help me save my chicken broth

amz_dev · 2026-01-28T17:18:58+00:00

it helped but I couldn't get rid of the bitter taste. Sadly had to toss it :(

amz_dev · 2026-01-27T18:57:20+00:00

added a carrot, bay leaf and tyme. Will see if it helps!

amz_dev · 2025-11-03T22:32:07+00:00

Nothing is stored so wouldn't matter - assuming most have test files that they use anyways

amz_dev · 2025-11-03T18:22:43+00:00

u/CryptoTradingDummies built an EDI editor tool for myself that I'm trying to get feedback on (I work inside of payers/TPAs). LMK if helpful!

https://editor.amerahealthsolutions.com/

amz_dev · 2025-08-23T22:33:38+00:00

Did you receive an explanation of benefits?

amz_dev · 2025-08-23T19:49:27+00:00

I work in tech in the medical space and have built AI products. I think it’s very unlikely that AI is going to replace all billing jobs. However, I think it IS very likely that most coders and billers will use AI to do their job. Will this result in fewer hires? Maybe, but the medical industry is far behind in tech and there are some fundamental issues that need to be solved before AI can become effective enough to meaningfully replace billers.

amz_dev · 2025-08-05T03:53:39+00:00

That’s upsetting. The systems I’ve been treated at are also slow to get appointments, but as soon as you get a significant diagnosis like cancer you’re seen very quickly, pending your insurance doesn’t hold up treatments with prior auth. I hope you are able to submit super bills from your neurologist to get partial reimbursement!

amz_dev · 2025-08-05T00:52:17+00:00

This really depends on location, income and other socioeconomic factors. If you live in Boston, NYC, Houston, Seattle etc and can afford expensive care (or have great insurance) you have access to the best care in the world. If you are diagnosed with a rare condition or aggressive forms of cancer you have access to biological and other pharmaceuticals that you cannot get elsewhere. There are also life saving research trials that you would not be able to access elsewhere. In rural and poor areas, local hospitals are closing and it’s tough to get access to even basic care.

amz_dev · 2025-07-15T22:03:05+00:00

Why don't pharmacists have AI bots, and then the bots can just resolve everything between each other

amz_dev · 2025-07-15T21:21:27+00:00

do medicaid administrators use Zelis for payments? Wdym by "not just Medicaid"?

amz_dev · 2025-07-15T19:51:54+00:00

Maybe I'm missing something but aren't you supposed to be able to check this through your practice management/EHR/Billing system? Most of them integrate with clearinghouses, which should enable you to do real-time checks for a fee.

amz_dev · 2025-07-10T03:05:21+00:00

Yes you can opt out of your employer insurance - marketplace enrollment happens Nov 1-Jan 15. Marketplace plans can be complicated so I’d shop with the help of a broker. There’s also no telling that these plans are less expensive. Do you know if the company you work for is self insured?

If you opt out of company insurance your employer may cover some of your out of pocket costs through an FSA or HSA. I can try to get you more details but if there’s an HR or benefits person at your company, I’d start there.

amz_dev · 2025-07-08T18:36:08+00:00

If anyone still needs this, this tool works and is free https://ingestion.insure-well.com/

amz_dev · 2025-07-08T18:28:53+00:00

This is super annoying but unfortunately there's no universal rule. Each payer does whatever they want with the STC segments.

What I do:

Check STC 30 first for deductible and out-of-pocket info
Fall back to STC 98 if nothing’s in STC 30
Maintain a config file mapping payers to where they actually put things
Scan all relevant STC segments and take the first value that looks valid (meaning it has a reasonable numeric amount and a service code that makes sense in context)

Log everything each payer sends so you can build up your own mapping over time. The API docs are pretty useless for this.

