Cut a $195,628 hospital bill to about $32,500 by checking it against Medicare rules

Try it yourself

What you get

A line-by-line comparison of a hospital bill with what Medicare would pay, a list of billing-rule problems, and a negotiation letter with a concrete offer.

Tools

• Claude (any plan)
• ChatGPT, to double-check the analysis
• The hospital's UB-04 form or itemized bill with CPT codes

Time / cost: About an hour of back-and-forth with Claude, plus 20 minutes spot-checking on Google (per author)

Steps

1. Ask the hospital for an itemized bill, then for the UB-04 form (the coded claim it would send to an insurer).
2. Give the codes to the assistant and ask for a spreadsheet of what Medicare pays for each one, for your state and year.
3. Ask it to flag unbundled charges, mutually exclusive codes and care that was billed but never given.
4. Paste the whole analysis into a second AI and ask it to check every detail, then spot-check the key rules yourself.
5. Send a letter that lists each problem and offers to pay the Medicare-based amount promptly in exchange for a zero balance.

Copy-ready prompt

Here is my itemized hospital bill / UB-04 with CPT and revenue codes: [paste]. Location: [city, state]. Date of service: [date]. Insurance status: [uninsured / insurer].
1. Make a table: code, description, amount billed, what Medicare would pay for this code in my area this year, notes.
2. Flag anything that looks unbundled (components billed separately from a comprehensive procedure), mutually exclusive codes billed together, inpatient-only codes on an outpatient visit, or care that the records don't show was given.
3. Show your sources for every rate and rule so I can check them.
4. Draft a polite but firm letter to the billing office that lists each issue and offers to pay [amount] promptly in exchange for a zero balance. Don't send anything.

Prompt written by AgentPlays from the source. Fill in the [brackets] and approve before anything is sent or bought.

Watch out: AI can get billing rates and rules wrong. The author double-checked with a second AI and read the Medicare rules himself, and he says he doesn't recommend using AI as your lawyer.

Proof / source

Detailed write-up First-person essay in Business Insider by the family member who ran the negotiation.