It's the healthcare industrial complex. Just like the military. You get back some percentage of what you charge. They're incentivized to charge more because they'll get more, and sometimes it's an all-or-nothing.

I have doctor friends who quote they spend over 60% of their time dealing with insurance and it's intricacies. It's the fault of the system, with large foundations on insurance and perverse government policy to enrich the leaders therein, and the providers are simply making do with the system they must operate in.

I'll never forget the story I heard about a military squadron that needed like one bolt to fix a relatively important piece of equipment, and it cost like $10 itself.

But the only way they could get it was through a package deal of a million dollars of other insane amounts of equipment that was entirely superfluous and they ended up getting shitloads too many guns and threw away thousands of hardware bits just to get that one screw.

Similar systems at play here.