This is true. My wife paid out of pocket for a procedure that should have been covered, and when she finally made it through the labyrinthine process to seek reimbursement, they only wanted to reimburse her for half of the cost, because that's the negotiated price the provider would have paid the hospital.

In case you were still a bit unsure if the entire American health care system is irreparably broken or not.

My billing statements always include the insurance portion and the patient portion. Could be a Michigan law. The bills also include the billed price and the covered price (so the portion that they 'negotiate' is also on there).

It would be big news if the amounts they said they paid weren't actual payments.

As someone else has already pointed out, ACA imposes an 80% medical loss ratio on insurers. That means 80% of premiums have to go towards medical expenses.

Insurance is a financial product, and there will be winners and losers. I pay my auto insurance bill on time and without a complaint even though I haven’t had an accident in 20+ years.

Few people incur north of their 10k deductible in medical fees a year, but nearly everyone pays for something every year out of pocket.