Audit a year of medical bills against your insurance contract with ChatGPT (partial)
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- by Robin Hartill (CNET)
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Evidence: Article or interviewA newsletter, journalist or interview account of what happened.
PartialThe source says it only partly worked, or had a significant problem a person had to deal with.
What went wrong: ChatGPT confirmed and explained the $1,512 overpayment but didn't find it unprompted; Hartill spotted it from their own payment records, and the refund was still pending when the article was published.
Outcome
CNET's Robin Hartill, a certified financial planner, hit a $10,150 out-of-pocket maximum in under five months after two eye surgeries. Hartill redacted and uploaded 14 itemised bills and EOBs, a 149-page insurance contract and a spreadsheet of 87 claims to ChatGPT with an auditor prompt. It flagged nothing new on its own and showed an insurance rep had been wrong about a $250 co-pay. When asked directly why Hartill had paid $11,512, it confirmed a $1,512 overpayment on the second surgery and explained why.
Agent
Prompt Original prompt
Exact prompt as published in the source.
Act as a medical billing expert and auditor with deep knowledge of the US healthcare system, medical billing codes, surgical billing practices and outpatient billing practices. I will provide my insurance contract, an itemized bill and an explanation of benefits. Look for incorrect charges, unusually expensive or questionable charges, mathematical errors, charges that appear inconsistent with my insurance contract and other potential inaccuracies.
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Optional stronger version
Our rewrite with extra checks. The poster didn't test it.
Run this task now, exactly as written below. Everything you need is here, so start straight away and only stop if something required is missing or a rule below tells you to. Goal: Compare my itemised medical bills and EOBs with my insurance contract and my payment records, and flag anything that doesn't add up. Fill in before running: - Itemised bills, with name, date of birth, address and member ID removed: [BILLS] - Matching explanations of benefits (EOBs): [EOBS] - My plan document or the relevant sections: [CONTRACT] - My own log of what I've actually paid, with dates: [PAYMENTS] You're not my accountant or financial adviser. Show your working, label estimates as estimates, and tell me which points a professional or the official source should confirm. Rules: - Match each bill to its EOB and to my payment log line by line. - Flag duplicate charges, maths errors, and anything I paid above my listed patient responsibility. - Check my total payments against my out-of-pocket maximum. - For each flag, quote the contract section and say whether it's a likely error or just a question to ask. - Check facts that can change (prices, opening hours, dates, availability, rules) against the official source, and tell me anything you couldn't verify. - Tell me which errors you can't detect from documents alone, such as time billed for a procedure. Output: A table of claims (billed, insurer paid, my responsibility, what I paid, flag), then a short list of questions for my insurer or provider. You'll know it worked when: any overpayment is confirmed in writing and refunded. Before you finish: re-read my goal and constraints, check your answer against each one, and list anything you assumed or couldn't confirm.
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Your prompt
Run this task now, exactly as written below. Everything you need is here, so start straight away and only stop if something required is missing or a rule below tells you to. Goal: Compare my itemised medical bills and EOBs with my insurance contract and my payment records, and flag anything that doesn't add up. Fill in before running: - Itemised bills, with name, date of birth, address and member ID removed: [BILLS] - Matching explanations of benefits (EOBs): [EOBS] - My plan document or the relevant sections: [CONTRACT] - My own log of what I've actually paid, with dates: [PAYMENTS] You're not my accountant or financial adviser. Show your working, label estimates as estimates, and tell me which points a professional or the official source should confirm. Rules: - Match each bill to its EOB and to my payment log line by line. - Flag duplicate charges, maths errors, and anything I paid above my listed patient responsibility. - Check my total payments against my out-of-pocket maximum. - For each flag, quote the contract section and say whether it's a likely error or just a question to ask. - Check facts that can change (prices, opening hours, dates, availability, rules) against the official source, and tell me anything you couldn't verify. - Tell me which errors you can't detect from documents alone, such as time billed for a procedure. Output: A table of claims (billed, insurer paid, my responsibility, what I paid, flag), then a short list of questions for my insurer or provider. You'll know it worked when: any overpayment is confirmed in writing and refunded. Before you finish: re-read my goal and constraints, check your answer against each one, and list anything you assumed or couldn't confirm.
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4 blanks are still empty: Itemised bills, with name, date of birth, address and member ID removed; Matching explanations of benefits (EOBs); My plan document or the relevant sections; My own log of what I've actually paid, with dates. They'll stay in brackets in your prompt, so the chat tool may ask you about them.
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Source
https://www.cnet.com/tech/services-and-software/chatgpt-medical-bill-errors/
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