Choosing a healthcare provider is difficult in the best of times. Understanding the complexities of the healthcare system is challenging, and providers take advantage of that confusion more often than not. A recent story from N.C. highlights the dangers of our fragmented healthcare system, and the complications that plague the beleaguered victims of a process designed by committee.

How health insurance works

The premise behind health insurance is deceptively simple: your insurer agrees to pay a healthcare provider a certain percentage or amount of the costs associated with a procedure. For example: let’s say that the hospital charges $100 to put a cast on a broken leg. Your insurance company says that it will not pay more than $75 for a cast, and the hospital agrees that it will accept $75 instead of $100.

Then, your insurance company tells you that it will only pay for 67% of the cost (in this case, $50) for the cast, and the remaining 33% (in this case, $25) will be your responsibility. You agree, the contract is signed, and when the bill comes, the insurance company pays $50 and you pay $25. And that other $25 dollars that the hospital wanted to charge for the cast? Well, no one pays that at all; it’s just the cost of doing business with insurance companies.

Hospitals bill patients for care, but individual providers bill separately. Just because a care provider treats you in a hospital doesn’t mean that he or she is employed by that facility; some staff run their own practice, and independent medical staffing companies that contract with hospitals and other healthcare facilities employ others. For this reason, it is possible to go to an in-network healthcare facility and be treated by an out-of-network doctor.

But there’s a snag. The root of the problem lies with the complexity of large healthcare providers. Yarnell Beatty, vice president of advocacy and general counsel of the Tennessee Medical Association, told the Tennessean, “You’re never going to get a 100 percent guarantee