28 ms·
Using AI to negotiate a $195k hospital bill down to $33k
- kronk 1y agoI find it odd that his brother in law was married to his sister-in-law. How exactly does that work?
- kronk 1y agoSo, his brother in law was married to his sister-in-law?
- mcv 1y agoI don't understand how this is not wildly illegal fraud. They intentionally bill you incorrectly, charge you twice for costs that they know they're not allowed to bill you twice for. This is blatant fraud. Why is that not enforced?
- A1kmm 1y agoOne thing here doesn't seem right. I thought the whole thread that this was about them negotiating down how much the executor of a deceased estate would pay to one hospital making claims against it. But the thread included things like: "She had been afraid of being sent to collections and asked why we wouldn’t just take their counter-offer", which suggests a (mis)understanding that it is a personal debt of the sister's. This suggests an 'AI can't see gorillas' problem here in that, during an AI-human interaction, identification of relevant big-picture context that a human advisor could have helped with is also missed.
- stackskipton 1y agoDepending on the state and their laws, spouses can be responsible for debt. Along with that, hospital could maybe not sue her but sue husband estate and those liabilities would trickle down onto shared assets so if they had a house, it's now got a lien attached to it.
- wiseowise 1y agoRelated: https://www.economist.com/finance-and-economics/2025/10/27/the-end-of-the-rip-off-economy https://www.economist.com/finance-and-economics/2025/10/27/t...
- thih9 1y agoI hope this will have an impact, but I worry it will be “AI can fix US healthcare”. I appreciate the author’s disclaimers about that and especially about double checking AI output.
- vzaliva 1y agoFor those of us who do not access Thread, if there is a copy elswere we can read?
- RadiozRadioz 1y agoIt's always interesting to hear stories from third world countries, it's good to be mindful about how different their lifestyles are to ours. Having lived in Europe my whole life, I couldn't imagine this scenario.
- nick_travels 1y agoGotta up vote here, well done!
- FireBeyond 1y agoApart from anything else, family has zero obligation to pay their brother-in-laws medical bills after death (or before). Hospitals will pull all sorts of shady stuff to strongly imply that you should pay for a family members medical bill, however. From very strongly hinting that you're obligated to, through to impugning honor, "It would be doing the right thing by your dad", etc.
- zepolen 1y agoThe real wtf is that they consider $33k for four hours of 'treatment' a win.
- bravoetch 1y agoCan a bill for one patient be sent to their spouse? I don't understand how this even starts.
- mrcwinn 1y agoAmazing story. And if Anthropic is really in it for humanity and spreading good, they’ll productize this for all of us to drive efficiency! Or, more likely, they’ll just sell enterprise products to wealthy hospitals and look the other way.
- atbvu 1y agoI’m really curious if every patient started using Claude or GPT to negotiate with hospitals, how would the system respond? Maybe hospitals and insurers would start using AI too to fight back?
- KnuthIsGod 1y agoThis is why hospitals go broke. While it is great for the individual, society suffers. Here in Australia, our 2nd biggest private hospital owner has just gone broke. At a fire sale, there was so little interest in buying the hospitals that many will be shut down. The rest of the unsalable hospitals will be shoved into a stripped down charitable tax exempt trust so that the creditors ( banks and pension funds ) can recoup a small amount of the money they lent the hospitals.
- caycep 1y agothe nice thing about Medicare is that if he was +65 y/o Medicare patient, the hospital is not allowed to do this. If you are an American and under 65 and make too much money to be covered by medicaid, then you are vulnerable... Also...having heard a talk given by the hospital administrator's association lobby...you can kinda get a sense where this funny math comes from....
- throwawayffffas 1y agoTangent but the fact that they charged 195k or even 33k after the patient died is outrageous. If you are not going to do universal healthcare at least do outcome based charging.
- ern 1y agoThis is the exact sort of performative garbage that LLMs are great for. I had to do an electrical install, but the installer felt that the code required additional work (I don't think he was trying to rip us off, he sincerely believed it, since it's a volume business model). I got ChatGPT to come up with some plausible interpretations of the electrical code that allowed the install to continue, including citations. I don't know how accurate it all was, but I sent the argument off to the installer, and he came back and did the work the next day. Even if it gets audited, the chances of the auditor picking apart the arguments are probably slim to none. He has plausible deniability. This is also why schools and colleges are struggling. No one expected superficially "high quality" work from average and poor students, and now that they have to carefully evaluate everyone's work, they've been caught with their pants down. Someday superficial AIs will talk to other superficial AIs and they'll deadlock, requiring humans back into the mix. Until then, it's a useful way to do bureaucratic judo.
- jmspring 1y agoThis is interesting. In the past 1/2 dozen years, I've ended up in the hospital twice (both via ER, one at Stanford, one at Dominican in Santa Cruz). In both cases, I was there for ~3 days (I push to get myself out as quickly as I can). We ended up paying barely anything (decent insurance), but the bills were interesting in what they charge and for what. The Stanford visit was predated by a two night stay at Eastern Plumas Hospital (rural, interesting experience). EPH wanted as much for two days and Stanford charged for three. Seeing the billed amount and what insurance agreed to in each case was enlightening -- basically 1/3-1/2. I would not want to deal with fighting this if I was chronically ill.
- anakaine 1y ago$33,000 is still so unreasonable from the perspective of anyone who has lived in a first world nations with socialised healthcare. It is just absolutely mind boggling.
- silexia 1y agoPeople blame insurance, but insurance is just a willing punching dummy. Insurance just charges a percentage over the base costs. This is why every president who has tried insurance reform has failed. The guilty are the hospitals and the American Medical Association, which limits seats of new doctors in the USA. It is the strongest trade union on the planet, making millions for it's members and using the excuse of "safety" to try to pull the wool over your eyes.
- sharts 1y agoSome will say this is the great innovation that can cone from free market capitalism. Completely forgetting that the problem it solves was created by that very same system.
- 29athrowaway 1y agoOf course, there will be another insurance AI whose job will be delaying and denying coverage for those who appealed.
- qwertytyyuu 1y agoAi may not be able to pass the butter but at least it can save on hospital bills
- repiret 1y agoThe 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.
- Trias11 1y agoNow you just need to vibe code it into agentic solution and sell subscriptions to it!
- ultim8k 1y agoAre there still first world countries without public healthcare?
- Anonasty 1y agoI'm too european for this.
- oliwarner 1y agoThe comments surrounding this story feel so alien to so many outside the US. Negotiating with a hospital caught double and triple billing and somehow being happy with a bill for four hours down to just $33k? This should have ended in litigation. Elsewhere I see people facing $4k Ambulance rides jubilant at only paying $500. People laughing that they've already paid so many tens of thousands out of pocket that year so can't be gouged any further. And so many others just saying "Oh that's how hospital billing works" as if you've just explained how central locking works. Guys, this isn't civilised. It's exploitative and in many cases just outright fraud. Why can't you fix it?
- deleted 1y ago[deleted]
- eiektro 1y agowtf is this threads' login sh*t
- ornornor 1y agoThis is insane. 4h in the hospital, 195k (or even 33k). Pure madness.
- lunias 1y agoIs there a service that you can buy where they will do this sort of thing for you automatically for every medical bill? E.g. "Here's an obfuscated, probably incorrect bill." "Ah, okay, go ahead and send that to my billing scam insurance and they'll let you know what we'll actually pay you."
