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And I don't understand this statement: "If the reimbursement rate was too low then we would not contract with the insurance co. In that case we took the reimbursement paid and charged the patient the difference."

If the reimbursement rate was too low you took the money anyway. From the insurance company, I assume. Thus you contracted with the insurance company. Then you charged the patient the difference. So you got all your money no matter what.

Where are the rules that say what percentage of a medical procedure an insurance company can consider reasonable to pay? What if an insurance company decides that what they're willing to pay for a $4,000 procedure is only $500? So the patient is stuck with a $3500 out of pocket.

Again, the ACA was written by the insurance companies. Just as in a casino, the house doesn't lose, ultimately, even though some individuals make out quite well. The profit-driven insurance companies, likewise.

But this will all come out in the wash, notwithstanding any disagreements on this board. Wait until a lot of claims start coming in and the stories get posted somewhere.