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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

#811
post #671

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.

This is why insurance plans have out of pocket maximums. To prevent this exact issue.

We can say whether those maximums are still too high (some really are), but the mechanism is there.

The real issue is that most people don't have a rainy day fund to deal with such emergencies. And that they are too expensive anyway.

There are 2 concepts you should always keep in mind.

1. Always avoid the hospital unless you are literally dying. Surgery centers are owned by doctors who will negotiate a fixed fee, because there's someone to negotiate with (unlike Hospitals which run on the CYA principle). Also, most doctors can do procedures in office, if they have the right one.

2. Medical debt will never lead to collections. Hospitals may sue you, depending on the state, but that carriers reputational risk. A good PR push and a decent lawyer to threaten discovery will be enough to fend off even the most aggressive hospitals - this allow you to setle at a very reasonable price vs what insurance would normally pay.

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

#812

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…

The norwegian healthcare is really bad at specific sectors if they deem you as a 2nd class citizen (for example trans healthcare, where there is a lot of malicious gatekeeping and multi-year long waitlists)

that sounds like 0.0001% of sectors

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

#813

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…

I'm curious, where do you live that denies a child a life saving surgery just because insurance won't cover it? Because in the US there's laws against that.

There's a difference between immediate stabilization, required by law, and life saving surgery in general, not required by law.

If you come in with a gaping head wound and can't pay, by law, hospitals are required to treat you.

If you come in with brain cancer, no one is compelled to give you the radiation, chemotherapy or surgeries you may require, even though it is literally life saving. You are stable, albeit slowly dying, so too bad.

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

#814

Earlier quoted context omitted.

I'm curious, where do you live that denies a child a life saving surgery just because insurance won't cover it? Because in the US there's laws against that.

> I'm curious, where do you live that denies a child a life saving surgery just because insurance won't cover it? Because in the US there's laws against that. Maybe I'm just too skeptical, but a) This is a very new account with exactly 1 other posting 3 months ago, and b) They don't refer to their child with any sort of gender. They even used slightly awkward sentence construction just to avoid gender. Few parents th…

Or they value privacy? Especially regarding their children?

Many people nondescriptly don’t gender themselves in online discussions.

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

#815
The inflated medical bills are not malice from the medical provider, they're incentivized by the insurance system. Providers are required to have a standard price list for all their billing codes; hospitals are required to publish it even, although compliance with publishing is sketchy.

Their contracts with insurers says they can't bill the insurer more than what's on the standard price list, but the insurer won't pay more than the contracted amount for each billing code. As a result, the standard way to make a price list is to periodically review what insurance has paid on all the billing codes you've used lately, and if there's any billing code for which insurance has fully paid, increase the price.

This is exacerbated by the fact that a single encounter might be encoded into multiple billing codes. One billing code for an aspirin, one for the nursing time to administer it, for example. Suppose insurance A pays reasonably for the nursing time but in exchange pays a pittance for the aspirin, but insurance B pays enough for the aspirin to cover the nursing time to administer it, but doesn't pay the nursing time billing code, but insurance C pays for an omnibus code for "spent a couple hours in the ER", but doesn't pay for nursing time or aspirin separately at all. A provider can agree to all three contracts, because they each give them enough money to profitably provide the service, but that requires that their price list has a high price for the aspirin, an high price for the nursing time, and a high price for the omnibus billing code.

A cash payer gets the same bill an insurance company would - high prices on all three items. But insurance companies never pay that. In the old days, you would just have a totally separate cash pay price list, but medicare rules don't allow that anymore, and limit the magnitude of cash discounts.

Fix the insurance system, and the bogus hospital bills that the hospital doesn't actually expect people to pay go away.

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

#816

Earlier quoted context omitted.

So what you're saying is the AMA is openly hostile to Americans.

Anything related to healthcare (except some genuine minority of doctors and staff) is almost openly hostile to Americans. I used to think American healthcare was in part expensive because Americans have poor health (e.g. high obesity). Now I am beginning to think that Americans have poor health by design for the healthcare industry to be able to maximize their profits. Making some Americans healthy just seems to be a…

I will throw a story out here because I don't know where else to put it and want it off my chest (I will leave a lot out of this):

Daughter tried suicide a few weeks ago. "It was not a serious attempt," but obviously it is. We go to only local hospital; they don't have a pediatric unit, so ER basically just looks at her and aren't sure what to do because it's not like she's bleeding out. They clean the cuts and ask if I want county behavioral health involved. I'm in over my head and need help, so I say yes.

