My wife got an allergy test at a local allergy clinic, but she had 20% coinsurance so we tried to figure out how much it would cost. Everyone there treated us like garbage. Even when we called the billing department in advance they told us there was no way to know in advance how much the basic allergy test would cost until she saw the doctor. So we went to the clinic (stupidly), and the nurses just acted like we were crazy. Finally one did tell us what the bill would be:$12k. I had researched these tests online and was floored; that’s way more expensive than it should be, and the doctor who gave her a referral had told us it would be a reasonable price. So we were in the awkward position of just leaving the appointment. The doctor then basically talked to us somberly like we were the poorest people on earth, and said “listen, most of the test is for allergens that don’t exist in northern California.” If I just give u the local ones it’ll be like $1800.” I started laughing. Later on I read an NPR story about a lady who had a$48k allergy test from there. Just a complete scam, much worse than a car dealer because at least there they will tell you a price and they will not sell you ten extra useless cars evenif you don’t explicitly say “don’t give me ten superfluous cars for no reason.” Anyway, we got the limited test, and at the end the doctor said “listen I’m not supposed to do this, but given the financial hardship I’ll make an exception. If I don’t put the results in the system you’ll only be charged for the visit.” And he just wrote the results on a yellow notepad paper and tore it out for us.
Tldr we were treated like annoying busybodies for asking the price at an in-network facility, and then treated like indigents when we balked at paying way more than anywhere else charges, for totally bs procedures.
I assume you mean by "provider" humans like doctors, nurses, aides etc.
Drug and device prices are essentially not regulated. Medicare/Medicaid pays a fixed percentage of the price set by the company -- but that price is indeed set by the company!
(I used to work in pharma and this dynamic was an important part of our pricing plans)
If you ever need a drug with an enormous copay (say, $2000/month) you can often contact the manufacturer and get most of that copay rebated. WTF? Well the manufacturer wants a high list price for the drug so that they get paid a lot by insurance companies and MC/MC. Paying your copay means you won't object to the prescription, the rest of which (which is much larger than the copay) is paid by third parties.
Put another way - the government gets a 33% discount compared to private insurers.
If the argument is that medicare prices are unreasonably low, that seems like a different issue.
And this is for emergency rooms where typically you don't have a choice.