I need some help figuring out this question and I'd be grateful for any assistance.
In my state (MD), like 95% of the health insurance is provided by only two companies. The inscos have payment agreements with the doctors and other suppliers. In most instances - as I found out - you can't see a doctor without having insurance and your treatment plan is controlled by your insco, not your doctor. When is a market considered closed?
This is the background for why I want to know. After a long period of time with no insurance (and thankfully no issues) I got insurance a couple years ago and then needed a test this year. When I got an explanation of benefit form, it said that the test, normally priced at $775 was marked down to $194 since it was actually sold to the insurance carrier.
The ethics of this really bothered me so I wrote my state reps about whether that was actually legal - that the person with the least ability to pay had to actually pay 4 times the amount that the insco paid. The rep forwarded it to the attorney general who said that it was an open market and they could do whatever they wanted.
I want to reply back to both the ag and my rep with the lack of an open market argument - if its reasonable - and the ol' micro and macro economics from 20 years ago just isn't enough. I don't think its open - not when there are actually only 2 payers (perhaps 3 including the state) who each have pricing agreements. I could just be an idiot, tho(sigh), wouldn't be the first time.