Using AI to negotiate a $195k hospital bill down to $33k • Hacker News Board

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

#691

Post by kemitchell » Tue, Oct 28, 2025, 11:49 PM UTC

Zambyte wrote: post #163

pbhjpbhj wrote: post #138

Earlier quoted context omitted.

A code is not an artistic expression and so can't be copyrightable. The layout of a book of codes, for sure, but the information in it... might be protectable with other IPR but not copyright. Does not stop people threatening you though. This is my opinion only, not legal advice, and does not relate to my employment.

Software I write at work is not artistic expression yet is covered by copyright. This isn't a counter argument, just pointing out how absurd copyright is.

Copyright under US law does not require "artistic expression". One of the requirements is called "creativity", but it's very easy to meet. The key phrase is literally "some minimal degree of creativity".

The fundamental policy choice was to protect computer software under intellectual property law, with exclusive rights and market compensation. There were a number of ways that could have been done. Other jurisdictions toyed with new, software-specific laws. But in the end the call in the US was to bring it under existing copyright law with some tweaks to definitions and a small handful of software-specific rules.

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

#692

Post by no_wizard » Tue, Oct 28, 2025, 11:50 PM UTC

epistasis wrote: post #682

no_wizard wrote: post #663

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 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.

Off the top of my head:

- The Partnership for America's Health Care Future

- American Hospital Association

- U.S. Chamber of Commerce

- Various lobbying organizations related to private insurance and adjacent systems, like pharmacy benefit management organizations

Politico has a great article about the Medicare For All fight[0]

The opposition spent hundreds of millions of dollars fighting it.

[0]: https://www.politico.com/news/agenda/2019/11/25/medicare-for...

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

#693

Post by Freedom2 » Tue, Oct 28, 2025, 11:51 PM UTC

billy99k wrote: post #687

egorfine wrote: post #253

Earlier quoted context omitted.

[flagged]

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

I doubt this comment is true, given that other countries with government run healthcare have surgeries and choice. Do you happen to have any evidence that every country with government run healthcare has no choice or surgeries at all? Your comment seems to imply as such.

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

#694

Post by stephen_g » Tue, Oct 28, 2025, 11:52 PM UTC

BobbyTables2 wrote: post #688

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…

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.

For comparison, 4 weeks is the absolute minimum for any full-time worker here in Australia, and that’s less than people in the UK/Europe get.

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

#695

Post by tyoma » Tue, Oct 28, 2025, 11:52 PM UTC

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.

Surprise ambulance bills are mostly (but not completely) illegal in California as of Jan 1 2024. Ask the LLM of your choice about AB 716 and whether it applies to your situation (it likely but not certainly does). Have the LLM draft a letter and send the physical letter to the ambulance company. If they are bothering you, request they only contact you by US mail.

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

#696

Post by Me001 » Tue, Oct 28, 2025, 11:52 PM UTC

lotsofpulp wrote: post #250

swiftcoder wrote: post #199

Earlier quoted context omitted.

> This only makes sense if they have no competitors since another insurance company would just steal their customers by having lower rates. This assumes the competitors are not all colluding to raise prices across the board

Then they must suck at collusion, given they can't even beat a risk-less broad market index. SP500 10 year annual return: 14.6% UNH: 13.59% Elevance: 10.79% Cigna 9.42% Humana: 6.1% CVS: 0.55% Molina: 9.42% Centene: 0.9% Or, the likelier explanation, is that health insurance prices are highly regulated and have to get their prices approved by a government official(s), and B) they don't have a lot of pricing power due…

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

#697

Post by BobbyTables2 » Tue, Oct 28, 2025, 11:53 PM UTC

Aloisius wrote: post #158

fatnoah wrote: post #62

Earlier quoted context omitted.

>The wider implications of this are left to the reader. IMHO, it's actually worse than we realize. The Medical Loss Ratio requirement is good because it requires insurance companies to spend 80% or 85% of premiums on health care. It's bad because one way for insurance companies to make more money is to have inflated health care prices to justify increasing premiums so they can get 80% of a bigger pie. It also gives t…

> one way for insurance companies to make more money is to have inflated health care prices to justify increasing premiums This only makes sense if they have no competitors since another insurance company would just steal their customers by having lower rates. The truth is though, healthcare providers are ultimately responsible for prices.

Insurance companies are required to spend something like 80% of premiums on claims.

This sounds like a really good thing, almost everything coming in has to go back out…

What it really means is they love high “allowed” prices. They live on the 20% and want to see the pie as large as possible.

Healthcare costs go up? They raise premiums — win-win.

The road to hell is only paved with good intentions.

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

#698

Post by t0mas88 » Tue, Oct 28, 2025, 11:53 PM UTC

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…

Sure 92% of Americans have insurance, but they pay 5-10x the monthly premium compared to most Europeans and then on top of that the co-pay is thousands of dollars more than the small (or zero) amounts Europeans have. And insurance is not guaranteed, it's all linked to your employer. It's bad for nearly everyone, but enough people accept it so it doesn't change.

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

#699

Post by fn-mote » Tue, Oct 28, 2025, 11:53 PM UTC

tptacek wrote: post #659

StackRanker3000 wrote: post #593

Earlier quoted context omitted.

> 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 similar patterns resulting in a large percentage of students paying no tuition, the middle ground of students paying some fraction, and a small number of students from wealthy families subsidizing everyone else. As someone from a country (Sweden) that to a larger…

There's always this subtext that Europeans solve these problems just by caring more about human values, but the truth usually involves interesting sets of tradeoffs. So in Europe the norm, besides free university, is extensive tracking: in the US, your choice of major is essentially a consumer decision, where in many European systems it's fixed at a relatively early age by your performance on things like the Abitur.…

I agree that European schools are heavily tracked, but I’m not seeing the connection between that and the tuition costs.

It seems like these are unrelated issues.

Does the wider freedom of choice in US education somehow cause college to cost more? Because more people want to go?? I don’t get it.

> Europeans solve these problems just by caring more about human values

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

#700

Post by epcoa » Tue, Oct 28, 2025, 11:54 PM UTC

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…

HSAs are triple tax advantaged retirement accounts. Not taxed on contribution, gains, or withdrawals for qualified expenses. In the worst case it becomes like a pretax IRA because after age 65 you will not pay a penalty on non qualified expenses - but qualified expenses tend to increase with age. For many it should be their primary retirement account. Even for people with certain chronic conditions (not in perfect health), depending on how good/expensive the PPO offered by the employer, it might still work out better to do HDHP/HSA. You can get as many basically free HSA accounts from Fidelity.

An FSA really has nothing to do with an HSA.