Behavioral health mobile response person comes out -- good guy, made me see something I hadn't prior -- because I've had her in therapy for half a year prior but we weren't really making much progress on anxiety/depression issues -- but he says we weren't going to get anywhere with therapy before drugs, that she was too far out, and in retrospect that was absolutely the right call. Anyway, he puts her on 72-hours mandatory hold. Here, this means the child must be transferred to a pediatric health facility with suicide watch and psychiatric services. This became a big problem.

Cincinnati Childrens Hospital had no beds (and I have ill will toward them anyway). Dayton had no beds. Charge nurse was calling people for hours and hours, and I joined in calling places (we stayed at hospital the whole time without sleeping), and it wasn't until 24 hours after admission we're finally transferred. My mom was/is a social worker for those with developmental disabilities, and spent about a decade working at long-term facilities for juveniles, where it was almost always court-ordered. I spent a fair bit of my time there for economic/childcare reasons while she was working -- awful place for the kids (not for me; I hung out in staff rooms and watched movies). Doors, by law, could not be locked, and they were terribly understaffed; violence and rape was expected. We had a second person from county behavioral come out, and once I realized the only kinds of places open to us, started pleading and insisting to have the hold lifted, but they refused. I wind up with one out-of-state option, and one in-state; both about an hour and a half away, and both the kinds of facilities I was terrified of. I later talked to other parents and was surprised to find time to find a facility, lack of beds, and travel time were all common issues between us. I went for visitation every day, and at least one adult would almost always come out of visitation crying, not realizing these places are poorly-staffed, unsafe prisons until they first visit and talk with their kid.

Anyway, so the 72-hour clock starts only once daughter's transferred to this pediatric psych facility (she wound up staying for 5 days; this is a whole other issue where they had no social worker available to provide AMA paperwork, they claimed). -And this place is a long-term juvenile psych facility, so it tends to have a lot of kids who were sentenced by courts to be there; violent offenders, but it was a mix (daughter has a story about playing Uno with a kid experiencing "weed psychosis", which'd I'd never heard of before; interesting stuff). You know, so I'm going to bed every night, and I've got some wild nightmares I could share -- BUT everything turned out mostly fine. At one point, daughter witnessed staff slam a kid against the wall hard enough for him to bleed from the head, and didn't clean the blood off the wall; the toilet in her room didn't work and the room smelled like feces; they couldn't lock doors, and the facility was severely understaffed. A recipe for disaster, but it could have been a LOT worse than it was, though trauma is there nonetheless from the experience.

Now, the reason the county insisted on sending her to this hellhole is because it's the only way to unlock county behavioral services. You must first have committed an attempt to harm yourself or someone else, or be ordered by courts. I wrote at the beginning I was able to get a counselor before all this, but this took a lot of emails and phone calls, and the place I found with help required 2 hours on the road per visit. The person I got was new in the field and didn't specialize in pediatric; he was not a licensed psychologist nor psychiatrist, but he was the only person I could get and I was grateful for any assist. There were/are no available pediatric psychiatrists or psychologists EXCEPT through county behavioral; they have them all locked away from the market, basically.

The total bill for all this, by the way (uninsured, cash, including the ambulance) was $8,709.45. I didn't negotiate; I've planned for this, I took out $20k from broker on the first day I got to go home. Money isn't the issue; it's the non-availability of service which's the real problem here, for us. I was surprised to walk into county behavioral and be told while registering at front desk they don't accept self-pay; that they aren't set up for it. I've never run into this before, and it got a morbid chuckle out of me because this's been a heck of a roll of the dice up to now, specifically to get in county services, and now I'm told they don't offer anything for us.

I ask for the people who insisted on the 72-hour hold (and btw, the facility which held daughter prescribed nothing but an antihistamine, with trauma inflicted, though minor; worthless experience except to unlock services) to speak with me, and I get one of them. She talks to supervisor, and apparently nobody knows their own policies because they do, in fact, accept self-pay. I had to fill out a Medicaid form, which we don't qualify for. Now, the strange part about this is if you have insurance (and this is why they have you apply for Medicaid), they charge you on a sliding scale, but if you don't have any insurance and get rejected by Medicaid, they really don't have any system set up to bill you, so everything's free. The psychiatrist and counselor both are free; it's crazy, so I'll kick some money to food pantries while SNAP's cut off in the state due to federal shutdown, but it's like nobody's ever really thought through the systems we have for healthcare; it's inefficient and brittle from every angle, not just the providers/insurers screwing people over for capitalism angle; like a proof-of-concept someone slapped together over a weekend where everyone's spinning their wheels without a clue what to do, except it's something we've had for centuries and are spending $trillions/year on. -And every time the government provides new weapons or issues new mandates, it somehow seems to get worse.

