[seandougall]

> Now if you walk in with no referral

You mean like, say, an ER visit?

Though, actually, the one time I've been referred to the ER by a doctor (he called ahead and everything), the billing was still a shitshow. Insurance delayed paying for months while they tried to work out a way to claim it was a pre-existing condition (this was pre-Obamacare), until the hospital gave up and tried to send me directly to collections for upwards of a quarter million dollars.

Given that most private practices (around here, anyway) usually have lucrative hospital affiliations, the incentive to keep doctors happy by keeping patients happy really doesn't exist.