Late last year I got an annual physical and when my doctor asked me if I was having any problems, I told her that I thought I needed to go back on the machine for my sleep apnea.

When I was diagnosed over a decade ago, my insurance company paid for the machine that one wears while asleep. For the past few years, I’ve been practicing what they call “positional sleeping.” Basically, you sleep on your side and pack a pillow or two on your backside to prevent rolling back over.

When I was in need of a new machine, my insurance company required me to go back to the doctor who had diagnosed me and reconfirm that I still have sleep apnea.

This doctor is apparently popular because the first appointment I could get wasn’t until this month. That’s when I learned that the business office of the doctor I was scheduled to see canceled my appointment.

When I asked why, I was told that they did not accept my insurance carrier. Ironically, my insurance carrier changed at the first of the year, after the appointment was scheduled, and I no longer had insurance with the company the doctor’s office refused to accept.

I asked why I was not offered the opportunity to pay for the expenses out-of-pocket and was told they assumed if they didn’t accept my insurance carrier, I wouldn’t pay.

I’ve elected to see another doctor for my condition, one who has a business office that doesn’t make assumptions about a patient’s decisions regarding payment of care.

A couple of years ago I had to have my gallbladder removed. What amazed me about the statements I received for my surgery were the costs associated with the procedure and the negotiated rates the insurance company paid and the hospital agreed to accept.

For most medical services short of catastrophic care, the negotiated costs would cost a patient less than the insurance premium.

This phenomenon of medical care vs. medical costs is at the root of the problem with healthcare today.

Harold Miller, president and CEO of the Center for Healthcare Quality and Payment Reform, recently said that the reason rural hospitals are closing by the droves is primarily “because of low payments and claims denials by commercial insurance and Medicare Advantage plans.” Secondly, he said it was because of losses on uninsured patients.

While advocates spend most of their time attempting to reduce the number of uninsured, Miller says they should be focusing on requiring health insurance companies to pay something closer to what the hospital charges.

I’m not so sure about that.

Mary Daniel is a board-certified patient advocate who founded ClaimMedic in 2016 for the purpose of helping patients understand and manage overwhelming medical bills.

Daniel’s company says that in our healthcare system, typically the people responsible for billing never actually talk to the people who create the medical records. Both use an incredible complex coding system and have an incentive to bill the most amount of money possible.

Because of this, a procedure like gallbladder surgery will likely result in out-of-network bills because most hospitals, particularly the ones in rural areas, outsource many of their services (such as laboratory testing). So even if you go to an in-network facility, you get billed for outsourced services at much higher rates.

Then there are increased charges incurred due to intentional abuse in billing that the government projects results in $770 million worth of errors every year.

ABC News has reported that insurance company auditors have found that 90% of hospital bills contain errors, and an Equifax audit found that hospital bills that total more than $10,000 contain an average of $1,300 in incorrect charges.

Whatever the solution is, it must be applied equally at both ends. While a for-profit facility providing medical care has an incentive to make as much money as it can, the insurance company has an incentive for paying the least that it can.

Meanwhile, this system that we trust with our lives is providing its own self-care at our expense, and the suffering is chronic.