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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

#641

Post by SkyPuncher »

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…

I briefly worked in adjacent space. While I hate the way it works, it makes a lot more sense when you understand that the billed amount is essentially just a negotiation tactic that represents a price well above what they ever expect to be paid (and a bit added to that for safety).

Then, they negotiate with all of the in-network providers for some number that’s well below the billed amount. That number varies a bit based on how effective various negotiations are.

Realistically, OP simply found the number that insurance was going to pay out anyways.

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

#642

Post by keybored »

georgeecollins wrote: post #278
egorfine wrote: post #253

Earlier quoted context omitted.

[flagged]

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,…

A Princeton study showed over a decade ago that the policy preferences of the vast majority of Americans have no correlation with actual policies. That you put forth these completely detached theories is quite impressive.

I don’t know if this a case of ideological delusion to go along with political impotence or just the usual upper middle class playing their part in obfuscating the on-the-ground realities. Structurally the latter is more likely.

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

#643

Post by frikskit »

georgeecollins wrote: post #630
kwanbix wrote: post #363

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…

If this were true, the number of Americans I have known who moved to Europe would be roughly equal to the number of Europeans I have known who have moved to the US. That's not data, that's anecdote. But what is the European country where more people go there from the US than come to the US from there?

High fractions of Europeans speak English, eg Poland has 50% of population speaking English (for those of working age it’s probably much higher) whereas the fractions of Americans speaking non-English European languages is much lower (0.25% for Americans speaking Polish).

If 50% of Americans spoke Polish by the shake of a wand, I bet there’d be more Americans in Poland than Poles in Poland.

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

#644

Post by FireBeyond »

Apart from anything else, family has zero obligation to pay their brother-in-laws medical bills after death (or before).

Hospitals will pull all sorts of shady stuff to strongly imply that you should pay for a family members medical bill, however. From very strongly hinting that you're obligated to, through to impugning honor, "It would be doing the right thing by your dad", etc.

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

#645

Post by knollimar »

thatfrenchguy wrote: post #635
egorfine wrote: post #253

Earlier quoted context omitted.

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Add a French and American person, in the US you hear "insurance did not approve", in France it's more "you can't get an appointment / the surgery provider does not have any spots unless you go to their spots in their private hospital". The French system is more predictable (because any vaguely sane healthcare system has a price for a code instead of negotiated rates, negotiated rates is the most inefficient way to ru…

Do negotiated rates not affect quality of care? I work in contracting and negotiated rates allow me to add quality, while systems like price codes incentivize minimum effort/outcomes.

I know doctors probably take their jobs more seriously, but I'd be surprised if it doesn't bleed over into healthcare quality.

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

#646

Post by tptacek »

spacechild1 wrote: post #633
tptacek wrote: post #435

Earlier quoted context omitted.

In fact many of the largest insurers are nonprofits, and insurance itself is a small faction of our total expenditure. People believe a lot of weird things about US health care economics. https://nationalhealthspending.org/

There's another aspect: In my country, hospitals and (public) health insurance are both operated by the state and work together. If I break my arm, I go to the hospital, show my e-card and that's it. All the financials are directly handled between hospital and the (public) insurance provider. I don't have to worry about cost of treatment because I know it will be fully covered.

Right. The mainstream progressive proposal for comprehensive health care reform in the US is single payer, so-named because it does not nationalize the providers. But the providers are where all the cost is!

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

#647

Post by franktankbank »

Workaccount2 wrote: post #177
lifeisstillgood wrote: post #108

The rest of the western world just looks at this as wonders why Americans put up with this. Using the latest in technology to move an a bill from existential to merely crippling

Because 92% of Americans have health insurance, and 22% have totally free everything covered health insurance. Of the uninsured, most either are eligible but don't apply, have insurance through work but forgo it, or are not US citizens. All said and done, you end up with a very small sliver of people who are legitimately uninsured, which means the problem mostly exists as scary stories rather than people actually exp…

Having insurance you still wind up paying 30k+ a year for that privilege whether you use it or not.

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

#648

Post by knollimar »

egorfine wrote: post #568
robrenaud wrote: post #484

Earlier quoted context omitted.

A lot of employed people like the status quo for the healthcare that they receive. "In contrast to their largely negative assessments of the quality and coverage of healthcare in the U.S., broad majorities of Americans continue to rate their own healthcare’s quality and coverage positively. Currently, 71% of U.S. adults consider the quality of healthcare they receive to be excellent or good, and 65% say the same of t…

So basically they accept and approve of them being bankrupted by an unfortunate medical event no matter how top tier their health insurance package. Right?

Are there not out of pocket maximums on most plans?

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

#649

Post by jhgb »

georgeecollins wrote: post #630
kwanbix wrote: post #363

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…

If this were true, the number of Americans I have known who moved to Europe would be roughly equal to the number of Europeans I have known who have moved to the US. That's not data, that's anecdote. But what is the European country where more people go there from the US than come to the US from there?

USAians are not exactly famous for commonly speaking most European languages at a level that would allow them to resettle to the respective European countries. This makes for a considerable barrier that essentially doesn't exist in the opposite direction.

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

#650

Post by levocardia »

egorfine wrote: post #253
chrisgeleven wrote: post #245

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…

[flagged]

Why do you put up with long wait times and lower-quality care in your home country?
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