Providers should have to stick to one amount per diagnosis code no matter what. I don’t care if the patient has private insurance, Medicare, or pays cash. Providers also should not be able to bill patient above and beyond reimbursement.
deductibles yes.
Let me explain how the "game" works.
I had blood work done years back, two different insurers. Both reimbursed similarly. It was about $275-300 per workup.
The first insurer reimbursed $300. The following year, the line items were billed as $300 for the workup, and the provider tried to tack on another "$25+" for "apheresis". The blood draw.
Insurance included that as part of the $300, so they lined it out and reimbursed +$0.25
$300.25 total. W/o insurance, a private, cash payer, was paying out that extra $25, because that was the bill.
This is the game that goes on between providers and payers. When you come with a checkbook, you literally have zero bargaining power. You pay it, or they'll send collections after you. And if you do not understand the medical codes, you get f****d in the ass.
I had an outpatient procedure done a few years back. Full insurance coverage, reimbursed at about $600. MSRP was $1200, but insurance paid half. Insurance tried to bill me for "anesthesia" for $50 more. I asked the provider about it, and they said they coded it correctly. I looked up the medical codes: they had. Told the insurer it was covered already. Insurer said the provided coded wrong. I gave them the codes and they bailed. They (insurer) literally tried to bilk me, and everyone else they cover, for a bullshit $50, because who's going to bother. This is what I told them over the phone: this is "fraud", and if you want a class action for everyone you cover for taking back this $50 a pop, good luck with paying back millions plus legal fees.
Bill "disappeared". I sent my files and info to the state attorney general.
Haven't had a problem with that insurer since, because they don't want people who call them out and know how to send fraudulent billing info to state AGs.
The system is full of bad-player-middlemen from provider to insurer on up. ACA didn't fix that, but it should be the next step.