Hospitals and insurance companies are co-dependent. In my experience, hospitals price everything high so that they have more room when they negotiate with the various insurance companies. No one is meant to pay these prices.

Hospital billing is also pretty awful. I've seen them place every possible reimbursable item on every bill, full well knowing that some insurance companies would cover some items and others different things. This resulted in inflated bills that were never paid in full regardless of a person's insurance coverage.

Many hospitals will negotiate with the uninsured but it's rare for them to make this easy to do.

This article is pretty weak, but the best I could find on this relatively arcane subject:

http://truecostofhealthcare.net/hospitalization/

There have been plenty of reports showing something even worse - that pricing usually has no basis in reality, and you can have a 1,000% price difference by going to a hospital across the city.

Most hospitals can't even quote you a price. We were researching a procedure our insurance doesn't cover. One non hospital place quoted $750 cash price within 20 minutes on the phone. We called a nearby hospital and after over 10 hours on the phone spread over a week, and claiming that we don't have insurance (because their policy is you MUST use insurance even if they don't cover it), they quoted us $350 cash price.

We chose the hospital, and when we got there they said that price didn't actually include everything. WTF? It's a frigging mess.

It's true, I can't argue with you. There are people at the hospital (or their parent organization) that know actual dollar amounts and then argue them with insurance companies. Outside of that person it's pretty hard to get any numbers, let alone numbers you should feel confident about.

I am a software developer, I worked for a mid-sized community hospital. "It's a frigging mess" is a reasonable summary and also heart-breakingly accurate.

This is one area in which the ACA is making progress: providing an incentive to the hospital to know what a particular procedure actually costs. Your example, while disappointing and frustrating, was extremely rare in the 90's. High deductible insurance has given every customer a reason to shop for the hospital with the most reasonable rates. I can't say if that incentive is strong enough, but I believe it is progress.

It's an unfortunate feedback cycle. Medical providers charge high numbers because they know insurance companies will only pay out a percentage of the billed amount.