- ctrust 1y agoFrom the artichokel: "If bills are a fiction in order to back up the fiction of charity so the hospital can write off accounts and look like they are somehow doing right by people, this is an effed system." So close, yet so, so far! If a corporation commits fraud against you, and you literally ask if the corporation has committed fraud against you, and you proceed to voluntarily send that corporation THIRTY-THREE THOUSAND DOLLARS anyway, are you not a willing co-conspirator in the fraud?
- candiddevmike 1y agoWhile 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 the bill down, probably more around the legal action and PR threats. Ironically, the hospital will probably count this as charity even though OP didn't want to be considered charity, as they had to write off part of the bill.
- t0mas88 1y agoIt's insane that somehow a 195k bill can change into a 34k one, without putting serious doubt on the validity of that final bill. How does this work in court? Are they going to claim their 34k bill is all correct while starting at 195k? Or would it be equally plausible if the debtor said "I've not received any of the care billed for, so I'm not paying" They can't really claim their records are any kind of proof if apparently they now agree that 82% of it was wrong?
- ddtaylor 1y ago> Hospital billing folks are acutely aware that the initial bill is outrageous and indefensible from their end. I've I'm sure they also have a long arsenal of various legal tricks they bundle into offerings like they did in the linked thread with respect to attempting to relabel it a charitable donation, etc.
- mbac32768 1y agoIMO the pro move is not to get the hospital to accept what an insurance company would pay, but get them to accept slightly more than what a debt collector would pay.
- ryanjshaw 1y agoI’m confused why - if this is indeed common practice - it’s not considered fraud on the part of the hospitals?
- jimbohn 1y agoThe real treat would be using AI to stop regulatory capture so you don't end up in a country where it's okay to be presented with a 195K bill that can be magically lowered if you insist hard enough.
- xnorswap 1y agoIt seems pretty messed up when a $30k bill is written up like a big win.
- candiddevmike 1y agoTheir brother presumably didn't have insurance, and it sounds like some pretty major procedures involving specialists, equipment, and hospital intake. While the outcome was horrible, all of those people need to get paid for the services rendered somehow if we want folks in the US to continue receiving this standard of care.
- runako 1y ago> While the outcome was horrible, all of those people need to get paid for the services rendered somehow if we want folks in the US to continue receiving this standard of care. Food for thought: - this approach produces systemic outcomes that are worse and cost more than other approaches - there are lots of ways for people to get paid to provide medical care. Medical professionals do not work for free in other countries, and they buy the same equipment and drugs from the same suppliers as Americans do. - we are allowed to look at how other countries have solved this problem without hitting people with giant medical bills. We are allowed to apply those solutions here. - the US standard of care is overall not particularly high in the global rankings. We may decide that we don't want to continue providing this standard of care, we may decide we want to be in the top 10 globally.
- computerex 1y agoExcept everything in America is ludicrously priced. The cost of supplies and equipment is not even close to being realistic in America vs what you'd be charged for equal care in another country.
- abathologist 1y agoWhat a deeply dystopian future y'all are building for us :( -- (Including the fact that this link leads to nothing but a logo, for me).
- vessenes 1y agoInteresting. Upshot - bill sent to Claude, Claude generated questions, human in the loop to negotiate and summarize. Ultimately they suggested a number to the hospital, the hospital chiseled them a few grand, and they settled. Not mentioned, and I'm interested, is how accurate Claude's reading of the various medicare rules are. I presume these letters went to someone who had only slightly more knowledge of medicare billing rules than the author -- hospitals are arcane and cryptic places, most especially the billing departments.
- Esophagus4 1y agoYes, wish I could see the Claude conversation here. The good news is this should be easy to reproduce to see how it does - just google around for an example medical bill with billing codes and feed it to Claude.
- mikkupikku 1y agoJust tell the hospital you don't have much money but will pay what you can with cash. I got a $2k bill down to $200 like that. The system is totally absurd.
- SoftTalker 1y agoThey probably pull your credit and have a pretty good idea what you can pay.
- aeturnum 1y agoIt seems like the AIs role was in applying lengthy and complex medicare billing rules - it did not do negotiating and it doesn't seem like the accuracy of its understanding of medicare practices was actually checked. The author reasonably accused the hospital of gouging and the hospital came back with a much lower offer. I'd be interested to hear from a charge coding expert about Claude's analysis here and if it was accurate or not. There's also some free mixing of "medicare" v.s. "insurance" which often have very different billing rates. The author says they don't want to pay more than insurance would pay - but insurance pays a lot more than medicare in most cases. It's pretty clear that even access to a potentially buggy and unreliable expert is very helpful. Whatever else AI does I hope it chips away at how institutions use lengthy standards and expertise barriers to make it difficult for people to contest unfair charges.
- ibash 1y agoThe thing is the prices are all made up anyway. The hospital hallucinates prices, so they don’t blink an eye when an llm does the same.
- lokar 1y agoBut that’s expected. Even in a restaurant it’s not like each dish is priced as cost to make plus a markup. It varies widely, what matters is that the prices make sense in the market and over a week/month the overall numbers work out. A hospital is vastly more complex. They have huge costs (for things they must have) that can’t be recovered 1:1 with services.
- mjr00 1y agoYeah, 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 credit score, so, fuck you basically." The bill was revised to $500, which he paid just to not have that debt on his record.
- A_Duck 1y agoIt's really terrifying that someone less savvy might have spent their life savings paying this bill unnecessarily As OP says: "I had access to tools that helped me land on that number, but the moral issue is clear"
- toomuchtodo 1y agoThe direction is clear though; enable healthcare consumers using generative AI to appeal their bills, and scale up. If it breaks insurance companies and healthcare billing departments, well, we could fix this, right? It is a choice not to, healthcare consumers will act accordingly as rational actors in a suboptimal system. Working systems are rarely changed; failing systems at least have the opportunity for change to occur. https://fighthealthinsurance.com/ https://fighthealthinsurance.com/ was previously posted about a year ago, but I see no traction. There is no moat, just build and distribute, right? Show HN: Make your health insurance company cry too Fight Health Insurance - https://news.ycombinator.com/item?id=41356832 https://news.ycombinator.com/item?id=41356832 - August 2024 (broadly speaking, my thesis is generative AI can be weaponized to break down bureaucracy designed to extract from the human, from cost efficiency and power asymmetry perspectives)
- nerdsniper 1y agoIt seems like every time consumers automate against the-powers-that-be, the powers change the rules. - Can’t just cancel credit cards to reset subscriptions/memberships, because new card info now gets forwarded to your vendors. - Chargebacks are now much less successful, even when the consumer has clearly been wronged.
- hooverd 1y agoI think a lot of "let's use technology to solve a social problem" takes forget to assume that both sides have access to technology.
- toomuchtodo 1y ago
- sandeepkd 1y agoSomewhere down the line I have a feeling that there is a human in the loop somewhere in between who's expert at reviewing these kind of bills. How the expert or their knowledge was added to the flow is the engineering art in here
- cm2012 1y agoI've just ignored any medical bill I don't agree with or think was fair ($10k+ worth in the last 10 years). At least in new york state there has been no downside for me. It never went on my credit score and I bought a house a few years ago.
