I've been a provider, worked for an insurance company and paid out of pocket for healthcare. Insurance companies negotiate a rate with providers - a provider will say, "We charge 'x' for a procedure" and will say to an insurance company, "We'll accept 'x' - $150." But if you approach the provider without insurance, they will charge you "x." And if you're an insurance company, you try to present as many hurdles as possible before you issue payment. That's because insurance companies put premium payments into short-term investments. It benefits the insurance company to hold onto that money as long as possible to make money on it. As evidence of that, consider the fact that in the US, we pay more for healthcare bureaucracy than any other country in the world. Snafus, billing problems, medical code problems, etc., etc., all benefit insurance companies.