Payable costs between providers and insurance companies are tightly negotiated and controlled. Generally, providers bill at one level, but agree to accept negotiated fee settlements that limit out-of-pocket costs to the insured at a much lower level. So you actually pay the costs via higher insurance premiums and not direct provider reimbursement. Our out-of-pocket was about $4,000. That was a 96% reduction for us. Not too bad. However, to cover the shortfall my employer's cost of his employee's medical insurance premiums are insanely high. This limits his ability to expand and hire.
And because insured patients pay so little out-of-pocket—and uninsured patients almost nothing—there is no visibility of the problem. And no incentive, when feasibile, to shop around for lower costs. It's always somebody else's (the insurance company's) money, so why worry? Except that the insurance companies get that money from us.
It's not a ripoff. In the absence of reform, this is how the system has evolved and works. We deny access to millions, thus forcing them into the most expensive levels of emergency care possible, then spread that unneccesary extra expense to those who do have insurance via insurance company premium structures. In other words, we all pay far more than is necessary to get much lower levels of care (stabilization only) than are actually required.
Something has got to change before we bankrupt this entire country.