And the more you dig into it, the worse it gets. That price discrepancy exists at the provider level too.

• You have a health issue and need treatment.
• The treatment cost the Dr $200 to perform.
• The list price for the treatment is $500.
• The big insurer uses the weight of their customer base to negotiate with the Dr and the agree to pay $300 for the treatment. If the doctor doesn’t accept, then they’re out of network and can’t get patients.
• The plucky startup co-op doesn’t have the same negotiating leverage, so they have to pay $400 for the treatment.
• The co-op is going to cost more to operate, and now the real monthly cost you have to pay with the co-op is $700 instead of $600.

And it gets worse.

This video is a nice little primer about how the insurer might not even pay that $300 they agreed to, how that let’s them profit further on the treatment while creating financial pressure on healthcare providers, and how your Dr may end up being owned by the insurer, further reducing the ability of a new co-op to compete.