stevenhubertronOct 28

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

https://www.threads.com/@nthmonkey/post/DQVdAD1gHhw

Matt Rosenberg (@nthmonkey) on Threads

My brother in law died in June. Heart attack. Four hours in the hospital and gone. And then the bills came. He’d let his insurance lapse two months prior. Bills were a few thousand here for the cardiologist, another few there for the ER docs, a bit for the radiologist. I helped my sister-in-law negotiate these down but they weren’t back breakers. Then the hospital bill came: $195k. This is a story about that.

Threads
Show threadchrisgelevenOct 28

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.

Show threadegorfineOct 28

Non-US person here.

Happy for your happy-end to that story!

Though why do you Americans put up with all this? I have heard the US is a democracy. So then insurance-based healthcare is what American people truly want?

Show threadtptacekOct 28
Scarcity is a fact of every country's health system and you'll quickly find stories with similar fact patterns with e.g. the NHS. There's not a lot to recommend the US system as implemented today, but the problem isn't "insurance-based health care"; lots of countries have insurance-based health care.
Show threadtracker1

It's largely a side effect of a couple things... first the ACA (ObamaCare) limited the percentage of profit that insurance and medical providers can make... so they instead just grow the pie larger by inflating everything. Second is that they are allowed to have effectively vertical monopoly investments controlling multiple layers of healthcare as a whole from insurance, providers, pharma and pharmacies.

Trust busting and multiple supply lines really need to be established in order to have a chance at restoring normalcy. Which is all but impossible as Pharma alone is the single biggest spender of advertising alone, let alone policy influence over politicians.

Oct 28 at 7:15pmWeb
Show threadlotsofpulpOct 28

> so they instead just grow the pie larger by inflating everything

So why would they deny coverage? All they have to do to earn more money is keep paying for more and more healthcare.

Show threadtracker1Oct 28

Because they make more by not paying than by paying... When the payouts are larger, they raise premiums, make money on both sides.

Not to mention, if they can delay payment for a month, that's a month worth of interest on the money in an interest bearing account.

Show threadtptacekOct 28

How exactly do they make more money by not paying? They're required to spend 80% of their funds on provider expenses. The only obvious way to sustain the narrative that insurers are distorting the system for profit is the preceding comment's hypo that they'd be over-paying (and then driving rates up as their expenses increased). You propose the opposite fact pattern here.

(Net cost of health insurance, all expenses, is around 6.5% of total US spending, as against 51.5% of direct provider costs for doctors, nurses, and procedures, not counting prescriptions.)

Show threadtracker1Oct 28

They keep the 20% that they don't pay out... what they do pay out, they get the invested fraction of, which is less than than what they paid out.

Even if they only get to keep up to 20%, doesn't mean they will pay a dime of what they can get away with not paying.

Show threadtptacekOct 28
"What they do pay out they get the invested fraction of"?