Have You Met My Friend Claude?

During a professional development activity a few weeks ago, on election day, we did a whole session on how to use artificial intelligence, in particular Claude, to help us write our lesson plans. And I hated it. I hated the idea of it, and I really hated that Claude could create lesson plans in seconds that had taken me years to figure out for myself. I was close to tears in frustration, trying to think of questions to ask Claude to make him useful without letting him take over my life. And I felt like such a meanie, because one of my colleagues was generously trying to share his knowledge with us and all I could do was grumble. I survived the rest of the afternoon, just barely, and went home to watch TV and block out the reality of the coming robot apocalypse for a little while longer.

The next day, though, I remembered something my boss had said while I was too busy banging my head against the wall to listen, that if I didn’t need Claude’s help with lesson planning maybe there was something else Claude could help with, something that I would have struggled to figure out on my own. And that reminded me of my previous adventures with Dr. Google (aka Claude’s cousin Gemini), when he helped me research some of my ongoing health issues. I had an appointment coming up with my endocrinologist, so I decided to ask Claude if my doctor was right, that I wouldn’t qualify for the Medicare Bridge program to reduce the cost of my GLP-1 medication. I’ve been on Zepbound for two years now, paying $450 a month out of pocket, which is itself a discounted price, but over the summer, when I first heard about the Medicare Bridge program (a program put in place to bypass the restrictions against covering weight loss medication for Medicare patients in order to allow seniors and people with disabilities, like me, to improve their health and thereby lessen overall healthcare costs), I asked my doctor if I would qualify and he said he didn’t know much about it, but he was sure I wouldn’t qualify. He was confident that they wouldn’t cover a GLP-1 medication for someone who was no longer overweight, and while that sounded crazy, and unfair, it was pretty much par for the course for the US health care system, so I believed him. But I didn’t give up completely, I started researching other possible ways of getting GLP-1 type medications, and other avenues to qualify for insurance coverage, especially since Medicare was now covering people who needed a GLP-1 for Fatty Liver, which was the diagnosis that had led me to the GLP-1 in the first place. At that time, my Gastroenterologist had told me that weight loss was the only known treatment for Fatty Liver, and he’d championed the idea of a GLP-1 and railed against congress for not getting its act together to change the rules and allow Medicare to cover weight loss medications. He had no idea how to help me access the medication, let alone how to get insurance to cover it, but he encouraged me to keep looking, and that was how I ended up with my current endocrinologist, who was willing to prescribe the medication and had found me a discounted price, through Lilly Direct.

When I whined to Claude that my latest Abdominal Ultrasound had showed that my liver was fully healed, and therefore, if I couldn’t qualify for the Medicare Bridge program because I’d already lost the weight, then I wouldn’t qualify for coverage under a diagnosis of Fatty Liver which no longer applied to me, Claude said, politely, your doctor is wrong. Then he showed me the research and gave me links to Medicare documents and drafted a letter to the doctor for me, clarifying the rules: if I was sufficiently overweight for my doctor to prescribe the medication two years ago, and I still needed to take the medication, then I qualified for the Medicare Bridge program today. Claude went on to say that it would be cruel, and counterproductive, to create a system that would punish people for having been proactive with their health, and actively encouraging them to regain the weight just to qualify for insurance coverage. It was both comforting, and bizarre, that Claude, a bot, seemed more sensitive to my situation than any of my doctors had been, and I worried that I was witnessing the much-derided phenomenon we’d learned about at professional development – sometimes Claude, and other artificial intelligence programs, just makes things up. But I kept studying the research and going back to the original sources, and it really did seem as if Claude was right. The language was vague and confusing, as usual, but one link after another seemed to show that my starting weight, rather than my current weight, was the important number.

I brought all of my notes (and Mom) with me to my next appointment with the endocrinologist, sure that I would chicken out at the last minute and not ask him about the Medicare Bridge program, but I surprised myself. I explained to the doctor what I’d learned, and asked if he would send in the prescription to start the process, just to see if it would go through. I showed him my research, with the important lines highlighted, and gave him the letter Claude had drafted for me, setting out the step by step of what to do next, and he said, “I’m on your side, but I won’t lie.”

