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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

#441

Earlier quoted context omitted.

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.

thanks for that datapoint and that is crazy. were you in a rural area?

In the middle of Albuquerque. Rural areas offer hardship pay to attract medical professionals, but it’s really touch and go. IHS has its own host of issues.

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

#442

When UnitedHealthcare CEO was killed the public sentiment was that the health insurance companies are the bad guy—and the CEO deserved what he got. Then when stories like this come out we realize no, it is actually the hospitals. In reality the whole system is broken. Some people think single payer system is the solution but then when they talk to Canadians they realize that's not the solution either. I think the cor…

> Some people think single payer system is the solution but then when they talk to Canadians they realize that's not the solution either. I don't know a single Canadian who would swap their system for the USA's. Theirs might not be perfect, but nobody argues that it isn't at least better than the literal worst system the world has ever come up with.

Canadian here; our system has some pretty extreme issues. The vast majority of Canadians still prefer it to the U.S. Wealthy Canadians (>$500M net worth) would likely prefer the U.S. system in all cases though. Even moderately wealthy Canadians ($1M+ net worth) would likely get better treatment from the American system 95% of the time (when they don't have extreme issues which result in exceptionally costly treatment)

One thing to consider is that doctors seemingly prefer things about how the U.S. system works (I'm not just talking about the amounts charged, but inefficiencies and red tape in the Canadian system, some of which seem to be a consequence of socialized health care). Ultimately this does lead to some brain drain which then compounds the issues with our system.

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

#443

Earlier quoted context omitted.

Almost 40% of the USA is on medicare, medicaid, or entitled to VA benefits or military healthcare. It's only a narrow majority that depends on unsubsidized private healthcare, and those people skew in the upper income levels.

So what about this? It is a question, not meant as a counter. Although I have to say the rosy picture some paint here about the high incomes is counter to anything I ever heard - and saw, although I left the US in the early 2000s, after having lived there for almost a decade (still mostly paid from Germany, never ready to make a complete move). "Medical Bankruptcies by Country 2025" https://worldpopulationreview.com/…

Careful there, thats a rightwing propaganda point. Immigration into an aging society does not raise healthcare costs, it lowers it. See https://archive.is/XxfTH (and note that this is a NZZ article, a right-wing publication by now, so not slanted towards being immigration friendly).

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

#444
post #3

The real treat would be using AI to stop regulatory capture so you don't end up in a country where it's okay to be presented with a 195K bill that can be magically lowered if you insist hard enough.

It seems pretty messed up when a $30k bill is written up like a big win.

To a lot of people, that's out of the fire and into the frying pan.

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

#445

Earlier quoted context omitted.

As a non-american (from South America) who lived in both USA an Europe: Yes, in USA you get much more money, like you said 2x~5x, but then: University is expensive as fck. Health care is expensive as fck. You have 5 days of paid sick leave per year in most companies. You have 10 days of paid holidays per year in most companies. In contrast, in Europe: University was cheap or free. Healthcare is cheap and universal. I…

>> University is expensive as fck. While healthcare is brought up all the time this is usually ignored. The idea of parents saving a 'college fund' for their child is something I only know from movies. It's such a strange idea that access to education would be something you either need to be able to afford or need to get a 'scholarship' for (another strange concept).

Implicit in all these stories is that "education" means "access to highly selective universities". In-state tuition at Directional State University is much more manageable.

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

#447

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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Without making a claim about whether it's what most people actually want or not, there's not much that an individual can do about this by changing their voting preference. The US doesn't have proportional representation, and the overwhelming majority of elections are "first past the post" rather than one of the more "modern" alternatives like ranked choice votes, so in practice very few elections ever swing to anyone outside of the two major political parties (neither of which have a particularly large contingent of politicians who have come out in favor of something like single-payer healthcare). Even for a purely single-issue voter who only cares about this, from a game theoretic perspective you're likely to be essentially throwing your vote away if you vote for someone outside of those two major parties because it's unlikely enough others will.

Presidential elections are even worse because they're determined by electoral college vote rather than popular vote. Even ignoring the potential for "faithless electors", all but two states allocate the entirety of their electoral votes to the candidate who wins the majority of their vote, which means that if you live in a state with a majority who reliably vote for a specific party's candidate every four years, your vote for president is effectively meaningless.

