The doctor has no clue how the nurse (or assistant that handles billing) will bill the interaction, as they'll often optimize billings to extract the most money

The doctor has no clue how the nurse (or assistant that handles billing) will bill the interaction, as they'll often optimize billings to extract the most money possible from your insurer. Its scummy and fraudulent, but issuing a large bill to an insurer, then getting a much smaller check back is how medical billing works here in the USA. Having your insurance pay for a trip to the ER after a car accident would be $7k for them, or $84k for your car insurance, hence why one should carry a car insurance policy with good driver/passenger injury coverage :P