I'm in the industry and just because your bill is $40,000 doesn't mean the insurance gets that much money. They hospital increases the prices for everything with hopes they will get more back. They usually get about 30% of what they bill the insurance. That's how come when we pay out of pocket it's only $15,000. It's so confusing I don't thinik anybody understands it. Just know that the hospital isn't making $40,000 for one surgery.