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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

#701

Post by _heimdall »

wing-_-nuts wrote: post #524
_heimdall wrote: post #334

Earlier quoted context omitted.

I don't think this has much to do with being a democracy. I, for one, wouldn't trust our federal government to competently run an efficient, most uncorrupted healthcare system for all. The incentive structures that have built up around US politicians simply doesn't leave any room for it to realistically happen. Until the incentives are changed I'd vote against nearly any major government program.

I hope you refuse Medicare at 65 under those same principles

That would entirely depend on the coverage I could get and how it compared to private. If Medicare is changed over the next few decades to look more like Medicare Advantage, aka Plan C, you couldn't pay me to deal with that.

Edit: its worth noting that your question for whether I'd take medicare is a separate issue from my original point. If the existence of Medicare as it is today was on the ballot, I would vote to get rid or drastically change it. If the program exists regardless of my opinions of it, my choice to take benefits from it is entirely a question of means and comparative benefits of all the options.

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

#702

Post by supertrope »

intrasight wrote: post #214
mjr00 wrote: post #42

Earlier quoted context omitted.

Yeah, US hospital billing is based on the idea that the patient has insurance and won't really care about what their insurer gets charged. (The wider implications of this are left to the reader.) For the uninsured this sort of thing is actually really common. Had an online friend who had to get emergency treatment and they sent him a bill for $20k. His response was, "lol I'm uninsured and don't give a fuck about my c…

Health Care Sharing Ministries (HCSMs) are an interesting loophole in healthcare regulations that excepts uninsured people that participate in an HCSM from paying the tax penalty. HCSMs are membership organizations in which people with common religious or ethical beliefs share medical expenses with one another. They are not the same as traditional health insurance. Because patients are considered "self-pay", they neg…

Warning! As grotesque as health insurance companies are, in theory they are obligated to pay valid claims under your policy. Health sharing ministries can exercise discretion to deny payment because they disagree with your lifestyle choices. Or for any reason or no reason given at all. They are subject to far fewer regulations and audits and in some extreme cases the administrators just pocketed the money.

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

#703

Post by sxg »

lesuorac wrote: post #513
sxg wrote: post #486

Earlier quoted context omitted.

Public service loan forgiveness (PSLF) exists and a huge number of people in medical professions actually take advantage of it. I know of multiple medical students and residents with over $500k in debt that are in the process of having all of their loans forgiven after 10 years in training and a total cost of approximately $75–150k for their entire education. Sure, that's still a decent amount of money, but it's very…

How successful are those people being? IIUC, there was a bit of a scandal where the companies the DoE where paying to manage those 10 year forgiveness plans where giving incorrect advice and so a lot of people aren't going to qualify. https://oag.ca.gov/news/press-releases/attorney-general-bece...

Anecdotally, it's worked out for a number of friends and people on /r/PSLF. There's definitely poor communication around PSLF, but it is a real program.

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

#704

Post by nonfamous »

tptacek wrote: post #497
nonfamous wrote: post #467

Earlier quoted context omitted.

>>> 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.

There are plenty of other countries with car accidents, homicide and cardiovascular disease. They also do worse than the US in life expectancy.

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

#705

Post by BobbyTables2 »

Aloisius wrote: post #303
xp84 wrote: post #178

Earlier quoted context omitted.

> since another insurance company would just steal their customers by having lower LOL. Meanwhile, in real-life America, there are only four or five major carriers that control the market, and none of them are incentivized to do this "competition" thing you speak of by engaging in damaging price wars. Why would they when continuing to be part of the problem makes them more and more profits each year? See also: milita…

Four or five competitors is plenty for a healthy market. Where I live, they do compete on price - prices vary by about 30% for similar coverage. They can't engage in the kind of price war you're thinking of since insurance companies, by law, have to maintain a fund able to cover costs, have to get rate changes approved by regulators and are largely banned from price discrimination. I understand the desire to shift bl…

Providers have certainly gotten greedy but still can’t compete against hospitals when it comes to ridiculous billing.

I practically damn feel sorry for surgeons when I see what they get from insurance versus the hospital for providing the operating room or bed.

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

#706

Post by bko »

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]

US person here.

I have insurance through my employer as do most Americans. And most are happy with their insurance. I can go to the doctor often same day, I can see a specialist and pay just a co-pay of between $25-50.

I had some bills but my out of pocket max is something like $5k, which I have saved up. The benefits of living in the US is that the same kind of work (engineer) pays about 3x as much here and you pay a lot less taxes (save many multiples of my out of pocket max).

So I prefer to live in a vibrant economy and take care of my own insurance.

