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Comments (815)

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  chrisgeleven
  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, 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.
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  ecosystem
  The 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...) 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.
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  aeturnum
  It 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.
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  tonymet
  We suddenly woke up in the Kafka-esque purgatory of critical American healthcare billing. We’re in our 50s and had been perfectly healthy, then suddenly we got diagnosed with what will be over $500k in treatment over the next 12 months— and multiple millions for the foreseeable future. We have insurance, but many of the required procedures are “out of network” and there’s no way to tell (we have “the best” insurance, supposedly). Even with insurance it will be at least $50k/yr out of pocketBut 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 .
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  dekhn
  I 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.
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  xp84
  > Long story short, the hospital made up its own rules, its own prices, and figured it could just grab money from unsophisticated peopleThis 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.
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  tracker1
  I 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.
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  jimbohn
  The 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.
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  candiddevmike
  While it's an interesting story, I doubt they needed Claude to work a hospital bill down to that amount. Hospital billing folks are acutely aware that the initial bill is outrageous and indefensible from their end. I've heard a ton of cases where folks basically "pay what they can" for the bill and that's good enough for both parties. I doubt the reasoning Claude provided was ultimately what got the hospital to knock 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.
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  lateforwork
  When 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.
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  cowmix
  For all my constant freak-outs about AI in general, it turned out to be a godsend last year when my wife’s mom was hospitalized (and later passed away a few weeks afterward). Multimodal ChatGPT had just become available on mobile, so being able to feed it photos of her vital sign monitors to figure out what was going on, have it translate what the doctors were telling us in real time, and explain things clearly made 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.
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  kwanbix
  Having lived in Europe 10 years (I am from south America), it is crazy that the rest of the world doesn't follow Europe's health coverage: everybody is covered, all the time, you can be covered either by public insurance (was my case) or private. There are no preconditions. Kids get covered for almost everything up until they are 18 or 21 (don't remember), drugs for adults is only 5 euro each. No matter the cost. And 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.
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  gehwartzen
  There’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
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  liendolucas
  $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.
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  lifeisstillgood
  The 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
• oliwarner
  The 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?
• Anonasty
  I'm too european for this.
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  timenotwasted
  It 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.
• jmspring
  This 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.
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  A1kmm
  One 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.
• repiret
  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.
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  bloat
  Why 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.
• tsoukase
  Health 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.
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  A_Duck
  It's really terrifying that someone less savvy might have spent their life savings paying this bill unnecessarilyAs OP says: "I had access to tools that helped me land on that number, but the moral issue is clear"
• ern
  This 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.
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  vessenes
  Interesting. 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.
• ultim8k
  Are there still first world countries without public healthcare?
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  ruralfam
  I 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.
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  BeetleB
  It'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).
• huqedato
  This 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.
• KnuthIsGod
  This 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.
• mcv
  I 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?
• siliconc0w
  Never 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).
• MontgomeryPy
  Relevant: The End of the Rip-Off Economy https://www.economist.com/finance-and-economics/2025/10/27/t...
• kmfrk
  I 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.
• tecleandor
  Worst part it shouldn't even be called "negotiation". It was just plainly fraudulent.
• anakaine
  $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.
• anon
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• mcoliver
  Used 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.
• throwawayffffas
  Tangent 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.
• atbvu
  I’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?
• JohnMakin
  Double 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 paymentinsurance company denies paymentprovider bills youwhat 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.
• anonu
  The 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.
• caycep
  the 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....
• vjvjvjvjghv
  That 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.
• itissid
  Does 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?
• bgirard
  I 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.
• ellisv
  The 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.
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  codedokode
  These exorbital numbers are due to government and voters not willing to regulate the industry and rely on free market instead, correct?
• 999900000999
  Not 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.
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  itissid
  What'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.
• qwertytyyuu
  Ai may not be able to pass the butter but at least it can save on hospital bills
• kronk
  I find it odd that his brother in law was married to his sister-in-law. How exactly does that work?
• wiseowise
  Related: https://www.economist.com/finance-and-economics/2025/10/27/t...
• itissid
  A fit sequel to a line in 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.
• RadiozRadioz
  It'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.
