> The provider can bill $5000 for one Advil and there's little that can be done about that.There's no way out of this problem except federal laws that sets the

> The provider can bill $5000 for one Advil and there's little that can be done about that.There's no way out of this problem except federal laws that sets the prices of services. First, no insurer pays $5000 for Ibuprofen, the same way no (sane) customer pays sticker price when buying a car. That number is intended as the starting point for negotiation with the insurer, and they all know that. Secondly, the reason that this negotiation is necessary is, indirectly, because of a federal agency artificially setting the prices of services. Medicare owns 40% of the payer market and also reimburses about 7% less than COGS. That is, not counting for the fact that any practice has overhead and SG&A (labor) that it needs to pay for, Medicare reimburses 7% less than what it costs providers to cover their own direct costs of supplies. Basic accounting tells you that's not sustainable unless you overcharge the rest of your patients. So, they make up for it by doing this awkward dance where they attempt to overcharge the private insurers by 50x or more, and then the private insures come back and say, "no, how about we only pay you 300% what Medicare reimburses", and then they agree on that.