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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

#681

Post by [deleted] »

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?

[deleted]

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

#682

Post by epistasis »

no_wizard wrote: post #663
epistasis wrote: post #485

Earlier quoted context omitted.

While I don't doubt that there are endless stories of bad care, especially among the non-unionized working class, the bulk of voters with middle class lifestyles do have good care. Which is why it's so hard to make it into an issue that drives political change. > there are plenty of studies that show that Americans have lower expected lifetimes than citizens of peer countries, despite much higher per-capita health ca…

>While I don't doubt that there are endless stories of bad care, especially among the non-unionized working class, the bulk of voters with middle class lifestyles do have good care. Which is why it's so hard to make it into an issue that drives political change This ignores the outsized influence of lobbyists, especially post Citizens United. The majority (depending on which polls you cite, seems to range anywhere fr…

What lobbyists are opposed to universal healthcare?

It seems to instead be merely a wedge issue in culture war. Republicans firmly oppose it, Democratic politicians fight for it, and apparently voters don't care enough to advocate for what they say they want in polls.

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

#683

Post by georgeecollins »

fukka42 wrote: post #376
throwaway0123_5 wrote: post #325

Earlier quoted context omitted.

> So like these are less serious issues if you are paid an extra $1-200k/ year Ok but to be fair most people in the US aren't making "extra $1-200k / year" over a person in Europe. They aren't even making $100k / year to begin with.

It's hilariously out of touch, but it's what you should expect from the HN bros. They live in a bubble. I'm from the eu and earn far less than these American techbros do, but far more than my American friends who work normal jobs. They work at the DMV, a supermarket, or general office work. You know, normal people. The vast majority.

I agree I am not in any way representative. But the forum is hacker news, not my day at WalMart.

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

#684

Post by no_wizard »

maxerickson wrote: post #597
lesuorac wrote: post #510

Earlier quoted context omitted.

FSA's not HSA's are use-it-or-lose-it. If you have a FSA I strongly suggest that you get an HSA instead. https://www.fidelity.com/learning-center/smart-money/hsa-vs-...

A lot of people with FSAs will have insurance that disqualifies having an HSA. I have the paranoid idea that they designed FSAs in such a goofy way for budget scoring and it drives me nuts.

>A lot of people with FSAs will have insurance that disqualifies having an HSA.

Which should be illegal. It should be only HSA across the board. Its nonsensical that this is a thing.

I'd love an HSA, but I can't due to my plan (can't do a high deductible plan for $reasons).

I think there may be some loophole in setting up an independent HSA but I haven't looked into it enough, only recently heard of such a scheme

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

#685

Post by DennisP »

tptacek wrote: post #559
dragonwriter wrote: post #553

Earlier quoted context omitted.

> 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. The US spends nearly as much in taxpayer funds as a share of GDP as other developed countries (and v…

Again, you can just do the math on this. You're making an argument about the macro costs of our system --- I think those costs are fucked, too. But I'm not talking about that; I'm talking about the actual experience of an ordinary middle-income family with private health insurance. That family would likely (in fact, almost certainly) be worse off in a single-payer system. I'd appreciate if you'd avoid using language…

There is a middle ground here. Many European countries do not actually have single-payer, but still perform better than the US.

It's a bit out of date now but the book The Healing of America found that Germany, France, and Japan had world-leading healthcare results, measured by things like survival time after major disease diagnosis, but spent much less of a percentage of their GDP on healthcare. None of them had single-payer. Their systems were pretty close to the ACA, with private insurance companies and a mandate.

They were also different than the US in certain ways. Probably the biggest was a national price list for services. A lot of healthcare isn't really a functioning market; in many cases you're in no position to comparison shop. A result of the price lists was that doctors made a lot less money, but this didn't seem to affect quality.

Other differences included: no claim denials allowed for anything on the price list (which saves a lot of administrative staff), effective national digital records systems (ditto), and the insurance companies had to be nonprofits.

All three countries actually got better bang for the buck than Canada's single-payer system. Japan was the cheapest, spending only 5% of their GDP on healthcare, despite an aging population of heavy smokers. Germany was the most expensive at 13% (compared to US 18%) but covered things like week-long visits to the spa for stress relief.