(Things are going well now, btw; we got a real psychologist scheduled same-day, and first appointment with psychiatrist was 2-3 days after intake. She's doing better, but the journey here was straight Hell.)

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

#817
post #671

Earlier quoted context omitted.

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.

This is why insurance plans have out of pocket maximums. To prevent this exact issue. We can say whether those maximums are still too high (some really are), but the mechanism is there. The real issue is that most people don't have a rainy day fund to deal with such emergencies. And that they are too expensive anyway. There are 2 concepts you should always keep in mind. 1. Always avoid the hospital unless you are lit…

That analysis is flawed because it misses the systemic nature of the risk. The Out-of-Pocket Max is an annual liability, not a one-time fix. A single serious illness, like cancer, spans multiple plan years. A $9,200 OOPM hitting three years in a row, on top of $15k-$18k in annual premiums, is the bankruptcy. This also assumes 100% in-network care, which is a fantasy in a real emergency when you don't get to pick the ambulance or the anesthesiologist. This isn't a "rainy day fund" problem. This is a system that requires a $50k-$100k emergency fund just to handle a single medical event, all while assuming you're still healthy enough to keep the job that provides the plan.

"Always avoid the hospital" isn't a choice either. You don't "negotiate" with a surgery center for a heart attack, a stroke, or a major car accident, which are some of the common events that cause this. And the claim that "medical debt will never lead to collections" is factually incorrect.

It is the number one cause of collections in the United States. The idea that every citizen can just "hire a decent lawyer" or "run a good PR push" to settle debt isn't a functional or scalable mechanism, nor is it reality.

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

#818
post #797

Earlier quoted context omitted.

Do you think countries with even the most coveted universal healthcare just approve everything blindly? Should everyone (anyone?) receive monoclonal antibodies, gene therapies, biologic medications? What criteria should be used to make these determinations?

Everything? No. But routine stuff will NEVER be denied. If your doctor thinks you need a scan, you're getting the scan. I have quite literally NEVER heard of someone in my country (Australia) going bankrupt from medical bills. It can happen but the rate is so low it's not something anyone ever worries about happening to them.

Routine stuff is never denied in the US either. I've never had one thing denied ever and I even have a weird condition that requires expensive testing to diagnose and even more expensive treatment (narcolepsy). The insurance companies will throw up annoying bureaucracy like prior authorizations, and made me switch medication to generic when it came out (reasonable) and then back from the generic to another brand name when it came out (WTF??), but never actually a denial.

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

#819

Earlier quoted context omitted.

Realistically it's much more likely that someone in the US would be telling this story vs someone from Norway. Norway has only 50k births a year. The US has 3.6 Million, and >40% of those are 100% free to Medicaid recipients. So 1.4 million each year, meaning a story like this is about 28 times more likely to be told from someone in the US than Norway.

Medicaid isn't paying parents to not work. New parents will still have to worry about paying bills and the economy. When those parents die, any potential generational wealth for their children will be taken by the state to pay back the benefits they received from Medicaid.

Well of course it will because medicaid is healthcare for poor people, not people with generational wealth. If you are rich and use medicaid that's fraud, and medicaid should take double for that.

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

#820

Earlier quoted context omitted.

Realistically it's much more likely that someone in the US would be telling this story vs someone from Norway. Norway has only 50k births a year. The US has 3.6 Million, and >40% of those are 100% free to Medicaid recipients. So 1.4 million each year, meaning a story like this is about 28 times more likely to be told from someone in the US than Norway.

Medicaid isn't paying parents to not work. New parents will still have to worry about paying bills and the economy. When those parents die, any potential generational wealth for their children will be taken by the state to pay back the benefits they received from Medicaid.

>Medicaid isn't paying parents to not work. New parents will still have to worry about paying bills and the economy.

That would be up to their job if they had one of course, but Medicaid does have some cash benefits and if you have a baby on Medicaid you typically get auto-qualified for TANF so that covers a lot of bills.

>When those parents die, any potential generational wealth for their children will be taken by the state to pay back the benefits they received from Medicaid.

This would only be true if the parents received long-term care or something. And this happens to TONS of people who have otherwise been financially well off, they have to exhaust their assets before Medicaid starts paying for a nursing home. It's got nothing to do with pregnancy benefits.

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