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AI agent for caregivers

Medical Bill and Statement Review Agent

Every medical bill is checked against the insurer's statement, and open questions are followed until balances agree.

AdministrationData cleanupHealthcare
See how it worksGet access
Medical Bill and Statement Review Agent: what goes in, what the agent does and what you get

What it does

Hospital bills and insurer statements rarely match, and the deadline to appeal passes while the caregiver is busy with care. The agent matches each bill to its insurance explanation of benefits and the visit record, flags duplicates, wrong codes, services not received and balances billed before the insurer paid, and drafts a polite question to the provider or insurer. When a reply comes, it checks it against the original bill and keeps the case open until the balances agree. It also tracks appeal deadlines. The caregiver approves anything that is sent or paid. Edge case: a bill for a service that happened, billed twice with different dates.

How it works

Follow the arrows from top to bottom. The orange dashed arrow is the loop: when a check fails, the agent goes back and tries again.

Start and resultWhat it doesA check on its own workWaits for your OKGoes back and retries
Yes, continueApprovedYes, continueNoNo 1 STARTS WHEN Bill or statement received 2 USES A TOOL Read the bill and find the matching statement 3 DOES Match the visit date, service and amount 4 CHECKS THE RESULT Do the bill and the statement agree? If not: List the differences with dollar amounts. Backto step 3. 5 DOES Check for duplicates and early billing 6 USES A TOOL Draft a question to the provider or insurer 7 YOU APPROVE Caregiver approves anything sent 8 USES A TOOL Track the reply and appeal deadline 9 DOES Compare the reply with the original bill 10 CHECKS THE RESULT Do the balances now agree? If not: Draft a follow-up and keep the case open. Backto step 3. 11 RESULT Closed or open case list
Read the steps as a list
  1. Bill or statement received
  2. Read the bill and find the matching statement
  3. Match the visit date, service and amount
  4. Do the bill and the statement agree?If not: List the differences with dollar amounts. Back to step 3.
  5. Check for duplicates and early billing
  6. Draft a question to the provider or insurer
  7. Caregiver approves anything sentThe agent waits here for your OK.
  8. Track the reply and appeal deadline
  9. Compare the reply with the original bill
  10. Do the balances now agree?If not: Draft a follow-up and keep the case open. Back to step 3.
  11. Closed or open case list

How it decides

It trusts a bill only when the visit, codes and amount agree with the insurer's statement, and ranks problems by dollar value and deadline.

  • Flag a balance billed before the insurer paid
  • Flag identical charges on different dates
  • Start an appeal reminder 30 days before the deadline
  • Pay nothing until the statement shows the patient share

Make it yours

Every agent is a starting point. You choose these settings for your own situation.

  • Deadline reminder days (default 30)
  • Providers and insurers tracked
  • Dollar level for follow-up (default $25)
  • Format of the case list

What keeps you in control

It always asks you first

  • Caregiver approves every message and every payment

Hard limits

  • Never pay or sign anything itself
  • Do not give legal or medical advice

It stops when

  • Done: balances agree and the caregiver has approved any payment
  • Stop: deadline is near and the caregiver must call the insurer

Set it up

We guide you through the set-up, step by step

Members get the full set-up guide for this agent. No technical skills needed: you copy, paste and upload.

10 minto set it up in your AI
5 AIsChatGPT, Claude, Copilot, Gemini, Grok
  • One set of instructions to paste into your AI, with the clicks for ChatGPT, Claude, Microsoft 365 Copilot, Gemini and Grok
  • The agent then walks you through connecting your own data, one source at a time
  • A downloadable copy with the flow chart, the rules and the full guide
Get access to this agent

An example run

What happensA $1,240 hospital bill shows $380 patient share on the insurer's statement. The agent finds the bill is for the full amount, and a lab fee of $210 appears twice. It drafts a question to the billing office, and the caregiver approves. The reply corrects the bill to $380, but a $60 fee remains on a second look, so the agent keeps the case open.

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