re: What’s the point of medical insurance?

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Where did you get this total cost from? Is it the same if Medicare paid it? Is it the same if a different insurer paid it? Is it the same if you'd have cash in hand

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Yes, it’s the same, thanks to government.

Not all of this is directed at you.

I’ve made it through 3 pages, haven’t seen someone medical explain insurance and costs yet, so here goes.

It is illegal for an entity to bill differently to private insurance vs government. Has to be the same, otherwise fraud.

Who controls cost: government. Medicare sets what they will pay for each procedure/visit/etc. All private insurers and Medicaid base their payment on a percentage of what Medicare sets.

Hospitals and doctors could charge you $1,000,000 for anything, but what they get paid by insurers is what the contract says. For instance, I take out your appendix, i charge $4000? Insurance says nah, we’ll pay $1000 based on my contract with them. The patient is on the hook for whatever percentage of that $1000, not the $4000. Billed Vs allowed.

So, providers base their charges on a percentage above Medicaid.

Why no one can tell you how much anything costs? There are 6+ major insurers plus many small ones. Within each of those are 6+ options to chose from, and within each of those are levels. The contract for each is different. So there may be 100 different variations, and the only one that knows the true cost is the insurance company. And the people that do the pre-certifications are not connected to billing, so are clueless to what it costs.

Why is it cheaper to get a cash price? It isn’t. Going back to billed Vs allowed, for the appendix, I’ll charge you $4000 (because I can’t charge anyone differently) but tell you I’ll drop the bill to $1000 because that’s the average that I get from insurance. If you can’t pay in full but want to, I’ll set up a payment plan.