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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

#771

Post by ab_testing »

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]

I think the root cause of the problem is not insurance companies but they definitely do play a part. The real reasons are multiple but can be listed as below.

1 A very high cost of drugs due to no intervention by the government as part of free market philosophy. This means that the same insulin that costs $25 in Canada can be sold for up to $1000 per month. New introduced drugs for Alzheimer's or other diseases can cost up to 50k per year - again because no price controls.

2. Insanely high prices of services due to a captive market - example a ten minute ambulance ride can cost up from $1000 to $5000. The private ambulance companies know they can charge a high base rate because they are connected to a city or municipality via contracts. Bribes as campaign funds are popular here. E.g. a new York based ambulance operator paid 45k in campaign funds to NY's governor elect and got a contract worth one billion dollars

https://www.wkbw.com/news/state-news/report-nysdoh-awards-mu...

3. Overcharging by hospitals for medicines and services again due to a captive audience. The hospitals are free to maintain various price books and you are not told what each service will cost at the time of administration of service. lately the hospitals have been forced to open up their price books but they are so convoluted that no normal human can decipher those prices.

Thus a ten cent aspirin would cost you $25 in the hospital and a MRI can run up to 15k.

4. Very high charges for doctors due to strict control on the number of MD positions and no increase in colleges or D seats over multiple years.

https://www.aamc.org/news/press-releases/new-aamc-report-sho...

5. Insurance companies have a for profit motive and need to extract their profits from premiums paid. Thus they fight tooth and nail to deny procedures and medications and set up convoluted processes for appeals.

6. Extensive fraud on Medicare and other government run health programs especially in durable medical goods and fake billing. In fact one of sitting US senators medical care company was involved in the largest Medicare fraud fines in the US and he still holds his seat.

https://www.justice.gov/archive/opa/pr/2003/June/03_civ_386....

Infact fraud billing Medicare for services not rendered is so popular that even Insurance companies do it

https://oig.hhs.gov/fraud/enforcement/united-states-interven...

Combine all the above factors and you will see why the US consumer gets so little while paying so much for his healthcare.

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

#772

Post by parineum »

tsimionescu wrote: post #753
Aurornis wrote: post #438

Earlier quoted context omitted.

> 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…

It's very funny to see the US perspective here. $30-40k debt for a new graduate of an average university sounds crazy expensive to virtually everyone outside of the USA, I would bet. I paid $0 for my university, as did most of my colleagues, but even if I had had to pay the tuition, it would have amounted to $4k total for a 4-year bachelor's degree, or $6.5k total for a 6-year bachelor's + master's, at one of my coun…

> $30-40k debt for a new graduate of an average university sounds crazy expensive to virtually everyone outside of the USA

That's the cost over 4 years. Most people will be able to get financial assistance to help pay for that and you easily manage to make 30k (or less with grants) in 4 years to pay for school. People making below 35k per year are going to pay practically zero taxes. You can work about 15 hours a week making $10 per or full time over the summer to pay for that.

There's no need to take on any debt.

People in the US make considerably more money than those in the EU and, generally pay less taxes so there's a lot more disposable income available. I think people here prefer to be able to just get what they can pay for rather than hope the government will let them pursue the education they want (there are aptitude tests and quotas in some EU countries).

It's not really better ir worse, it's just different.

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

#773

Post by throwawayffffas »

kwanbix wrote: post #51

Having lived in Europe 10 years (I am from south America), it is crazy that the rest of the world doesn't follow Europe's health coverage: everybody is covered, all the time, you can be covered either by public insurance (was my case) or private. There are no preconditions. Kids get covered for almost everything up until they are 18 or 21 (don't remember), drugs for adults is only 5 euro each. No matter the cost. And…

European healthcare in my experience has capacity issues.

Typically hospitals are overwhelmed by the sheer amount of patients. Waiting times for procedures are incredibly long.

Where the system kind of shines is emergency care and long term illnesses, you go in and they save your life for free.

For any other kind of treatment you are generally better off turning to the private sector in Europe. You are going to have to pay depending on the country the cost might be outrageous but typically you will get access to procedures in days vs months.

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

#774

Post by throwawayffffas »

bazmattaz wrote: post #190
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…

How do the hospital determine how much you’re able to pay though. You could say $20k is the max I can afford or $2k is the max

Google and friends has made sure the hospital knows among other things how much you make, your life insurance policy payout, the value of your home, etc.

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

#775

Post by kamaal »

diob wrote: post #671
magicalhippo wrote: post #422

Earlier quoted context omitted.