- toomuchtodo 1y agoI want to stress that this is not universal, and in some states, medical providers are pursuing this debt aggressively. This is not to say you should not be aggressive in countering their claims (I do this for folks in a volunteer capacity), but you should be knowledgeable as to your potential credit and financial risk exposure before proceeding. NPR Investigation: Many U.S. hospitals sue patients for debts or threaten their credit - https://www.npr.org/sections/health-shots/2022/12/21/1144491711/investigation-many-u-s-hospitals-sue-patients-for-debts-or-threaten-their-credit https://www.npr.org/sections/health-shots/2022/12/21/1144491... - December 21st, 2022 Some Hospitals Kept Suing Patients Over Medical Debt Through the Pandemic - https://www.propublica.org/article/some-hospitals-kept-suing-patients-over-medical-debt-through-the-pandemic https://www.propublica.org/article/some-hospitals-kept-suing... - June 14th, 2021
- jack_tripper 1y ago>I've just ignored any medical bill As a not-American, I wonder what are the rules of this "game". Can anyone in the US just ignore their bills and debt and it's all ignored anyway? Because in most European countries, debt is a very serious thing. Even small debt like an unpaid 50 Euro bill can be sold to debt collectors who can seize your property or garnish your wage, pension or bank accounts to pay your debt plus the collection fee, so people here are incredibly weary of unpaid bills or taking debt for unnecessary things other than houses or cars.
- giancarlostoro 1y agoHomeless people do. Personally I rather pay something, but I'm not spending tens of thousands if that's not what everyone else is paying uniform. This is why there's no transparency on hospital prices, because nobody is ever billed the same, ever. Someone's bill is offsetting the losses from someone else.
- kojeovo 1y ago[flagged]
- barbazoo 1y agoCan’t negotiate a bill if you’re not getting a bill.
- oldpersonintx2 1y ago[dead]
- jack_tripper 1y agoNot really. You get a bill in any country when you're not insured not just the US. But most people in most western countries tend to be insured by default through some national system if they have a legal job, or, if their system is private like in the US, then heath insurance is mandatory for everyone, unlike in the US. US is kind of a "wild west" where people can live and work, sometimes illegally, and not be insured if they don't want to. Weird system.
- danlugo92 1y ago> You get a bill in any country when you're not insured not just the US. Non - sequitour. You can travel to Europe (not to a third world country mind you), get your treatment without insurance, pay in full, and fly back and still spend much much less, including cosmetic procedures and dental.
- jack_tripper 1y agoI don't think that contradicts what I said previously but feels more of an off-topic tangent. And of course when you earn US wages you can afford to get private care in Europe out of pocket given how lower wages in Europe are in comparison to US, which is why plenty of locals like low income people and pensioners can't afford private healthcare.
- timenotwasted 1y agoIt does feel like AI has really started to level the playing field for some of these industries that are black boxes. Close family members have fed medical data to Claude and ChatGPT and had much more useful interactions with care providers than previously possible. Was it possible to sort this out before? Sure, but not without a lot of research, now it is become much more accessible and that is a great thing.
- lovelearning 1y agoFor now. But not hard to imagine United Health "investing" in OpenAI and Anthropic to "curate" the information they generate.
- tecleandor 1y agoWorst part it shouldn't even be called "negotiation". It was just plainly fraudulent.
- thedudeabides5 1y agothis is what the doomers want to take from you
- JohnMakin 1y agoDouble billing is an insanely common problem. How it’s gone for me in the past is like this: Provider wants to do procedure. You need it right away, or the procedure allows pre approval with the assumption insurance won’t haggle or deny payment insurance company denies payment provider bills you what i learned is, often, the provider will eventually be paid. do they tell you? not usually. oh woops. I haven’t very successfully fought these other than just hours of phone calls with both companies chasing down what actually got paid and when, and they on purpose make it difficult. If you find yourself in this situation do NOT pay the hospital until the last possible moment it will go to collections. often, you’ll find it mysteriously disappears. it also doesnt hurt your credit very much anyway if it does. There’s no real defense of these practices or of the industry in general as it exists in the USA. anything <$500 now by CA law cant show up on credit report so I basically stopped paying those. unethical? sure. will it affect the quality of my care? probably. sometimes though being a deliberate pain in the ass feels better than letting the system fuck you over and over.
- MontgomeryPy 1y agoRelevant: The End of the Rip-Off Economy https://www.economist.com/finance-and-economics/2025/10/27/the-end-of-the-rip-off-economy https://www.economist.com/finance-and-economics/2025/10/27/t...
- cowmix 1y agoFor 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 an incredible difference. I even used it to interpret legal documents and compare them with what the attorneys were telling us — again, super helpful. And when the bills started coming in, it helped there too. Hard to say if we actually saved anything — but it certainly didn’t hurt.
- brikym 1y agoDoubters 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 prompt it with plenty of information and open questions that don't contain leading presuppositions. An LLM read my wife's blood lab results and found something the doctor was ignoring.
- throwawayffffas 1y agoAll these things are language parsing and transforming. That's the kind of thing llms are good at.
- brikym 1y agoAnd statistical modelling. LLM's must have a weights that associate _seen X chemical high, so Y condition likely follows in the documents I've read_.
- dansmith1919 1y agoWhat it the dystopian fuck is this headline
- dekhn 1y agoI had an odd but successful experience with medical billing recently. My daughter went to urgent care for an urgent problem; after things were mostly cleared up, they transferred her by ambulance to an ER (even though there was no emergency). Both the urgent care and ER were handled by our insurance but the ambulance company sent us a large bill ($4K for a short drive) which felt too large to us (they had already tried to get my insurance to pay, but insurance said it wasn't covered). My wife was going to call the ambulance company to try to negotiate it down, but I recalled that I had recently received a random piece of mail saying that my employer subscribed to a service that could negotiate medical bills. We contacted the service and provided our info (the context of the situation, the billing information, the actions we'd taken so far, etc) and a couple weeks later, the service reported that they had converted the ambulance ride from an uncovered insurance to covered by insurance (since the transport was between a covered urgent care to a covered EHR) and had our insurance cover the majority- we ended up paying $500 to the ambulance company. While I am not surprised that such a service exists, what did surprise me is that it's just a division of my insurance company: they literally have a division that negotiates with another part of the insurance cmpany to get better coverage for patients. I was pretty lucky to notice the mail about this- there's nothing on my employer's site saying we have this coverage(!) and the vast majority of people in the US likely don't have this service. If there is anything that will bankrupt the US, it's excessive medical charges and a lack of knowledge of how to address them. Maybe AI will help, but I really doubt it long term.
- protocolture 1y ago>While I am not surprised that such a service exists, what did surprise me is that it's just a division of my insurance company: they literally have a division that negotiates with another part of the insurance cmpany to get better coverage for patients. I was pretty lucky to notice the mail about this- there's nothing on my employer's site saying we have this coverage(!) and the vast majority of people in the US likely don't have this service. 100 years ago I used to work for the fruit company in phone support. My KPI's were 100% customer satisfaction. However, I needed to get approval from another team to advance any kind of free/gratis repairs replacements or gifts. That team's KPIs were opaque to me, but my understanding is that they were find as long as they offered some resistance. Between those two pillars we got a lot of good done for customers. I dont think theres anything necessarily wrong with having internal friction like that if its designed correctly. Its probably better than having both responsibilities in a single person. In terms of health insurance however it seems ghoulish.
