Ethically, the provider should charge everyone the same for a given service. The private-practice doctor in my hometown always did just that. There was a government-funded clinic in the same town that charged a 'sliding fee' - those with the ability to pay payed more than those who didn't. That included, presumably, the insurance companies. However, the government was supposed to reimburse them for the cost of treating the poor, with the result that the overall cost of treatment was supposed to have been the same. Word is that that didn't happen correctly, and the government and insurance paid more than the paying customers. But this was in the bad old days before Medicare, Medicade, and insurance payments went under the microscope. Supposedly, the fees are set and charged in accordance with a set standard. However, since HIPPA forbids most of us from seeing the bills of others, I have no way of knowing if this fairness was ever achieved or maintained.
Having said that the bill should be the same, however, I do not oppose the concept of discounting services to insurance companies - specifically because the risk of non-pay is greatly reduced when dealing with insurance companies. If the average cash-paying customer pays only 60% of his bill, it is understandable that providers will raise their rates so that they make a profit at that payment percentage. On the the other hand, if insurance companies default only 15% of the time, they should be rewarded for their dilligence in paying.
I know of people with good insurance who nevertheless owe great deals of money to their health-care providers, simply because they refuse to pay their co-payments and deductibles. It hardly seems fair to overbill the insurance to cover the costs to these dead-beats, since the insurance has met its part of the obligation. The providers can pursue payment from the dead-beats through collection agencies, garnishments, etc., but there is a cost to that as well, which must also be made up.
I'm not saying it's a fair system, but I'm saying it is as fair a system as can be devised under the circumstances. In an ideal world, the non-pays would be forced to pay both the amounts owed and the costs associated with obtaining the amount owed, but we know that ain't gonna happen. So, they structure the system in a way that is least offensive to their best paying customers (the insurance companies), and meets the legal test of their fall-back source (the government). The cash customer is lowest on the totem pole, so that's who gets stuck with the excess. After all, the cash customer has no bargaining union or collective to negotiate for him. It's one man against the system, and they can shut the door in his face if they don't want to deal. The insurance and the government have all the bargaining power, and they aren't afraid to use it.
Quod scripsi, scripsi.