Even on an HDHP, the discount you get by going through insurance is significant. For a recent bill, my insurance website shows: Total amount billed: $771

Even on an HDHP, the discount you get by going through insurance is significant. For a recent bill, my insurance website shows: Total amount billed: $771 Plan discount: $699 Plan paid: $0 You may owe: $73 Because I haven't hit my deductible yet, the plan didn't pay for anything, but I got their negotiated pricing, so I'm only paying ~9.5% of the "billed rate". > But the expectation is that you “negotiate”, which is one the dumbest things I’ve ever heard of. Why can’t my insurance company do that? If you have insurance, you're not expected to negotiate - the insurance company does that for you. That's the "plan discount" quoted above. You have to negotiate if you don't have insurance. Not defending the system - I think billing is incomprehensible and hard to stay on top of. Just pointing out that you get significant benefits from being insured even if you never hit your deductible.