> You get $FOO as the code and $BAR as the cost. That lets the market discover, over time, which providers are charging $BAR+$EXTRA, which insurances only cover

> You get $FOO as the code and $BAR as the cost. That lets the market discover, over time, which providers are charging $BAR+$EXTRA, which insurances only cover $BAR-$uncovered. The problem with this view is that it assumes providers have relatively few SKUs and relatively static pricing, and that providers are relatively static over time. In reality: - medical providers have an incredibly long list of SKUs, which can have adjustments (e.g. quantity). - pricing changes frequently - staff changes frequently. A bill is typically not a provider charging $BAR+$EXTRA, it's more like provider A working at facility B on procedure C has Price 1, but that same provider working at facility D on the same procedure has a different price. And all the prices are affected by the patient's insurance, and the specific contracts that were in place between the provider, the facility, and other parties at the time of service. (I'm simplifying this, in reality pricing is more complex). It's entirely possible for Provider A to be the cheapest option in town (for a given patient-insurance combination) when a procedure is done at Facility 1, where they work Monday-Wednesday but the most expensive in town for that same patient when a procedure is done at Facility 2, where they work Thursday & Friday. This relationship can change frequently. Worse, this relationship can be subject to the specific service codes that end up being performed (all of these may not be knowable before the service begins). I want to especially highlight the "over time" aspect as it assumes the relationships between any of these items are relatively static. In truth, it's entirely possible that your insurance carrier has a great deal for a given service this year, but next year has a terrible deal for that service at the same facility (possible because one of the underlying providers has changed). Second, it highlights the opacity in all of this. Even if you had the ability to digest all of the raw data, it's likely the outcome would not be very predictive at all for a given individual who needs to make a purchase today. > If you have a better proposal for determining what the market will bear, lets hear it. The market needs a lot more regulation. Think more like electric utilities instead of software.