atourgates (u/atourgates)

atourgates commented on I didn't reverse-engineer the protocol for my blood pressure monitor in 24 hours james.belchamber.com/arti... · Posted by u/jamesbelchamber

dhosek · 3 months ago

I got it when an eye clinic wanted to do my blood pressure (which is kind of weird in itself), which they did shortly after the glaucoma test which never works for me because I have an overdeveloped blink reflex and it turned up high.

It really amazes me how people whose job it is to take blood pressure don’t recognize the stress situations that people are in might result in abnormal readings.

atourgates · 3 months ago

Beyond any clinical reason that your eye clinic might want to know your blood pressure (your vascular system is pretty important to your vision) - they may have been incentivized by the CMS to track blood pressure via the MIPS program which ties provider payments to specific documentation and screening measures.

AKA - the government might pay your eye clinic more if they screen you for high blood pressure. (Among other things).

atourgates commented on Ask HN: What Are You Working On? (Nov 2025) · Posted by u/david927

ml- · 3 months ago

Yeah, that's cool. Currently tangential, but conceptually not something that would be completely out of scope in the end. I'm planning to use machine translations, text-to-speech, and multi modal generative models for accessibility already. There's also an idea for baking in GPS audio tours. Obviously depends on sourcing some quality content first

When you say open source is it so you could self host it, use your "own" models, and curate your own datasets? or some other reasons? I could see a future where a lot of the project could potentially be open sourced and work with any defined geojson API.

atourgates · 3 months ago

Open source was the wrong term (though that would be fine).

I meant community-sourced. Some kind of community where local "experts" or history enthusiasts could contribute info.

AKA - invite a local or regional historical society to contribute data for their region, with the benefit that they could then easily generate a regional tour map/route/recommendation.

atourgates commented on These Men dove to the Edmund Fitzgerald shipwreck decades ago. Their stories freep.com/story/news/loca... · Posted by u/rmason

atourgates · 3 months ago

This was interesting:

> Still, Mixter and the team were labeled "ghouls and pirates," and "the state of Michigan actually passed a law against recording bodies on shipwrecks that are less than 50 years old," he said.

Assumedly, as of today, the Edmund Fitzgerald has aged out of that law?

The latest episode of the NYTimes book review podcast [https://podcasts.apple.com/us/podcast/the-sinking-of-the-edm...] is a really interesting interview with John U. Bacon who just wrote a book on the Edmund Fitzgerald, called The Gales of November. Quite interesting if, like me, you didn't know anything about the historical event beyond the song.

atourgates commented on Ask HN: What Are You Working On? (Nov 2025) · Posted by u/david927

ml- · 3 months ago

Started work on a project to put local history on a map. If I go somewhere I would ideally want to just open this webapp and immediately get presented with cool or interesting history that happened close by.

Maybe it's a story about named local fishermen from the early 1900s, with pictures, the history of a statue and videos of the process, or the state of a graffiti wall over time.

Currently in a phase of UI development and testing, and historical societies outreach for collaboration. It might stall and just fizzle into nothing, or it might be something cool.

Also still doing https://wheretodrink.beer, but haven't added anything of note since playing on this other project.

atourgates · 3 months ago

Ever since I discovered Gypspy nearly a decade ago (now Guidealong https://guidealong.com/) - I've been dreaming of an open source app that'd pull local history from sources like Wikipedia, those roadside historical signs, etc., and narrate as you drive.

https://autio.com/ is similar - but obviously not open source, and more limited.

It seems like it could even tailor itself to what an individual user is interested in, and with AI - could turn more "dry" encyclopedia-type information into more compelling narratives. With some kind of route planning software, you could even pre-plan your trips ahead of time and select the things you're interested in.

Obviously not what you're building, but something related that's been clunking around in the back of my head for a while.

atourgates commented on Samsung makes ads on smart fridges official with upcoming software update arstechnica.com/gadgets/2... · Posted by u/stalfosknight

Supermancho · 4 months ago

Contextual means based on related taxonomy of interest. How that interest is measured and what "related" means is proprietary.

