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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

#711

Post by MattyRad »

dghlsakjg wrote: post #229
dcow wrote: post #128

Earlier quoted context omitted.

I think the argument is that it’s criminal to take advantage of the patient without insurance and ask them to ruin their life trying to come up with 195k when your system is setup to reasonably profit off the 37k you get from the insured patients. I firmly believe that even in a capitalist society the idea of profiting off of anything let alone healthcare in the thousands of percentage points is criminal.

I think he meant literally criminal. The hospital double billed for over $100k worth of services on the original invoice. At a certain point a pattern of issuing inaccurate invoices crosses the line into negligence. If a business just have a habit of blasting out invoices that bill for services never received, and they know that they keep doing this, and only correct it when the customer points it out, at a certain p…

From a quick Google query, it says that ~%90 of Americans have health insurance (which seems higher to me than I'd expected). I'd be very interested in knowing the number of uninsured, negligent/nefarious, and exorbitant invoices that are issued as a percentage of all invoices, for the purpose of determining the scale of criminality with respect to your description.

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

#712

Post by kemitchell »

fucalost wrote: post #137
potato3732842 wrote: post #18

Earlier quoted context omitted.

Exactly. You can do this with anything where the racket is based around the layman not being able to take in the amount of arcane subject matter info they'd need to argue their case, not just medical. Tons of institutions that specialize in screwing people are built this way because it's pretty hard to "overtly" build an institution to screw people.

This! People underestimate the extent to which lawyers are negotiable also. “I’m not paying that” is a surprisingly effective method; they’re often willing to compromise on payment terms, work at-risk subject to a successful outcome, significantly reduce their rates, etc.

In my experience, most people underestimate what's negotiable across the board. Especially those making enough to do most of their business with mass-market operations, like big-box stores and retail service providers, that profit by doing many, many standardized transactions every day, with minimal discretion or even personal involvement.

Below that, lots of haggling and informal trade often help people get by. The costs of that process can be another burden on the poor. At the high end, it's worth involving people with discretion on the sell side. Additionally, sales are often one-off and customized. They may also bundle a bunch of different items and benefits without clear line-item breakdowns.

When hiring a lawyer, I'd nearly always recommend getting terms down in a written and signed engagement letter before work starts. That is very much a negotiation, but it's fine to ask questions and comparison shop.

If you're starting with a call, it's perfectly normal to start by asking whether initial consultation will be billed or not. If it will be, ask the rate. If it won't be, expect some limits on what can be discussed. The best lawyers I know aren't cheap or easily tricked into giving free advice on consultation calls with speedrunners, but they are up-front about what they charge for and how.

Disclosure: Am lawyer. Negotiate professionally.

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

#713

Post by xp84 »

lotsofpulp wrote: post #258
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…

>Why would they when continuing to be part of the problem makes them more and more profits each year? In real-life America, they don't even earn enough profit to earn their shareholders a better return than SP500: https://news.ycombinator.com/item?id=45736978 And in real-life America, the only people health insurance companies engage in price wars with is the state insurance regulator who gets to deny requested price…

Fascinating observation, thanks for challenging my assumptions here. Just seems to further point out how useless health insurers are, even to their shareholders.

My most sincere wish is that all insurers would be nationalized, every last employee summarily fired, and their HQs all imploded and replaced with memorials to all the people whose lives they have cut short over the years. Not a thing of value would be lost IMO. Worse than paying people to dig holes and fill them in again.

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

#714

Post by janalsncm »

levocardia wrote: post #650
egorfine wrote: post #253

Earlier quoted context omitted.

[flagged]

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

It is very interesting that you do not where they are from but you assume longer wait times and lower quality of care. This suggests you believe the US has the shortest wait times and highest quality of care, which is objectively not true.

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

#715

Post by gonzobonzo »

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…

> For those who don't attend the prestigious universities with large endowments, average in-state state-run University tuition is under $10K, though again a large percentage of students receive some form of aids or grants to bring that number down even further.

This is an extremely important point that keeps getting ignored. People keep comparing _public_ schools in Europe to _private_ schools in America.

To further your point, just about every place has a community college where you can do the first two years of your education for about half the price of the state school. The total tuition for this route (2 years at community college, 2 years at a state school) is going to average just under $30,000 for 4 years. Which is definitely in the "work your way through college" range.

And this is before any financial assistance, which the majority of students receive.

Foreigners talking about how crazy expensive college is in the U.S., but they're likely mislead by people who took out large loans to go to extremely expensive private colleges. There's an easy way to stop this kind of debt - don't allow federal loans for private institutions. But no one is really interested in stopping it.

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

#716

Post by intrasight »

supertrope wrote: post #702
intrasight wrote: post #214

Earlier quoted context omitted.

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.

More and more states are auditing them. But yes it's a faith thing. And definitely not insurance. Works better for tight-knit communities where there is trust.

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

#717

Post by supertrope »

ryanjshaw wrote: post #45
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…

I’m confused why - if this is indeed common practice - it’s not considered fraud on the part of the hospitals?

The hospitals and insurers are locked in a Red Queen Race. The hospital bills for 10x actual market value. The insurer touts they are getting you a 90% discount. The individual who got sick or injured gets crushed in the middle.

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

#718

Post by tptacek »

fn-mote wrote: post #699
tptacek wrote: post #659

Earlier quoted context omitted.

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

In the US, to make tuition free, you'd have to answer the question "who gets to enter university programs". In Europe, the answer isn't "everybody".

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

#719

Post by deanishe »

georgeecollins wrote: post #665
jhgb wrote: post #649

Earlier quoted context omitted.

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.

I have never heard this term before, but to clarify what I mean (it's so weird to bring race into this!): I have worked with dozens of native born dutch, german, french people etc. and lots of latin people etc. But I know almost very few that I grew up with, went to school with, who moved from the US to another country. I am not saying this is good, the US is good etc. I am saying you have to understand the revealed…

> I am saying you have to understand the revealed preference vs what people tell you.

And what they're saying is that this isn't just an indication of how awesome the US is compared to other places, but also of how averse Americans are to learning other languages compared to other people.

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

#720

Post by no_wizard »

throwaway2037 wrote: post #710
no_wizard wrote: post #640

Earlier quoted context omitted.

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 wher…

>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.

This circumvents the original predicate, which did not have such a limitation. I know many countries have priority / helpful pathways for STEM career individuals as well as capital investors, but that wouldn't apply to everyone.

Even the US has very different pathways to citizenship depending on various factors. Last time I looked into it as research in depth, there alot of common limiting factors across Europe. Their policies are much more strict once you dive into the nuance.

That said, the US immigration landscape is extremely lopsided, thats a fair point.

>Europe is enormous -- like continent-sized -- with ~50 countries.

I realize, though as a US citizen I also realize that when most US citizens say this, they mean a much smaller contingent of countries, rightly or wrongly. I'm sure Europeans dislike how loose we use the term, but as a US citizen, it usually means cold war boundary countries, so Germany and what was considered western Europe before the iron curtain fell. Thats been my experience. People also generally forget about Portugal and a few island nations. Its a safe bet most people mean the Nordics, France, Germany, the UK, Netherlands and Denmark most of the time, conceptually.

However to be specific, France, Germany, Switzerland, the Nordics, all have strict general requirements to have a path to citizenship. I don't think the average US citizen would be able to meet them.

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