Relative recently had their baby come several months early. The baby needed intensive care for a couple of months, and breathing support (CPAP) for another two. Mom lived at the hospital hotel for the duration. Baby got regular inspections of the heart, lungs and eyes (too much oxygen in the blood can lead to problems with the cornea or something), including after checkout. They got billed exactly zero. Both parents…

A lot of folks are looking at the higher US comp but aren't correctly pricing in the long-term risk. You can be fine for years, but a single, major medical event can zero out those salary gains and lead directly to bankruptcy. It's a systemic flaw that isn't obvious until it's your turn to deal with it.

I know of Indian immigrants who suffered for decades/years on H1B, endless anxiety and tensions, eventually make it to GC, then a passport.

Then all of a sudden fall ill, lose everything and return back to India.

People keep forgetting the US society is a giant stack/pyramid ranking system, the structure keeps getting narrow as you move upwards. You get pushed off the sides, in the ever narrowing funnel, and you need increasing levels of luck at every level to survive.

BTW, this is not just with regards to health care. You could lose your job, suffer from ageism. Lose your home, run out of money. A million different things can happen, that can cause the above said phenomenon.

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

#776

Post by throwawayffffas »

brikym wrote: post #733
cowmix wrote: post #29

For all my constant freak-outs about AI in general, it turned out to be a godsend last year when my wife’s mom was hospitalized (and later passed away a few weeks afterward). Multimodal ChatGPT had just become available on mobile, so being able to feed it photos of her vital sign monitors to figure out what was going on, have it translate what the doctors were telling us in real time, and explain things clearly made…

Doubters say it's not as accurate or could hallucinate. But the thing about hiring professionals is that you have to blindly trust them because you'd need to have a professional level of knowledge to qualify who is competent. LLMs are a good way to double check if the service you're getting is about right or steer them onto the right hypothesis when they have some confirmation bias. This assumes that you know how to…

All these things are language parsing and transforming. That's the kind of thing llms are good at.

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

#777

Post by Sincere6066 »

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…

(this thread paid for by OpenAI)

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

#778

Post by itissid »

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…

A pharmacist once told me that big insurance companies have call centers out in other countries whose job it is to call everyone who has medication approved and any one with misleading line of questioning:"Did you get or approve medication worth $$$$$$..?".

Calling 100's of people Ofc the find one poor guy never heard of such a sum denies this kind of line of questioning. Then the insurance company uses this to deny all claims made by the pharmacy for ALL their patients for that given drug/medication.

The pharmacist told me the mountain of documentary evidence they have to collect to rebut these denials is very large. Once a customer at their pharmacy said he did not want to sign off on a paper that he got a medication, the pharmacist got the customer's ok though to video record his consent, just so he does not have to deal with this mess.

He also mentioned to me that a pharmacist should NEVER pay any kind of reimbursement to an insurance company on a claim that was denied cause that somehow legally can let the insurance company deny future claims. Not entirely sure what exact legal procedure allows them to do that.

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

#780

Post by kamaal »

tonymet wrote: post #48

We suddenly woke up in the Kafka-esque purgatory of critical American healthcare billing. We’re in our 50s and had been perfectly healthy, then suddenly we got diagnosed with what will be over $500k in treatment over the next 12 months— and multiple millions for the foreseeable future. We have insurance, but many of the required procedures are “out of network” and there’s no way to tell (we have “the best” insurance,…

>>It’s the Terry-Gilliam-level of absurdity of the billing process. Absolutely no one will tell you how much things are, and when you ask, they sass you that it is a ridiculous question.

Here in India when my dad underwent bypass surgery, I checked the bills the breakdown is insane. This how a charge goes, Nurse comes to see you, so she wears a pair of gloves, that gloves is billed. And often something like 10x the price those are available in the regular pharmacy. Each and everything is billed, and you would be surprised just how many things like these can be be billed.

>>You’ll be asked to take a diagnostic not knowing whether it will cost $10 or $15000 . Even if you try to be responsible and call the provider (who isn’t your doctor, clinic, or hospital ) – they won’t be able to tell you.

Often some 'visiting doctor' comes to see you. Like in the case of my dad we were billed for a diabetic consultation, despite clearly telling them he wasn't diabetic, even more so, the same doctor came in the day before and had to told the same. We didn't need it. But you will see they bill you like 2000 rupees just for the person to enter the room say 'Hi' and exit.

>>The only thing I’m sure of is that there has to be tremendous amounts of incidental and deliberate corruption . Auditing a single patient’s billing is impossible – so a population’s worth is a goldmine .

In these situations most people are so stressed and anxious often people just have no mental bandwidth to fight side battles.

Its really a corrupt system to the core, and I don't see hospitals and doctors giving all this up anytime soon. Or even ever.

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