This is distinct from demographic (trends based on physical attributes, like age) or geographic or behavioral (your buying patterns) and they already know the device targeting because it's their fridge.

Classic digital advertising vectors.

atourgates · 4 months ago

"I noticed you had Yoplait brand yogurt in your fridge. Here's a coupon for $0.75 off your first six-pack of Chobani!"

atourgates commented on 1X Neo – Home Robot - Pre Order 1x.tech/order... · Posted by u/denysvitali

leetharris · 4 months ago

Incredible technology, but that was an insufferable video. Still very cool, I might preorder one!

atourgates · 4 months ago

I hope you do!

I'm skeptical of v1 of this technology, but I could imagine a mature version of this technology could be great.

And $500/mo for essentially an always-available housekeeper seems very reasonable.

Where I live, having a housekeeper come for a few hours once a week costs about $100 a week, or $400/mo. Having a robot that could potentially always be there to:

* Tidy up.

* Clean

* Do laundry

* Help with other stuff

Seems well worth $500/mo. I don't expect that V1 of this technology will be able to effectively do all that stuff, but I'm hopeful that v2 or v5 might be able to.

On a related note, "folding laundry" seems to be a really hard challenge for machine learning to solve. Solutions like "Foldimate" kind of work if you individually hand it every piece in the right way - but nothing seems to be cable of having a human dump a bin of washed clothes in and spitting out nicely folded laundry. And everything so far that's promised to do that seems to be vaporware.

atourgates commented on Using AI to negotiate a $195k hospital bill down to $33k threads.com/@nthmonkey/po... · Posted by u/stevenhubertron

BeetleB · 4 months ago

It's nice they succeeded, but a word of caution: Medicare is not a good standard - it's often lower than what it costs them to provide the care. If everyone paid Medicare rates, lots of providers would go out of business.

The usual benchmark is the "usual and customary" charges for a procedure. You can look it up for a procedure for your area. You then go to the hospital and point out these charges. My guess is they're much more likely to agree with this than the Medicare rates.

It's also the rate your insurance will use if you go out of network. So if your insurance pays 40% out of network, and you get billed $1000 for a $100 procedure, your insurance will pay only $40 (4%).

(Although by all means, you can start your negotiation with whatever is lower).

atourgates · 4 months ago

I broadly disagree.

Yes - Medicare is typically lower than private insurance plans, but if you can't deliver care for the reimbursement that Medicare offers as a health system/plan/office/provider, you're probably overcharging.

More than that, Medicare is the de facto starting place for most reimbursement negotiations between providers and payers. One of its benefits is that it's transparent and readily available. Blue Cross isn't gonna tell you what it's contracted to pay an individual provider (and that individual provider often won't know what they'll be reimbursed untill after they submit a bill) - but with Medicare the data's out there.

I know a good number of private clinics that'll offer cash pay discounts that effectively mirror Medicare or even slightly below Medicare, since you're saving them the trouble and expense of going through the medical billing process.

atourgates commented on Using AI to negotiate a $195k hospital bill down to $33k threads.com/@nthmonkey/po... · Posted by u/stevenhubertron

woadwarrior01 · 4 months ago

> What the author calls criminal is the way hospitals typically bill Medicare and private insurance providers.

Interestingly enough, the FBI considers double billing and phantom billing by medical providers, to be fraud.

https://www.fbi.gov/investigate/white-collar-crime/health-ca...

atourgates · 4 months ago

Yes. Though I think technically none of that happened here.

If I sound like I'm defending the morality of the hospital for billing a private individual $190k for services they'd expect to be paid $37k for, please know that I'm not. But it helps to understand WHY the hospital billed that much, and whether it's legal for the hospital to bill that much.

The biggest semantic "mistake" the author makes in their thread is saying, "Claude figured out that the biggest rule for Medicare was that one of the codes meant all other procedures and supplies during the encounter were unbillable."

The Medicare rule does not make those codes "unbillable" - it makes them unreimburseable.

