There are a lot of absurd inefficiencies in the American medical system, from a lot of different causes:
1) InsCon procedures that cause them to question payment for established routine treatments they had previously approved...usually a cyclical behavior
2) InsCon procedures that cause them to send out physical checks for amounts so small- as little as $0.01- it costs the InsCon, bank, postal service, and doctor EACH more to process than the check is worth.
3) InsCon procedures that cause them to pay out frivolous malpractice claims and cap coverage for defending against legitimate claims
4) Lawyers who have mastered the art of the frivolous claim
5) Health care providers' over competition for patients leading to over investment in equipment or physical plant, as well as improper billing practices
6) State-level as opposed to national regulation & licensing of health care professionals and InsCons.
All of these- and more- lead to very real economic costs measurable in dollars spent, man-hours lost, and even more serious negative patient outcomes.