- kmfrk 1y agoI don't know about using AI to win legal and procedural arguments outright, but it seems like an interesting way to at least help win the war of attrition that corporations and weaponized bureaucracies wage on us to make a buck and keep us from claiming ours.
- gehwartzen 1y agoThere’s something absurd about a hospital charging 195k for 4 hours of work with the end result of the patient being dead. Not saying the doctors did anything wrong but… oof
- jojobas 1y agoWhile 195k sounds preposterous, should those surviving treatment pay for the labor of trying to save the dying?
- jacquesm 1y agoIt's a crazy system. You can save frugally your whole life long and then two minutes to twelve the health care system swoops in and takes your estate away from you.
- 999900000999 1y agoNot low enough. You could probably tell them to eat dirt,the receiver of services can't be collected against as he's no longer physically here. Getting the money from his estate would probably take years, if possible at all. I am not a lawyer, so I might be completely wrong, but suing a widow for 200k would be a nightmare for any hospital. Anyway, maybe one day we'll join the civilized world and not bankrupt families for the crime of being suck.
- bgirard 1y agoI used AI to deal with customer support when a company tried to assign me the rental contract from the previous owner. ChatGPT correctly quoted the relevant Ontario Consumer Protection Act sections that applied. I just did quick verifications to make sure it wasn't hallucinating (it didn't). They tried to push back, but I had ChatGPT write a few responses standing first and they relented after a few exchanges.
- tonymet 1y agoWe 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, supposedly). Even with insurance it will be at least $50k/yr out of pocket But the raw numbers like $200k for this poor gentleman’s heart attack or $500k aren’t the most alarming. 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. Even though one of my providers just recently started offering estimates, those are off by 100-200% , and completely missing for about half of what has been ordered. We are both very strong accountants, and despite trying to do audits of these services, it’s impossible. There are 3-4 levels of referred services, bundled codes, nested codes, complication / technical / professional codes , exceptional status codes . Providers overbill, double bill. On accident and on purpose. When we call to get it corrected there is no way to make corrections. 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. The point I’m trying to make isn’t to make you sympathetic. It’s to reinforce in all of the great technical minds here that healthcare billing is the most complicated spaghetti code cluster flock of a system that you’ve ever imagined. It’s far worse than any piece of software you’ve ever seen. And we all just accept the bills and pay them. Supply and demand and finding a better vendor doesn’t work. There are some rare exceptions like elective MRIs – but those aren’t the norm. Nearly every service is something time sensitive or your disease will get significantly worse. Moreover, signing up a new provider has $1000+ in billing and a few hours in paperwork to make the transfer. is it worth saving $500 for one MRI when $250k worth of services are unaccountable? 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 .
- vjvjvjvjghv 1y agoThe stuff you are describing is what bothers me the most. There is a lot of talk about how we should have a free market system. But there is no real market for patients. Most people can't pick an insurance plan for themselves because the employer picks. Then it's extremely hard to get an estimate for anything. And even if you get an estimate, it's most likely wrong. Then the billing is totally opaque. Insurance and providers constantly make mistakes or lose things. I went through this with my ex after a surgery. It was totally insane to figure out where the numbers are coming from and basically a full time job. Even if we don't want to go to single player or similar, I don't understand why it's not at least possible to mandate clear and binding estimates and billing a normal person can understand. And let the market work its magic through competition.
- deleted 1y ago[deleted]
- kwanbix 1y agoHaving 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 it just works. By the way, Private is cheaper when you are younger, gets more expensive when you are older. So if you choose private, under very phew circumstances you can switch to Public. In the other side, you have the US health care which is probably one of the worst in the world. Crazy.
- throwawayffffas 1y agoEuropean 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.
- ivolimmen 1y agoCapacity issues are dependent on country. In my country (Netherlands) is it not that bad and you can easily switch Hospitals if there are queues for certain operations (that are not urgent).
- throwawayffffas 1y agoFair everywhere I have lived the system was spread thin by personell shortages, mostly driven by long hours, bad working conditions, and austerity driven budget cuts.
- lifestyleguru 1y ago> 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, Stop lying. It's trivial in Europe to end up without any health insurance even as a citizen, e.g. in Poland without employment and without unemployed status (the offices make it very difficult to register and keep the unemployed status).
- blitzar 1y agoThe hospital billing system (built by 3 Harvard MBAs) probably had $10k as the break even point.
- itissid 1y agoHospital pricing transparency is a joke as reported on by WSJ here too https://archive.ph/bp2Mc https://archive.ph/bp2Mc
- abhaynayar 1y agoThe most appalling thing in this whole post is that people are still using Threads (TM).
- lukewrites 1y agoI would commit to using Threads every day for the rest of my life if that meant the US had a sane health care system.
- dcchambers 1y agoHere's the fundamental problem I have with this: This is treating the symptom and not addressing the problem. The problem is that America's healthcare system is ridiculously broken. The symptom of that problem is that prices are astronomically high. I am happy AI is useful for things like this, but I want to focus on CURING the problem and not just making the symptoms more tolerable.
- ecosystem 1y agoThe American Medical Association owns copyright to all the codes and their descriptions. They have an extremely restrictive and expensive licensing options and they strictly forbid training models with the codes. This month, the practice was called out (https://www.help.senate.gov/rep/newsroom/press/chair-cassidy-rebukes-ama-for-abusing-cpt-system-raising-health-care-costs-on-american-families https://www.help.senate.gov/rep/newsroom/press/chair-cassidy...) so the Overton window may be opening. The AMA (a nonprofit!) clears ~$300M/year revenue from the codes, which is the direct cost passed through to consumers, but the indirect costs are the byzantine nightmare of OP.
- topaz0 1y ago$300M/year is less than $1 per person. This is not why healthcare is expensive.
- paulryanrogers 1y agoThe opaque costs add up. If nothing else all the layers make things slow, when time is the difference between life/health and death/illness.
- ecosystem 1y agoIt's ~$1/person direct, but how much indirect cost? Things become inexpensive when automation and technological progress makes them so, and the code copyright and restriction is a major barrier to do that.
- newZWhoDis 1y agoInsurance companies get a lot of (deserved) hate, but the doctor cartel seems to skate on by in the eyes of the public. The white coats are far from blameless here.
- mr_toad 1y ago> extremely restrictive and expensive licensing options The license is meaningless if training AI is considered fair use, and if you never agreed to the license. They might be able to lean heavily on medical researchers and the like (who probably need a license for other uses), but when push comes to shove I suspect Google and OpenAI would win.
- itissid 1y agoA fit sequel to a line in Dead Souls https://www.theparisreview.org/blog/2021/05/17/americas-dead-souls/ https://www.theparisreview.org/blog/2021/05/17/americas-dead... A meager amount of AI will insulate you from a lifetime of woe, exactly as it was designed to.
- Reptur 1y agoI also had success, less negotiating, more just helping me form the letters in a few minutes rather than hours so I could get reimbursed for denied coverage, and it did get reimbursed.
- mykowebhn 1y agoI really hope this being on Threads is not the start of a trend. I don't really need or want to rely on another social media outlet.
- beanjuiceII 1y agoimagine paying 33k in hospital bills when all you have to do is ignore it and pay nothing...AI ripped them off here
- deleted 1y ago[deleted]
- LightBug1 1y agoGranted, $33k vs $195k is an excellent saving ... but $0k is what I, or my family, would pay. Which makes the cost seem insane by any measure.
