There is also a perverse incentive here. Per https://www.healthcare.gov/health-care-law-protections/rate-review/ https://www.healthcare.gov/health-care-law-pro

There is also a perverse incentive here. Per https://www.healthcare.gov/health-care-law-protections/rate-review/ https://www.healthcare.gov/health-care-law-protections/rate-... you can verify that insurers are required to spend a fixed fraction (80-85% depending on the size of the group insured) on premiums. With their own costs, profits, etc taken out of the remaining. Which means that the more they pay, the more profit they can potentially make. Therefore it is in the interests of insurance companies that hospitals be expensive but predictable. A hospital with high premiums that can be negotiated down after the fact at need is both. (Better yet is to have a pool of catchable fraud. You look as hard as you need to to get your numbers where you want them.)