiate a $195k hospital bill down to $33k
#226Earlier 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…
> 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 U.S.).
I have never heard any of them get an MRI or CT scan same day "just in case." And for the one who got an MRI close to same day for stroke symptoms, it wasn't free. (And even in that case, the earliest appointment with the specialist to assess the MRI was nearly a month later.)
Someone getting their first colonoscopy had an appointment two months out.
Someone getting shoulder surgery four months out.
A person on Medicaid with Stage 4 cancer waiting a week and a half for a fentanyl patch because the pharmacy couldn't get approval from the Medicaid subcontractor for whatever reason.
People from the U.S. who post on HN: please tell HN which is more common:
* my stories
* your parents getting free MRIs and CT scans "just in case"
Re: Using AI to negotiate a $195k hospital bill down to $33k
#227> Long story short, the hospital made up its own rules, its own prices, and figured it could just grab money from unsophisticated people This is the core truth that all of healthcare in the US spins out from. A few personal experiences which back this up: 1. I received a $1500 bill because an ambulance that was sent when I called 911 was an "out of network ambulance". I looked it up: One small ambulance company in SF…
Can you elaborate a little on point 1? I also somewhat recently had an expensive ambulance ride in SF that I'm dealing with - Insurance told me it was out of network, but would negotiate down on my behalf. They were able to negotiate away most of the bill, but since then the ambulance company has just come back to me asking for all of the money that the insurance company had told me they negotiated out of the bill.
Re: Using AI to negotiate a $195k hospital bill down to $33k
#228Earlier quoted context omitted.
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.
>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.
The IRS disagrees every single year.
They say they can easily recover significant revenue from tax cheats if they were staffed and funded enough, to the point that every dollar you fund the IRS recovers 1.6 dollars.
The rich people who say they are just getting their fair deductions then refuse to fund the IRS.
If they weren't cheating, they wouldn't have to kneecap the IRS.
Re: Using AI to negotiate a $195k hospital bill down to $33k
#229Earlier 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…
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.
I think he meant literally criminal.
The hospital double billed for over $100k worth of services on the original invoice.
At a certain point a pattern of issuing inaccurate invoices crosses the line into negligence.
If a business just have a habit of blasting out invoices that bill for services never received, and they know that they keep doing this, and only correct it when the customer points it out, at a certain point it turns into a crime.
Re: Using AI to negotiate a $195k hospital bill down to $33k
#230Earlier 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…
I waited over three years to get a routine colonoscopy in New Mexico and finally just got one after moving out of state. More standard waits for a specialist there are 9-18 months, if you can even find someone competent in the specialty. Many people have to go out of state for care.
Provider availability is non-uniform across the US.