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If you’ve ever seen the initial bills, the first set, for a procedure from a provider to an insurer you’ll realize that the whole process is very complex and bureaucratic. Mine were sent to me for some reason that I didn’t understand and I watched them go from 10’s (multiple 10’s, shockingly high) of thousands of dollars down to the thousands after the process completed. The first bills come through and then they are negotiated in to a form that fits the process.
As far as the medical-industrial-insurance complex don’t forget that the insurers have codes for each procedure that they will readily reimburse. Procedures that do not have a code have to be explained. The surgeon that implanted my mesh had to go before a board, of surgeon-peers if I recall correctly, to explain what he was proposing when I had mesh problems. I had forgotten about that. Actually I can’t remember clearly who exactly had to go before the board it might have been the one that removed the mesh, Dr. Billing. Often I feel like I have PSTD from that time in my life. I could probably find it in my notes but it’s probably not relevant. The approval boards do exist.
My basic point is that the high volume nature of the industry leads to it becoming very bureaucratized. Once bureaucracy takes hold then results matter much less. The process becomes the goal, not the results.