Well, the hope is your plan would cover what is required to treat a given condition. I.e. if you have a simple broken bone, you get the cheap x-ray. If you have a complex fracture that requires fine resolution, they cover the brand new fancy x-ray. The problem right now is: Your doctor prescribes the fancy x-ray as a catch-all, for everything that requires an x-ray. The insurance company then gets billed for "x-ray", which the doctor said was necessary. There is no incentive pressure for you to choose the cheap one, because you're not paying. The doctor doesn't care because they're not paying. And the insurance company gets screwed - but they're a business, so what do they do? Raise rates for everyone, and pass it on down the line.
Someone commented but was downvoted (apparently because they work for an insurance company?), and they deleted their comment. I think it's informative enough to quote here for history:
> Actually, in many cases, we slap an authorization requirement on the fancy imagining or deny the claim for a lack of medical necessity. (Source: I work for an insurance company)
You want to improve healthcare? Fix drug prices, fix the adversarial model between insurers and providers and do whatever you have to to get patients more facetime with clinicians. Connect and coordinate care - especially post discharge. Worry about things outside of medicine like food or social isolation or financial health.
I think that's true when they can tell the difference. But a lot of times, the doctor is just "go get an MRI, and hey, why don't you go to the place in our building". The price will be 3x higher than the place down the street, but the patient doesn't know that or care. Now, some insurers do indeed have strict in-network requirements, where they approve each place and how it provides care, and that can be a reasonable solution to this problem, but patients hate it, so many of them don't do it, and instead absorb this cost.
> You want to improve healthcare? Fix drug prices, fix the adversarial model between insurers and providers
What does 'fix drug prices' mean though? And why would 'fixing the adversarial model between insurers and providers' help things? In every other setting, adversarial models push costs down. These seem more like aspirations than solutions.
