I'm not sure why you think there is no price transparency in the US. I know exactly how much I was billed and how much my insurance paid. I generally don't ask ahead of time, because it's going to cost me $20. I get an explanation of benefits for every visit. When I was still below deductible at one appointment they gave me options and how much it would cost. What I don't really get is the option to choose. Limited providers and the network limit my options. From your description you have extraordinary insurance. I have good insurance (according to a staff member commenting on our low deductible). It does not work how you describe. Our insurance servicer (United Healthcare) makes all the decisions. Doctor prescribed x, it gets denied. We've had denials on meds they have been covering for years. I wish we could shop around. It's just not realistic.