- alistairSH 1y agoOn what basis are you refusing to pay? Services were rendered...
- ayewo 1y agoServices were rendered for just 4 hours is somehow worth $30k?
- LightBug1 11mo agoCriminal.
- LightBug1 1y agoRefusing? ... you misunderstand. I'm from a country where we have a national insurance scheme. And I'm incredibly glad about that.
- alistairSH 1y agoAh, gotcha. So you're still paying (just via taxes, not at time of service). But, I'd much prefer something closer to a European system vs what we have in the States.
- gnarlouse 1y agoThe irony is they would have been happy receiving $10k for not saving a man's life. So at the end of the day, they still swindled you.
- itissid 1y agoWhat's crazier is that for 80k you can get a jet to fly you anywhere in the world and for far lesser than that get world class treatment. What's even more bonkers is that the private and govt insurance companies, and hospitals have negotiated those rates and there is a market to fly people to other countries that is just sitting there and no one is really exploiting it.
- higginsniggins 1y agoHonestly, that's not a bad idea for a start up. Maybe a marketplace where people can see what things cost in different places and book a surgery directly.
- lifeisstillgood 1y agoThe 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
- noisy_boy 1y agoWhat I wonder is people are ok paying hundreds of dollars and going bankrupt but they haven't heard of taking a flight to a location that doesn't bleed them dry? They haven't heard of medical tourism?
- Workaccount2 1y agoBecause 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 experiencing it.
- lawn 1y agoExcept if you have health insurance and the medics choose the "wrong" medicine which isn't covered by your particular insurance. Or when an ambulance from the wrong company shows up. Or as in OP when the hospital makes up the charge. And add the 8% of uninsured Americans, which is still almost 30 million people! Only in America will this all add up to "scary stories" and they will shrug and defend the system.
- eqvinox 1y ago> So the hospital had billed us for the master procedure and then again for every component of it. Uh. Call me naïve, but how is this not fraud?
- supertrope 1y agoFraud is knowingly deceiving others for material gain.
- alistairSH 1y agoIt sounds like it would be only be fraud if the bill was submitted to Medicare/Medicaid. But, yes, that practice is morally bankrupt, even if they're getting away with up-charging on a technicality.
- vjvjvjvjghv 1y agoThat such a thing is even possible shows how messed up the system is. Basically they are charging some fantasy amount of money. I would love Medicare for All but if we want to keep doing some kind of free market approach, let’s at least make sure there is a real market where everybody knows the price of things and can make an informed decision. Right now it seems you have to go to a hospital and just hope for the best.
- culebron21 1y agoSuch a case when one must pay a good portion of a home price for a man dying in a hospital, is why I won't ever try to move to the US, and will retell story to everyone considering.
- stuffn 1y agoThese wild cases aren't worth considering as far as "do I move to the US or not". They are exceedingly rare and while they can happen so can the wing falling off your plane on the trip here. The bigger concern, IMO, is insurance is tied to employment. The time you get your massive bill is when you get very sick after being fired/laid off and your COBRA is up. The next biggest concern is the ACA which is the greatest scam ever pulled on Americans. It started out as, what would've been, universal healthcare. Instead, it simply played into the insurance company profit centers by forcing people (now by law) to hold some kind of insurance or pay a large tax fine. So you're stuck paying $1,500 for sub-par care on a bronze plan with a massive deductible and no limit. So much for "increasing the competitiveness of the market". Healthcare spends more money on lobbying than any other sector in America. The solution isn't to start breaking it down with crap like the ACA. That will get gutted by the bought and paid for politicians (which it did). What we need to do is begin by repealing citizen's united, limiting campaign contributions to 0 from industry professionals (in both their professional and personal capacity), and fire the congressmen taking the most money from them. They don't have hearts. They have large wallets. Hit them where it hurts.
- dragonwriter 1y ago> The next biggest concern is the ACA which is the greatest scam ever pulled on Americans. It started out as, what would've been, universal healthcare. No, it didn't. Universal coverage between the mandatory coverage and the Medicare expansion was the goal, but universal coverage separate from the mandate you criticize was never part of the ACA or Obama’s proposals before Congress actually crafted the ACA (which differed somewhat from what the President proposed, and actually was closer in many ways to Clinton’s proposal from the campaign.) > Instead, it simply played into the insurance company profit centers by forcing people (now by law) to hold some kind of insurance or pay a large tax fine. ...except the tax penalty was small, and it only existed for three years (first coming into play in 2014 and being set at 0 since 2017.) > So you're stuck paying $1,500 for sub-par care on a bronze plan with a massive deductible and no limit. "No limit" for...what? This sounds like you are talking about out-of-pocket limits, but there are out-of-pocket limits for bronze plans.
- m_fayer 1y agoOne of my most successful uses of ai is dealing with various obtuse German bureaucracies, private and public. I don’t think the ai is being particularly smart in my case, and its occasionally flat wrong. What it does give me is persistence and motivation. I have a nice workflow cobbled together that lets me dump OCRd scans and digital comms into “workspaces” organized by topic. With that workflow, I can basically dump a letter in, say “wtf is it now?”, and have the llm spit out a response. I do basic due diligence and send. Done. They don’t have to be that accurate, and neither do I. I feel like I have a new superpower now: outlasting it, whatever it is this time.
- mcoliver 1y agoUsed Claude to negotiate a 50% bump in a car insurance payout citing laws I didn't know existed. Yeah you have to cross check things and direct the prompt for tone and angle, but what an incredible leveling mechanism.
- ratelimitsteve 1y agowith or without AI you'd be shocked at how much of a medical bill can disappear if you just ask. Ask for an itemized bill, then ask what programs they have available to help. The real fact is that the hospital barely knows what they did to you, has no idea what it should cost overall, has a foggy idea of much you'll pay vs your insurance (but only a foggy idea because of all of the constantly-shifting backroom deals that insurers and providers make with one another), and then whatevertf price they arrive at with all of this gets an arbitrary number tacked onto it designed to mitigate the fact that a lot of people just don't pay their bill at all and it's not like the hospital can reach into them and claw back their $80 tylenol if they don't get paid, so they just bill it forward and hope that most people will look at their bill as the final word on the subject and pay it despite the fact that they're being badly overcharged. Combine this with the "reject all claims and hope they don't follow up" model of insurance and you can see where this all clearly needs to burn to the ground so that something that works can grow in its place, but also where a lot of people get really rich doing it this way and no one gets super rich when services are provided at a reasonable price so there's no real will to unruin this system. So what we end up with is a system where we pay a lot more than everyone else in the developed world and, for our money, we get to die earlier, which may or may not be preferable to dealing with the american healthcare system. When I was figuring out what I actually owed for my 4 days in the hospital for diverticultitis I strongly considered just dying next time.
- ancorevard 1y agoRookie mistake. Should have identified as an undocumented immigrant. $0 bill.
- siliconc0w 1y agoNever pay the first hospital bill if it's a non-trivial amount and you've waited a few months to get all the bills. 100% of time there is an error, mis-code, up-code, outright fabrication, etc. In California you cannot be taken to collections for less than $500 and they have to wait at least 180 days. If insurance denies a claim, you can ask for an internal appeal and then ask an independent medical review(IMR) (always do this, the internal appeal never works). With today's context windows, you can shove the whole insurance coverage booklet into the LLM and have it draft everything. I've had $10k+ bills brought down to $200. $2k+ tests re-coded and fully covered, etc. There is definitely a business in a LLM-powered medical billing agent that could handle this end to end (esp, contacting hospitals/insurance, waiting on hold, etc).