The hospital can both bill Medicare for a bigger procedure code, and the individual components of that procedure, but Medicare is gonna say, "Thanks for the bill, you're only entitled to be paid for the bigger procedure code, not the stuff in there."

Neither the FBI nor Medicare is gonna go after the hospital for submitting covered procedure codes and individual codes that are unreimbursable under those procedure codes. That's not crime, that's just medical billing.

Actual double billing would occur if, say, your insurnace paid the hospital for a procedure, and then they came after you for more money, or billed a secondary insurance for the same procedure. Or if they'd said, "Oh no, the OP's brother in law wasn't here for just 4-hours, they were here overnight so now we're billing for that as well."

NOW - a much better way for the hospital to handle this scenario would be to see that the patient is cash-pay, and then have separate cash-pay rates that they get billed that essentially mirror Medicare reimbursement. That's essentially what the author got them to do, and it absolutely sucks that's what he had to do.

atourgates commented on Using AI to negotiate a $195k hospital bill down to $33k threads.com/@nthmonkey/po... · Posted by u/stevenhubertron

aeturnum · 4 months ago

It seems like the AIs role was in applying lengthy and complex medicare billing rules - it did not do negotiating and it doesn't seem like the accuracy of its understanding of medicare practices was actually checked. The author reasonably accused the hospital of gouging and the hospital came back with a much lower offer.

I'd be interested to hear from a charge coding expert about Claude's analysis here and if it was accurate or not. There's also some free mixing of "medicare" v.s. "insurance" which often have very different billing rates. The author says they don't want to pay more than insurance would pay - but insurance pays a lot more than medicare in most cases.

It's pretty clear that even access to a potentially buggy and unreliable expert is very helpful. Whatever else AI does I hope it chips away at how institutions use lengthy standards and expertise barriers to make it difficult for people to contest unfair charges.

atourgates · 4 months ago

What the author calls criminal is the way hospitals typically bill Medicare and private insurance providers.

If the OPs brother-in-law had had insurance, the hospital would have billed the insurance company the same $195k (albeit with CPT codes in the first place).

The insurance company would have come back and said, "Ok, great, thanks for the bill. We've analyzed it, and you're authorized to received $37k (or whatever the number was) based off our contract/rules."

That number would typically be a bit higher for private insurance (Blue Cross, Blue Shield, United Healthcare, etc), a little lower for Medicare, and even lower for than that for Medicaid.

Then the insurance would have made their calculations relative to the brother-in-law's deductible/coinsurance/etc., made an electronic payment to the hospital, and said, "Ok, you can collect the $X,XXX balance from the patient." ($37k - the Insurers responsability = Patient Responsibility)

Likely by this point in a chronic and fatal disease, the patient would have hit their out-of-pocket maximum previously, so the $37k would have been covered at 100% by the insurance provider.

That's basically the way all medical billing to private and government insurance providers in this country works.

"Put in everything we did and see what we can get paid for by insurance" isn't criminal behavior, it's the way essentially every pay-for-service healthcare organization in the country bills for its services.

I don't say that to either defend the system, or to defend the actions of the hospital in this instance. It certainly feels criminal for the hospital to send an individual an inflated bill they would never expect to pay.

atourgates commented on Antislop: A framework for eliminating repetitive patterns in language models arxiv.org/abs/2510.15061... · Posted by u/Der_Einzige

atourgates · 4 months ago

I've been using ChatGPT fairly regularly for about a year. Mostly as an editor/brainstorming-partner/copy-reviewer.

Lots of things have changed in that year, but the things that haven't are:

* So, so many em-dashes. All over the place. (I've tried various ways to get it to stop. None of them have worked long term).

* Random emojis.

* Affirmations at the start of messages. ("That's a great idea!") With a brief pause when 5 launched. But it's back and worse than ever now.

* Weird adjectives it gets stuck on like "deep experience".

* Randomly bolded words.

Honestly, it's kind of helpful because it makes it really easy to recognize content that people have copied and pasted out of ChatGPT. But apart from that, it's wild to me that a $500bn company hasn't managed to fix those persistent challenges over the course of a year.