I'm not sure if the PPO (Preferred Provider Option) applies to the whole country or not but it seems to work well around here for Blue Cross/Blue Shield. Basically all the doctors & hospitals have to sign a contract with them to accept their schedule of rates to be charged for all services, they don't have to sign the contract at all, they're just going to lose the bulk of their patients if they don't. So the insurance company says service ABC should cost $100 but the hospital or doctor bill $450 for ABC, the insurance company pays $100 for ABC and I get a bill showing that $100 paid and $350 as "write off", I pay zero.
And people who don't have medical insurance are billed the full $450 and are expected to pay every penny of it out of pocket, with no discount. What a ripoff!
Of course, there are people can't or won't pay any of it at all, so they end up having the entire bill written off.
A few things fall between the cracks, like that silly set of plastic pieces that every patient gets in their hospital room, I gotta pay about $25 for that $2 plastic junk. A few lab tests will cost me a few bucks each time they're run but the insurance picks up the biggest part on them also.
Medical items and educational items are two things that are nearly always
way overpriced. I recall years ago when I used to do field service work, when I would service stuff at hospitals and be astounded at how much they said some of the medical equipment cost. Knowing what was inside the enclosure, I could see no way it could have been worth what they paid, and often the very same equipment, in non-medical applications, would cost a fraction of what it cost to hospitals. Prices are highly inflated because they know the cost of medical equipment will trickle down to the insurance companies and ultimately to the policyholders, and the cost of educational equipment will be passed on to the taxpayers.
Prescription drugs are another story here, my usual drug bill was running me about $15-20 per month, now I'm paying about $150 per month for the same prescriptions, still investigating what the !@#$ is going on there.
You can thank Medicare Part D for that. A friend of mine, a former bus driver, has been on blood pressure, cholesterol and glaucoma medications for years. He retired several years ago because other vision problems he developed disqualified him from driving the bus, so he went on Medicare, before Part D went into effect. He tells me that with Part D, he pays a monthly premium and still has a high deductible before Part D kicks in, in addition to a substantial co-pay for each prescription. But just as soon as Part D was enacted, the prices of his medications immediately took a big jump. So his annual out-of-pocket expenses for medications (co-pay, deductible plus Part D premiums) is now about the same or a little more than what he paid out of his own pocket before the Part D plan was created.