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

#707

Post by fn-mote »

Aurornis wrote: post #438
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…

> 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…

> almost nobody actually pays those mind-blowing $60K/year tuition prices

This is not true at all.()

You quote tuition at the school with the highest endowment in the country. The college cost situation is absolutely still high at the less endowed second tier, and “ordinary” (non-generational wealth, two full time earner) families are paying full price.

() Except in the sense that “almost nobody” goes to any of these schools, comparing to the 50k enrollment at large public institutions.

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

#708

Post by willio58 »

egorfine wrote: post #387
svobodovic wrote: post #372

Earlier quoted context omitted.

How did you come to this conclusion from the previous answer/comment?

Because they don't want/don't change the electoral system

The problems with the electoral system are just one symptom of a deeper issue: unlimited political donations. The wealthiest individuals in the world can funnel endless money to politicians through Super PACs, and that influence shapes policy more than an individual voter ever could.

Even if we magically fixed the electoral system tomorrow, the results would be superficial. Sure, we might see more Democrats in office—but if they’re still beholden to massive, uncapped donations, how can we expect them to enact real, meaningful change?

This problem with money in politics is not something that only affects one party. It's a systematic issue that needs regulation. Without real regulation on money in politics, everything else is a band-aid on an open and festering wound.

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

#709

Post by supertrope »

kasey_junk wrote: post #216
vincnetas wrote: post #174

Earlier quoted context omitted.

this looks like shopping in Moroccan bazaar with no price labels. But here you bargaining not for couple fruits but for your health and price range is in thousands. WTF :)

It’s worse than that. In a bazaar there are only 2 participants and they are looking out for their own interests. Most Americans don’t choose their own insurance their _employers_ do. The insurance company has no reason to make the health recipient happy and the health recipient has little agency in pricing.

In a bazaar you can examine the fruit or rug yourself.

An average person cannot call up $750K in a year to pay for cancer treatment. But for-profit businesses (and any organization for that matter) treat you much better if keep the carrot of another payment in front of their face. If you've forked over the whole wad of cash upfront they immediately de-prioritize keeping you satisfied.

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

#710

Post by throwaway2037 »

no_wizard wrote: post #640
georgeecollins wrote: post #630

Earlier quoted context omitted.

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?

The two things are not equals. The US has for a western country, relaxed standards for immigration[0], in particular if you were coming from Europe, it's quite a bit easier to establish residency here. The reverse is not true. European nations aren't very immigration friendly by comparison. On top of that, the US government, assuming you keep your citizenship, does not make it easy to live abroad. US government tax p…

    > The US has for a western country, relaxed standards for immigration
My comments will only concern skilled migration, e.g., you are a computer programmer or something STEM'ish and you want to work in a different country.

First, let's start with the "Anglo-American sphere" (my term): US/UK/CA/AU/NZ. Of those five, US is the hardest to get a working visa for skilled individuals. The rest are "points-based" system where you can apply for a working visa even before you have a job (95% sure about this -- pls correct if wrong). They are much more friendly. Also, the rules are simpler, clearer, and applied more consistently.

I know much less about other OECD-level (and G7-level) nations, but anecdotally, overall, the process is much more straight forward compared to the US. What the rules say, the rules do. Not so much in the US where they randomly delay or reject applicants without good reason. (Also: Google to find horror stories of what happens when you lose your job in US as a foreigner who does not have PR. Fucking nitemare.) You hear this much less in (to name a few): Ireland, UK, France, Germany, Belgium, Netherlands, Denmark, Norway, Sweden, Finland. (I don't hear as much about Portugal, Spain, and Italy, but quality of life looks awesome!) All of those countries are wealthy, highly developed and have excellent quality of life. All of them welcome skilled migration and have clear programmes (you can Google about them) to get a working visa. Again, strictly anecdotal: The US immigration system is much more adversarial compared to all of the other countries that I mentioned. Oh, and I forgot to add Japan: After PM Abe changed the rules, it is way easier these days to get a skilled worker visa in Japan.

Last point:

    > European nations
I see this over and over again on HN. I want to repeat: Europe is enormous -- like continent-sized -- with ~50 countries. It doesn't say much to say "in Europe". Are we talking about Belarus, Albania, Germany, or Italy? All of them are culturally and economically much more different than anything in the US (comparing US states / regions). Immigration/healthcare/public school/public safety/retirement all looks very different in those nations. Advice: It's better to say something like: "the Nordics" or "Benelux" or "GBR/FRA/GER/ITA" (the four economic giants of Europe). The best comments are when people comment about specific European nations, like "I lived & worked in Belgium for 7 years and this happened."
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