I've done that. Except I didn't know the words "accept assignment". I basically just said that I'd pay whatever they'd charge if I had insurance. So they could either accept that, or let it go to collection. And if they let it go to collection, I argued, they'd probably get less than the insurance price that I'd pay them.

And I got an adjusted bill.

God this a thousand times. How in the /fuck/ have we allowed our medical system to come to this?

I get the negotiation side of things. I get that the leverage insurance companies have is the culprit. But at the end of the day, hospitals just upcharge so they have the upper hand in negotiation. There’s no reason that individuals who choose not to go the insurance route are artificially charge X times what insurance companies are. There’s no excuse.

Charge them the cost of the procedures with whatever markup is reasonable for the hospital to stay in business. It shouldn’t be any other way.

When you remove the middlemen, what will you replace them with?

Tiny bits of software.

What's the purpose of the software?

Replacing the middle men

Middle man out algorithms

Is the software written by people who would not profit from the software?

Could be an open standard

This is quickly degenerating into... an xkcd comic

Middlemen are not indispensable - they need to justify their existence not others to justify their absence. The whole point of cutting out the middlemen is to force them to go from a parasitic role to offer some sort of actual utility for their price.

If the middlemen have something of value to offer they have little to fear - just someone to buy gasoline by the tanker for instance keeps gas station middle-men safe because they provide both a workable connection between logistics of the very large production and consumer scale amounts - in addition to the distribution.