Work through an insurance external appeal for a child's surgery with ChatGPT
- Posted
- by chrisgeleven (Hacker News)
- Last checked
- Method:
- How we verify
Evidence: Described by posterThe person describes what happened in words, without screenshots or video.
Outcome
A Hacker News commenter says that after insurance declined a life-saving surgery for their 6-year-old at the last minute, ChatGPT guided them through the external appeal process, suggested who to contact to apply pressure, researched questions and helped with wording. They didn't follow every suggestion and checked steps with friends and family; the procedure was approved 10 days after the denial.
Agent
Prompt Recreated prompt
The source didn't share its exact prompt, so we wrote this from what it describes.
Let's work this out together. I'll tell you what I know, you suggest options and ask what you need, and we'll narrow it down step by step. Nothing gets booked, bought or sent until I say so. Goal: Map out and work through the appeal for a denied insurance claim, step by step, as fast as the process allows. What I'll share as we go: - The denial letter (remove names, member ID and birth dates) - Plan type (employer, marketplace, Medicaid) and state - How urgent it is, and what the doctor's office says - Dates so far, and any deadlines in the letter This is admin help, not medical advice. Don't diagnose or suggest treatments. If anything I mention sounds urgent, tell me to contact a doctor or emergency services first. Rules: - Start with the exact appeal steps and deadlines for my plan type, including expedited or urgent review if it applies. - List who to contact and in what order (insurer, doctor's office, employer benefits, state insurance department), with what to ask each. - Draft appeal wording from facts in my documents only; mark anything I need the doctor to supply. - This is admin help: decisions about the treatment stay with the doctors. - Check facts that can change (prices, opening hours, dates, availability, rules) against the official source, and tell me anything you couldn't verify. Output: A step list with deadlines, a contact plan, and a draft appeal letter with blanks for the doctor's input. You'll know it worked when: every deadline is on my calendar, the right people have been contacted, and the appeal is filed with the doctor's support.
Optional stronger version
Our rewrite with extra checks. The poster didn't test it.
Let's work this out together. I'll tell you what I know, you suggest options and ask what you need, and we'll narrow it down step by step. Nothing gets booked, bought or sent until I say so. Goal: Map out and work through the appeal for a denied insurance claim, step by step, as fast as the process allows. What I'll share as we go: - The denial letter (remove names, member ID and birth dates) - Plan type (employer, marketplace, Medicaid) and state - How urgent it is, and what the doctor's office says - Dates so far, and any deadlines in the letter This is admin help, not medical advice. Don't diagnose or suggest treatments. If anything I mention sounds urgent, tell me to contact a doctor or emergency services first. Rules: - Start with the exact appeal steps and deadlines for my plan type, including expedited or urgent review if it applies. - List who to contact and in what order (insurer, doctor's office, employer benefits, state insurance department), with what to ask each. - Draft appeal wording from facts in my documents only; mark anything I need the doctor to supply. - This is admin help: decisions about the treatment stay with the doctors. - Check facts that can change (prices, opening hours, dates, availability, rules) against the official source, and tell me anything you couldn't verify. - Keep a dated log of every call and letter so I can show it in an external review. Output: A step list with deadlines, a contact plan, and a draft appeal letter with blanks for the doctor's input. You'll know it worked when: every deadline is on my calendar, the right people have been contacted, and the appeal is filed with the doctor's support. Before you finish: re-read my goal and constraints, check your answer against each one, and list anything you assumed or couldn't confirm.
Source
https://news.ycombinator.com/item?id=45736945
Related cases
After a new dentist's visit left her owing $1,201.80 on top of the $2,111.29 she'd already paid, Jamie Phillis gave ChatGPT her call transcripts, receipt, explanation of benefits and her insurer's appeal instructions. It wrote a formatted appeal letter in under a minute and flagged duplicate evaluations and a charge at seven times the allowed rate. The first appeal was denied; ChatGPT then drafted a second-level appeal and a complaint to the Arizona Department of Insurance. She says the case was never formally resolved, but the office never sent her a bill for the uncovered balance and she never paid the $1,200.
Poster says:$1,201.80 balance never billed after appeals
ChatGPT · Personal · Source date:
- Have ChatGPT review a finished tax return for missed savingsEvidence: Described by poster
Matt Koppenheffer redacted his TurboTax return and worksheets and asked ChatGPT in a temporary chat whether they were under-optimized or should take other actions. The first 17-minute run found they had taken a foreign tax deduction instead of a foreign tax credit; switching raised state tax but cut federal tax more, saving money. A couple more hours of back-and-forth produced no further savings, but he says it raised his confidence the return was correct.
ChatGPT · Personal · Source date:
- Find who to escalate a stuck insurance bill to with ChatGPTRecreated promptEvidence: Article or interview
Medical Xpress reports that Lauren Gonzalves spent almost two years fighting an $1,800 Anthem bill for her newborn's hospital nursery care. After a free AI appeal assistant (Counterforce's Maxwell) pointed to supporting reasons, she asked ChatGPT how to escalate a grievance with Anthem and got email addresses at a company handling the insurer's complaints. Within days an analyst found the claim, and a week later the bill was dismissed, she says.
ChatGPT · Personal · Source date: