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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

#491

Post by nxor »

jkartchner wrote: post #414
mothballed wrote: post #330

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.

You believe the top 60% of the nation skew in the upper income levels? Median pay is $61k a year for the entire country. The top 1% skews to the upper income levels. The rest are charged $30 for a dose of aspirin and can't afford it.

People in the US can't afford aspirin? Where do you live? It's just not true

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

#492

Post by vjvjvjvjghv »

tonymet wrote: post #48

We suddenly woke up in the Kafka-esque purgatory of critical American healthcare billing. We’re in our 50s and had been perfectly healthy, then suddenly we got diagnosed with what will be over $500k in treatment over the next 12 months— and multiple millions for the foreseeable future. We have insurance, but many of the required procedures are “out of network” and there’s no way to tell (we have “the best” insurance,…

The stuff you are describing is what bothers me the most. There is a lot of talk about how we should have a free market system. But there is no real market for patients. Most people can't pick an insurance plan for themselves because the employer picks. Then it's extremely hard to get an estimate for anything. And even if you get an estimate, it's most likely wrong. Then the billing is totally opaque. Insurance and providers constantly make mistakes or lose things.

I went through this with my ex after a surgery. It was totally insane to figure out where the numbers are coming from and basically a full time job.

Even if we don't want to go to single player or similar, I don't understand why it's not at least possible to mandate clear and binding estimates and billing a normal person can understand. And let the market work its magic through competition.

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

#493

Post by tracker1 »

lotsofpulp wrote: post #437
tracker1 wrote: post #355

Earlier quoted context omitted.

It's largely a side effect of a couple things... first the ACA (ObamaCare) limited the percentage of profit that insurance and medical providers can make... so they instead just grow the pie larger by inflating everything. Second is that they are allowed to have effectively vertical monopoly investments controlling multiple layers of healthcare as a whole from insurance, providers, pharma and pharmacies. Trust bustin…

> so they instead just grow the pie larger by inflating everything So why would they deny coverage? All they have to do to earn more money is keep paying for more and more healthcare.

Because they make more by not paying than by paying... When the payouts are larger, they raise premiums, make money on both sides.

Not to mention, if they can delay payment for a month, that's a month worth of interest on the money in an interest bearing account.

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

#494

Post by tonymet »

throw310822 wrote: post #489
tonymet wrote: post #307

Earlier quoted context omitted.

It’s just so insane that the entire industry accepts that no one knows how much things are. Even the “financial services” team will just say “yeah that estimate is wrong” and not blush. What are you guys all doing?

But then somehow they know how much things are when they send you the bill?

my exact curiosity. They seem to have a rough scope on CPT codes ahead of time, with some buffer. It's baffling that the cost per CPT changes between estimate and billing. Id like to talk to a billing administrator to ask how that process works. Does the admin pad the doctor's figures with additional codes and markup?

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

#495

Post by tptacek »

throwway120385 wrote: post #482
Aurornis wrote: post #469

Earlier quoted context omitted.

Also very true, and a good point. Even people in the US don't understand why those $200K hospital bills aren't real. Insurance providers (including government programs) have a fixed limit for what they pay for procedures. They pay min(billed_amount, allowed_amount) so providers don't want to risk leaving money on the table by having billed_amount So every time you see posts on the internet where people talk about the…

That depends a lot on your insurance. For example, our out of pocket for my son's birth was somewhere in the neighborhood of $10k after insurance. I've met tons of people who would be bankrupted by that amount. What you're describing isn't true for people on High Deductible Health Plans, and those plans are a bit of a racket because they're frequently paired with HSAs where the employer gets to pocket anything left i…

HSA funds are meant to roll over. Your employer generally should not be pocketing whatever's left over in the account. The idea is that many (most?) people are better off with a lower premium and higher deductible given that most years (for most people) aren't characterized by high medical expenditures; HDHP+HSA is closer in nature to actual "insurance", rather than a structured financing plan for health care.

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

#496

Post by tptacek »

throwforfeds wrote: post #473
Aurornis wrote: post #438

Earlier quoted context omitted.

> University is expensive as fck. One thing that's hard to understand from the outside is that almost nobody actually pays those mind-blowing $60K/year tuition prices. US universities charge on a sliding scale based on the applicants' families' ability to pay. For an extreme example: Harvard's tuition is nominally $60K per year, but for families earning $200K or less it's $0. Many prestigious universities follow simi…

Yes, but Americans have an incredible amount of student loan debt too. Something like $1.7 trillion. If you can get into one of the best schools in the world that has a huge endowment, then sure, you'll get grants and whatnot. It may even be free, in the case of Harvard. But then there's a long tail of schools that are honestly not that great, charging only slightly less than the top schools per year, with smaller ai…

American student loan debt skews sharply towards the top income quartile.

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

#497

Post by tptacek »

nonfamous wrote: post #467
epistasis wrote: post #411

Earlier quoted context omitted.

Oddly enough the big rhetorical push against a universal system from prior decades was about "death panels" deciding what care somebody would get. And guess what's happened with insurance? Death panels! The propaganda spin on the health care system in the US has been on overdrive ever since Hillary Clinton wanted to implement some reforms in the 1990s, leading to absolutely massive resistance to any change whatsoever…

>>> And for most people, the healthcare system works fairly great. There are exceptions, like the denial described in this thread, and they usually get lots of attention because holy hell is that a messed up situation. But the everyday care that most people get is better than adequate. As an individual who has lived in multiple countries in three continents, I dispute that “the care most people get is better than ade…

Life expectancy tells you basically nothing about the quality of health care in the US. It's dominated by car accidents, homicide, and then CVD --- but CVD varies dramatically across the United States (from states in the south with drastically worse CVD outcomes to states in the north with outcomes on par with the Nordics) despite the same health care structure across all those states.

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

#498

Post by nxor »

onli wrote: post #443
nosianu wrote: post #407

Earlier quoted context omitted.

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).

Are people ever allowed to criticize migration?

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

#500

Post by mindslight »

Aurornis wrote: post #469
nonfamous wrote: post #459

Earlier quoted context omitted.

One thing that's hard to understand from the outside is that almost nobody actually pays those mind-blowing $200K hospital bills. US hospitals charge on a sliding scale based on the applicants' families' ability to pay. (I don’t mean to belittle your comment about universities which is factual and helpful. I’m just pointing out that US education system is just as fucked up as the US healthcare system the OP is talkin…

Also very true, and a good point. Even people in the US don't understand why those $200K hospital bills aren't real. Insurance providers (including government programs) have a fixed limit for what they pay for procedures. They pay min(billed_amount, allowed_amount) so providers don't want to risk leaving money on the table by having billed_amount So every time you see posts on the internet where people talk about the…

Note that another word that straightforwardly describes this behavior is "fraud". Medical bills aren't like a bill from a car mechanic where there is a contract (either written or at least implied because the mechanic will readily give you estimates and quotes).

In the medical context, the only contract in the picture is possibly between the medical provider and the healthcare management organization. It would be fine if providers only sent the fake bills to them as they're both willingly playing this perverse game.

But the problem is when they send their fake numbers to patients as if they're some kind of legitimate bill. Medical bills to patients are presented on a "cost reimbursement" basis - helping you cost them this much, so you are responsible for reimbursing them. By inflating the numbers 3-5x they are straight up lying about the costs they incurred. That's fraud.

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