And if you’re transported to the ER, you might find out that while the hospital takes your insurance, but the ER doesn’t, because it’s a separate legal entity and has its own practice group and billing.

You can then deal with the wonders of getting billing and fighting over coverage that you had no control over because an ambulance took you to the nearest hospital, which you normally consider would have your insurance.

That happens more than you know, and those who are uninsured end up having to pay out of pocket or get hounded by collection agencies. Those with insurance end up somewhat subsidizing all those who don’t, but even there the costs aren’t entirely transparent. Then there’s a whole separate mess over doctors taking Medicare/Medicaid, and their complaints over reimbursements not being enough to cover their costs/charges.

At the same time, you can have hospitals with comparable levels of skill/regard and the costs for care at each are wildly divergent.

You can get a simply appendectomy at one and the cost will be $10k before insurance. At another, it could be $6k. Or 20k. With the same outcomes.

That’s what a lack of transparency also means - people end up paying far more for care when they have the option (they can pick lower cost if they know it exists).

MRI tests have same thing - the machine costs X to purchase, so running tests is simply function of how much to profit and make back what it cost to purchase. And yet, some facilities will charge 2x as much (or more) as others for comparable equipment used in the test.