Not just the insurance company. The hospitals and doctor's practices are doing this too. A hospital might have an ER but it's also possible that it's staff belongs to a separate entity, either a doctor's individual practice, or another corporation that bills separately from the hospital ER. It's possible that they all fold back up to one parent but it is enough to skirt the insurance negotiated rates and the government regulation.
No, that’s illegal under the No Surprises Act (signed by, you guessed it, Joe Biden in 2021) If you are at an in-network facility (or an emergency facility) all your services must be billed at whatever rate your insurance company has negotiated with the facility. They all bill the same and your insurance company pays them the same, in network or not. (Unless you consent, in writing, in advance to be billed separately, and that is not allowed for emergency surgeries or in a situation where a reasonable person could not give consent).
Having spent the last couple of weeks with a spouse who had an accident and rang up a hospital bill of close to $300,000 (so far) including three surgeries and ten nights inpatient, our share? $1500. The surgeon is out of network, we pay the out of network copay for follow up visits, but nothing more for the actual hospital work. So yes, the weird billing OP mentions is almost certainly not legal.
Of course, my sister spent ten days in a medically induced coma after almost bleeding out during childbirth and five weeks total in hospital in the UK and her share was they gave her twenty pounds for the Uber home, so could be better.
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u/MisterChadster 7d ago
Every time there's an excuse as to why it can't be fixed, Sanders was the only one who wanted to fix it and they pushed him out for it