This issue is so severe that insurance companies are now paying you to get the surgery done in Mexico by an American surgeon who they fly down for the day.

Flying and paying a surgeon (more than he/she would get in network), flying you down, paying for your hotel/rooms, the same knee replacement device, etc. AND giving you $5,000 is still cheaper than what your negotiated insurance would pay for a knee replacement.

If that doesn't indicate there's an issue, I don't know what will.

https://www.nytimes.com/2019/08/09/business/medical-tourism-mexico.html