The author did a spot check on the user experience by seeing a doctor in each country for a shoulder problem, and those three countries worked out really well for him. In Japan the doctor offered surgery the next day, at a very modest cost. They did make do with simpler equipment; the MRI machines were bare-bones but they got the job done and a scan cost $100.

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

#686

Post by t0mas88 »

candiddevmike wrote: post #2

While it's an interesting story, I doubt they needed Claude to work a hospital bill down to that amount. Hospital billing folks are acutely aware that the initial bill is outrageous and indefensible from their end. I've heard a ton of cases where folks basically "pay what they can" for the bill and that's good enough for both parties. I doubt the reasoning Claude provided was ultimately what got the hospital to knock…

It's insane that somehow a 195k bill can change into a 34k one, without putting serious doubt on the validity of that final bill. How does this work in court? Are they going to claim their 34k bill is all correct while starting at 195k? Or would it be equally plausible if the debtor said "I've not received any of the care billed for, so I'm not paying"

They can't really claim their records are any kind of proof if apparently they now agree that 82% of it was wrong?

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

#687

Post by billy99k »

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]

The alternative is no surgery and no choice, which is what happens with government-run healthcare.

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

#688

Post by BobbyTables2 »

kwanbix wrote: post #363
georgeecollins wrote: post #278

Earlier quoted context omitted.

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,…

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…

In tech, 3-4 weeks vacation not usual for senior roles. Often “unlimited” but in practice far more than 10 days. That might be for new/inexperienced hires in crappy companies.

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

#689

Post by xp84 »

altshiftprtscrn wrote: post #227
xp84 wrote: post #168

> 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.

I'm always happy to help people stick it to crooks. Here's what I know:

The California Department of Insurance may be the regulator for your health insurer, but it may not be. If not, it's the Department of Managed Health Care. You should be able to find a reference to who their regulator is in their plan documents.

# DOI:

complaints start here: https://www.insurance.ca.gov/01-consumers/110-health/50-h-rf...

list of who they regulate here: https://www.insurance.ca.gov/01-consumers/110-health/20-look...

# CDMHC:

complaints start here: https://www.dmhc.ca.gov/FileaComplaint.aspx

list of who they regulate here: https://wpso.dmhc.ca.gov/hpsearch/viewall.aspx

My original ambulance thing was with an insurer regulated by DOI. Much more recently than my original story, I went to file with CDMHC, which requires that you first file a formal grievance with your health insurer first. I would definitely recommend to file a grievance. In my case, I filed a grievance and also contacted the office of the CEO, who emailed back and miraculously made another made-up problem go away even faster than the grievance process did.

But anyway, yours is an interesting case here. I can't be sure if the insurer is the one who screwed up here, also the ambulance company may not be allowed to balance bill you. The only thing I'm pretty sure of is that you shouldn't be responsible for more than an in-network ambulance would cost you, presuming you didn't just take an ambulance in a non-emergency, just for fun (as they seem to always assume).

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

#690

Post by tptacek »

DennisP wrote: post #685
tptacek wrote: post #559

Earlier quoted context omitted.

Again, you can just do the math on this. You're making an argument about the macro costs of our system --- I think those costs are fucked, too. But I'm not talking about that; I'm talking about the actual experience of an ordinary middle-income family with private health insurance. That family would likely (in fact, almost certainly) be worse off in a single-payer system. I'd appreciate if you'd avoid using language…

There is a middle ground here. Many European countries do not actually have single-payer, but still perform better than the US. It's a bit out of date now but the book The Healing of America found that Germany, France, and Japan had world-leading healthcare results, measured by things like survival time after major disease diagnosis, but spent much less of a percentage of their GDP on healthcare. None of them had sin…

I agree. I'm a fan of the non-single payer European systems, and, especially, of the Australian system. Nobody can look at the American system and say we've got it right! I do like the private->Medicare compromise we have, but we also have the original sin (a strange and I think unintended consequence of the mid-century tax code) of employer-sponsored coverage.
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