Price transparency for medical billing remains a hot button issue across the country. A study from the Department of Health and Human Services Office of Inspector General in 2024 found that only 63 out of 100 hospitals surveyed were up-to-date with government price transparency requirements (1).<\/p>\n
These unclear billing practices have real-world consequences for many Americans. Matt Rosenberg of New York recently took to Instagram Threads to describe how he combated out-of-control billing practices with a combination of his own financial literacy and using AI tools (2).<\/p>\n
Here\u2019s how he managed to get a $195,000 medical bill reduced to just $37,000.<\/p>\n
Rosenberg described how his brother-in-law died suddenly of a heart attack earlier this year. After helping his sister-in-law field smaller bills for the cardiologist and other specialists, the family was hit with the real cost: $195,000 for the hospital bill, with no transparency about the pricing and no standard CPT codes.<\/p>\n
Rosenberg\u2019s brother-in-law had allowed his health insurance to lapse some months before his death, and so the family was left to deal with the bills on their own. Feeling certain that the bill could be negotiated down, the family demanded the CPT codes, which took some time to receive. Rosenberg used Claude AI to analyze each code against the Medicare billing rules, and found that there were several major issues with the itemized charges, including double-billing for procedures (3).<\/p>\n
Using the information from Claude AI, Rosenberg cross referenced the information using ChatGPT, and also did his own research to ensure the findings were accurate. He then used AI to write a letter outlining the billing violations he found and threatening legal action. The hospital capitulated and re-issued a bill to Rosenberg\u2019s sister-in-law for $37,000.<\/p>\n
\u201cUltimately, my big takeaway is that individuals on self-pay shouldn\u2019t pay any more than an insurance company would pay \u2014 and which a hospital would accept as profitable business \u2014 than the largest medical payer in the country,\u201d Rosenberg wrote.<\/p>\n
\u201cI 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.\u201d<\/p>\n
Trending: Are you richer than you think? Here are 5 clear signs you\u2019re punching way above the average American\u2019s wealth<\/a><\/strong><\/p>\n At the end of his post, Rosenberg urged readers to speak up about unethical practices. \u201cAmericans: this doesn\u2019t improve unless you make loud, constant, and discomforting noise to your representatives. We need a single payer health system in the U.S.\u201d<\/p>\n His story not only highlights the urgent need for reform in health care billing practices, but also how average Americans should educate themselves about typical medical costs and the rules governing medical billing. For example, a study from 2015 found that the 50 most expensive hospitals in the U.S. at that time were charging up to 10 times their Medicare-allowable costs (4).<\/p>\n In Rosenberg\u2019s case, his brother-in-law\u2019s bill was several times the typical charges for heart attack treatment, with a recent study putting the average cost at $18,970 to $23,173 (5).<\/p>\n His story comes at a time when the Trump administration is enacting policy to weaken protections for those with medical debt. While several states have made moves to keep medical debt off of consumers\u2019 credit reports, the rollback of these policies at the federal level could see those with medical debt struggle with their credit, including being unable to find housing, get a car loan, or even find employment (6).<\/p>\n As Rosenberg urged, Americans should research their medical bills to ensure the pricing is fair, and in alignment with the Medicare physician payment rates. If you have received a medical bill with unclear charges, don\u2019t be afraid to ask for the CPT codes so that you can compare your charges with the Medicare standards. The Centers for Medicare & Medicaid Services (CMS) offer information on how to dispute a medical bill, with the reminder that you are entitled to dispute charges, and your costs won\u2019t increase if you dispute a bill (7).<\/p>\n Whether you decide to use AI or not, the CMS offers the PFS Look-Up Tool so you can find Medicare payment information and related policies on over 10,000 common services (8).<\/p>\n With Medicare payments set to rise for physicians in 2026 after several years of cuts, Americans should brace for higher bills across the board. However, any bills that don\u2019t include a detailed, itemized list of CPT codes shouldn’t be accepted at face value \u2014 you have the right to ask for a properly itemized bill before you make any payments.<\/p>\n Remember that even those with a great deal of medical knowledge can get hit with unreasonable bills, as the recent story of Lauren Hughes<\/a> proves. A physician herself, she was taken to an out-of-network hospital after a car accident with a broken ankle and some minor injuries \u2014 and was given a bill for $63,976.35 for her overnight stay.<\/p>\n As more stories like these circulate, growing calls for government-level reforms and a rise in AI-assisted consumer advocacy could create better transparency in medical billing \u2014 potentially spelling trouble for investors who have found heavy profits from \u2018surprise billing\u2019 practices.<\/p>\n Policymakers will also need to address the reasonable rates for medical care as more reports find unequal billing practices across hospitals and care providers in the current system. A recent analysis from the Kaiser Family Foundation on Transparency in Coverage (TiC) data hopes to open the \u201cblack box of health care pricing\u201d so that everyone can see and compare prices across payers and providers for similar items and services (9).<\/p>\n For now, the 100 million Americans who owe medical debt will have to advocate for themselves, and look for ways to ensure their bills are fair and transparent.<\/p>\n \u201cDebt is no longer just a bug in our system. It is one of the main products,\u201d said Dr. Rishi Manchanda, former board member of the nonprofit RIP Medical Debt, in an interview with the Kaiser Family Foundation. \u201cWe have a health care system almost perfectly designed to create debt (10).\u201d<\/p>\n Join 200,000+ readers and get Moneywise\u2019s best stories and exclusive interviews first \u2014 clear insights curated and delivered weekly. Subscribe now.<\/a><\/strong><\/p>\n We rely only on vetted sources and credible third-party reporting. For details, see our editorial ethics and guidelines<\/a>.<\/p>\n U.S. Department of Health and Human Services (1<\/a>); Instagram Threads (2<\/a>); All-In-One AI Chatbot (3<\/a>); National Library of Medicine (4<\/a>, 5<\/a>); KFF Health News (6<\/a>, 10<\/a>); Centers for Medicare & Medicaid Services (7<\/a>, 8<\/a>); Peterson-KFF (9<\/a>)<\/p>\n This article originally appeared on Moneywise.com<\/a> under the title: New York man lost brother-in-law to a heart attack, faced $195K hospital bill. How he used AI to slash it down to $37K<\/a><\/p>\n This article provides information only and should not be construed as advice. It is provided without warranty of any kind.<\/p>\n","protected":false},"excerpt":{"rendered":"Price transparency for medical billing remains a hot button issue across the country. 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