@parados,
I realize that, but the patient should also review the charges. For example, I have demanded a review of charges a couple of different times, and have found the hospitals charging for stuff that was never provided. The insurance company would not have known that, did not know that, but I did because I was the person receiving the medical care.
In one experience of mine many years ago, not only was an ambulance ride charged that never occurred, but various dressings, etc. in the surgery were charged bu were never provided. We sat down with the billing office of the hospital and requested a full accounting of the coded items and services. Interestingly, they were a bit offended at the intital request, but after I told them that an auto mechanic at least will tell you what he did to my car, and since my deductible was high and therefore I would be personally paying for the medical bill, perhaps it is not too much to ask them what they did to me and what the codes on the bill actually were, and the costs. They then became cooperative and apologetic. The end result was a reducion of almost 20% of the bill, or several hundred dollars at that time. From my experience, observation, talking to others, and plus my brother is a doctor, many hospitals have institutionalized overcharging, padding the bill, and have found ways around the contracted costs and agreements with insurance companies. If insurance companies deem something is worth only an amount, but if the hospital finds that it costs them more, they simply add other things to recoup their costs. This is only one example of the countless examples of abuse in the system, I am very sure.
I read one time that there were companies that had as their business to review medical bills to filter out errors and overcharges. I do not know the current status of those businesses. I am sure insurance companies concentrate very hard to hold costs, review costs, limit and throw out some charges, but the fact is still very clear that they do not personally know what the doctors or hospitals provided or performed on patients. Thus, the person that gets hit in the pocket with charges should be able to review, compare, and choose their services and charges. There is no denial that it keeps the system more honest and efficient.
What if we turned over buying our groceries and meals in our own homes to the government, or to insurance companies? What would our meals look like, and what would it cost us. Let your imagination wander. The sky is the limit, but the abuse and waste would probably be monumental.