It isn't hard at all. Last year I spent ONE night laying in a hallway in an observation wing after I went in for some dizziness. BIG MISTAKE. Ended up with a perfect health report after a dozen tests that I didn't order, and half of which were not necessary, and a bill for $12 THOUSAND. (Note: Prior to being admitted, I did the good Boy Scout thing and asked to talk to someone from the billing department to get a rough idea of what might be in store for me. She hadn't the slightest idea. Not one clue.) Never, ever go to an E.R. if you can avoid it. They are blood-suckers waiting for your warm body to come crawling in, at which point every technician, nurse, assistant nurse, intern, resident, and doctor within 100 yards will pay you a brief visit, and bill you for it later. And of course this is on top of the "Emergency Room Fee", which itself can be thousands of dollars. Writer Tom Wolfe once said that any time he felt that he might need to go to the hospital ER, he'd check into a first-class room in the best hotel in town, and treat himself to room service for every meal. He'd walk out feeling great, and at a fraction of the cost of a hospital stay.
The amount you see on the paperwork from your medical insurance company may not be the amount the insurance company actually paid. Insurance companies negotiate discounts with providers and hospitals. They may not tell you about this discount and calculate your co-pay on the non-discounted price. They were sued for this some years back in some states. They have to be sued state by state.<sup>*</sup> They are exempt from federal antitrust laws, and instead are regulated state by state. That's why they can act in restraint of trade with impunity. Example: they can pay a smaller percentage of your total bill if you go out of state for treatment then if you stay in state, even if you went out of state because you were quoted a lower price for the same procedure out of state. *The supreme court ruled in 1944 that insurers were subject to the antitrust laws. The next year, 1945, Congress passed the McCarran-Ferguson Act that has since protected insurance firms from federal prosecution for price fixing, bid rigging and carving out protected markets. The original House Obama care language would have removed these exemptions for health insurers, but that language was removed from the final bill.