• mawadev
  This is probably the first instance AI has provided real world value, I'm cheering on this
• flenserboy
  Can'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.
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  donatj
  I'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.
• anon
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• blitzar
  The hospital billing system (built by 3 Harvard MBAs) probably had $10k as the break even point.
• cowsandmilk
  It 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.
• andybak
  I 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)
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  cm2012
  I'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.
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  abhaynayar
  The most appalling thing in this whole post is that people are still using Threads (TM).
• thih9
  I 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.
• bravoetch
  Can a bill for one patient be sent to their spouse? I don't understand how this even starts.
• sandeepkd
  Somewhere 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
• ambicapter
  > 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.
• anon
  undefined
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  culebron21
  Such 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.
• huqedato
  4hrs of hospitalization => $195k. America is great!
• Reptur
  I 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.
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  abdulhaq
  To 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
• itissid
  Hospital pricing transparency is a joke as reported on by WSJ here too https://archive.ph/bp2Mc
• ddmdd
  AI 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
• mykowebhn
  I 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.
• SubiculumCode
  Well 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. :(
• mannyv
  The estate of the dead person would be on the hook for the bill, unless the spouse co-signed. You might want to check that.
• huevosabio
  "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.
• gv83
  AI good or US health system trash?
• vzaliva
  For those of us who do not access Thread, if there is a copy elswere we can read?
• rwc
  There's a nonzero chance his AI bot was just talking to their AI bot to reach this happy conclusion.
• lvl155
  I would like to think our children will one day live in a society where healthcare is nominal.
• mv4
  Getting it down to 33k may seem like a success story. It is not. 33k is still messed up.
• m_fayer
  One 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.
• abathologist
  What a deeply dystopian future y'all are building for us :( -- (Including the fact that this link leads to nothing but a logo, for me).
• sharts
  Some 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.
• Sharlin
  Good news, everyone! We don’t need single-payer healthcare after all, just use an AI!
• selfawareMammal
  I'm too european for this.
• ancorevard
  Rookie mistake. Should have identified as an undocumented immigrant. $0 bill.
• claytongulick
  For 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[2] https://www.aafp.org/family-physician/practice-and-career/de...
• kronk
  So, his brother in law was married to his sister-in-law?
• anon
  undefined
• zepolen
  The real wtf is that they consider $33k for four hours of 'treatment' a win.
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  eqvinox
  > 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?
• gnarlouse
  The 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.
• nick_travels
  Gotta up vote here, well done!
• 29athrowaway
  Of course, there will be another insurance AI whose job will be delaying and denying coverage for those who appealed.
• silexia
  People 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.
• dontshutupnerd
  This reads like an ad for Claude
• mv4
  Only in America.Why are we accepting this?
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  LightBug1
  Granted, $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.
• mrcwinn
  Amazing 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.
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  mikkupikku
  Just 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.
• beanjuiceII
  imagine paying 33k in hospital bills when all you have to do is ignore it and pay nothing...AI ripped them off here
• philipbjorge
  > 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.
• dansmith1919
  What it the dystopian fuck is this headline
• FireBeyond
  Apart 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.
• user3939382
  I have a better idea
• anon
  undefined
• keernan
  I 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).
• whatever1
  Can we ask why do we even have to freaking negotiate ? Many of them are non profit, the costs and margins should be transparent.
• dcchambers
  Here'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.
• Trias11
  Now you just need to vibe code it into agentic solution and sell subscriptions to it!
• mhuffman
  Next up: A start-up that spins up AI instances to negotiate against AIs trying to negotiate hospital bills down!
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  majorbugger
  Another day thanking God I don't live in the United States.
• yieldcrv
  interesting, the alternate headline "using AI to negotiate a $33k hospital bill down to still $33k" would have been pretty egregious toowhat 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
• thedudeabides5
  this is what the doomers want to take from you
• jnskender
  What a terrible medium for long form story telling
• dakpapa
  1000
• ratelimitsteve
  with 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.
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  stivatron
  how the hell is that possible. Why isn't someone taking economical advantage of offering lower prices. Costs can't be that high.
• breakingrules3
  [dead]
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  kojeovo
  [flagged]