The only obvious way to fix these issues with how elections work would be to elect people who make different decisions about how to run them, which is hard to do because of the issues themselves. The system is self-reinforcing in a way that makes it extremely difficult for the average person to do anything about it, and any desire to do so gets weighed against the concerns about the policies that you might actually get to influence by voting for one of the two candidates who might actually win. At the end of the day, people who are concerned with the fundamental systemic flaws in things like elections and healthcare still likely end up picking pragmatism over principle (with the expected value of a vote for a candidate who is almost guaranteed not to win being lower than one who is might be less desirable than a third-party one but still has an actually realistic chance of winning and is preferable to the other major party candidate) or just check out of the system entirely (with people not bothering to vote at all already being a fairly common phenomenon in the US).

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

#448
post #266

Earlier quoted context omitted.

Wildly false. This thread is full of people sharing stories of being supposedly "insured" and getting fucked anyway. The complete lack of transparency around what your insurance covers, something you can't be expected to verify while in the middle of a dire medical crisis, can lead to a life destroying bill. Nobody should have to be wondering what company an ambulance works for. It's crazy. The whole world thinks it'…

> Nobody should have to be wondering what company an ambulance works for. Is this real?!

Absolutely. General advice is to never ever get in an ambulance since they charge $$ and may not be covered by insurance. Drive yourself if able or get a taxi.

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

#450

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…

I live in the US in one of the largest metro areas. I've had to wait nearly a year to see a specialist in the past, and that was with "good" PPO insurance (see my comment history for trying to find a dermatologist for what I thought was potentially skin cancer). Its really not that uncommon to have long waits. I've had insurance deny prior authorizations over and over delaying care many months despite actually meeting their own documented criteria for approving the surgery. My kids have had to wait months to get an important, medically necessary surgery multiple times, because the decent in-network providers are massively booked out.

Comparing getting imaging work done to actually seeing a specialist is comparing apples to oranges. They're both healthcare related things but are massively different.

There's tons of imaging clinics staffed by people who only needed an associates degree from a community college, radiologists work remotely all over the place spending little time on each patient and writing a report. Overall its really cheap and easy to build and staff an imaging location.

Seeing a specialist requires actually going to the doctor in person, that doctor had to spend many many many more years and limited spots for an education, and probably only sees patients in clinic a few days of the week. You'll have a whole staff of nurses & PAs (who quite probably had more education than the rad tech) and office staff to support the small handful of specialists.

As a personal example, I had an issue with my knee, locking up from time to time bending with weight on it. I looked up kinesologists in my area covered under my insurance. Dozens within a short drive, awesome. Calling up, "sorry, we're not taking new patients", "we can see you in four months", etc. A few months go by, I finally get in to see the doctor. He has me do some motions, asks me a lot of questions, takes a quick x-ray in the clinic, recommends I go get an MRI and come back. I am able to find an MRI clinic that's covered and can get the imaging done that same day. However, its several more weeks until I can see the doctor again to actually review the radiologists notes. I finally go back, the doctor recommends surgery, a prior authorization gets filed. We wait. We wait. Denial, no MRI, imaging required to determine medical necessity. Huh, they paid the bill, didn't they wonder what the MRI said? Resubmit. We wait. Denial, MRI was inconclusive (it wasn't). Resubmit. We wait. Denial, physical therapy is recommended instead (except the thing they call out as a reason to have surgery is verbatim what the radiologist notes say). Resubmit. We wait. Denial, same response. Its now been almost a year of intense joint pain every time I crouch down, walking is starting to be difficult. I'm in a brace and crutches and the pain is getting worse. I finally just wait at the clinic all day, we spend hours and hours on the phone with the insurance company to try and get an approval over the phone directly. I finally get approval, and manage to get in for surgery several weeks later. I have the surgery in the morning, and I'm back to walking without any pain and without crutches or the brace by lunch.

And in the end, after the surgery, the insurance company complains they shouldn't have covered the procedure because supposedly I didn't have an MRI of that knee. Idiots.

This is just one of several shitty stories I have of dealing with health insurance companies. Multiple over the years.

And that's on the insurance side, not even the care side of things! One time, while waiting multiple hours in an ER complaining about becoming massively lightheaded and weak and barely able to sit, I finally passed out and fell on the floor out of my seat. The shock of hitting the floor woke me up a bit, and the first thing I heard was "sir, you're not allowed to lay on the floor, stand up." Uh, I would if I could!

All in all it took over a year of joint pain before I managed to get surgery to fix my knee, all because the insurance company was rationing care. A year I won't have playing with my toddler at the time (I couldn't easily crouch down to play and expect to stand back up easily). Arguments of "bUt RaTioNinG!" ring extremely hollow to my ears. We already have rationing in America, you just haven't experienced it yet.

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