Seems like the $50k "bill" might just be sneaky way to get the patient to fork over the 1.5k instead of the 300.
All the rest is a hand-wavy misdirection. Is it even possible to know if, after all the shells stop moving, the insurance company really "paid" anything like they said they did? Or was the real cost of service the 1500 and everything else just expensive theater funded by the insurance "premium"?
Health insurance companies in the US are legally obligated to[1]:
1. Spend 80-85% of premiums on medical spending (with a loophole that "quality improvement" initiatives count). That leaves 15-20% for overhead and profit.
2. Rebate you any excess they collect if they don't meet that medical spending requirement[2].
3. Justify large rate increases.
The insurance company really does pay those costs, rather than playing theater. They have absolutely no incentive whatsoever to limit inflated passthrough costs, and every incentive to justify as high of passthrough to providers as possible. Any attempt at cost control above the bare minimum will result in cannibalizing their own profit potential, because they're not allowed to keep that improvement. And the more inflated the passthrough costs, the more they can justify large rate increases (which then increases the absolute size of the 20% they're allowed for non-medical spending).
But wait. Only their health insurance arm is subject to such profit capping. Now that "market rate" for various intermediate services has been established at such an excessive level within the environment of payers having no incentive to reign in costs, they can gobble up some of those middlemen and reap the benefit of those crazy profit margins. Because their insurance arm is complying with their 20% overhead mandate, but their newly acquired PBM has no such mandate on profit[3]. That way the profit transfer from one internal entity with a statutory profit limit to another without one is seen as kosher and not a run-around.
So it is theater, in a sense. But it only works because it didn't start out as theater. They had to truly passthrough costs and get acceptable and normal market rates established, then start gobbling up the intermediaries in the value chain that they fattened up. If they hadn't done that, it would have looked like self-dealing from the outset and never would have been successful. Whereas now they're able to hand-wave it through regulatory approval with vague promises of efficiencies.
[2] Individual plans rebate to the individual. Group/Employer plans rebate to the employer, and don't have to pass it through to the employee if they can think of a way to "apply the rebate in a way that benefits employees".
All the rest is a hand-wavy misdirection. Is it even possible to know if, after all the shells stop moving, the insurance company really "paid" anything like they said they did? Or was the real cost of service the 1500 and everything else just expensive theater funded by the insurance "premium"?