A 20+ times difference? how can they justify it It's not right, but I know how they justify it. Health insurers negotiate a "discount" rate, that doctors tole

A 20+ times difference? how can they justify it It's not right, but I know how they justify it. Health insurers negotiate a "discount" rate, that doctors tolerate for two reasons. The first is that the insurer will actually pay. The second is that, since insurers direct patients, they have leverage. One might call it extortion, in that the physician either needs to accept the insurer's rates, or end up "out of network" and get no patients from that insurer. Uninsured patients have no leverage, and the vast majority of them never pay their medical bills, so the people who do pay get marked up severely.