You know what's all wrong with our whole medical system? Money is meaningless. Really. It means nothing.
For example, I might dispense a prescription for quetiapine, a generic drug that costs me $11 for 30 tablets. I bill the insurance $302. That's because the other options I could bill - like the brand-name drug, which retails for nearly $600 - would cost the insurance company much more. So they are willing to pay me a little extra for this generic. But they don't pay me what I ask for. They pay me a $4 dispensing fee, and $271.80 for the drug, which is 90% of the average wholesale price of the drug. Because they set their own pricing, and if I don't like it, I can just jump off a cliff. I like the $264 profit, though, so I stay on top of the cliff.
Or, I dispense a bottle of insulin that costs me $88 to a patient. I bill the insurance company a reasonable $96. They reimburse me $82.50, because the drug is the wrong brand. They prefer a different brand of insulin that costs $79.50, so they only reimburse me based on that drug, even though I don't have the authority to substitute it for the other brand. I lose money, but I can't do anything about it, because my contract with the insurance company says I can't turn patients away based on reimbursement. I'm considering jumping off the cliff.
Or, you go to the emergency room with a fever. They give you a tylenol, and you go home. You read your (whopping) bill later, and see that you were charged $9 for a tylenol. That's because you weren't paying for the tylenol. You were paying for the boxed lunch the hospital provided a Medicare patient who came in to the emergency room because she was too busy on Friday to go to her scheduled dialysis appointment, and now she's trending toward acute kidney failure. That, and she likes the box lunches that the hospital provides but Medicare doesn't reimburse.
Or, I have an outpatient surgery. The hospital bills my insurance $55, 000.
My insurance company disallows $45,000 of it and, between United Healthcare and I, pay the hospital $10,000.
Was the surgery worth $55,000? Heck no. That's stupid. They didn't give me a platinum implant, geez. Is it reasonable to reimburse just 9% of the bill? No, that's stupid, too! Of course the hospital can't bill the actual cost of the surgery, and the insurance can't just pay them back.
Ludicrous? Yep. Money has absolutely no meaning in the world of medicine.