- SubiculumCode 1y agoWell this is a depressing forum. I'm going to go back to work and pretend that I will live a hundred more years, thank you. :(
- stivatron 1y agohow the hell is that possible. Why isn't someone taking economical advantage of offering lower prices. Costs can't be that high.
- eks391 1y agoThere is no economic advantage of offering lower prices in the US medical sphere, as there is no way for a patient to know that you charge less than another provider. Most medical practices do not provide any form of costs until after a procedure except ones usually not covered by insurances, such as dental and chiro, which do offer transparent and low prices because they compete in the free market.
- alistairSH 1y agoBecause there's no incentive to stop extorting the uninsured. That's all this is. Medicaid and Medicare pay fixed fees set by the government. Insurance companies negotiate "reasonable" fees for services. As I have insurance, my medical bill usually looks something like... Procedure A...... Amt Billed: $2000.......Paid by insurer: $100.... Amt Owed: $25 Where $25 is my co-pay and $100 is the fee the insurance company negotiated as "reasonable". For in-network care, the contracts disallow "balance billing" (trying to collect the $1900 in make-believe charges). For out-of-network (no negotiated rates), the hospital often will balance bill (except where prohibited by law). It's a completely ridiculous system in which "non-profit" hospitals make billions (and write off those imaginary "losses") and insurance companies (who have to pay our ~80% of revenue on care) are happy to have inflated numbers all over the place because 20% of 100 billion is more than 20% of 10 billion.
- philipbjorge 1y ago> We asked for a bill with the standard CPT codes. No reply. Asked again. “Oh, we meant to send it. We upgraded our computers five months ago and nothing works.” Uh-huh. Finally got the CPT codes. I work in healthcare RCM. I have no trouble believing the staff here that nothing in their system works.
- itissid 1y agoDoes someone here understand how exactly to fight Facility Fees — outside of indiana or a state where its outlawed — which is what the author mentioned most of their fees were? Could one when signing admission forms accidentally agree to paying them without fully understanding it? After one gets the the bill can one simply get an itemized breakdown, spot these fees and negotiate them down?
- Sharlin 1y agoGood news, everyone! We don’t need single-payer healthcare after all, just use an AI!
- selfawareMammal 1y agoI'm too european for this.
- deleted 1y ago[deleted]
- rwc 1y agoThere's a nonzero chance his AI bot was just talking to their AI bot to reach this happy conclusion.
- xp84 1y ago> 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 is in-network with that insurer. The SFFD runs the vast majority of ambulances and is "out of network." Insurance companies of course are not allowed to penalize you for accepting the first ambulance that arrives in an emergency. I filed a formal complaint with the California regulator that regulates that insurer and within 2 weeks the bill had been properly taken care of. 2. Our family has met its family Out of Pocket Maximum this year. Twice in the past month I've had doctor's offices lie to me and say that we still have to pay a copay. The last one claimed "well, you still have to meet your individual one though." Lie. That's literally the opposite of the way it works. We've paid copays to these people accidentally in previous years and they would never give the money back, they just keep it and also double dip since insurance pays them anyway. In all cases, both hospitals and insurance companies simply ask for the maximum possible thing they can ask for, knowing that a frightening majority of people are afraid of them, and will pay whatever they're told. In OP's case, an unsophisticated payer would have gotten a $195k bill, been sent to collections, the hospital would have sold the bad debt, and then the person would have maybe "gotten a good deal" by getting it cut down to $50k over many years of high-interest payments and having ruined credit. Insurance and hospitals are both filthy, money-grubbing machines. To paraphrase a famous cartoon character, their business is bad and they should feel bad.
- throw310822 1y agoI find it curious that people are celebrating when they manage to not pay (part of) an absurdly wrong bill that can only be either the result of gross incompetence or- much more probably- an attempt at fraud. The actual happy ending of such a story would be that the healthcare provider is sued for damages and/ or attempted fraud, and has to pay back a large multiple of what has asked.
- altshiftprtscrn 1y agoCan 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.
- lateforwork 1y agoWhen UnitedHealthcare CEO was killed the public sentiment was that the health insurance companies are the bad guy—and the CEO deserved what he got. Then when stories like this come out we realize no, it is actually the hospitals. In reality the whole system is broken. Some people think single payer system is the solution but then when they talk to Canadians they realize that's not the solution either. I think the correct solution is stronger laws for price disclosure, strong penalties for the kinds of abuses mentioned in this thread, and incentives for patients to question every charge.
- dvrj101 1y ago> health insurance companies are the bad guy using AI to deny claims to maximize profit seems bad enough to me. More Luigi please.
- ryandrake 1y ago> Some people think single payer system is the solution but then when they talk to Canadians they realize that's not the solution either. I don't know a single Canadian who would swap their system for the USA's. Theirs might not be perfect, but nobody argues that it isn't at least better than the literal worst system the world has ever come up with.
- pcthrowaway 1y agoCanadian here; our system has some pretty extreme issues. The vast majority of Canadians still prefer it to the U.S. Wealthy Canadians (>$500M net worth) would likely prefer the U.S. system in all cases though. Even moderately wealthy Canadians ($1M+ net worth) would likely get better treatment from the American system 95% of the time (when they don't have extreme issues which result in exceptionally costly treatment) One thing to consider is that doctors seemingly prefer things about how the U.S. system works (I'm not just talking about the amounts charged, but inefficiencies and red tape in the Canadian system, some of which seem to be a consequence of socialized health care). Ultimately this does lead to some brain drain which then compounds the issues with our system.
- spelk 1y ago
- dakpapa 1y ago1000
- ruralfam 1y agoI had a 20 minute appointment with a doctor at Kaiser in WA. I thought I had set up a free, yearly wellness meet. However due to Epic's really epically bad UI (they provide Kaiser's online presence), I had setup a standard meeting. My bill was nearly $1,700 discounted to $200 which I was fully responsible for as I/We (family) had not yet reached our deductable limit. Funny things: 1) Doctor wanted me to approve the use of AI to take notes of the meeting so she would not have to (I agreed). 2) The one issue I cited caused my doctor to say (pretty close paraphrase), "I have an idea what the problem is." I asked what it was, but the appointment was over so was advised to setup another meeting. I decided to keep working on it myself as I am pretty sure it is a stiff-ligament issue. Thanks Doc. Also: I like Kaiser overall. This one doc (who is not my regular one) was not as asset to Kaiser imho.
- dboreham 1y agoThis is a common bill stuffing scam. After having this same thing happen a few times I now ask at the beginning of the appointment to confirm that it's a wellness visit. Then I ask the provider to tell me if I inadvertently ask a question that will turn it into not a wellness visit. Then I ask at the end to confirm it will be billed with the wellness visit billing code.
- huevosabio 1y ago"figured it could just grab money from unsophisticated people" This sums up my experience with US Healthcare. They bill expecting you to autopay, and either have no incentive to bill correctly or they outright are trying to scam but the result is that every hospital bill is sus. This also makes insurance a lot less inherently valuable: you are paying for someone to do this untangling shitshow on top of the actual insurance. As if the hospitals just put the billing burden on the client. There has to be a penalty for sending wrong bills, or they should pay me for my time wasted. Finally, the prices are so inflated that often the price without insurance in Europe is the same as the copay/coinsurance in the US. Its a fucking catastrophe.
