“Last year I went through three days of tests at one of the hospitals in Philly; all was covered by my insurance, but I didn’t get the bill. I did have access to the insurance co.’s online system through my employer, and pulled the records showing procedure/amount billed/amount paid. I noticed that there were about 25% of the line-items that were denied, due to Not Applicable, or as Included in Other Payouts. Of the balance, any MD or other qualified medical individual’s bill was cut to 55% or less; Drugs and Durable Medical Equipment charges were cut to 35% or less. My insurance paid out less than $14K on the original $40+K bill.”
Your description is typical of many people that I know. It’s a game, or at least it looks like that from where I’m at.
Oh, it's turned into a game, alright.
Noticed the others comments above; one thing I recall is back when I was a kid and had appendicitis and we had no insurance, was that while costs were lower, they weren't as egregious as they seem today. You went to the Doc's office and paid his bill -- $15 or $20 plus $3-5 for the shots or pills. The insurances were for catastrophic care, hospitalisation and surgical care. Any radiology/pharmacy/etc. was billed under the hospital charges, instead of multiple bills from a dozen different entities.
Of course, back then we didn't have the feds mandating coverages the way they do now; I believe that Medicare/Medicaid is the driving force to the over-pricing and over-billing across the board. No; I don't have an answer as to how to fix it.