Yes. Prior to insurance. Insurance is the reason prices aren't transparent; insurance companies demanded discounts, so providers raised their prices to then say "you're saving X from list". But not every company had the same bargaining power, and individuals had none, so the actual desirable price to offer couldn't be made broadly available. With a hidden price (so no shopping around), that is discounted at wildly different rates (so no meaningful way for third parties to track it), and a necessary service (so no just avoiding it), in a private for profit industry, of course it skyrockets.

Our options are either to mandate publicly available price lists that are adhered to and hope the market pushes things downwards, mandate prices, or socialize insurance (so that the sole representative of everyone can negotiate the price downwards using the leverage of the provider risking losing most if not all their clients). Or, you know, keep doing what we're doing which is working so well (/sarcasm).

It’s always astonishing how I can get a fully itemized vet bill right after a visit and pay for it. Meanwhile going to the hospital is like “well gee, let’s submit to insurance, see what they’ll pay, we’ll readjust prices and then come back to you in a few months.”

Months after my last real procedure in a hospital, even after the insurance was settled, I could not get them to tell me how much money I owed them. Even when I went in person and told them "I want to pay you all of the money right now" they just shrugged their shoulders and told me they didn't know how much I owed them.

They just sent me a bunch of small bills in the mail one at a time and had a text field online where I could blindly pay them without indicating whether or not I had completed my payments.

Makes you wonder how this works for them. How do they know if they are in the black or the red if they can’t tell who owes what?

Fucking beats me (although this particular hospital seems to be very disorganized). I will never understand why anyone would make it difficult for me to give them money.

Yep. Seems ripe for fraud too.

I ended up getting sent to collections for $40-50 for missing one of the bills. Never in my life have I not wanted to pay a bill, but god forbid any large organization just take my money and leave me alone.

More than that, I can get an estimate upfront, that in 100% of cases matches the bill unless they find something additional they need to do, which they'll inform me of and create a new total estimate for.

Of note, my vet insurance doesn't negotiate on my behalf; they just pay X% afterwards. The price the provider quotes for a given service is the price everyone gets (probably; some of the smaller vets might modify it if someone is low income and in need).