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.
It'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?
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.
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.
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.
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
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.
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.
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 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.
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.
Doubters say it's not as accurate or could hallucinate. But the thing about hiring professionals is that you have to blindly trust them because you'd need to have a professional level of knowledge to qualify who is competent.
LLMs are a good way to double check if the service you're getting is about right or steer them onto the right hypothesis when they have some confirmation bias. This assumes that you know how to 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.
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.
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.
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.
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.
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 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 .
>>It’s the Terry-Gilliam-level of absurdity of the billing process. Absolutely no one will tell you how much things are, and when you ask, they sass you that it is a ridiculous question.
Here in India when my dad underwent bypass surgery, I checked the bills the breakdown is insane. This how a charge goes, Nurse comes to see you, so she wears a pair of gloves, that gloves is billed. And often something like 10x the price those are available in the regular pharmacy. Each and everything is billed, and you would be surprised just how many things like these can be be billed.
>>You’ll be asked to take a diagnostic not knowing whether it will cost $10 or $15000 . Even if you try to be responsible and call the provider (who isn’t your doctor, clinic, or hospital ) – they won’t be able to tell you.
Often some 'visiting doctor' comes to see you. Like in the case of my dad we were billed for a diabetic consultation, despite clearly telling them he wasn't diabetic, even more so, the same doctor came in the day before and had to told the same. We didn't need it. But you will see they bill you like 2000 rupees just for the person to enter the room say 'Hi' and exit.
>>The only thing I’m sure of is that there has to be tremendous amounts of incidental and deliberate corruption . Auditing a single patient’s billing is impossible – so a population’s worth is a goldmine .
In these situations most people are so stressed and anxious often people just have no mental bandwidth to fight side battles.
Its really a corrupt system to the core, and I don't see hospitals and doctors giving all this up anytime soon. Or even ever.
People discover that they are healthy until one day (when they live long enough) that they are not.
> 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.
The world does not move in a positive direction at the direction and discretion of “great technical minds”. They are too busy being narrowly technically brilliant that they fail to see what a sufficiently generalist and curious 15-year-old could figure out what is the root cause. Which this post demonstrates.
> People discover that they are healthy until one day (when they live long enough) that they are not.
the real challenge is that many diseases are asymptomatic and the diagnostics are also inaccurate. so there's no real way to tell if you have the disease
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.
European healthcare in my experience has capacity issues.
Typically hospitals are overwhelmed by the sheer amount of patients. Waiting times for procedures are incredibly long.
Where the system kind of shines is emergency care and long term illnesses, you go in and they save your life for free.
For any other kind of treatment you are generally better off turning to the private sector in Europe. You are going to have to pay depending on the country the cost might be outrageous but typically you will get access to procedures in days vs months.
> 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).
155 comments
[ 2.6 ms ] story [ 87.7 ms ] threadThey can't really claim their records are any kind of proof if apparently they now agree that 82% of it was wrong?
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.
The system is totally absurd.
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.
As OP says: "I had access to tools that helped me land on that number, but the moral issue is clear"
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.
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.
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.
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.
Not saying the doctors did anything wrong but… oof
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.
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 .
Here in India when my dad underwent bypass surgery, I checked the bills the breakdown is insane. This how a charge goes, Nurse comes to see you, so she wears a pair of gloves, that gloves is billed. And often something like 10x the price those are available in the regular pharmacy. Each and everything is billed, and you would be surprised just how many things like these can be be billed.
>>You’ll be asked to take a diagnostic not knowing whether it will cost $10 or $15000 . Even if you try to be responsible and call the provider (who isn’t your doctor, clinic, or hospital ) – they won’t be able to tell you.
Often some 'visiting doctor' comes to see you. Like in the case of my dad we were billed for a diabetic consultation, despite clearly telling them he wasn't diabetic, even more so, the same doctor came in the day before and had to told the same. We didn't need it. But you will see they bill you like 2000 rupees just for the person to enter the room say 'Hi' and exit.
>>The only thing I’m sure of is that there has to be tremendous amounts of incidental and deliberate corruption . Auditing a single patient’s billing is impossible – so a population’s worth is a goldmine .
In these situations most people are so stressed and anxious often people just have no mental bandwidth to fight side battles.
Its really a corrupt system to the core, and I don't see hospitals and doctors giving all this up anytime soon. Or even ever.
> 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.
The world does not move in a positive direction at the direction and discretion of “great technical minds”. They are too busy being narrowly technically brilliant that they fail to see what a sufficiently generalist and curious 15-year-old could figure out what is the root cause. Which this post demonstrates.
the real challenge is that many diseases are asymptomatic and the diagnostics are also inaccurate. so there's no real way to tell if you have the disease
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.
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.
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).