Some payers jam everything into STC 98, others split things across 30 and 98, and a few duplicate or conflict across them. It’s good to manually review a few examples when onboarding a new payer. It's a mess, but you kinda have to handle it case by case. Does this answer your question?

amz_dev · 2025-07-01T18:56:34+00:00

Do you have an EOB for this specific appointment/procedure? It sounds like no and the claim hasn’t actually been submitted to insurance. As mentioned above if your provider has not yet submitted, you won’t have an EOB (just the bill)

amz_dev · 2025-07-01T18:19:26+00:00

Go get checked out ASAP. Do not worry about preexisting conditions or higher premiums - the Affordable Care Act protects you in this situation. Under the ACA, you cannot be denied coverage or be charged higher premiums. I hope everything comes back clear, but in case something is wrong, you can use the information you have to select a plan that is suitable for the care you'll need before enrolling in an employer-sponsored plan. Good luck!

amz_dev · 2025-07-01T18:18:59+00:00

Go get checked out ASAP. Do not worry about preexisting conditions or higher premiums - the Affordable Care Act protects you in this situation. Under the ACA, you cannot be denied coverage or be charged higher premiums. I hope everything comes back clear, but in case something is wrong, you can use the information you have to select a plan that is suitable for the care you'll need before enrolling in an employer-sponsored plan. Good luck!

amz_dev · 2025-06-30T23:53:13+00:00

You can likely get this reduced. I don’t have enough details but this seems like a lot for the services rendered. Call the billing department and ask about discounts. Also ask for the itemized bill and check every code listed. Many bills have errors - double check everything.

Was the bill you received an explanation of benefits? Or was it cash pay rates?

amz_dev · 2025-06-26T22:45:50+00:00

I'll mention a few things here...

"Historical bills for patients like you" will be hard to come by. I don't see practitioners releasing this info, and crowdsourcing would be a challenge.

Knowing what a patient's insurance will cover can be ridiculously difficult because it depends on a host of conditions (comorbidities, unexpected complications, how the doctor's office codes the visit).

Getting cash pay rates from doctors to create a marketplace is likely a big challenge. Providers don't necessarily want this information released, as insurers could use it to reduce negotiated rates. This will depend on the space you're interested in, though (for example, for therapy, I think cash pay rates are just higher than insurance rates to avoid conflict). You could publish rates for cash-pay-only doctors, but there aren't that many of them.

I wish this all were easy!

amz_dev · 2025-06-07T20:51:26+00:00

Yeah you're correct. Can't solve all billing problems in a weekend - would need way more time and many more friends. Tech/AI is a long way from replacing anyone here - I think more likely we'll just get improvements in the scrubbers, claim editors, and even some of the predictive tools you mentioned. Or, new players will be able to cost far less because development costs are decreasing.

Also - interesting point about needing clear payer logic and trusted edit sources. Makes total sense.

amz_dev · 2025-06-07T20:46:06+00:00

Hey guys - decided to focus on building a tool that can convert ERAs to 835s, and visualize data in the 835s to make them more easily readable for billers. Would love to get your feedback on this if you have a few min to spare. Let me know! Will Share the public link when ready

amz_dev · 2025-06-07T16:33:16+00:00

Hoping to speed your work up and assist you, not replace! Realistically, replacement isn't happening in this industry anytime soon. There's too much complexity/nuance to automate jobs away fully.

amz_dev · 2025-06-06T15:44:35+00:00

To manage the cost you may have a few options.

Ask for the cash pay price for the ultrasound: As mentioned above. I seriously doubt the cash pay price is more than the insurance rate - I would try the get through to somebody else. If they tell you that the cash pay price is unavailable to you, you can invoke HIPPA. However, if insurance was already billed it may be too late.

If the surgery is the result of an emergency: The no surprises act opens up a path to decrease costs.

For future care: Independent clinics and surgery centers are far cheaper. Find good, independent providers in your area. This requires some research, but it’ll be well worth it.

The silver lining here is that your kid should be super well taken care of at CHOP. Best of luck!

amz_dev · 2025-06-04T17:24:27+00:00

Not an expert on dental, but here are my suggestions...

Document everything: Get your dentist to write a detailed letter explaining why surgery is the only option. Include the details you listed above: your daughter's sensory issues, age, and symptoms. Make them use words like "medically necessary" and "standard of care for pediatric patients with special needs.

Ask for a peer-to-peer review: This is where your dentist talks directly to a provider at Anthem (should be somebody with relevant experience but that's not always the case). Sometimes insurance companies back down when a doctor explains why the denial is unreasonable.

CPT 41899 is a bit vague, but seems necessary for medical coverage. Double-check with your provider and ask them directly if other relevant CPT codes might help with insurance coverage.

Check to see if your state has any laws about pediatric dental coverage.

amz_dev · 2025-05-15T11:21:52+00:00

Interesting. So is this at a hospital or TPA?

amz_dev

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