> But it is the way things work Sure, it's the way things are done. What I'm questioning is why it should even be expected to "work", apart from people's seemi

> But it is the way things work Sure, it's the way things are done. What I'm questioning is why it should even be expected to "work", apart from people's seemingly misguided sense that what essentially amounts to a request for a tip is somehow a binding debt they're obligated to pay. What you've described is the exact same set up as a waiter at a restaurant. And yet despite waiters often handling identifying information, nobody gets a post-hoc bill in mail asking for arbitrary table service fees. And if some waiter did try this hustle, the recipient would likely roll their eyes and toss it in the bin. > Your deductible is not payable to the insurance company; they require the billing entity to collect it themselves Sure. I wouldn't call this backwards - rather inconvenient but still legally sound. The provider enters into a contract with the "insurance" company that requires this. The customer enters into a contract with the provider by requesting and using their service, so the provider can bill the customer. What you (and most of the industry) are somehow claiming is that even though the patient already has a business arrangement with the hospital for treatment, that the hospital calling in a subcontractor means that subcontractor is somehow entitled to bill the patient directly despite having no business relationship.