- mannyv 1y agoThe estate of the dead person would be on the hook for the bill, unless the spouse co-signed. You might want to check that.
- claytongulick 1y agoFor folks who aren't healthcare tech nerds, what happened in this case is called "unbundling" which is a fraudulent practice that can have steep penalties from CMS. CMS maintains a service and set of tools to help prevent payers from getting hit with this called the National Correct Coding Initiative (NCCI) [1]. NCCI only applies to provider services and outpatient billing codes, but is still applicable for emergency room services. There are a bunch of technical details for implementing the edits in the NCCI, but I think it's worth taking a moment to reflect on this. It's pretty popular to point to the insurance company as the "bad guy" in healthcare, but this is the sort of stuff they deal with thousands of times per day. As frustrating and horrible as this story is, it's not unique to an uninsured individual. A big problem in US healthcare is provider overbilling. One of the most tragic jobs I held in healthcare tech was developing software for billing negotiation between providers and insurance companies. It was pretty eye-opening how terribly everyone behaves, and I learned to have a lot more sympathy for what insurance companies/government payers have to deal with. As a patient trying to have necessary treatment paid for, it's incredibly frustrating to have a claim denied, and these are what we see in the news and experience personally. As an insurance company, building robust systems that authorize necessary care while catching overbilling, overutilization and outright fraud is unfathomably complex and error prone. This one of the reasons I've become a fan of DPC (direct primary care) models [2] with HSAs and supplement high-deductible catastrophic insurance to protect against hospital stays. It puts primary care back into a direct relationship with the patient, and lets insurance companies do what they are good at: pricing risk. Some of the unintended consequences of how insurance companies are currently regulated is that in some states it can be difficult or impossible for an insurance company to provide a low cost, high deductible plan. They are forced to cover things that drive the costs up, so it's hard to do a DPC + catastrophic insurance option. [1] https://www.cms.gov/national-correct-coding-initiative-ncci https://www.cms.gov/national-correct-coding-initiative-ncci [2] https://www.aafp.org/family-physician/practice-and-career/delivery-payment-models/direct-primary-care.html https://www.aafp.org/family-physician/practice-and-career/de...
- bloat 1y agoWhy is the man's wife worried about being sent to collections? She owes nothing to the hospital, the dead man's estate owes money. Let the hospital line up with the other creditors. She shouldn't be paying her late husband's hospital bills out of her own funds.
- dangus 1y agoI don’t think she likely had to pay a dime and wouldn’t have faced any consequence besides a few months of annoying calls. Her credit score wouldn’t have even been impacted. I think given this story they totally messed up.
- dvrj101 1y ago> besides a few months of annoying calls. normalizing harassment and fraud, great
- dangus 1y agoOh, I’m not suggesting this system is normal or sane at all. Merely that OP could have understood it better and paid $0 instead of $33k.
- ryandrake 1y agoA lot of people are unaware of who is responsible for what, and may be convinced to pay debts they don't owe. And creditors absolutely take advantage of this. Any debt collector worth his salt will hound everyone they can identify until they are told to stop in the particular way the law prescribes.
- codedokode 1y agoThese exorbital numbers are due to government and voters not willing to regulate the industry and rely on free market instead, correct?
- dragonwriter 1y agoNot really. The healthcare market is a very heavily regulated market, not an unregulated free market. The prices are not a result of there being a free market without regulation, but a product of what is and is not regulated. Both government and insurers take into account the "sticker price" of service in setting their reimbursement limits (they either have negotiated discounts from the sticker price, limit reimbursement based on the general charge to the public along with other factors, etc.) As a result, the nominal general charge to the uninsured public is generally inflated, but also tend to be very easy to negotiate down.
- ambicapter 1y ago> Long story short, the hospital made up its own rules, its own prices, and figured it could just grab money from unsophisticated people. America in a nutshell. To be fair, I'm taking this whole twitter thread at face value.
- ddmdd 1y agoAI is finally leveling the playing field on all those long and confusing documents that were designed to make regular people give up and pay whatever
- breakingrules3 1y ago[dead]
- anonu 1y agoThe problem is the insurance+hospital industrial complex. The insurance companies will negotiate this down on your behalf. They basically operate on fear of walking into a hospital and getting a 6-figure bill. My SO had to take a medevac helicopter once: we got a $65k bill just for the 20-minute helicopter ride which suddenly became under $4k with insurance. The discount made me feel like I was getting a deal, so I gladly paid.
- dontshutupnerd 1y agoThis reads like an ad for Claude
- deleted 1y ago[deleted]
- keernan 1y agoI assume the law will only award a medical provider in a fee collection dispute for fees that are reasonable and within what the provider usually charges and receives in the normal course of business. Every EOB I receive shows medical charges many multiples of what insurance actually pays (and the provider actually accepts). IMO that is not only prima facie evidence of fraud, but - since every provider does the same thing - of collusion on fees amongst and within the medical industry - worthy of anti-trust investigations (I have no anti-trust experience).
- chrisgeleven 1y agoI 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, helped with wording on the appeals, and yes, helped keep me pushing forward at some of the darkest moments when I was grasping for anything, however small, to help keep the pressure up on the insurance company. I didn't follow everything it suggested blindly. Definitely decided a few times to make decisions that differed from its advice partially or completely, and I sometimes ran suggested next steps by several close friends/family to make sure I wasn't missing something obvious. But the ideas/path ChatGPT suggested, the chasing down different scenarios to rule in/out them, and coaching me through this is what ultimately got movement on our case. 10 days post denial, I was able to get the procedure approved from these efforts. 21 days post denial and 7 days after the decision was reversed, we lucked into a surgery slot that opened up and my child got their life saving surgery. They have recovered and is in the best health of the past 18 months. This maybe isn't leveling the playing field, at least not entirely. But it gave us a fighting chance on a short timeline and know where to best use our pressure. The hopeful part of me is that many others can use similar techniques to win.
- nmz 1y ago> incompetence No, that's the goal. Denying coverage is how insurance companies make money. The less money they give, the more money they keep.
- miki123211 1y agoThis is why AI is an equalizing force. Eventually, we'll just have a free (or at least much cheaper) psychiatrist in our pocket. Sure, AI advice is workse than the advice of a competent professional, but it's very often better no advice, and that's what you get if you can't afford the professional.
- ASalazarMX 1y agoI shudder to think when insurance companies use AI to counteract customers using AI to navigate through their system. They'll eventually catch up, and people who don't use any kind of AI will be disadvantaged. That is, until someone sells them a turnkey AI service to do insurance claims... and decides to play both teams so resolutions come back at pre-AI levels, and the free market(TM) is happy because a new equilibrium has been reached. Maybe I just need more sleep.
- BeetleB 1y agoIt's nice they succeeded, but a word of caution: Medicare is not a good standard - it's often lower than what it costs them to provide the care. If everyone paid Medicare rates, lots of providers would go out of business. The usual benchmark is the "usual and customary" charges for a procedure. You can look it up for a procedure for your area. You then go to the hospital and point out these charges. My guess is they're much more likely to agree with this than the Medicare rates. It's also the rate your insurance will use if you go out of network. So if your insurance pays 40% out of network, and you get billed $1000 for a $100 procedure, your insurance will pay only $40 (4%). (Although by all means, you can start your negotiation with whatever is lower).
