The payment system is so screwed up that it's not even understandable. The one thing that is absolute is that for services provided to the patient no matter of their insurance or ability to pay is the same for all! That is the law. If you have 3 patients who all have the same surgery, and they all use the same exact care, same exact drugs, day of hospital care, same exact minutes in the OR and recovery etc, the bills would be identical (does that ever happen NO because every case is different in nearly every aspect).
What is so painfully different is the payment of that bill. Insurance companies contractually control every penny of that. This includes Medicare and Medicaid. The amount paid by each insurer is contractually way less than charged, with only a few very rare exceptions can the hospital balance bill the patient any more than the deductible. Those who are "cash patients" will pay the whole bill but often the hospital will negotiate a less payment, but the settlement can never be less than what Medicare allows and that's the law. Any balance the hospital or provider is due they have to make a good faith effort to collect, that's the law no matter if it costs them more to collect it than the outstanding bill.
