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Sure but imagine you hire a landscaper and they send you a $40 invoice for $20 of law cutting and $20 of leaf cleanup. You go look outside and see a ton of leafs so you just send them $20.

That's the insurance companies' stance. The work you performed is this and so our agreed upon rate is this.

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But in reality, the landscaper bills you for $100, you say you’re only going to pay $90, and then you write them a check for $31.50.

(That’s because you’re a major, well-known insurer and pay an industry high 35%. The guy who mows the Medicare yard might pay 40 cents on the dollar. The person mowing the Medicaid yard has to file 87 forms to get paid his $6.)

Source: I’ve co-owned doctors offices.

but the landscaper has a photo of the clean yard after they finished. They send it to you but you ( as the insurance company) say they need to call a specific time and speak to your 12y/o who is the yard representative of the house.

The 12 y/o say ‘no you stink’ and hangs up. Then you send the landscaper a letter saying ‘sorry your peer to peer was denied’

( I know this is exaggerating a bit and made to sound funny but it mostly works like that in healthcare )

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