It's not a middle man, it's that insurance companies only cover so many things, so they bill everything and collect what the insurance company covers. To keep u

It's not a middle man, it's that insurance companies only cover so many things, so they bill everything and collect what the insurance company covers. To keep up the charade uninsured get bills like this, which they then take to some hospital board to get reduced to something 2-3X what an insurance company would pay.