They bill you after the fact, after they know what they did and what insurance paid for. At that point it is easy. But before the operation, nobody knows what they will find or what insurance will decide.

Your example is extraordinary and could be specifically excluded.

On what evidence do you conclude that it is extraordinary?

All evidence that I have, including my conversation last night with a retired head nurse, is that confusion and uncertainty about what will be covered by insurance and what negotiated limits there might be on what can be charged are more the rule than the exception. And if my impression is correct, then what you want is impossible. Because before the fact, nobody really knows.

I went for a routine visit, and paid the $30 copay before the visit.

After the visit, I get a bill for Ridiculous_Number_X - Ridiculous_Number_Y = $30.

The "actual cost" of the visit and the "negotiated discount" are numbers that are obviously pulled out of someone's ass because they magically align so that I have to pay $30.

And since everything was handled by Kaiser, how the hell could they not know before my visit that they would want $30 extra and just charge me $60 beforehand and be done with it?

I'd imagine the reasons for the complexity are the same as an injury.

Edit: Just a thought...

What if enough consumers went line-by-line AFTER the fact and shared what the specific breakdown of every item cost? So then you'd be able to say, okay, at this hospital them giving us an Advil cost $X and them doing this procedure cost $Y.

Some way of making the master price list for how much individual items cost public and grouping together ones that generally appear together...

Crowdsourcing it would make it significantly more transparent, but the problem (to me, at least) is more that submitting that information somewhere is more of a privacy/HIPAA thing than most consumers and companies are willing to handle.

I could definitely envision a government system, like medicare, would hire people to do this, and make the prices more transparent to consumers, but this is the same medicare whose part D cannot negotiate drug prices due to lobbying efforts.

We could call that...oh wait. Nevermind.

Complications and hospital related infections are not extraordinary. For most of the history of healthcare they were the norm.

To me, the actual problem seems to be that they would like to make up the price after the fact, when they have a better idea how much they can charge and get away with. This gives them the unfair advantage of setting their own prices unchecked by market forces, and is frankly a reprehensible business practice.