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What failure modes can you foresee if insurers start paying their patients for choosing cheaper healthcare services?
Right now, patients want the best service their insurance plan covers, which causes hospitals to come up with more and more expensive services that are only marginally better. Insurance companies have no real incentive to drive prices down either, as they are legally obligated to spend their money anyway, and the more people pay them, the larger is the absolute share they are allowed to keep.
But what if the insurer could offer you two hospitals, both covered by your plan, and by opting for the cheaper one, you would get the bulk of the difference in cash, with the insurer pocketing the remainder as rightfully owned profit not subject to the 15% rule? Theoretically, it would cause hospital networks to manage costs more aggressively, as cheaper service would now be a real competitive advantage. "Do you want a $30k C-section, or a $20k C-section and $9k in cash?"
How much can I make in a year of substandard (or sub-excellent) healthcare? How hard is it to think up a reason to get more care and therefore more cash?
Currently, the patients bear some cost for seeking healthcare: even if their out-of-pocket expenses are zero, they still have to invest time, effort, and discomfort. Under your idea, seeking care becomes profitable. Probably more profitable than working at a job for some people.
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