- atourgates 1y agoI broadly disagree. Yes - Medicare is typically lower than private insurance plans, but if you can't deliver care for the reimbursement that Medicare offers as a health system/plan/office/provider, you're probably overcharging. More than that, Medicare is the de facto starting place for most reimbursement negotiations between providers and payers. One of its benefits is that it's transparent and readily available. Blue Cross isn't gonna tell you what it's contracted to pay an individual provider (and that individual provider often won't know what they'll be reimbursed untill after they submit a bill) - but with Medicare the data's out there. I know a good number of private clinics that'll offer cash pay discounts that effectively mirror Medicare or even slightly below Medicare, since you're saving them the trouble and expense of going through the medical billing process.
- BeetleB 1y ago> One of its benefits is that it's transparent and readily available. So is the usual and customary rate - I think it's been available since before Obamacare. > Blue Cross isn't gonna tell you what it's contracted to pay an individual provider (and that individual provider often won't know what they'll be reimbursed untill after they submit a bill) You'll find out when you get the bill :-) The bills I get have: - Cost the provider is charging (e.g. $1000) - Agreed upon cost with the insurance company ($600) - Amount due ($60 assuming 10% and deductible met). I don't know if they publish it transparently, but for common procedures, it's easy to find out. They're not going to prevent you from posting your bill online.
- cowsandmilk 1y agoIt isn’t clear to me that the OP’s sister-in-law would be responsible to pay these debts and they couldn’t have just allowed payment from the estate. Since insurance had lapsed, I’m assuming the estate was not large.
- abdulhaq 1y agoTo me, in the UK, it sounds like there is an opportunity here for some sort of centralised representation and/or app that can fight claims for people
- supertrope 1y agoBureaucracies begrudgingly allow a few shortcuts to exist so they can respond to regulators and media attention. But once enough customers realize it exists they will shut it down and raise the bar to keep the vast majority of peasants herded down the profitable happy path.
- andybak 1y agoI will never understand why people tolerate the US healthcare system. If anything points to complete ideological capture of the general population then it's this. (I live in the UK if that's relevant)
- liendolucas 1y ago$33k is still lot of money! What happens if you don't have that sum? How does the system allow to be arbitrary charged on health? I'm Argentinian and while we might be a country lagging behind in so many things these kind of ripoffs do not happen. How come the US government allows this? From other stories sometimes posted, the US seems to be one of the worst countries in the world to either die or get sick.
- mirthflat83 1y agoYou just don’t pay. Hospitals eat the cost.
- pcthrowaway 1y agoI assume it'd get sold to a collection agency for something like $500, which would then try to get you to pay as much as possible, possibly settling for as low as $2000). So the hospital is still getting paid something, and the billee has the option to take a bigger credit hit or to negotiate down
- sdsd 1y ago>How come the US government allows this? Allows? The government works for the wealthy and powerful. That includes the masses, who (if they organize) have their own power, but it also includes every other powerful group or individual. Why would the government want to stop this? It's the average person who would want to disallow this, and they'd have to pressure the government enough that the pain of popular opposition outweighs the brazillions of dollars they're making.
- ellisv 1y agoThe most impressive part to me is finding the right channel to communicate with the hospital. We had to dispute a billing issue with our hospital and it simply wasn't possible to talk to any person that wasn't part of the "patient relations" team. Billing problems went through patient relations who talked to the billers.
- deleted 1y ago[deleted]
- tracker1 1y agoI was hospitalized about two decades ago, before ACA passed, so my insurance was limited to 500k, I was on the hook for about 180k beyond that... because I was making decent income I was ineligible for Medicaid or any other assistance... I worked extra jobs for a number of years after, every tax return, the couple bonuses that I'd earned all went towards paying it down... Anyone who was willing to negotiate the amount or take reasonable payments got paid... the rest could wait... after the 7 years before it was no longer eligible for being on my credit statement, I stopped (still owed about 40k iirc). The past few years, I've been receiving some very expensive treatments for my eyes... given the job market, I've been without and switched jobs a couple times... been caught with a few unexpected bills for around $15k... it just sucks. I'm currently making about 2/3 of what I was a couple years ago, with no better job prospects, the insurance I have is "emergency" based and doesn't cover my regular doctor bills... I'm at my max at this point, thinking about bankruptcy for a while now. The system sucks... the billing system(s) suck and the fact that it's as messed up as it is, is so much worse. From monopoly positions, to messed up billing, to everything else... I don't even know. Even on a six figure salary, I cannot afford private insurance and the multiple $300-400 doctor and pharmacy bills each month are seriously destroying me.
- lvl155 1y agoAnd it’s going to get progressively worse for everyone. My rule of thumb is that for every perceived 15% increase in care outcome, cost doubles for patients. This is how drug or procedure costs exploded over the past two decades.
- flenserboy 1y agoCan't wait for it to be AIs arguing back & forth with all sorts of unforeseen consequences arising. We have much to think through, & strong, simple rules to put in place, or things are going to get rather out of hand.
- lvl155 1y agoI would like to think our children will one day live in a society where healthcare is nominal.
- majorbugger 1y agoAnother day thanking God I don't live in the United States.
- Ylpertnodi 1y agoBut I heard God was there...
- donatj 1y agoI'm confused about some particulars here. Who was on the hook for the bill here? The wife? What state is this? At least in Minnesota my understanding is I'm not on the hook for my wife's medical bills if she were to pass.
- ericlang 1y agoprobably the insurance payout can be grabbed from
- mv4 1y agoOnly in America. Why are we accepting this?
- mv4 1y agoGetting it down to 33k may seem like a success story. It is not. 33k is still messed up.
- huqedato 1y ago4hrs of hospitalization => $195k. America is great!
- yieldcrv 1y agointeresting, the alternate headline "using AI to negotiate a $33k hospital bill down to still $33k" would have been pretty egregious too what would the outcome of the charity option have been? they did not change any practice here, the hospital almost got caught, once, for one bed that was occupied for 4 hours in a single day
- user3939382 1y agoI have a better idea
- huqedato 1y agoThis explains why a friend of mine, anesthesiologist, emigrated to US about 15 years ago and now has an annual income of a million USD. While my wife, anesthesiologist, same age and experience here in EU, has less than EUR 100k.
- mhuffman 1y agoNext up: A start-up that spins up AI instances to negotiate against AIs trying to negotiate hospital bills down!
- jnskender 1y agoWhat a terrible medium for long form story telling
- mawadev 1y agoThis is probably the first instance AI has provided real world value, I'm cheering on this
- gv83 1y agoAI good or US health system trash?
- tsoukase 1y agoHealth care is an extremely sensitive, personal, diverse and vital part of our life. It cannot be exploited in the USA like you are in a casino, because health is a roulette. It makes us Europeans our jaw to drop. It plays no role how much you earn. It is inhuman, cruel, mocking and severely impacting the society. Developing countries surely have better systems, I don't know about underdeveloped ones.
- whatever1 1y agoCan we ask why do we even have to freaking negotiate ? Many of them are non profit, the costs and margins should be transparent.
- nullbyte808 1y agoI would of applied to the charity relief after lowering to 35K.