Driving Healthcare Transformation Through Generative AI
Dear Mr . Smith ,
This is an explanation of your insurance benefits for your recent hospital stay from 9 / 8 / 2023 to 9 / 10 / 2023 at Mercy Hospital for treatment of a heart attack .
Hospital Charges : The total billed charges from the hospital are $ 35,000 . This includes costs for the emergency department , lab tests , cardiac catheterization procedure , operating room , hospital room stay , medications , and more .
Insurance Payment : Your insurance , UAC Health Plan , has negotiated discounted rates with Mercy Hospital . The discounted allowed amount they will pay is $ 22,000 .
Your plan paid $ 17,600 directly to the hospital under your in-network benefits which covers 80 % of allowed costs after you meet the annual deductible . Your deductible of $ 2000 was reached earlier this year .
Your Responsibility : That leaves a remainder of $ 4,400 which is your 20 % coinsurance responsibility under the plan . The hospital will bill you separately for this amount owed .
Additional Notes : The cardiac rehab program you will need is covered at 100 % under your plan benefits . Your ambulance transport will be billed separately . It is covered at 80 % after deductible . Your emergency room copay was $ 250 and will appear separately .
Let me know if you have any other questions ! I am happy to explain your plan ’ s benefits in detail so you understand the costs associated with your care . Please reach out if you need any help with appeals or negotiating payment arrangements .
Sincerely , [ GenAI Assistant ] UAC Health Plan
4 HIGH LEVEL ARCHITECTURE
Let ’ s look at the high-level flow of the GenAI assisted patient care in Figure 4-1 . The figure shows the four different use cases we have covered in this paper . The first three use cases shown in the Figure are for the productivity and efficiency of the medical professionals as they provide service to the patients . The fourth use case is for the patients to develop a better understanding of the insurance benefits applicable to them .
100 March 2024