Um, who asked you to lie?

He ranted on about how Medicare is coming after doctors and sending them to jail for the slightest infractions, and while he certainly believed that I deserved to have my medication covered, he couldn’t lie on the forms and risk being arrested. I didn’t cry, even though he was pressing hard on my Rachel-is-always-wrong-and-morally-suspect buttons, and I calmly repeated what I’d found in the research and suggested that he could call Medicare for clarification, and he mumbled about how hard it is to get anybody on the phone and how you get a different answer every time, and he repeated over and over that he wouldn’t lie for me on an official form, no matter how broken the system was. But even as he went on and on, his nurse was reading through my notes and showing him how to fill in the request form on his computer. He looked up at me with surprise when the prompt on the screen asked for the patient’s starting or historical BMI, rather than the current BMI – which he still insisted on measuring, even though I’ve been at the same weight, and on the same dose of medication, for a while now. He also insisted on being exact with his math, that my historical BMI was still half a point below the number required by the program, but he filled in all of the information anyway, and then he shrugged and told me it probably wouldn’t work.

He sent me to wait in the next room until the nurse could take my blood (to check on my thyroid medication, which was the ostensible reason I’d come in). She was already three tasks behind because of me, or because he expected one person to do the work of three people, so we had to wait for a bit, but I didn’t mind. Mom was so proud of me for standing my ground, and so annoyed with the doctor for not believing me, and I had to remind her to keep her voice down because even though she’s gotten to the point where she doesn’t give a shit what other people think, I still worry. And then, after a few minutes, the doctor came to the door and said, “Huh, ChatGPT agrees with you. But, you know, ChatGPT can be wrong.”

I smiled and said something like “Hmm, huh,” instead of “Jackass.” There was something both ironic and perfect in the idea that he was relying on ChatGPT to check my work (with Claude), rather than doing his own research by going to the Medicare website or making a phone call (to be fair, it is hard to believe that something genuinely helpful has been implemented by the current administration).

When I went in to see the nurse and get my blood taken (I’m an old pro at this point), she quietly mentioned that we’d hear something in a day or two, implying that she’d actually been through this process before and knew how it worked, even though the doctor had declined to ask her opinion before.

Two days later, at around eight o’clock at night, I got a text notification from CVS saying that I had been approved for the Medicare Bridge program. A minute later my phone rang and it was the endocrinologist’s nurse, calling to tell me that I’d been approved, because she didn’t want me to have to wait even a moment longer than necessary for the good news.

So, this medication that clearly works for me (both as a weight loss agent and a method of reversing my Fatty Liver) is now going to be (mostly) covered, and Claude helped get me there. He didn’t do the work for me, or argue with the doctor for me, or magically take on the role of the nurse for one day to facilitate the process, but Claude was able to explain things to me clearly and patiently and that made all the difference. I’m still not a huge fan of artificial intelligence or the potential takeover of all of our information systems by inanimate search bots, but if Artificial Intelligence is happening anyway, whether I like it or not, why not make use of it? Especially since Claude didn’t seem to take it personally when I didn’t want his help with my lesson plans. Of course, after the robot apocalypse takes place who knows what life will be like here, but for now, as long as I can think of the right questions to ask, Claude is a pretty helpful tool (just as long as I remember to double check his work).

If you haven’t had a chance yet, please check out my novel, Yeshiva Girl, on Amazon. And if you feel called to write a review of the book, on Amazon, or anywhere else, I’d be honored.

Yeshiva Girl is about a Jewish teenager on Long Island, named Isabel, though her father calls her Jezebel. Her father has been accused of inappropriate sexual behavior with one of his students, which he denies, but Izzy implicitly believes it’s true. As a result of his problems, her father sends her to a co-ed Orthodox yeshiva for tenth grade, out of the blue, and Izzy and her mother can’t figure out how to prevent it. At Yeshiva, though, Izzy finds that religious people are much more complicated than she had expected. Some, like her father, may use religion as a place to hide, but others search for and find comfort, and community, and even enlightenment. The question is, what will Izzy find?