Edits because more specificity was required:

I’ll take every opportunity to say it, I once had an IV medication that cost $1500 per vial and the doctor’s office negotiated the price with my insurance at $90,000 per vial. (This was out of network so I was charged by the doctors office, then I received a reimbursement check from insurance. Insurance agreed to pay the full price for the medication, treatment was a separate cost which was covered at the usual rate). I was concerned I’d be left with the difference when the insurance company found out (ie realized they made a mistake or something) so I called them and asked them about it and they told me that the doctor could literally charge any number he wanted *and they’d pay it as long as they had preapproved that contracted price. There were no rules or boundaries though to how much they were charging over the list price. (I thought the doctors office was just putting the service charge in with the medication but was assured multiple times by both insurance and doctor that this was purely for the medication. I have recorded calls and written documentation from both insurance and doctor side confirming all of this. Furthermore this was a new medication and the patients were all talking about it together. Everyone had the same experience with the price of the medication).

My opinion: That doctor just got disgustingly wealthy giving this medication to patients. And this also meant that he was deeply incentivized to tell patients they needed it when they might not.

The Insurance system is a complete scam in ways that I never would have imagined.

*ETA the part where the insurance company said they’d cover whatever the charge was because they’d approved the treatment.

Edit 2: i wonder what benefit i would get for making this up lol. Ah Reddit. Anyway, the doctors office was a private practice and they contracted this price with insurance. My question to the insurance company was how they were allowed to charge that much extra. Their answer to that was simply that they could name any price they wanted and make an agreement with the insurer. The only reason I cared was that the doctor was out of network meaning the insurance company sent me the checks in my name and I had to sign those checks over to the doctor in his name.

No, it wasn’t some fake insurance company, it was one of the major three in the US, and no the doctor was not just some random quack. He was very respected in the industry. This is a major US city.

I’d love to hear what someone who’s worked in insurance thinks happened if they can accept these facts. Because I thought it was fraudulent enough to have the insurance company investigate beforehand.