Your general point about the bill being divorced from the reality of what the hospital expects to be paid is true but the idea that this usually involves the co

Your general point about the bill being divorced from the reality of what the hospital expects to be paid is true but the idea that this usually involves the court system is not. In most but not all cases the insurance companies pay less because they have pre-negotiated rates with the hospital and not due to challenging a bill. Even when parts of a bill are challenged by an insurance company the issue is more frequently resolved without involving the courts. I have a chronic condition which requires monthly visits to a doctor. For every visit the doctor bills the insurance company $380 and the testing lab bills $75. For every visit the insurance company reduces the charges paid to $90.60 and $14 which are the rates they have pre-negotiated with the doctor and lab for these particular services. No court or case by case negotiation required.