Matt Rosenberg

The Atlantic covered and gave good context to the story of a massive and unconscionable hospital bill and how I used AI to knock it down to something still high but manageable. Healthcare is broken in the U.S. AI is one tool to help consumers overcome the power asymmetry with huge companies.

Weren’t you guys the hackers that promised to expose every rotten thing about Trump (and other rotten things). Are you just a social account now? Where are the revelations?

At least we have that.

Seriously, some people are way too cynical. Also, if you're a Brit, please don't vote for Farange and his brethren--if they privatize NHS, you'll soon be in this sort of mess. Single payer is the only way American health care can be saved, don't screw up yours. Ours is NOT better in any way.

Thank you for reading this. I hope it helps someone fight back. I posted this to Threads last week and it went quite surprisingly viral. From those comments I want to say up front that I am a writer and a marketer but I have no AI clients and this was my actual experience, not a campaign for AI.

I had access to tools that helped me land on that number, but the moral issue is clear. Nobody should pay more out of pocket than Medicare would pay. No one.Let’s not let them get away with this anymore.

Ultimately, my big takeaway is that individuals on self-pay shouldn’t pay any more than an insurance company would pay—and which a hospital would accept as profitable business—than the largest medical payer in the country.

I’ve done a lot of this kind writing. Claude helped with facts and math, but you need to calibrate the language.

Hospitals know they are the criminals they are and if you properly call them on it they will back down. That doesn’t mean yelling, that means writing a letter a lawyer might write, with the correct cadence and tone and threats.

Yes, AI assistants can hallucinate and give you garbage. So I didn’t rely on it. I spot checked by looking up its big findings myself and found it was right. I also had ChatGPT, to which I subscribed for one month just to do this, read the letter and fact check it. No notes.

So we are now right in the middle and the hospital accepted. Here are the morals I draw from this experience. If you have the money and they want it, you have more power than you might think. An invoice isn’t an entitlement. Fight with knowledge. My $20 subscription to Claude paid for itself.

I presented this to my sister-in-law and suggested we split the difference. She had been afraid of being sent to collections and asked why we wouldn’t just take their counter-offer. I said, that’s four thousand more dollars you’ll have and they didn’t earn it.

We said we weren’t looking for charity, we were negotiating price and we had caught them in a bad place that they couldn’t defend in court or in public. Don’t make threats you aren’t willing to follow through on. We were. And it worked. They came back and asked for $37k.

With Claude’s help, I wrote a letter explaining their billing violations and threatening legal action, bad PR, and appearances before legislative committees if they didn’t take what Claude calculated Medicare would have reimbursed them.

The hospital wanted to discount the bill based on charity because they are obligated to provide charity to keep their tax exempt status. Bills are a fiction so the hospital can write off accounts and look like they are somehow doing right by people, this is an effed system. So we didn’t play.

We told the hospital they had billed an unconscionable amount. They suggested we apply for charity assistance. But here’s the thing: my sister-in-law is not a charity case. He left a million dollar life insurance collection. She could have paid.

A third was ventilator services, which Medicare says you can’t bill for on the same day as a critical care issue. Supplies were billed between 500% and 2,300% of Medicare reimbursement. The hospital made up its own rules, its own prices, and figured it could grab money from unsophisticated people.

So, if they did that thing then they would have had to re-bill everything else under inpatient rules and if they didn’t then why was it on the bill?

That was over a hundred grand of cost that Medicare would have reimbursed zero dollars for. Another was a code that was inpatient only and because it was an emergency he had never been admitted.

Like going to a restaurant and being charged for the experience of eating a pizza and then getting separate bills for the dough, the sauce, and each pepperoni.

Claude figured out that the biggest rule for Medicare was that one of the codes meant all other procedures and supplies during the encounter were unbillable. So the hospital had billed us for the master procedure and then again for every component of it.

Looking up codes wasn’t helpful. There are rules to each code. And this is where it got interesting. I fed the itemized bill and codes to Claude (AI).

No reply. “Oh, we meant to send it. We upgraded our computers 5 months ago and nothing works.” Uh-huh. Finally got the CPT codes. It’s not like medical care is just a menu of things they do with a cost for each. Four $31 low-dose aspirin. I take that 81mg aspirin. A bottle of a thousand cost $8.

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. We asked for a bill with the standard CPT codes.

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.

Got Covid, flu, RSV, and pneumonia vaccines today. I don’t care if I can’t lift my arms tomorrow, my middle fingers are flying high in RFK, Jr.’s direction.

The only thing that makes me sad about James Dobson’s death is that it didn’t happen 60 years ago.

Pray for the President?! Ok, here’s one.

Now I lay me down to sleep.
I pray thee Donald’s soul to keep.
And if he dies before I wake,
I pray thee too JD to take.

(H/t to Tom Lehrer)

There is nothing inconsistent being pro-Israel and anti-Netanyahu.

Meta Unveils Wristband for Controlling Computers With Hand Gestures

Better headline: Meta Unveils Another Product No One Wants Or Needs